bluuebunny/crossref_metadata_2025 huggingface dataset:
PROFILE OF OLDER PUBLIC TRANSPORTATION USERS IN THE UNITED STATES: IMPLICATIONS FOR AGE-FRIENDLY COMMUNITIES
Authors: Gimie Afnan , Castillo Andrea Melgar , Mullins C Daniel , Falvey Jason
Published: December 2022

Public buses, trains, and trams are a growing mode of transportation for older adults in the United States, yet many environmental and health related barriers to use have been reported. Characterizing the population of older public transit users is essential for developing age-friendly communities. We used data from 5696 urban, community dwelling older adults in round 5 of the National Aging and Trends Study (NHATS), an annual nationally representative survey of late-life disability. Using SAS (version 9.4), weighted frequencies were calculated and compared between public transit and non-transit users using procedures that account for the complex design of the NHATS survey. Compared to non-transit users, those who reported using transit within the last month (n=555, 9.8%; weighted n=3,122,583) were significantly more likely to identify their race/ethnicity as Black or Hispanic (50% vs 28%) and reported difficulty meeting financial needs for housing, utility, and food (12% vs 7%), and to speak a language other than English (14% vs 8%). Transit users were significantly less likely to use a walker (9% vs 14%) or wheelchair/scooter (4% vs 9%). Additionally, 15% of transit users did not have a working cell phone and 42% did not have a working computer. Over 20% of transit users (weighted n=658,850) rely on these services to get to their doctor. These findings highlight the clinical, social, and financial barriers that disproportionately affect over 3 million older adult transit users in the United States, and inform initiatives oriented towards improving community access for older adults.
A JOURNEY FROM GERIATRIC MEDICINE TO GEROSCIENCE
Authors: Ferrucci Luigi
Published: December 2022

In 1984 LZ Rubenstein group demonstrated that geriatric assessment improved function and QoL in frail in frail, older patients. I heartly joined the international sparkle of enthusiasm generated by these results although later work did not match our expectations. Understanding the complexity of older person is an extraordinary tool for geriatricians, but coding the nuances of making the “best choice” in a randomized trial remains difficult. Frailty is difficult to reverse because it occurs when resilience is exhausted. Geroscience postulates that chronic diseases and frailty stem from the biological mechanism of aging and that interventions that slow down aging will successfully improve resilience. This approach have shown great potential but whether it will lead to prevention or improvement of frailty is unknown. While we continue to provide optimal care to frail older patients, we need to push forward the translation arm of geroscience both in area of prevention and care of older patients.
EXCURSIONS INTO HEALTHCARE SYSTEMS TO HELP INFORMAL CAREGIVERS MANAGE DEMENTIA
Authors: Fortinsky Richard , Callahan Christopher
Published: December 2022

With the establishment in 2019 of the National Institute on Aging-funded IMPACT Collaboratory, the era of designing and implementing pragmatic clinical trials in partnership with health care systems to improve care and health-related outcomes for people living with dementia (PLWD) is well underway. An important focus for Collaboratory-funded work involves targeting and engaging family and other informal caregivers of PLWD across health care system settings. In this Symposium, we feature three Collaboratory-funded investigators who are partnering with health care systems to determine how to engage informal caregivers most pragmatically, with the goals of improving caregivers’ capacity to manage dementia and provide sustained input into the clinical care of PLWD. Symposium presenters Quincy Samus and Hillary Lum are the first two Collaboratory-funded Health Care System Scholars and Richard Fortinsky is a pilot study awardee. Dr. Samus will present on her experiences and lessons learned in her multiple efforts to adapt and embed the MIND at Home family-focused care management model into health care systems, including her current work with a large managed care organization. Dr. Lum will explain ongoing capacity-building stakeholder engagement activities at a large academic health system in preparation for pragmatic clinical trials for PLWD and their caregivers. Dr. Fortinsky will present on experiences and lessons learned from ongoing efforts to identify caregivers of PLWD to join caregiver support programs, and store caregiver data electronically, in two health system outpatient care settings. Dr. Christopher Callahan, Leader of the Training Core for the Collaboratory, will serve as Symposium Discussant.
ARE INTRINSIC CAPACITY AND MULTIMORBIDITY ASSOCIATED TO FRIED’S FRAILTY REVERSIBILITY?
Authors: Bautista Emmanuel Gonzalez , Rodríguez Aarón Salinas , Almaraz Ana Rivera , Espinoza Betty Soledad Manrique
Published: December 2022

