bluuebunny/crossref_metadata_2025 huggingface dataset:
HOME-BASED REMINISCENCE INTERVENTION IN DEMENTIA: QUALITATIVE THEMATIC ANALYSIS
Authors: Jin Xianglan , Wu Kuan-Ching , Chien Shao-Yun , Zaslavsky Oleg
Published: January 2025

Reminiscence intervention has shown promising potential in alleviating dementia-related morbidities, thanks to the relatively intact remote memories of persons living with dementia (PLWDs). However, reminiscence interventions have been primarily delivered in group settings by healthcare professionals, which is costly and hard to scale up. One innovative solution is training family caregivers to carry out reminiscence conversations with their loved ones in their homes at their convenience. This thematic analysis aims to examine the participants’ perspectives of a home-based reminiscence intervention to inform future research on dyadic reminiscence interventions. A pilot study on a home-based reminiscence intervention was conducted between November 2022 and May 2023. Qualitative data were collected through semi-structured individual interviews with nine dyad participants at the end of the intervention. The interviews were audio-recorded and transcribed verbatim. Initial codes and categories were developed inductively, and queries on Atlas.ti were used for theme identification and recontextualization. Peer debriefing and external review were utilized to ensure rigor. Participants reported positive experiences of the home-based intervention. Centering on and engaging the PLWD in conversations was perceived as positive brain stimulation. Participants highly appreciated that it was conducted in home settings and acknowledged that the intervention content, duration (1-1.5 hours for 24 weeks), frequency (biweekly), and logistics were acceptable. PLWDs expressed willingness to share stories with their families. Most caregivers showed great interest in training on reminiscence conversations. Future studies should empower family caregivers to initiate and lead reminiscence conversations at home along with the provision of adequate caregiving support.
P. GINGIVALIS-LPS PROMOTES AD/ADRD VIA CASPASE-4-MEDIATED NONCANONICAL INFLAMMASOME PATHWAY
Authors: Verma Ambika , Azhar Gohar , Patyal Pankaj , Zhang Xiaomin , Wei Jeanne Y
Published: January 2025

Alzheimer’s disease (AD) and related dementias (ADRD) are significant contributors to illness and death in the older adult population worldwide. Chronic periodontitis and its keystone pathogen, Porphyromonas gingivalis, have increasingly been linked with AD/ADRD. P. gingivalis releases various virulence factors, including lipopolysaccharide (LPS), which have been shown to trigger systemic inflammatory events responsible for neuroinflammation and AD/ADRD. Caspase-4 directly senses and binds cytosolic LPS, promoting its oligomerization and activation, leading to the formation of the non-canonical inflammasome. However, the role of caspase-4 in P. gingivalis- LPS mediated AD-related neuropathology remains poorly defined. We hypothesized that P. gingivalis- LPS may be responsible for neuroinflammation via activation of caspase-4 mediated non-canonical inflammasome pathway through activation of its downstream NOD-like receptor family pyrin domain containing 3 (NLRP3) and caspase-1 inflammasome dependent cell signaling. Our overall hypothesis is exploring the cell signaling pathway by which P. gingivalis- LPS are able to affect the microglial/neuronal cells via activating caspase-4, that might be responsible for neuroinflammation and lead to AD/ADRD. Our results suggest that P. gingivalis- LPS activated caspase-4 and cleaved gasdermin D (GSDMD) to form the GSDMD pores to trigger pyroptosis, a form of programmed lytic cell death. The GSDMD pores in the plasma membrane also promoted K+ influx, sensed by the NLRP3 inflammasome to activate caspase-1, resulting in IL-1β maturation and secretion, as well as pyroptosis. This P. gingivalis- LPS induced caspase-4-mediated NLRP3/caspase-1 activation and associated IL-1β secretion, promotes neuroinflammatory environment that drives AD/ADRD pathogenesis.
WELL-BEING AND FUNCTIONING PROFILE AMONG OLDER ADULTS BETWEEN DIFFERENT LIVING SETTINGS
Authors: Hsu Wan-Ling , Ahn SangNam
Published: January 2025

Addressing the care needs of older adults in the United States is complex and challenging, especially considering that more than half of Americans aged 65 years and older have three or more chronic diseases, often accompanied by cognitive impairment. Thus, it is imperative to identify the types of care that may be more suitable for older adults who are potentially cognitively impaired. This study examined well-being and functioning profile (WFP) among older adults with probable or possible dementia between nursing home and comprehensive senior living settings, using the living settings as a proxy for types of care. The WFP includes assessments of emotional well-being, bothersome pain, general health, and functional limitations. The analysis is based on data collected from the National Health and Aging Trends Study spanning from 2018 to 2022. Linear regression with survey weights revealed a significant association between living settings and WFP among the 338 participants with probable or possible dementia. Specifically, older adults residing in comprehensive senior living settings exhibited notably enhanced emotional well-being (Coef= -5.276, p < 0.001), general health (Coef= -1.117, p = 0.006), and limitations with mobility (Coef=-3.180, p = 0.003) compared to those in nursing home settings. Findings emphasize the potential strength of comprehensive senior living settings in caring for older adults with probable or possible dementia, enhancing improved outcomes. This prompts further research into specific care components and strategies to integrate successful practices from comprehensive senior living settings into nursing home settings, fostering well-being for this growing demographic facing cognitive challenges.
ASSISTANCE, PLANNING, AND UNMET NEEDS: FACTORS SHAPING OLDER ADULTS’ PET CARE BEHAVIORS IN THE UNITED STATES
Authors: Bibbo Jessica , Nicolay Sarah , Tuft Samantha
Published: January 2025

