bluuebunny/crossref_metadata_2025 huggingface dataset:
ARE STATINS THAT GOOD? ASSESSING THE PROTECTIVE EFFECT OF STATINS AMONG OLDER ADULTS WITH SERIOUS ILLNESS OR INJURY
Authors: Sanchez-Reilly Sandra , Yarrarapu Siva Naga Srinivas , Sidle Erin , Khalikov Marla , LaCoss Jennifer , Reilly Elizabeth , Crenshaw Shannon , McGinity Ashley
Published: January 2025

Background

Older Adults (OA) constitute the majority of Emergency Department (ED) visits, largely due to fall-related injuries and acute serious illnesses (ASI). OA’s ED visits lead to potentially extended hospitalizations and increased healthcare costs. Statins, commonly prescribed for cholesterol-lowering effects/cardiovascular benefits, are widely used among OA. Few inconclusive studies have explored the relationship between statins and OA falls/ASI. Objective: To investigate the relationship between statins and its protective effects among OA who visit ED due to injury/ASI.

Methods

OA ED visits (age>65) were collected for seven weeks (summer 2024) at level-1 trauma center. Variables included acuity score (1-4, 1 being worse), diagnosis, ICU admission need, death and statins usage prior to event.

Results

1771 OA-ED. Median age 73 (68-80), 52% female (923), 34% White, 55% Hispanic. Acuity: 1(3%), 2(33%), 3(59%), 4(5%). OA statins usage was 50%. 25% visits were falls, followed by infections (13%), GI complaints (11%) among others. 50% OA went home, 43% admitted. 12% became ICU admissions, 2% died. Among statin-takers, 13.2% were admitted to ICU vs.11.4% not-on-statins (p=0.27,NS). Interestingly, 1.3% statin-takers died because of the injury/ASI that brought them to ED, vs. 2.6% not-on-statins (p=0.04). Falling was the most common reason for seeking ED: 21.6% statin-takers vs. 27.9% not-on-statins (p=0.002), suggesting a protective effect.

Conclusions

Statins appear to have a significant protective effect on falls/ASI among OA, specifically pertaining to decreasing their fall risk and in-hospital mortality rate. Further studies should explore prophylactic ways to use statins in improving hospital-related outcomes and decreasing risk of geriatric syndromes.
ASSESSMENT OF A U.S. NURSING STUDENT EXCHANGE PROGRAM FOCUSED ON JAPANESE OLDER ADULTS
Authors: Ono Keiko
Published: January 2025

From May 13 to 15, 2024, undergraduate nursing students from the U.S. participated in an international exchange at a university in Japan. A one-day program explicitly focused on learning about services for older adults in Japan: this study aimed to evaluate that program. On May 14, 2024, an intervention program was conducted in Japan, featuring lectures on Long-Term Care Insurance and other issues concerning older adults, including visits to nursing care facilities for older adults. The study involved seven undergraduate American nursing students. A qualitative descriptive research design was employed to assess the program’s impact. Before the intervention, participants individually responded to several questions via QR Codes using Microsoft Forms. These responses served as the basis for a group discussion, during which students summarized their thoughts on a sheet. After the intervention, the group discussed and revised their initial thoughts on the same questions. Finally, participants answered several questions using QR codes. The survey results indicated that none of the students were familiar with services for older Japanese adults before the program. However, after the program, the percentage of students interested in nursing care services for older adults in Japan increased from 57.1% to 71.4%. Additionally, the program positively influenced the student’s perception of older adults. They described older adults with terms such as “sociable,” “active,” “happy,” “willing to live,” and “well cared for.” This program may have made students perceive older adults in Japan as positive and content.
ASSOCIATION BETWEEN SARCOPENIA AND NEUROPSYCHIATRIC SYMPTOMS IN OLDER ADULTS WITH ALZHEIMER’S DISEASE
Authors: Zeng Derong , Zhang Nan , Qi Bingbing , Kawasaki Teruaki , Akiguchi Ichiro , Kinoshita Ayae
Published: January 2025

Sarcopenia is a vulnerability state that increases the risk of many adverse health outcomes, but little is known about the effects of sarcopenia on neuropsychiatric health. To explore the association between sarcopenia and neuropsychiatric symptoms in older adults with Alzheimer’s Disease, data from 110 participants were assessed using the Asian Working Group for Sarcopenia criteria. The participants had a mean age of 83.15 years (SD = 5.49), a mean MMSE score of 20.69 (SD = 5.03). The study focused on the relationship between sarcopenia and 12 neuropsychiatric inventory items, including delusions, hallucinations, aggression, depression, anxiety, elation, indifference, disinhibition, lability, aberrant motor behaviors, nighttime disturbances, and eating disturbances. The relationships between sarcopenia and these neuropsychiatric symptoms were explored using logistic regression models. Logistic regression analyses revealed significant associations between sarcopenia and both aberrant motor behaviors (Estimate=-1.5612, p=0.0141) and nighttime disturbances (Estimate= -1.2096, p=0.0194). Further analysis incorporating age, sex, MMSE, and grip strength showed that while the association between sarcopenia and eating disturbances was not significant (Estimate=1.51272, p=0.1248), age emerged as a significant predictor (Estimate = 0.18272, p = 0.00869), suggesting that age may be a more critical factor in the development of eating disturbances in this population. These findings suggest that sarcopenia may play a role in the development or exacerbation of specific neuropsychiatric symptoms in AD patients. Further research is needed to understand the underlying mechanisms and to develop targeted interventions to improve the quality of life for this population.
ASSOCIATION OF HEALTHCARE ACCESS AND DUAL ELIGIBILITY STATUS BASED ON ENROLLMENT IN MANAGED CARE
Authors: Dharia Aastha , Tarraf Wassim , Homayouni Ramin , Toseef Mohammad Usama
Published: January 2025