Our objective was to characterize older adults with reversible frailty in their baseline intrinsic capacity and multimorbidity status. MethodsWe used data from the most recent waves of the SAGE Mexico study (3 and 4), representative of older adults at a national level. Study n=749.We objectively measured gait speed and grip strength based on Fried's frailty criteria. Weight loss exhaustion was self-reported and physical activity (using the IPAQ).Reversible frailty was defined as going from frailty to pre-frail or robust and from pre-frail to robust. Worsening and stable frailty were coded similarly. Intrinsic capacity was measured using a summary index (0-100) based on five domains: cognition, locomotion, sensory, nutrition, and psychological. Multimorbidity was coded yes/no if the participant self-reported two or more chronic conditions. We compared the odds of being in the reverse group versus not in it according to baseline intrinsic capacity score and multimorbidity status, adjusting for age, sex, rural/urban, and wealth. ResultsReversible frailty=33% of those pre-frail or robust at baseline. Intrinsic capacity was higher in the reverse group than in those with worsening frailty but not significantly higher than those with stable frailty.Having multimorbidity significantly decreased the chances of frailty reversibility, adjusting for covariates. ConclusionsAs an expression of lifecourse damage to the physiological reserve, multimorbidity limits the chances of reversible frailty in Mexican older adults. High levels of intrinsic capacity did not characterize frailty reversibility in our study. Yet, low intrinsic capacity levels are a marker for older adults prone to frailty worsening.
TURNING THE ORDINARY INTO THE EXTRAORDINARY: EXPERIENCES OF PROVIDING FARM-BASED DAYCARE FOR PEOPLE WITH DEMENTIA
Authors: Pedersen Ingeborg
Published: December 2022

This study gives a deeper understanding of how service providers think and work when offering farm-based days care (FDC) services for people with dementia. Seven semi-structured interviews with service providers, analyzed using text condensation, resulted in the five main themes; “On fertile ground”; “The foundation”; “Activities with rippling effects”, “Positive social and emotional environment” and, “Making room”. The theme “On fertile ground”, reflects the ordinary aspect of the farm context; closeness to nature and the home-like atmosphere. “The foundation” describes the extraordinary aspect of FDC; the service providers relentless effort to tailor all aspects of the service to the attendees. These two themes lay the foundation for the activities, the social setting, and possibilities for having a personal focus, reflected in the three remaining themes. The study gives an enhanced understanding of the key role of the service provider and how they offer person-center care in the farm context.
UNDERSTANDING POTENTIAL INVOLVEMENT OF CARE PARTNERS IN CAPABLE
Authors: Fields Beth , Toto Pamela
Published: December 2022

This qualitative study focused on understanding how to involve unpaid care partners (‘family members or friends’) of older adults who are participating in CAPABLE. Using field notes, focus groups, and key informant interviews, the study revealed considerations for involving care partners, including providing choices, defining roles, sharing information in a collaborative manner, and reinforcing knowledge and skills training. These findings can help guide organizations interested in involving care partners in their older adult programs.
TEACHING MEDICAL STUDENTS TO INCORPORATE THE 4MS OF AGE-FRIENDLY HEALTH SYSTEMS ACROSS THE CONTINUUM OF CARE
Authors: Severance Jennifer , Ross Sarah
Published: December 2022

High quality and equitable health care for older adults involves patient-centered approaches that can improve the patient’s engagement, decision-making, and health outcomes. To educate future health professionals about patient-centered care across the continuum of care, a HRSA-Geriatric Workforce Enhancement Program created a four-week online elective course for third and fourth-year medical students using the Age-Friendly Health Systems 4Ms framework. Faculty identified geriatric tools and best practices in the 4M’s areas of What Matters, Mobility, Mentation, and Medication to develop self-directed asynchronous learning modules. Students were instructed on incorporating the 4Ms into patient assessments, care planning, interprofessional practice, and process improvement in different settings of care. Assignments included quizzes, case studies, discussion forums, and a patient experience interview with an older adult or caregiver. At course completion, students self-assessed their knowledge and skills and rated the course materials and assignments using five-point Likert-type items. Ninety-six students participated in the course between July 2020 and March 2022. Ninety-eight percent of respondents (n=80) felt the assignments were helpful, and 100% agreed the course improved their knowledge about Age-Friendly Health Systems and different care settings and processes. Also, 100% felt the content was applicable to their future practice and 96% would recommend the course. Qualitative thematic analysis of open-ended questions showed preferences for interactive elements, such as case presentations and guided interviews with older adults, as well as ways to improve student engagement. Educating students about Age-Friendly Health Systems can prepare future health professionals for collaborative patient-centered geriatrics care across a variety of settings.
FRAILTY AND CARDIOVASCULAR DISEASE EVENTS IN COMMUNITY-DWELLING HEALTHY OLDER ADULTS
Authors: Ekram A R M Saifuddin , Espinoza Sara , Ryan Joanne , Ernst Michael , Tonkin Andrew , Reid Christopher , McNeil John , Woods Robyn
Published: December 2022