Pets continue to be an important relationship for many people throughout life, while the abilities and resources available to provide for a pet change over the life course. This study surveyed people ages 50 and older on the assistance they had with pet care, whether they had gone without necessities to provide for their pet, and whether they had plans in place for their pet in case of emergencies or major life events. Participants (N=1,039) were enrolled in Foresight 50+, an omnibus survey representative of the US household population aged 50 or older. Descriptive statistics determined the proportion of adults who had experienced pet care behaviors along with specific types of assistance, necessity, and planning. A series of multivariate logistic regressions were conducted to identify associations between demographics and having assistance, going without, and planning. Most pet owners (72.4%) had some type of help with pet care, 18.8% had gone without at least one necessity to provide for their pet, and 23.7% had at least one plan in place for their pet. Larger household size was associated with having assistance (OR=1.96, p=.026). Lower income (OR=1.20, p=.024) and younger age (OR=1.06, p=.038) were associated with going without a necessity. Being female (OR=4.54, p=.003), smaller household size (OR=1.76, p=.036), and older age (OR=1.06, p=.010) were associated with having at least one plan in place. Available resources and personal characteristics significantly impact pet care behaviors. These results are a step toward better understanding how to support people and pets age in place.
DISCHARGE PREPARATION FOR OLDER ADULT IN PROLONGED EMERGENCY: A CASE-CONTROL STUDY
Authors: Liu Jinming , Gao Fengli , Chen Zijing
Published: January 2025

This study aims to explore the effectiveness of discharge preparation services in older adult with prolonged emergency observation and functional impairment. From August 2020 to June 2023, older adult (age ≥60 years) with Barthel Index < 100 and a hospital stay of >7 days in the emergency observation ward at a tertiary hospital in Beijing, China were included. A retrospective case-control study was conducted. The intervention group, guided by dedicated nurses, underwent personalized assessments, comprehensive care planning, and follow-up, while the control group received standard care. Primary outcomes included average hospitalization costs, length of stay, and 30-day readmission rates. A total of 628 patients were included after one-to-one nearest-neighbor matching without replacement. Among them, 314 received routine discharge preparation, and 314 received specialized nurse-led discharge preparation. Both groups demonstrated no statistically significant differences in baseline characteristics. The intervention group showed no significant difference in average hospitalization costs (72030 ± 63533RMB vs. 72446±68282RMB, t = 1.99, P = 0.906) or average length of stay (36 ±32days vs. 36 ±27days, t = 1.159, P=0.803). However, the intervention group exhibited a significantly lower 30-day readmission rate compared to the control group (6.7% vs. 15%, t = 3.36, P = 0.008). The findings suggest that while discharge preparation services may not impact immediate costs or length of stay for older adult with prolonged emergency observation and functional impairment, they significantly contribute to reducing the 30-day readmission rate. This emphasizes the importance of specialized nurse-led interventions in enhancing post-discharge outcomes and reduce healthcare system burden.
HEALTH CARE USE IN DIVERSE OLDER ADULT POPULATIONS WITH ALZHEIMER’S DISEASE AND RELATED DEMENTIAS
Authors: Kim Gee
Published: January 2025

Average medical costs for people aged 65 and older with a diagnosis of Alzheimer’s disease and related dementias (ADRD) are far higher than for people in the same age range without an ADRD diagnosis. Prior research shows the incidence of ADRD is significantly higher for Black and Hispanic populations than for non-Hispanic white and Asian populations. It is unclear, however, whether there are significant racial and ethnic disparities in the overall utilization and cost of care among patients with ADRD. An independent nonprofit organization, with the nation’s largest collection of private healthcare claims, studied the relationship between imputed race and ethnicity and overall healthcare utilization and spending in over one million patients aged 65 and older with a diagnosis of ADRD. Among the preliminary findings: In comparison with patients in other racial/ethnic groups, Black patients with ADRD had (1) on average poorer health, as measured by a higher average number of chronic conditions and a higher Hierarchical Conditions Category (HCC) score; (2) more intensive healthcare utilization, i.e., on average more admissions, longer admissions, more total days spent in the hospital, more claims filed, more distinct procedures received and more distinct providers seen; and (3) higher spending even after controlling for race/ethnicity-related HCC scores. These findings suggest race/ethnicity influences healthcare utilization and spending directly and indirectly for patients with ADRD. Results can be used to inform healthcare research, clinical guidelines, care delivery and benefits for older people with ADRD, as well as inform health equity approaches among minority and diverse populations.
AGEIST ATTITUDES AND PREPARATION AS INDIRECT PREDICTORS OF TRAINEES’ INTEREST IN CLINICAL WORK WITH OLDER ADULTS
Authors: Caskie Grace , Kirby Mackenzie , Root Eve
Published: January 2025