Dual-eligible beneficiaries (enrolled in both Medicare and Medicaid) remain a growing population with complex care needs. However, there are limited studies evaluating self-reported access to healthcare among these individuals. Using six key outcomes that describe the characteristics of beneficiaries’ usual source of care from the 2021 Medical Expenditure Panel Survey, we retrospectively analyzed self-assessment questionnaire data among individuals age 18 and older (N = 12,924) to evaluate the association between healthcare access and dual-eligibility status based on enrollment in managed care. A series of survey-weighted multivariable logistic regression models were estimated. After adjusting the models for demographic factors, socioeconomic factors, and interaction term between dual-eligible and managed care status, we calculated marginal effects of managed care and dual-eligibility on healthcare access outcomes and used analysis of variance contrast tests to estimate the difference in the probability of outcomes based on managed care and dual-eligibility status. The results demonstrate non-dual managed care beneficiaries were significantly less likely to seek care [4.1% versus 2.5%, p-value = 0.0338] and experienced greater delays in care [6.6% versus 4.9%, p-value = 0.0398] due to cost. We also noted no significant impact on established and regular care access independently based on dual-eligibility status or managed care status. These findings suggest managed care may not significantly influence dual-eligibles’ access to healthcare but should be analyzed further for associations with healthcare disparities before making policy recommendations. Future research should also examine associations between quality of care measures and dual-eligibility status to continue holistically evaluating healthcare equity.
BARRIERS AND FACILITATORS TO PHYSICAL ACTIVITY OF OLDER ADULTS IN KOREAN NURSING HOMES: A QUALITATIVE STUDY
Authors: Ko Young , Yun Seon Kyung , Yook Geun Sil , Kim Seo Young
Published: January 2025

Various factors can either reduce or improve the physical activity level of older people living in nursing homes. Although it is critical to manage the risk of inactivity, only a few studies have investigated the multifaceted factors associated with physical activity among nursing home residents. The purpose of this study was to investigate directors’ and care workers’ perceptions of barriers and facilitators to physical activity for older adults in Korean nursing homes. This was a qualitative descriptive study. We collected data from January 13 to February 14, 2023. We used thematic analyses to analyze data from 4 directors and 22 long-term care workers in nursing homes in South Korea. We extracted 4 themes and 11 sub-themes reflecting the factors related to older adults in nursing homes: (a) “safety is more important than activity,” (b) “encourage activities tailored to their preference,” (c) “activities in harmony,” and (d) “meaning of living at a nursing home.” Individual, interpersonal, environmental, and policy factors influence older adults’ physical activity in nursing homes. These factors guide policymakers, healthcare providers, and care workers in developing and implementing activity planning to help improve recipients’ physical activity level in nursing homes. This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Korean government (MSIT) (No. 2022R1F1A1074082).
BEHIND THE WALLS: THE IMPLICATIONS OF ASSISTED LIVING BUILDING CODES ON RESIDENT SAFETY
Authors: Pennavaria Adam , Smith Lindsey , Hua Cassandra , Carder Paula , Jutkowitz Eric , Thomas Kali
Published: January 2025

As the US population collectively ages, issues related to assisted living (AL) resident safety have become an increasingly pressing issue for the general public, reflected by major media reporting in the last year. The building codes that govern ALs play an important role in mitigating the risks associated with falls, wandering, and other hazards, especially for residents living with Alzheimer’s disease and related dementias. We sought to understand how states vary in their approaches to building code regulations that might impact resident safety. We used search term-based text retrieval to identify areas of text relevant to locks, alarms, and egress restriction. A preliminary analysis of 2023 AL policy text by state suggests that a majority of states’ AL policy regulations contain some kind of reference to requirements for locks, alarms, or other type of egress restriction, with a few outliers – regulations in Nebraska, Minnesota, South Carolina, and Tennessee appear to make no mention of any of these subjects, while New Mexico, Texas, Washington, and others include multiple references to each. For instance in NM, residents must have the ability to safely leave the building, so memory care units rely on alarms and provide access to secure outdoor environments. 38 states’ regulations (75%) refer to locks, 40 states (78%) refer to alarms, and 27 states (53%) refer to limiting/restricting egress. This research has implications for understanding the relationships between building code requirements and resident safety. It provides insight for those who seek to improve safety standards in AL communities.
BLACK-WHITE RACIAL DISPARITIES IN MORTALITY: FINDINGS FROM THE SAINT LOUIS PERSONALITY AND AGING NETWORK (SPAN)
Authors: Spears Isaiah , Wolk Megan , Gorelik Aaron , Siudzinski Jayne , Norton Sara , Esposito Michael , Oltmanns Thomas , Bogdan Ryan
Published: January 2025