BACKGROUND

Frailty is associated with adverse outcomes, but whether it independently increases cardiovascular disease (CVD) risk requires clarification.

METHODS

This study examined the association between frailty in a cohort with no previous CVD events and subsequent CVD outcomes in 19,114 community-dwelling older people from the ASPREE trial. Frailty was assessed using the modified Fried phenotype, comprising weakness, exhaustion, low body mass index (BMI), slowness and low physical activity, and a deficit accumulation frailty index (FI) of 66 items. CVD event was defined as a composite of CVD death, non-fatal myocardial infarction, non-fatal stroke and hospitalization for heart failure.

Results

Over a median 4.7-years of follow-up (interquartile range: 3.6 to 5.7 years), pre-frail/frail participants were more likely to develop CVD events (Hazard ratio (HR): 1.33; 95% Confidence Interval (CI): 1.16, 1.53 for pre-frail and HR: 1.68; 95% CI: 1.19, 2.38 for frail participants) according to Fried phenotype. Subtypes of CVD (fatal/non-fatal myocardial infarction and heart failure hospitalization) similarly increased HRs except fatal or non-fatal stroke. These effect sizes were more prominent when frailty was assessed using the FI than that assessed by Fried phenotype.

CONCLUSION

Pre-frail and frail participants were at significantly increased risk of developing CVD and its sub-types (particularly fatal/non-fatal myocardial infarction and hospitalization for heart failure). Addressing pre-frailty and frailty in older people could contribute to CVD prevention strategies.
COGNITIVE CORRELATES OF GAIT SPEED AMONG OLDER ADULTS FROM SIX COUNTRIES: FINDINGS FROM THE COSMIC COLLABORATION
Authors: Sprague Briana , Zhu Xiaonan , Rosso Andrea , Verghese Joe , Delbaere Kim , Lipnicki Darren , Sachdev Perminder , Rosano Caterina
Published: December 2022

Using data from population-based cohorts of older adults 65+ from six countries across three continents (N=6472), we aimed to (1) describe and (2) identify predictors of usual and rapid gait speed from studies participating in the Cohort Studies of Memory in an International Consortium (COSMIC) collaboration. We investigated whether clinical (BMI, hypertension, stroke, APOE status), psychological (cognition, mood, general health) and behavioral factors (smoking, drinking, physical activity) predicted gait speed similarly across cohorts; we used regression models controlling for demographics. Unadjusted usual gait speed ranged from 0.52-1.09 m/s and rapid gait speed ranged from 1.20-1.68 m/s. Lower BMI and better cognitive function consistently predicted faster usual and rapid gait speed in all cohorts. These patterns were not attenuated by demographics. Other psychological and behavioral factors were less consistently associated with gait. Taken together, gait speed is variable across ethnogeographic regions, but the influence of cognitive on gait is remarkably consistent.
PAST AS PRESENT: HOW LIVED EXPERIENCE INFLUENCES INTERACTION WITH LTSS AMONG OLDER SPANISH SPEAKERS
Authors: Glicksman Allen , Rodriguez Misha , Ring Lauren , Liebman Michael
Published: December 2022

Older persons who migrated to the mainland United States bring with them their experiences and culture from their homelands and the process of migration and settlement in their new communities. The attitudes, values and assumptions that emerge will contribute to the interaction of the individual with the formal Long Term Care Services and Support (LTSS) system. Our research focused on better understanding of that process among older Spanish speakers. Data from four focus groups (# of participants) conducted in Spanish about the participants experience with LTSS was used in this analysis. Findings demonstrate the importance of understanding the ways in which the worldview of these persons shape their expectations and use of the formal LTSS system. The findings will facilitate the development of a Social Interaction Model to enable planners, policy makers and practitioners in LTSS to more effectively work with older migrants.
A MIXED-METHOD SOCIAL NETWORK ANALYSIS OF LOW-INCOME DIVERSE OLDER VOLUNTEERS
Authors: Cao Katy (Qiuchang) , Dabelko-Schoeny Holly , Warren Keith , Lee Mo-Yee
Published: December 2022