The striking discrepancy between the number of older adults in need of mental healthcare and the small number of psychologists with specialized training in providing this care (Moye et al., 2019) underscores the importance of identifying modifiable factors that could increase psychology trainees’ interest in future clinical work with older adults. We tested a structural equation model specifying ageist attitudes and preparation regarding aging as having indirect effects on interest in working with older adults through three measures of perceived work with older adults. Doctoral trainees (N=187; age=22-43 years) in clinical/counseling psychology completed the Fraboni Scale of Ageism, a 10-point item assessing trainees’ perceptions of how well their program prepared them to work with older adults, the Working with Older Adults Scale (assessing perceptions of ease/difficulty of work, social approval for work, favorable evaluation of work, and interest in work), the Social Desirability Scale, and demographic items. Controlling for trainees’ age and social desirability tendencies, the model demonstrated good fit (CFI=.95, TLI=.94, RMSEA=.07). Significant indirect effects were found for ageist attitudes (p<.001) and preparation (p=.01) on interest. More ageist attitudes related significantly to greater perceived difficulty (p<.001), less favorable evaluations (p<.001), and less social approval (p=.02) regarding working with older adults, while greater preparation related only to less difficulty of working with older adults. Difficulty, social approval, and evaluation of work with older adults each significantly predicted interest (p<.001). Implementing training opportunities for trainees that aim to reduce ageist attitudes could increase interest in working with the older adult population.
DEVELOPMENT OF A TRAINING MODEL WITHIN HOSPICE AND PALLIATIVE CARE FOR NURSE PRACTITIONERS
Authors: Laffer Alex , Kumar Chandrika , Shamas Tracy , Gillespie-Heyman Sarah , Podosek Alexandra , Ruskin Andrea
Published: January 2025

Workforce shortages within palliative care restricts availability of this service. Although clinicians may develop an interest in this specialty later in their careers, acquiring the necessary education and training is challenging. In academic medical centers like the Veteran’s Administration (VA), interprofessional palliative care teams are well-positioned to deliver high-quality, accessible palliative care services when patient needs surpass what can be addressed by primary care and surgical subspecialities. Given workforce shortages, this quality improvement project aims to increase competency for nurse practitioners (NPs) in hospice and palliative care. A 12-month, minimum 500 clinical hour, training program designed to provide clinical and skill-based education to NPs currently working on the VA Community Living Center was developed. The predominantly practical curriculum focuses on interprofessional teamwork, communication skills, and application of medical, psychosocial, cultural, spiritual, and ethical content. The curriculum is designed in a longitudinal manner that supports the NP’s ability to maintain their routine clinical care responsibilities. The program includes two hours of protected time each day consisting of hospice and palliative care clinical experiences alongside interprofessional learning. The training cohort, beginning March 2024, consists of two NPs. The team developed a mixed methods approach to assess competencies and progress across the training period. This project has resulted in an innovative approach to enhance hospice and palliative care training that will advance mid-career clinicians’ skills and help address workforce shortages without requiring clinicians to leave their jobs for extended training. Implementation will have implications for the feasibility, sustainability, and replication of this model.
EFFORTS TO INCREASE GERONTOLOGY DEGREE-SEEKERS AND DEVELOP THE LOCAL WORKFORCE
Authors: Hall Lisa
Published: January 2025

Since 1990, Gerontology majors at Missouri State University (MSU) have served their practicums at a variety of sites, which we consider to be “community partners”. These community partners consist of public and private entities that serve older adults, ranging from the local Area Agency on Aging, which is authorized by the Older Americans Act, to caregiving individuals who own Limited Liability Companies (LLC). The services offered range from high-activity recreation to end-of-life care. The MSU Gerontology Program has routinely surveyed our community partners to understand their expectations for and opinions about our program and students. In 2023, we added two additional areas of inquiry: (1) their current networking practices with each other and (2) the degree to which they and their employees were interested in taking aging-related courses at our university. Results from our online survey and follow-up interviews will be shared. Next steps in our continued efforts to increase Gerontology degree-seekers and to develop the local age-related workforce will be discussed.
IMPROVING ELDER HEALTH BEHAVIORS AND STUDENT LEARNING OUTCOMES WITH HOPE-BASED INTERPROFESSIONAL EDUCATION PROGRAM
Authors: Howell Britteny , Redmond Leslie , Worthington Amber , Musa Najma , Mahanna Allexis
Published: January 2025

Although Interprofessional Education (IPE) and research enhances learning, communication, and care of patients, it remains underutilized in higher education, demonstrating the need for extracurricular IPE opportunities. This presentation describes an interprofessional research project that brought together faculty, undergraduate, and graduate students from several health and social science disciplines to design and deliver a 15-week healthy aging program for older adults living in the urban Circumpolar North. Five faculty and one graduate research assistant led the project while eight students team-taught weekly, 1-hour sessions in the community focusing on healthy lifestyles within a framework of Persuasive Hope Theory. We will present the results of the student satisfaction survey regarding their involvement with the research as well as the participant satisfaction with the program. Students reported gains in “thinking like a scientist,” increased confidence conducting research tasks, benefits from teamwork, and greater consideration of the needs of older adults in their field of study. Older adult participants (N=39) also indicated favorable opinions of the program, responding that they were satisfied with the student-instructors, learning, application, impact, and value of the program. Despite small sample sizes, results from student and participant surveys both demonstrate that the IPE and intergenerational learning opportunities were meaningful. Additionally, results suggest that students may be more likely to consider a career working with older adults if given hands-on research experiences.
TEACHING STRATEGIES FOR INTERDISCIPLINARY COLLABORATION THROUGH A PUBLIC HEALTH LENS
Authors: Jurkowski Elaine
Published: January 2025