Black-White racial health disparities in America are striking. Black Americans have worse physical health and lower life expectancy than White Americans. However, the potential factors contributing to increased mortality in later life among Black Americans are rarely investigated. Here, we examined Black-White racial mortality disparities in the longitudinal St. Louis Personality and Aging Network (SPAN) Study of older adults (n=1,630; aged 55-65 at baseline; 67.4% White; 32.6% Black), with mortality data collected from the National Death Index. Black SPAN participants had greater mortality over the course of the study than White participants(χ² = 47.667, p = <.0001). Specifically, 26.9% of Black participants (n = 142) passed away relative to 12.7% of White participants (n = 139). Indices of socioeconomic status (i.e., annual household income; educational attainment) partially accounted for this difference. Additional planned analyses will examine whether environmental (e.g., discrimination, stress exposure), biological (e.g., inflammation), and psychological/behavioral (e.g., health behaviors, personality) factors may also contribute to these Black-White mortality disparities. These findings replicate prior studies documenting racial health disparities, the potential contributions of socioeconomic status, and position the SPAN study to evaluate plausible environmental, behavioral, and biological mechanisms. Ultimately, better understanding the environmental, psychological/behavioral, and biological mechanisms that may contribute to Black-White racial health disparities may help facilitate interventions and policy to improve racial health equity.
BUILDING AN EVALUATION FRAMEWORK FOR THE OREGON CENTER OF EXCELLENCE FOR BEHAVIORAL HEALTH AND AGING
Authors: Smith Lindsey , Unsworth Julia , Stodola Allyson , Himes Dani , Brandis Leah , Cellarius Karen , Carder Paula , Dawson Walter
Published: January 2025

The Oregon Center of Excellence for Behavioral Health and Aging (OCEBHA) was established in 2024 with the mission to serve as a backbone organization, coordinating efforts to improve behavioral health services for older adults in Oregon. Housed at Portland State University and Oregon Health & Science University, the Center is focused on enhancing workforce training, supporting community partner organizations, advancing research, and promoting policies that improve access to care. We created an evaluation plan aligned with the Collective Impact model. The evaluation framework was developed to assess OCEBHA’s effectiveness in growing workforce capabilities, coordinating partnerships, promoting health equity, and driving systemic change. By constructing the Center’s role as a backbone organization, the evaluation plan was designed to measure both the process and impact of the Center’s efforts across multiple sectors. Key elements of the plan include the integration of community feedback, collaboration metrics, and health equity outcomes. This approach ensures that the evaluation reflects the complex, collaborative nature of the Center’s work and provides actionable insights for continuous improvement.
CAREGIVING IMPACT ON MEDICARE OLDER ADULTS: RESULTS OF THE US HEALTH AND WELLNESS SURVEY
Authors: Neumann Lycia Tramujas Vasconcellos , Annunziata Kathy , Stratton Lauren
Published: January 2025

As the number of older adults caring for someone with a serious illness increases, there is a growing need to understand better the impact of caregiving on older adults’ health and finances. Based on responses from older Medicare recipients (65+) to the US 2022 National Health and Wellness Survey, an internet-based, cross-sectional survey, this study investigated differences in self-reported health status, healthcare utilization, and out-of-pocket costs between (1) older adults who are caregivers (n = 1,159) and those who are not (n = 11,443), and (2) older caregivers of individuals living with Alzheimer’s disease or other dementias - ADRD (n = 255) and those caring for an adult with other conditions (n = 904). Results were weighted to the population by sex, age, and race/ethnicity. Caregiver and non-caregiver cohorts had comparable median and mean ages. Compared with older non-caregivers, older caregivers had significantly higher comorbidities and significantly lower global health, physical health, and mental health T scores (p< 0.05). There were no significant differences in reported use of ER, hospitalizations, and median number of medical visits in the six months before the survey. However, older caregivers reported higher mean out-of-pocket Rx expenses than non-caregivers ($44.51 vs. $34.02). Comparative analyses of older dementia caregivers with non-dementia caregivers did not indicate significant differences in health and financial impact. In conclusion, caregiving impacts older adults’ health in various ways, and health plans and providers should acknowledge and consider the impact of caregiving when assessing older adults’ health conditions, managing and coordinating their care.
DEVELOPMENT AND ASSESSMENT OF THE VIRTUAL INTERGENERATIONAL COMPARATIVE GLOBAL AGING CURRICULUM
Authors: Zurek Grzegorz , Zurek Alina , Holley Lyn
Published: January 2025