Although the health benefits of volunteering among older adults are well established in gerontology, older migrants’ abilities and interests in social participation are hardly recognized. To address the gap, we collected focus groups and survey information in Russian, Khmer, Somali, Nepali, and English to understand the volunteering experiences, social networks, and feelings of loneliness among low-income diverse volunteers in the Senior Companions Program (SCP) in Columbus, Ohio (N=41). The grounded theory approach informed the qualitative analysis. Exponential Random Graph Modeling (ERGM) was utilized to identify statistically significant structural features in the volunteers’ network. Five major themes emerged from the focus groups: (1) Expanding and strengthening social networks through volunteering; (2) Experiencing and coping with loneliness; (3) Experiencing and managing the social impact of COVID; (4) Exploring and loving the program; (5) Social connections outside of the program. Graphs and preliminary ERGM results demonstrate that participants tend to form homophily-based relationships with other volunteers of the same gender (β=2.45, p< 0.001) and from the same country (β=4.86, p< 0.001). However, participants tend to form friendships with people from different racial (β= -1.12, p< 0.001) and different educational backgrounds (β = -0.88, p< 0.001). The tendency to reciprocate (β= 0.96, p< 0.001) and to form triads (β= 9.90, p< 0.001) are both positively significant in the networks. Findings imply that practitioners should attend to within- and cross-cultural relationships in programs for diverse older adults. Addressing language barriers and other sources of homophily may facilitate cross-cultural friendships.
ELECTIONS MATTER: AGING POLITICS AND POLICY IN THE BIDEN ERA
Authors: Miller Edward , Fassi Janelle , Cohen Marc
Published: December 2022

The 2020 election of Joe Biden to the presidency has shifted the foundations of the American political system after four years of conservative policy leadership. Combined with a slim Democratic majority in Congress, the policies, priorities, and proposals of the Biden administration have important ramifications for all spheres of American life. Nowhere is this clearer than with older Americans who disproportionately supported Donald Trump’s reelection but are among those who benefit most with enactment of the Democratic party agenda. Between 2010 and 2050 the proportion of the U.S. population aged 65 years or older is projected to increase from 13% to 20%. Population aging creates opportunities and challenges for older adults, their families, and society in general. The Biden administration has chosen to meet these challenges, in part, by seeking to expand the social safety net. By contrast, the Trump administration largely supported Republican priorities to draw back on the federal government’s commitment to programs intended to support an aging population. This panel examines aging politics and policy during the first two years of the Biden administration. It reports on older adults’ voting patterns and the role of issue framing in limiting public support for proposals such as Medicare for All. It analyzes provisions in the American Rescue Plan Act and Build Back Better Bill to bolster formal care and services for older adults, as well as federal actions to support family caregivers. Edward Miller serves as panel chair; Janelle Fassi serves as co-chair and Marc Cohen as discussant.
BRINGING HOME CARE TO HUD HOUSING: AN EVALUATION OF NEW JERSEY'S ASSISTED LIVING PROGRAM
Authors: Zurlo Karen
Published: December 2022

The Assisted Living Program (ALP) in New Jersey provides home care services, financed by Medicaid and self-pay, to older adults living in low-income HUD housing. Because the program had attracted few providers and had low uptake, we designed a qualitative study aimed at understanding experiences of ALP participants compared to non-participants. After pandemic-related postponements, the study began in June 2021, collecting data from 63 respondents. Findings revealed differences in the demographics and needs of older New Jerseyans as well as differences between participants and non-participants in ALP. This paper will review the study and discuss investigators’ conclusions about how to strengthen this highly viable model of home-based care and better serve low-income older adults in New Jersey. Opportunities for improvement include modifications to regulations and financing; marketing of services, and collaboration among ALPs and housing providers.
ALIGNING GERIATRIC EMERGENCY CARE WITH THE 4MS OF THE AGE-FRIENDLY HEALTH SYSTEM FRAMEWORK
Authors: Raymond Jennifer
Published: December 2022