The Social Determinants of Health (SDOH) have become increasingly important in workforce training for health/medical professionals working with older adults to improve health outcomes. Inter-professional collaboration across disciplines such as primary care medicine, physician assistants, social workers etc. does not occur naturally since educational programs are siloed. However, these disciplines are required to work collaboratively with each other, targeting SDOH’s and patient outcomes. The objective was to promote communication across disciplines and help each discipline understand the roles played in practice with older adults. Three specific strategies to address Interprofessional Education were devised and implemented within a rural context to address the goal of improving collaboration and communication. An educational seminar was conducted using cases and guide questions. A second strategy was through “Student hot-spotting” where students worked with a high-need complex case over the course of a school year weekly, as a team-based approach. A third strategy made use of a weekly medical clinic for team-based patient care with students from medicine, social work, PA, nursing and nutrition. Findings suggest professionals were surprised at what they learned from the other disciplines they were collaborating with. They also learned about community-based resources and improved health outcomes when the lens of public health was in the forefront and an intentional part of the curricula. All participants felt that the chance to collaborate outside of their disciplines strengthened their skills and impact. In conclusion, curricula intentionally devised using a public health lens, in collaboration with other disciplines improves overall collaboration among professionals.
THE RAFT DEBATE: GETTING UNDERGRADUATE STUDENTS TO THINK CRITICALLY ABOUT AGING
Authors: Fiscella Andrew
Published: January 2025

A student-centered approach has been advocated to help students develop as learners, as it allows students to think critically, beyond what might be required in an essay. However, it can be difficult to achieve in larger classes, where a teacher-centered approach is more often utilized. The current study explores adapting a traditional debate format for students in a Physical Changes & Aging course as a tool to engage them in critical analysis of various topics related to biological aging, allowing the incorporation of student-centered techniques. In the Raft Debate, students represent gerontologists who become stranded on a desert island. There is a raft which can take them off the island, but it is only big enough for one group. To determine who gets off the island, students are split into teams, with pairs of teams assigned a topic which had been briefly introduced over the course of the semester. Students will be asked to prepare not only arguments in favor of their position but must also effectively counter-argue their opponents. After arguments by both teams have been presented, the audience will vote for the team which made the most convincing argument. Additionally, students will complete a peer review of their teammates. The goal of this assignment is that as students collaborate with each other and ultimately, compete against their classmates, they will gain a deeper understanding of the biological aging process and how it may be applied to both their professional and personal lives.
BEYOND BORDERS: LONG-DISTANCE CAREGIVING AND SLEEP HABITS IN SOUTH ASIAN COMMUNITIES
Authors: Siddiqui Aziza , Chekuri Srujana , Chataut Akankshya , Karki Dinesh , Boron Julie Blaskewicz
Published: January 2025

Caregiving is generally altruistic in South Asian (SA) communities; however, caregiving activities can still create significant strain for caregivers depending on situational factors, including sleep and built environments (Hossain et al., 2020). Particularly, long-distance caregivers may grapple with the added complexities of not being physically present to provide care. This study utilized an online survey to investigate sleep habits and routines, caregiving activities, neighborhood satisfaction, and access to community resources for the SA community located in Omaha, Nebraska (N=74, MAge=25.8, SD=4.58). Caregivers reported on their perceived burdens, highlighting the unique challenges faced as they logistically navigate from afar, which remains underrepresented in research for the SA community (Hossein et al., 2020). Results revealed that SA caregivers’ sleep satisfaction was significantly related to caregiver responsibilities, including familial and professional expectations (χ2(6, N=74)=20.74,p<.05). Caregivers concerned about their sleep patterns were significantly more likely to have impaired quality of life (r(72)=0.62, p<.001). Self-rated home cleanliness was also considerable in caregivers’ controlling their bedtime (r(72)=0.36, p<.001). Thus, control over sleep length and quality are essential factors to reduce caregiver burden. This highlights that how better sleep habits and a clean surrounding environment can potentially reduce strain experienced by many long-distance caregivers. The impact of home environments for the long-distance SA caregiving community is yet to be fully understood. It would be valuable to investigate this community’s caregiver norms and cultural expectations further to promote environments conducive to sleep quality and overall quality of life.
CLEAN AIR ACT 1990 AND ITS LONG-TERM IMPACT ON MORTALITY RISK AMONG OLDER ADULTS IN THE UNITED STATES
Authors: Lu Siyao , Zang Emma
Published: January 2025

Background

Air pollution significantly influences public health, being a predominant cause of illness and death in the United States. The 1990 Clean Air Act (CAA) marks a pivotal regulatory initiative aimed at confronting this issue by enhancing air quality and public health outcomes. This study investigates the long-term effects of the CAA 1990 on mortality rates among the elderly, paying special attention to racial differences in health outcomes.