This presentation describes didactic process in the international, experimental, hybrid course, Comparative Global Aging. Created by the University of Nebraska at Omaha and two Polish universities – the University of Wroclaw and the University School of Physical Education in Wroclaw, it was structured to nurture intra- and intergenerational relationships and understanding between students and older adults on different continents. Classes are conducted in a “real time” audiovisual format designed to accommodate geographical and temporal distance and cultural diversity of professors and students. Methods to track independent learning and conscious self-improvement of students were custom-fitted to the course and to the requirements of information/communication technology. The course has been conducted each year from 2018 to 2023. Qualitative data from students’ courses in each edition of the Post-Class Reflections and Learning Journals were used to evaluate and improve a series of planned and systematic teaching methods inspired by both teachers and students. Data are from 44 UNO students, 23 students from Poland and 35 students from European universities in 9 European countries participating in the ERASMUS academic student exchange program.. Although courses were conducted in English, student teams were intentionally multinational and multicultural. Qualitative evaluation of data from students informed continuous improvement of methods and resources in subsequent editions of the course, and indicate it meets accepted standards for international, intergenerational, comparative, gerontological, service-learning university and virtually synchronous pedagogies, and could provide a template for courses that give learners the opportunity to work collaboratively international teams and communicate effectively.
EARLY CHILDHOOD EXPERIENCES AND LATE LIFE COGNITIVE FUNCTION AMONG OLDER CHINESE ADULTS
Authors: Nguyen Duy , Liu Rui , Chen Limei , Lee Yookyong
Published: January 2025

Extensive research has documented the negative impacts of adverse childhood experiences on individual well-being, yet Asian older adults have been overlooking. For the current study, we used the China Health and Retirement Longitudinal Study (CHARLS), a national, longitudinal study of representative residents and applied the Life Course Perspective to test how childhood conditions and social relationship indicators affect cognitive health at later life. This study combined data from three datasets: Wave 1 (2011), The Life History Survey Data (2014), and Wave 5 (2020). The study sample (N=9,941) included respondents 50 and over at baseline, without cognitive impairment in the baseline, and still living at Wave 5. Women constituted 52.4% of the sample, and the mean age was 60.2 (SD=6.77). Two outcome variables (self-rated memory and cognitive health status) were used in data analyses. The multivariate analyses results showed that weak neighborhood quality and social cohesion, poor social relationships, poor childhood health status were associated with worse cognitive function. The study findings demonstrate the effects of early childhood conditions on late-life cognitive function. As aging in China accounts for most global aging, public health approaches that stimulate positive childhood memories can have a meaningful protective effect for older adult well-being. Our findings underscore the global importance of childhood health, childhood experiences, and social relationships, which are not only those older adults in China but globally. Further cross-national research is needed to understand the diversity in sociohistorical experiences across global aging populations.
ETHNIC AND RACIAL DIFFERENCES IN END-OF-LIFE CARE IN TEXAN COLORECTAL CANCER DECEDENTS
Authors: Leach Bethany , Polychronopoulou Efstathia , Kuo Yong-Fang , Raji Mukaila , Serna Myrna
Published: January 2025

There are known racial and ethnic disparities in advance care planning (ACP) and downstream outcomes. We hypothesized that among Texan Medicare decedents with colorectal cancer (CRC), there would be racial and ethnic disparities in ACP, palliative care (PC) consultation and hospice enrollment. Data from the Texas Cancer Registry linked with Medicare claims records for patients age ≥66 years who died 6 months to 5 years after a primary CRC diagnosis between 2010 and 2018 was analyzed. Number (proportion) of Non-Hispanic Black (NHB), Non-Hispanic White (NHW) and Hispanic decedents with ACP, PC consultation and hospice enrollment in the last 30 days of life are reported and chi-square tests used to assess statistically significant differences. A multivariable logistic regression model was used to assess racial/ethnic differences in odds of hospice enrollment, adjusting for CRC stage and other demographic variables. Among 5,757 Medicare decedents, ≤2.2% had ACP with no significant racial/ethnic differences noted. While NHBs were most likely to receive PC consultation (106 (18%), p=0.017), they were least likely to be hospice enrolled (369 (62%), p< 0.001). The multivariable logistic regression model showed NHBs had decreased odds of hospice enrollment when compared to NHWs (OR 0.67, 95% CI 0.55-0.81). Among Medicare decedents with CRC, there are low rates of ACP and racial/ethnic disparities in PC consultation and hospice care. More and earlier ACP is needed to provide patient-centered care. While more NHBs received PC consultation in the last 30 days of life, it is unclear if PC consultations were provided earlier in life course.
FACILITATORS OF AND BARRIERS TO ADULT DAY SERVICES PROVISION: PROVIDERS’ PERSPECTIVES
Authors: Udeh Kingsley , Noble Molly , Menne Heather , Hamill Randi , McLaughlin Sara
Published: January 2025

Adult day services (ADS) can help people living with various chronic conditions remain in their community, and may improve well-being among participants and their family caregivers. Despite the potential benefits, knowledge of the ADS landscape is underdeveloped, especially as it pertains to the experiences of ADS providers since the COVID-19 pandemic. This study aimed to understand the facilitators and barriers experienced by ADS providers. We conducted two focus groups with seventeen ADS providers in Ohio. Thematic analysis was used to identify themes in the data. Several facilitators for providing ADS were identified, including dedicated, consistent, and committed staff; partnerships with local organizations; sufficient reimbursement; and diverse funding sources. Barriers included: staffing issues (e.g., recruitment and retention); referral and recruitment of ADS participants; limited knowledge, awareness, and misconceptions about ADS among families and case managers; transportation services (e.g., inadequate and safe escort of participants to and from ADS centers); and insufficient or delayed reimbursement. Providers identified the following solutions with the potential to mitigate perceived barriers: educational initiatives to foster understanding of ADS among key stakeholders (e.g., regulators, case managers, community members) and additional funding and media publicity support from local, state, and federal authorities. As one of the only studies that seeks to understand the landscape of ADS in Ohio, this research is uniquely situated to provide crucial insights for tailoring interventions that consider ADS providers’ unique challenges. It also informs future research focusing on improving the quality of ADS.
NARRATIVES OF WARTIME VOLUNTEERING AMONG OLDER ADULTS IN ISRAEL
Authors: Sun Peter , Ayalon Liat
Published: January 2025