In 2019 Dartmouth-Hitchcock Medical Center (DHMC) was recognized by the Institute for Healthcare Improvement as a level 2 Age Friendly Health System (AFHS). Over the past two years DHMC leveraged the strengths of the AFHS to become a level 1 American College of Emergency Physicians (ACEP) accredited geriatric emergency department. Leveraging the paradigm of 4M care including: What Matter’s Most, Mobility, Medication and Mentation, DHMC achieved alignment between the geriatric emergency department accreditation and the AFHS framework. Pathways focusing on the 4Ms have been identified as a model to improve transitions of care post ED. This talk will focus on lessons learned and outcome data specific to the creation of the 4M pathways and transitions of care,
SAFE TRANSITIONS: POST-ED DISCHARGE FROM A RURAL CRITICAL ACCESS HOSPITAL
Authors: Foster Kristie
Published: December 2022

This talk will focus on leveraging the strengths of small rural communities to improve transitions of care post ED discharge. We moved beyond post discharge telephone calls, and partnered with already existing community based organizations. These collaborative partnerships enabled the use of standardized bundles of interventions targeting specific risks such as falls, depression, polypharmacy and the lack of documentation around goals of care.
ORGANOCHLORINE EXPOSURES AND COGNITIVE FUNCTION IN OLDER LIFE: THE ROLE OF RACE/ETHNICITY
Authors: Chanti-Ketterl Marianne , Aranda Maria , Plassman Brenda
Published: December 2022

Organochlorines (OCs) are persistent pesticides that remain in the environment and body for extended periods after exposure. Little is known about their long-term impact on cognition in later life. Some studies, but not all, have shown that higher levels of selected OCs are associated with lower cognitive function (CF). Using weighted linear generalized estimating equations, we explored whether the association between lipid-adjusted levels of 8 OCs and global CF is modified by race/ethnicity in 985 adults age 60+ from the National Health and Nutrition Examination Surveys (2011-2014). Adjusting for covariates, results indicated that higher levels of grouped-OCs are not associated with lower CF (p=0.121), but higher levels of specific OCs were associated with lower CF: Mirex[p=0.029]; Oxychlordane[p=0.036]; p,p’-DDE[p=0.009]; p,p’-DDT[p=0.003]; and trans-Nonachlor[p=0.023]. These associations did not differ by race/ethnicity. Disentangling the complex impact of OCs on late-life cognition—whether in combination or singularly—may lead to more equitable environmental health policies.
EXPLORING THE LIVED EXPERIENCE OF RACIALIZED AGEISM AMONG OLDER ADULTS: A PHENOMENOLOGICAL STUDY
Authors: Steward Andrew , De Fries Carson , Dunbar Annie Zean , Trujillo Miguel , Zhu Yating , Nicotera Nicole , Hasche Leslie
Published: December 2022

Ageism is a prevalent, insidious social justice issue which has harmful effects on the health of older adults. Preliminary literature explores the intersectionality of ageism with sexism, ableism, classism, and ageism experienced among LGBTQ+ older adults. To our knowledge, the intersection of ageism with racism, or racialized ageism, is largely absent from the literature. This qualitative study explored the following research question from a phenomenological perspective: “What is the lived experience of racialized ageism among diverse older adults?” Twenty participants 60+ years of age (M=69) in the U.S. Mountain West identifying as Black, Latino(a), Asian-American/Pacific Islander, Indigenous, or White engaged in a one-hour interview between February and July 2021. A three-cycle coding process used constant comparison methods. Five coders independently coded interviews, engaging in critical discussion to resolve disagreements. An audit trail, member checking, and peer debriefing enhanced credibility. Six umbrella themes and 20 sub-themes were identified. In this paper, the following six sub-themes are highlighted with direct implications for practice:1) compounding oppression, 2) being avoided or categorized due to others’ discomfort, 3) increased disrespect, 4) microaggressions, 5) acts of hate, and 6) cultural values/respect for elders as a protective factor. Implications include informing how practitioners may enhance support for older adults in preventing and coping with experiences of racialized ageism. Enhanced understanding of racialized ageism should also inform existing anti-ageism initiatives at the community level. Future research should focus on the experience of racialized ageist microaggressions and the relationship between racialized ageism and specific health outcomes.
PHYSICAL RESTRAINTS AT HOME AND THEIR FACTORS: A ONE-YEAR LONGITUDINAL SURVEY AMONG HOME CARE SERVICE USERS IN JAPAN
Authors: Yamamoto-Mitani Noriko , Numata Hanako , Fukui Chie
Published: December 2022