Methods

This study adopts a difference-in-differences approach, analyzing county-level administrative data from 1982 to 2000. This approach evaluates the long-term impact of the CAA 1990’s implementation on the mortality rates of older adults across counties classified as “attainment” or “nonattainment” regarding the National Ambient Air Quality Standards (NAAQS) in 1990.

Results

The analysis reveals that the CAA 1990 significantly lowered mortality risks among the older population. Black men experienced the most substantial health benefits, although the impacts on Black older adults manifested more slowly compared to their White counterparts. The next phase of this research will explore potential mechanisms by examining the CAA 1990’s influence on air pollution reduction.

Discussion

This study underscores the CAA 1990’s role in mitigating public health burdens among older adults and highlights the essential need for policies that address racial disparities in the effects of environmental health. The insights are crucial for guiding future environmental policy, promoting environmental justice, and narrowing health disparities.
AN OBJECTIVE MEASURE OF STRESS REACTIVITY/RESILIENCE IN BLACK WOMEN DEMENTIA FAMILY CAREGIVERS
Authors: Wright Kathy , Moss Karen , Helsabeck Nathan , Adams Ingrid Richards , Rose Karen , Klatt Maryanna D
Published: January 2025

Real-time objective measures of stress are crucial for identifying mechanisms applicable to health behavior change research for dementia caregivers. We explore the Pittsburgh Stress Battery (PSB) in a non-laboratory setting (R21AG077069) as an objective measure of stress reactivity/resilience. The PSB was administered to 16 Black American women caregivers with hypertension (40-65 years old). PSB includes three challenging tasks (Stroop, Mental Math, and Mirror Tracing). An automatic cuff measured systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) at three intervals during the 20-minute battery followed by a 30-minute recovery. Average participant age was 62.4 (SD= 6.1). Ten assessments were completed in an office and six at home. One Stroop and three Mental Math were not completed due to computer/internet issues or refusal. Mean SBP, DPB, and HR at baseline were 128.9 mmHg, 81.6 mmHg, and 71.3 (beats per minute). The difference from baseline in SBP was 10.5 mmHg (SD= 8.3) for Stroop, Mental Math -.94 mm Hg (SD= -0.6), and Mirror Tracing 1.6 mmHg (SD= 9.4). For DBP, Stroop was 5.0 mm Hg (SD=4.6), Mental Math 0.2 mm Hg (SD= 3.2), and Mirror Tracing 0.3 mm Hg (SD= 7.0). HR difference from baseline was 3.8 (SD= 0.5), Mental Math -4.24 (SD= 8.2), and Mirror test -0.75 (SD= -3.4). Findings indicate that PSB elicits SBP/DBP/HR stress reactivity/resilience. PSB was portable for use in community settings. Study results will help guide interventions for behavior change, aiming to improve health outcomes in Black Americans.
ASSESSING THE IMPACT OF THE WYOMING DEMENTIA TOGETHER CAREGIVER NETWORK ON RURAL CAREGIVERS
Authors: Dabrowski Barbara , McKibbin Christine , Carrico Catherine , Schenck Sabine , Carling Stacy , Teply Abby , Punke Elizabeth , Andren Katherine Kitchen
Published: January 2025

Approximately 15.7 million people care for a family member or friend living with dementia (CDC, 2023). Many programs have been developed to support and educate dementia caregivers, but fewer are designed to reach rural areas. The Wyoming Dementia Together (WDT) Caregiver Network is an adaptation of the Extension for Community Health Outcomes (ECHO) model, created to enhance capacity for care in rural areas. The specific adaptation of the model for caregivers includes a Hub team of dementia care experts and rural Spoke Sites (individual caregivers). This study investigated outcomes associated with caregiver participation in the WDT network. The sample (n = 13, M = 61.4 years old, SD = 10.2) comprised White female dementia caregivers (n = 12; 92.3%) who completed at least six months of the WDT program. Caregivers completed pre-post measures regarding self-efficacy, caregiver burden, depressive symptoms, and unmet needs. Chi-square analyses revealed significant reductions in unmet needs related to family (chi-square = 6.77, df = 1, p =.009) and daily living needs (chi-square = 8.55, df = 1, p =.003). Changes in self-efficacy, burden, or depressive symptoms were non-significant; however, means did change in the expected direction. Effect sizes for self-efficacy (p =.23, d =.25), burden (p =.38, d =.39), and depression (p =.12, d =.48) were small to moderate. These findings suggest promise for improved outcomes associated with participation in WDT. Future research is needed with larger samples to further examine the impacts of the WDT program.
CAREGIVER ROLE TRANSITIONS IN HOME-BASED ALZHEIMER’S CARE: A SHANGHAI CASE STUDY
Authors: Wang Qingwei , Zhao Fengzhi , Wu Zixuan
Published: January 2025