Volunteering is an important vehicle for the health promotion of older adults, yet research on its role during times of war remain limited. This research aimed to explore the representation and rhetoric of older adult volunteers in the Israeli media during Operation Swords of Iron. Using the LexisNexis database, four Israeli newspapers were searched for English-language articles published between October 7, 2023 and August 7, 2024: Haaretz, The Times of Israel, Yediot Achronot, and The Jerusalem Post. After removing duplicates and articles that were not relevant to older adult volunteering, a total of 23 articles were retained for thematic analysis. To probe the sentiments of these narratives, sentences containing keywords about older adult volunteers were compared against a preexisting lexicon of semantic orientations. Thematic analysis revealed three themes: (1) Older adult volunteers as heroic and self-sacrificial amid the risks of war, (2) the virtue of being productive versus unproductive, and (3) older adults as agile first responders in situations of distress. Sentiment analysis further uncovered both positive and negative feelings that were collocated with the rhetoric on volunteering, such as the juxtaposition of older volunteers with the lack of supervision or training. The rhetoric of heroism, sacrifice, and productivity suggest the need to attend to age-related stereotypes of older adults. This research not only has implications for the health of older adults, but also for supporting older adult volunteers contributing towards large-scale public health challenges.
THE EFFECT OF SOCIAL PARTICIPATION OF OLDER ADULTS ON DEPRESSION: FOCUSED ON THE MODERATING EFFECT OF HOUSEHOLD TYPE
Authors: Baek Sehyun , Lee Sungkyu
Published: January 2025

Previous studies have found that the social participation of older adults is positively associated with perceived health, happiness, and life satisfaction (Kim et al., 2018). However, as they age, their social activities tend to decrease, leading to increased depression (Choi & Kim, 2023; Kim & Jung, 2017). Given that older adults living alone show a gradual decline in social activities as they age (Shin, 2022), the household type may intervene in the relationship between social participation and depression among older adults. However, little is known about the structural associations of these variables. Therefore, we examined the extent to which household type (i.e., living alone vs. not living alone) moderates the relationship between social participation and depression among older adults. We utilized data from the 2022 Korean Longitudinal Study of Aging (n=6,055) and conducted moderated regression analysis using Process Macro. The study found a negative relationship between social participation and depression of older adults (b=-.136, p<.01), and a moderating effect of household types on this relationship was statistically significant (p <.05). More specifically, the effect of social participation on depression was greater for older adults living alone than for those who do not live alone. These results highlight the need for policy efforts aimed at increasing the social participation of older adults to reduce their depression. Also, considering that the negative association between social participation and depression is more pronounced among older adults living alone, the interventions targeting the growing number of older adults living alone should be prioritized in policy planning.
THE INTERSECTION OF OLDER ADULTS, DISABILITIES, AND MENTAL HEALTH
Authors: Mbanefo Onyinye , Teaster Pamela
Published: January 2025

The number of individuals aged 65 and older is projected to reach 82 million by 2050. This demographic shift is accompanied by an increase in the prevalence of disabilities and mental health issues among older adults. Nearly 46% of adults aged 75 and older report having a disability, and 25% of those aged 65 and older are living with a mental health condition such as anxiety or depression. These challenges are exacerbated by cumulative disadvantage, ageism, and a shortage of mental health providers trained to work with this population. To address these issues, we apply a strengths-based approach to explore the intersection of aging, disability, and mental health. Our approach emphasizes the resilience and potential of older adults, challenging the dominant narratives of decline and loss. Utilizing the Socio-Ecological Model, we examine how individual, relational, community, and societal factors influence the mental health of older adults, highlighting the need for integrated and holistic care strategies. We explore key concepts such as cumulative advantage and disadvantage, ageism, and intersectionality, which are critical in understanding the complexities faced by older adults. Our work advocates for comprehensive mental health care that addresses both the physical and psychological well-being of older adults, promoting dignity, equity, and quality of life. Our findings suggest that a strengths-based approach can effectively enhance mental health outcomes for older adults, providing a framework for mental health practitioners and policymakers alike.
THE LIFE STAGE AT MIGRATION MATTERS: A STUDY OF OLDER IMMIGRANTS’ SOCIAL WELLBEING BASED ON THE CLSA
Authors: Lee Yeonjung , Li Lun , Kim Boah
Published: January 2025

Based on life course theory, this study examines the different social wellbeing trajectories among older immigrants in Canada based on their life stage at migration. The study applies Linear Mixed Models (LMM) to three waves of data from the Canadian Longitudinal Study on Aging (2011 to 2021). Among the sample of 4,248 older immigrants, most of them (two-thirds) migrated before the age of 30 (young adults), one-fifth migrated between 30 and 45 years old (adulthood), and about five percent of them migrated after 45 years and older (middle and older age). Results from LMM reveal that older immigrants who migrated during middle and older age reported the lowest level of social wellbeing, measured by social participation, social support, and social network size. This group of older immigrants also experienced the greatest decline in social participation, social support, and network size over ten years compared to those who migrated before 45 years old. Older adults who migrated to Canada before the age of 30 reported the best situation with higher levels of social wellbeing, and well-maintained social connection over time. In addition, employment, income level, education, and family responsibilities are significant factors related to the changes in social wellbeing over time among older immigrants. The findings from this study highlight the need to support older immigrants who come to Canada in a later life stage (i.e., after a middle-aged period), and who lack the social resources and capabilities to accumulate social capital and enhance social wellbeing.
TOO SICK TO BE TRUE? EVALUATING PROBLEMATIC CODING PRACTICES IN MEDICARE’S PATIENT DRIVEN PAYMENT MODEL
Authors: Amaravadi Harsha , Prusynski Rachel , Fishman Paul , Mroz Tracy
Published: January 2025

The 2019 Patient Driven Payment Model (PDPM) aimed to promote budget neutral, patient-centered care by adequately reimbursing skilled nursing facilities (SNFs) for patient clinical complexity. Though PDPM mitigated financial incentives to provide excessive care, it may have introduced new incentives to falsely inflate or “upcode” clinical complexity. We hypothesize that upcoding may occur for common, chronic conditions associated with high reimbursement under PDPM. High reimbursement encompasses both diagnosis codes and services for complex conditions (e.g., diabetic wound care or IV use for severe anemia). Example conditions include complicated diabetes, blood loss anemia, and obesity. We sought to quantify the degree of documentation changes for conditions likely to be upcoded. Using a difference-in-difference design, we analyzed Traditional Medicare claims from 2018-2021 for all patients with a hospital-SNF care episode (n = 5.43 million), comparing diagnoses on the index hospital claim to the corresponding SNF claim for each patient. By using hospital claims, which are not subject to PDPM, as a control, we mitigate all patient-level confounding. We detected increased documentation for the selected conditions, representing an additional 32.18% [95%CI: 31.55, 32.82] in SNF coding for complicated diabetes, 54.59% [95%CI: 52.33, 56.95] for severe anemia, and 83.08% [95%CI: 82.00, 84.15] for obesity. PDPM sought to improve payment adequacy for caring for clinically complex patients, but Medicare’s financial sustainability also depends on accurate documentation of clinical factors that influence resource utilization and care provision. Our investigation of potential upcoding may inform future policy refinement to support sustainable, patient-centered care delivery for older adults.
UNCERTAINTY IN HOME HEALTH CARE FOR OLDER VETERANS: VA PERSPECTIVES ON AGENCY SELECTION AND CONTRACTING
Authors: Leonard Chelsea , Magid Kate , De Motta Lexus Ujano- , Daus Marguerite , Levy Cari , Jones Christine
Published: January 2025

Older Veterans discharged from the hospital with skilled home health care (HHC) have their HHC delivered by community home health agencies (HHA) and financed primarily through the Department of Veteran’s Affairs (VA) or Medicare. We sought to understand perspectives of VA personnel on the process of HHC agency selection and financing for Veterans referred for HHC. We used a sequential mixed methods study design and conducted in-person and virtual site visits at three VA Medical Centers (VAMCs) in the highest decile of VA-paid HHC services (3 in-person) and three VAMCs in the highest decile of Medicare-paid HHC services (1 in-person, 2 virtual). We observed processes related to HHC referrals and conducted interviews with key informants. Interviews were recorded, transcribed, and analyzed using inductive-deductive content analysis to identify themes related to referral processes, agency selection, and financing. We conducted 29 interviews with 39 personnel at 6 VAMCs. We identified 4 themes related to uncertainty around agency and payor selection: 1) VA roles are siloed and next steps are a “black box;” 2) VA personnel are uncertain how HHAs are selected for local networks; 3) Local VAMCs develop strategies to determine HHA quality and reputation; and 4) Veterans’ role in selecting HHA or financing is unclear. Understanding points of uncertainty has implications for VA’s ability to provide high-quality HHC for older Veterans. Our findings suggest that providing accessible information on HHA quality and clear guidance around Veterans’ role in HHA and payor selection may streamline the process of providing HHC to Veterans.
UNDERSTANDING AND EXPERIENCING AGEISM: PERSPECTIVES FROM OLDER ADULTS
Authors: Li Aaron , Morrow-Howell Nancy , Galucia Natalie , Johnson Khrystal , Carpenter Brian
Published: January 2025