Alzheimer’s disease poses a growing health crisis in China, exacerbated by the country’s rapidly aging population and cultural emphasis on family-based care. Caregivers shoulder immense physical and psychological burdens, often struggling to reconcile personal expectations with the demands of caregiving. This study, based on ethnographic data collected through prolonged engagements with a family in Shanghai caring for an older adult diagnosed with Alzheimer’s disease, explores the application of Role Theory. This framework explains the sequential stages of role assumption, enactment, ambivalence, and disengagement, offering insights into the complex dynamics of caregiving within China’s cultural context. While existing studies have identified factors influencing caregivers’ “willingness” and “psychological stress” primarily through assessments of psychiatric distress, the practical applications of theoretical models in caregiving practices for this population in China, especially those documented through first-hand experiences, remains underexplored. Drawing from diverse sources, including academic research and firsthand accounts, this study discloses the dynamic process of role transitions in practice, highlighting in particular the transition from a career-focused individual to a full-time caregiver and the subsequent role reversal between parents and children as the illness progresses. By clarifying the dynamic interplay of roles and responsibilities within caregiving relationships, insights gained through this in-depth case study applying Role Theory in practice can offer a roadmap for enhancing caregivers’ well-being and optimizing patient care outcomes.
GRANDCHILDREN WITH DISABILITIES: THE ROLE OF GRANDPARENTS’ RELATIONSHIPS
Authors: Mbam Kingsley , Fassi Janelle , Coyle Caitlin , Siperstein Gary , Ramdass Jeff , Rodriquez Jason
Published: January 2025

A body of research, largely in the disability and rehabilitation fields, has shown that grandparents support their grandchildren with disabilities (e.g., autism, down syndrome, and physical disability). However, how grandparents’ experiences of helping raise their grandchildren with disabilities influence their identity development in later life is largely unaddressed. This study examined grandparents’ relationships with their grandchildren under 21 with disabilities to learn how their experiences contribute to their identity development and perceptions of aging. We recruited 8 grandparents through senior centers across Massachusetts and conducted in-depth qualitative interviews with them by Zoom or phone. Interview questions asked about grandparents’ aging experiences as they relate to work, family and social relationships and self-perception, detailed questions about the nature of their relationships with grandchildren, identity development, and demographics. After transcribing the interviews, we used the NVivo 14 software program for qualitative data analysis to analyze our data, identify themes, and draw conclusions. We approached analysis using a constant comparative method that sorts data into various groups, according to specified attributes, and then organizes them in a way to formulate new ideas or theory. Themes that emerged were grandparents’ resilience, attitude of gratitude, role conflict of grandparental with parental influence, and the desire to live longer to remain a support for the grandchild. These findings highlight the paradox of grandparents’ emotions in supporting their grandchildren with disabilities for improved quality of life and functioning. Furthermore, these findings have implications for practitioners providing support services to grandparents raising their grandchildren with disabilities.
GRANDPARENT CAREGIVING AND EPIGENETIC AGING AMONG MIDLIFE AND OLDER ADULTS IN THE UNITED STATES
Authors: Bhat Aarti , Trexberg Kaitlin , Apsley Abner , Almeida David , Shalev Idan
Published: January 2025

In recent decades, grandparents have taken more active caregiving roles, with over 10% of U.S. grandparents raising a grandchild for 6+ months. Role theory postulates grandparent caregivers face unique strain due to complex roles as second-time parents, and physical demandingness of caring for children. Given grandparents are already vulnerable to aging-associated health deterioration, it is important to understand how grandparent caregiving may affect aging processes. Epigenetic aging is an indicator of healthspan and mortality risk that has not been studied in context of grandparent caregiving. DNA methylation patterns at sites associated with markers of aging have led to development of epigenetic “clocks”, which estimate biological age. We examined associations between grandparent caregiving and several epigenetic clocks among a sample of grandparents participating in the Midlife in the United States (MIDUS) study (n=488; mean age=59.41; Black=30.94%; other non-white race=6.56%; female=60.04%). 18.65% of grandparents reported taking on major responsibility for raising grandchild(ren) for 6+ months; among these individuals, mean number of years caring for grandchild(ren) was 5.27 (median=3, range=0-21). Preliminary analyses found, after controlling for sociodemographic characteristics (chronological age was compared against biological age estimates for each clock; race, gender, socioeconomic and marital status were covariates) and BMI (covariate), significant associations between grandparent caregiving and some epigenetic clocks (i.e., DunedinPACE), but not all. Among grandparents who reported providing instrumental care, number of years of care (using median split) was also significantly associated with DunedinPACE. These results indicate prolonged grandparent caregiving may contribute to increased stress and health deterioration at a molecular level.
MEASURING CAREGIVING INTENSITY
Authors: Nadash Pamela , Tell Eileen , Park Sung
Published: January 2025

This paper discusses measurement of caregiving intensity, using empirical data to illustrate the need to develop a consensus around measurement of this construct. “Caregiving intensity” differs from the related construct, “caregiver burden”, which measures the subjective experience of caregiving; caregiving intensity focuses instead on objective measures of the caregiving experience. Caregiving intensity is operationalized in various ways, employing hours of care provided, the perceived difficulty of care, care recipient characteristics, co-residence, or combinations thereof. We use a unique dataset comprising a representative panel of 385 family caregivers, which was compiled to help understand the decision-making process behind hiring professional home care. Consequently, the survey collected rich data about the caregiving experience of participants, including caregiving-related variables and respondents’ employment situations, enabling the construction of variables representing caregiver intensity, including the frequency of care provided for activities of daily living (ADLs) and instrumental activities of daily living (IADLs) and the level of perceived difficulty in providing those activities, as well as co-residence, long-distance caregiving, and having a child under 21. Using multivariate techniques employing these measures of intensity as predictor variables, the study found that while the frequency of helping with ADLs and IADLs mattered in predicting use of paid home care, the likelihood of being employed was not predicted by frequency of ADL and IADL support, but rather by the perceived difficulty of these caregiving tasks (as well as other variables). These findings suggest the need for further work in conceptualizing caregiving intensity.
SOCIAL MEDIA–BASED BIBLIOTHERAPY FOR INFORMAL CAREGIVERS OF PEOPLE WITH DEMENTIA: A PILOT RCT
Authors: Wang Shanshan , Isaac Leung Sze Him , Avis Fan
Published: January 2025