Interventions to reduce ageism usually target younger people and service providers, with little research on interventions directed explicitly at older people to identify and resist interpersonal and internalized ageism. This study increases knowledge to guide the development of such interventions by elucidating how older people think about ageism and clarifying motivations to confront it. We also need to know the language older people use to describe ageism and the experiences they report in employment, health care, and family setting. This knowledge is important for designing acceptable and effective anti-ageism programs. We employed a focus group methodology, gathering data on the lived experience of ageism among a diverse group of 50 people over the age of 60. Questions elicited participants’ thoughts about interpersonal and internalized ageism, examples of how they experienced it, and how they reacted. Findings suggest that older people are not clear about what constitutes interpersonal ageism, and internalized ageism is difficult to identify. Instead, participants resorted to talking about their experiences of growing older and frequently mentioned a lack of respect as the hallmark of ageism. Examples of ageism within their families and among younger acquaintances were more common than examples in other domains of daily life. Older age did not rise to the level of importance of other marginalized identities; instead, racism, ableism and homophobia were more central to their experiences of discrimination. Findings suggest that interventions with older people must include consciousness-raising about ageism and its consequences well as common examples and skills to combat it.
USING DIGITAL HEALTH TO REDUCE BURDEN IN OLDER ADULTS WITH CANCER UNDERGOING CHEMOTHERAPY: A SYSTEMATIC REVIEW
Authors: Sim Hyebeen , Shin Jinhee , Konlan Kennedy Diema
Published: January 2025

Digital health interventions have the potential to enhance health outcomes and support older adults with cancer in managing their conditions. However, the specific benefits and components of these interventions for this population remain inadequately defined. This systematic review aims to evaluate the effectiveness of digital health interventions in alleviating the burden of chemotherapy for older adults with cancer. This systematic review used PRISMA guidelines and the PICO framework. The Searches were conducted across five databases (CINAHL, Embase, PubMed, Cochrane Library, and Web of Science). Of the 5,683 articles screened, 13 were selected based on the inclusion criteria. Data extraction was performed by two authors using a predetermined matrix. The analysis was done using the interpretative thematic synthesis design. The digital health technologies examined included mobile apps, remote monitoring, and games, utilizing devices such as tablets, smartphones, and smartwatches. Significant benefits were observed for older adults with cancer undergoing chemotherapy, including improvements in symptom management, physical activity, nutritional support, and quality of life. Additionally, patients in the intervention groups experienced reductions in hospitalizations and treatment-related toxicities, along with improved efficacy in symptom monitoring. Digital health interventions show considerable promise in supporting older adults undergoing chemotherapy. However, further research is essential to clearly define the components of these digital health interventions for older adults with cancer and their specific impacts. Developing and adopting accessible digital health intervention applications that can be used at any time and place will be crucial in effectively preventing or alleviating the adverse effects of cancer treatment.
USING QUALITATIVE ANALYSIS TO DEVELOP HIRING GUIDELINES TO IMPROVE CAREGIVING FOR PEOPLE WITH DEMENTIA AT HOME
Authors: Watman Deborah , Reckrey Jennifer
Published: January 2025

Many people living with dementia are being cared for at home by hired paid caregivers. While paid caregivers frequently become an integral part of the care team, little is known about how they are selected by families of people living with dementia. We conducted a secondary analysis of qualitative data collected during two studies that examined family caregiver perspectives on the role of paid caregivers in home-based dementia care (study 1 n=15, study 2 n=9). We developed a codebook focused on emergent themes related to the selection and hiring of paid caregivers, specifically noting practical advice from family caregivers. We analyzed results using thematic analysis. Family caregivers frequently described difficulty setting up care and hiring paid caregivers. This was true for both those who hired paid caregivers privately and those who worked with agencies who provided Medicaid-funded paid care. Many had to cycle through several caregivers, increasing stress for the family, and reducing constancy for the person with dementia. Our findings point to the need for improved hiring guidelines for paid caregivers. Informational materials, including sample interview questions for both paid caregivers as well as family members, can improve the efficiency and quality of the hiring process. It behooves family members, home health agencies, and privately paid caregivers to approach the hiring process deliberately and thoughtfully. Creating and distributing formalized guidelines and protocols can serve as a helpful resource at a stressful time, and improve the overall quality of care for the person with dementia at home.
VALIDITY AND RELIABILITY OF THE MULTIDIMENSIONAL FUNCTIONAL ASSESSMENT QUESTIONNAIRE (OARS) IN ANGOLAN ELDERLY
Authors: Bárbara Rita , Gonçalves Rui , Sousa Carlos , Chingui Luciano , Armando Antonio , Lopes Mario
Published: January 2025

Introduction

The Older American Resources and Services (OARS) questionnaire assesses functionality and cognition in the elderly. Validating and culturally adapting instruments like the OARS is crucial to ensure their accuracy across different contexts. Objective: This study aimed to translate, culturally adapt, and validate the OARS for elderly individuals in Angola, focusing on cognitive and functional domains.

Methods

The adaptation of the OARS involved a rigorous process, including translation, cultural adaptation, and clinimetric analysis. A multidisciplinary panel of experts, including professionals from internal medicine, public health, epidemiology, physiotherapy, and nursing, reviewed and validated the adapted version. The sample comprised 102 elderly residents of Luanda, randomly selected to ensure representativeness. Reliability was assessed using Cronbach’s alpha coefficient, while validity was examined through exploratory factor analysis, with particular attention to item factor loadings.

Results

The physical activity domain demonstrated high internal consistency (Cronbach’s alpha = 0.80) and robust factor loadings, indicating reliability and validity in the Angolan context. The mental health domain showed moderate internal consistency (Cronbach’s alpha = 0.59) and variable factor loadings, suggesting the need for further refinement for better cultural and linguistic adaptation.

Conclusion

The adapted OARS version proved reliable for assessing physical activity among Angolan elderly, but the mental health domain requires adjustments. These findings highlight the importance of clinimetrics and factor analysis in the cultural adaptation of instruments, ensuring their effectiveness across diverse sociocultural contexts. Keywords: Cognition, clinimetrics, validation
VIRTUAL COMPARATIVE GLOBAL AGING CURRICULUM/COURSE – STUDENT GLOBAL COMPETENCES QUALITATIVE THEMATIC ANALYSIS
Authors: Zurek Alina , Zurek Grzegorz , Holley Lyn
Published: January 2025

Presents global competences acquired by students of the international virtual course Comparative Global Aging implemented in the years 2018-2023. The course is the result of American-Polish cooperation between the University of Nebraska in Omaha and two Polish universities - the University of Wrocaw and the University School of Physical Education in Wrocław. The content of thirty-seven Learning Journals of students from 10 European countries studying in Poland in the ERASMUS student exchange program and UNO students was subjected to qualitative analysis using MAXQDA software. Discuss the results in the three distinguished dimensions of global competences - cognitive, socio-emotional and ethical, and five thematic clusters: Critical and Constructive Thinking, Self-Awareness and Self-Direction in Education, Effective Cross-Cultural Cooperation, Open Intergenerational Communication, Innovation in Action and Problem Solving. Learning outcomes achieved by students, i.e. the ability to examine local, global and cross-cultural issues in the topic of ageing, understand and appreciate the perspectives of people living in other countries and cultures, engage in open and effective interactions, and work to solve the problems of older people using a broad global perspective of ageing countries and societies
VISUAL FUNCTIONS AND PERFORMANCE ON COGNITIVE CHALLENGE TEST IN OLDER ADULTS
Authors: Zheng Diane , Curiel Rosie , Ortega Alexandra , Crenshaw Kirsten , Carballea Denise , Bosworth Brooke , Neer Emory , Loewenstein David
Published: January 2025

The Loewenstein-Acevedo Scales for Semantic Interferences and Learning (LASSI-L) is a culturally sensitive Cognitive Challenge Test (CCT) that has been shown to be predictive of preclinical Alzheimer’s disease (AD). Visual impairment is a risk factor for AD and cognitive decline. Associations between LASSI-L and visual functions in older adults have never been evaluated. We assessed 133 adults aged 61 to 88 diagnosed with normal cognition, amnestic mild cognitive impairment (MCI), or pre-MCI using a comprehensive clinical evaluation and cognitive battery. The mean age was 73.5 years, 68% female, the average education was 15 years, and mean MMSE was 28.3. About 60% of the sample identified as Hispanic/Latino. Participants were administered objective vision tests measuring distance visual acuity and contrast sensitivity, and LASSI-L. Multiple linear regressions were performed to examine associations between visual function and LASSI-L measures. After adjusting for age, sex, and education, contrast sensitivity was statistically significantly associated with the LASSI-L maximum storage capacity (A2 cued recall, β=2.80, se=1.1, p=0.01), proactive semantic interference (PSI) (B1cued intrusions, β=-2.99, se=1.25, p=0.02), and failure to recover from proactive semantic interference (frPSI) (B2 cued recall, β=3.64, se=0.24, p=0.004). Distance visual acuity was not associated with LASSI-L measures. Contrast sensitivity, or the ability to discern characters on a similar color background or brightness, is an important visual function that facilitates daily activities. The association between contrast sensitivity and subtle cognitive decline such as PSI and frPSI on CCT suggests that visual changes co-occur during pre-dementia stages and may be considered alongside other diagnostic tools.
WHY NOT LONG-TERM CARE? EXPLORING STUDENT NURSES’ PERSPECTIVES ON CAREERS CARING FOR OLDER ADULTS
Authors: Childress Kristen , Kokinakos Angela
Published: January 2025

The aging population and growing numbers of people living with Alzheimer’s Disease and related dementias (ADRD) are increasing the demand for licensed nurses, especially in the long-term care (LTC) sector. More than 89% of long-term care facilities in the United States (US) report ongoing staffing shortages that persist despite recruitment and retention efforts, directly impacting quality of care and outcomes for people with ADRD. Existing evidence describes factors influencing nursing staff retention in LTC but there is a paucity of information related to factors that impact nursing students’ decision-making related to entering careers in LTC. The purpose of this qualitative study was to understand student nurses’ perceptions of LTC as a career path. The first of four focus groups was conducted with five individuals. Interviews revealed that most participants plan to work in the hospital following graduation. Themes related to lack of plans to work in LTC included limitations in career advancement, past experiences with LTC culture, and perceptions of the care provided in LTC. Pay was a mixed factor, with quality of the work environment being more important to participants. Participants felt that faculty representation of LTC careers was positive, but participants described limited exposure to gerontologic nursing and LTC as part of their training, indicating that modification of these factors might have changed their perspective of careers in LTC. These early results identify key areas where crafting and delivering positive messaging and implementing educational interventions could boost nursing students’ interest in LTC careers.