Background

Informal caregivers of individuals with dementia are often overlooked as they themselves experience mental health issues. This randomized controlled trial aimed to assess the efficacy of social media-based bibliotherapy in improving the mental health of informal caregivers.

Methods

A total of 60 informal caregivers were enrolled. Participants were randomly assigned to either the social media-based bibliotherapy group, which received eight weekly sessions of electronic bibliotherapy, or the usual care group, which only received routine services from community centers. Outcomes were assessed at baseline and immediately post-intervention. Descriptive statistics, t-tests, Mann-Whitney U tests, χ2 tests, and generalized estimating equations were used for quantitative data analysis.

Results

The average age of caregivers was 57.41 (SD, 13.63), with a majority being female (79.3%). Baseline characteristics were similar between groups. The findings demonstrated that social media-based bibliotherapy was well received for informal caregivers, with WhatsApp being the preferred medium in this study. The efficacy on mental health (Wald χ2=8.918, p=.003) and all the subscales of stress (Wald χ2=4.198, p=.040), anxiety (Wald χ2=7.667, p=.006), depression (Wald χ2=9.127, p=.003) was statistically significant. The efficacy on caregiving appraisal was only significant on the perceived caregiving burden subscale (Wald χ2=4.954, p=.026). The efficacy on the mental component scale of health-related quality of life approached significance (Wald χ2=3.634, p=.057). Conclusions: The utilization of social media-based electronic bibliotherapy was well received among informal caregivers of individuals with dementia, demonstrating potential positive effects on their mental health within this specific cohort.
THE IMPACT OF PAID FAMILY LEAVE ON INFORMAL AND FORMAL CARE RECEIPT FOR MIDDLE-AGED AND OLDER ADULTS WITH DISABILITIES
Authors: Qian Yuting , Chen Xi
Published: January 2025

About one-sixth of middle-aged and older adults in the U.S. have difficulty with at least one activity of daily living (ADL), and this prevalence increases with age. Working caregivers face a trade-off between spending time earning income and providing care for their disabled family members. Recognizing this challenge, thirteen states and Washington, D.C. have implemented or recently passed mandatory paid family leave (PFL) programs, which provide partially paid leave for workers caring for ill family members. This paper analyzes the impact of PFL policies on both informal and formal care receipt among middle-aged and older adults with disabilities in the U.S., and the heterogeneous effects by family availability. We use data from the 1998-2018 public and restricted-use version of the Health and Retirement Study (HRS) and leverage the PFL programs implemented in California (2004), New Jersey (2009), and New York (2018) in a difference-in-differences (DiD) design. We find that, among individuals with disabilities who have both a spouse and children, PFL access is associated with an 8.0 percentage point increase in the likelihood that disabled individuals report receiving informal care from their children. We also show that PFL access significantly increases the receipt of formal care and increases the use of home care services and nursing home care for disabled individuals who have a spouse. Our findings demonstrate that PFL policies support healthy aging for middle-aged and older adults with disabilities, but its impact is limited for some vulnerable groups, such as disabled individuals with children only.
UNDERSTANDING OLDER AMERICANS’ DEBT: INSIGHTS FROM COGNITIVE AND IN-DEPTH INTERVIEWS
Authors: Ortiz Hector
Published: January 2025

Debt is a common and important factor in older adults’ financial lives and balance sheets. According to the Survey of Consumer Finances, in 2022, 63 percent (31.3 million) of households headed by adults ages 60 and older held debt. In total, they held over $4.1 trillion in debt. Existing research and data suggest that there is also a strong relationship between debt and aging. This relationship is growing and changing. Despite the importance of debt in older adults’ financial lives, there are foundational gaps in qualitative data that limit researchers, policymakers, and educators’ ability to understand and monitor the level of debt held by older adults and the risk that debt poses to older adults. To address this gap, and provide insights into the growing and changing relationship between aging and debt, the Consumer Financial Protection Bureau (CFPB), an agency of the United States government, conducted cognitive and in-depth interviews with 54 participants, a majority (81 percent) of whom were age 62 or older, in June and July 2023. The findings revealed important gaps in the completeness of existing data sources that serve as a tool for monitoring trends and risks related to older adults’ debt. Moreover, the study findings also have important implications for areas where greater focus on consumer protection may be warranted.
ALZHEIMER’S DISEASE: GENDER AND GENERATION DISPARITIES IN ATTITUDES AND HELP-SEEKING AMONG AMERICAN INDIAN ADULTS
Authors: Lee Yeon-Shim , Roh Soonhee , Moon Heehyul , Warne Donald K , Thin-Elk Serene , Stone Sasheen T
Published: January 2025

Purpose

While the benefits of knowledge about health and preventive measures are widely acknowledged, little attention has been paid to the knowledge and attitudes of American Indian adults towards Alzheimer’s Disease and other dementias (ADRD). Therefore, this study examines the attitudes towards Alzheimer’s Disease and help-seeking intentions among American Indian adults, with a specific focus on gender differences. Method: Convenience sampling was used to recruit 227 American Indian adults in the Northern Plains. We employed t-tests and chi-square tests to examine the differences in attitudes toward ADRD (including stigma, knowledge, and attitude) and help-seeking intentions by gender and generation (Millennial or Younger vs. Gen X or older).

Results

More than two-thirds of the participants showed signs of cognitive impairment. Among the respondents, 60% were female, and 54% had completed education beyond high school. Approximately 50% were from the Millennial or younger generation. Female American Indian adults were more likely to report higher levels of ADRD knowledge, positive attitudes toward ADRD, and help-seeking intentions compared to their male counterparts. No significant differences were found in attitudes and help-seeking intentions by generation.

Conclusion

The findings underscore the gender disparities in ADRD-related attitudes and help-seeking intentions among American Indian adults. Tailored educational support programs should account for these variations, focusing on strategies to encourage American Indian adults to seek an ADRD diagnosis.
MALE SPOUSAL CAREGIVERS ARE ON THE RISE BUT THEY PROVIDE MOSTLY SECONDARY, INSTRUMENTAL, AND LOW-INTENSITY CARE
Authors: Cha Hyungmin , Ailshire Jennifer
Published: January 2025

Despite demographic projections that more men are adopting caregiving roles than ever before, there is a lack of population-level estimates regarding the prevalence of male caregivers over time. It is also unclear which types of caregiving tasks men typically provide. Using data from the Health and Retirement Study (2002-2018), we investigate trends in the prevalence of spousal caregiving among both men and women. We also analyze subcategories of caregiving, including primary versus secondary caregiving, activities of daily living versus instrumental activities of daily living, and high-intensity versus low-intensity care. Our results indicate that the prevalence of male caregivers has been increasing from 2002 to 2018, but these caregivers primarily focus on secondary, instrumental, and low-intensity caregiving. Further descriptive statistics comparing male caregivers in 2002 to those in 2018 reveal that this trend may be attributed to a growing number of Hispanic individuals, younger cohorts, highly educated, retired, and wealthy men, as well as those with older spouses. Our findings reveal the increase in male caregivers over time, which reshapes the gendered profile of caregivers. Nevertheless, male caregivers still primarily provide secondary, instrumental, and low-intensity care.
SLEEP AND STRESS IN MIDDLE-AGED AND OLDER CAREGIVERS OF CHILDREN, PARENTS, AND SPOUSES: EXAMINING SEX DIFFERENCES
Authors: Stearns Melanie , McGovney Kevin , Curtis Ashley , Costa Amy , Miller Mary Beth , Nair Uma , McCrae Christina
Published: January 2025

Informal caregiving is associated with sleep and stress, particularly among women, but no studies have examined the impact of caregiving for different individuals (child, parent, spouse) on sleep and stress. This study fills that gap. Caregivers of a child (N=151, Mage=40.50, 52%-female), parent (N=99, Mage=44.45, 52%-female), and spouse (N=71, Mage=55.26, 45%-female) completed the Perceived Stress Scale and reported bed/waketime consistency and night awakenings. Three-way ANOVAs evaluated interactions (caregiver-type x sleep/stress x sex) and main effects, controlling for age. Main effects also were examined separately for men and women. Pairwise comparisons clarified significant differences. Interactions not significant. A significant main effect (p=.049) occurred for night awakenings, consistent bedtime (p=.025), consistent waketime (p=.049), and stress (p=.045). Caregiver-child reported less consistent bedtimes (M=3.66+\-1.73) than caregiver-parent (M=2.93+\-1.63; p<.001) or caregiver-spouse (M=3.20+\-1.78; p=.009). Caregiver-child reported less consistent waketimes (M=3.23+\-1.62) than caregiver-parent (M=2.61+\-1.52; p=.003). Caregiver-child (M=4.39+\-2.87; p=.009) and caregiver-parent (M=4.28+\-2.91; p=.031) reported more night awakenings than caregiver-spouse (M=3.35+\-2.46). Caregiver-child reported more stress (M=19.91+\-5.95) than caregiver-spouse (M=17.56+\-7.46; p=.013). For women, a significant main effect (p=.008) occurred for stress and consistent waketimes (p=.047). Among women, caregiver-child reported more stress (M=21.25+\-6.02) than caregiver-parent (M=20.75+\-6.0; p=.014) or caregiver-spouse (M=16.63+\-7.4; p<.001). Caregiver-child reported less consistent waketimes for women (M=3.25+\-1.71) than caregiver-parent (M=2.83+\-1.30; p=.010). Thus, child and parent caregivers, particularly women, may experience increased sleep problems/stress. This may be in part due to caregiving burdens placed on women. Thus, women caregivers may need additional monitoring and support. We encourage longitudinal research examining what contributes to increased sleep and stress among caregivers.