We conducted a one-year survey of homecare service users aged 75 years and older. Data from 769 clients were examined. Altogether 47 (6.1%) received physical restraint at least once among the five survey points conducted over a one-year period. Among them, 27 (57.4%) received restraint only at one point, and only 2 received restraint in all five points. In the bivariate analyses, the factors associated with the use of physical restraint were: diagnosis of neurological disease, unstable general condition or terminal stage, high level of care required, medical treatment, and family burden. When those who were released from the restraint at 12 months (n=30) were compared with those who were not (n=17), not having stroke, not receiving suctioning, and not having home-visit medical care were significant factors. Physical restraints at home were not common but we must be careful when we serve clients with significant factors of prolonged restraints.
EAST MEETS WEST: MODELS OF "AGING IN COMMUNITIES": DEMENTIA, CAREGIVING, AND ACTIVE AGING BETWEEN THE US AND TAIWAN
Authors: Kuo TsuAnn , Torres-Gil Fernando
Published: December 2022

As countries around the world are entering the super aged societies, aging in place will need to be planned not only as an individual but also as a multi-disciplinary and age-friendly community. Many models are built based on the concept of "Aging in communities" in order to consider the multi-levels of needs and interests that older adults face when living in the same area. With Asia being the next fastest aging continent, innovative models and programs are also developed in Taiwan as it tries to promote healthy aging, combating dementia and supporting family caregivers. This symposium will include 4 papers by introducing a national program for frailty prevention, a community friendly model for people with dementia and a collaborative network to prevent family caregivers from being burned out. In addition, the village model developed in the U. S. will be compared to show how east meets west to demonstrate communities meeting the needs of older adults.
LONG-TERM PSYCHOLOGICAL CONSEQUENCES OF PARENTAL BEREAVEMENT PRIOR TO MID-LIFE: VOLUNTEERING HELPS
Authors: Huo Meng , Kim Kyungmin
Published: December 2022

Losing a child prior to midlife may be a uniquely traumatic event that continues to compromise parents’ well-being in later life. This study compared psychological well-being between bereaved and non-bereaved parents, and examined whether volunteering protects bereaved parents. We analyzed a pooled sample of parents aged 50+ (N = 12,023) from the Health and Retirement Study, including parents who lost a child prior to 50 and those who never lost a child. Bereaved parents reported more depressive symptoms and lower life satisfaction than non-bereaved parents, which was more evident among parents with fewer children alive. Among bereaved parents, volunteering, particularly volunteering 100+ hours/year, was associated with better well-being at baseline; yet, volunteering 1–99 hours/year led to a larger increase in life satisfaction over time. This study adds to our understanding of lasting effects of parental bereavement and suggests volunteering as a potential intervention aimed at helping bereaved older parents.
REIMAGINING DISASTER AND EMERGENCY PREPAREDNESS IN LONG-TERM CARE: EXAMPLES FROM FLORIDA AND TEXAS
Authors: Peterson Lindsay , Andel Ross , Bell Sue Anne
Published: December 2022

A thread common to all disasters is the effect on human health that results when the health care infrastructure and delivery of health services are disrupted. This view has reinforced the importance of an all “all-hazards approach” to preparedness, whereby disaster response planning incorporates principles common to all events and can be adapted to specific contingencies. Preparing for and responding to a disaster in long-term care (LTC) requires a broad view of multiple events that can disrupt daily life and needed services for LTC residents (e.g. hurricanes, pandemics). This symposium will examine the effects of varied emergency events on older adults residing in nursing homes (NHs) and assisted living communities (ALCs) using quantitative and qualitative methodologies. The first presentation will discuss morbidity and mortality of NH residents exposed to Hurricane Harvey (Texas). The second is an investigation of NH direct care staffing during the recent Winter Storm Uri (Texas). The third presentation qualitatively explores the challenges of providing care to residents living with dementia during the COVID-19 pandemic, based on interviews with Florida NH and ALC administrators. The fourth quantitatively and qualitatively explores issues related to resident-to-resident contact restrictions in Florida ALCs. Finally, we will discuss the application of the 4Ms Age Friendly framework (What Matters, Medication, Mentation, and Mobility) to disaster preparedness in LTC. This symposium will provide information that can be used to develop or revise public policies to improve preparedness for and response to a range of emergency events in NHs and ALCs.
FEDERAL ACTIONS TO SUPPORT FAMILY CAREGIVERS UNDER THE BIDEN ADMINISTRATION
Authors: Tell Eileen
Published: December 2022

Family caregivers are the glue holding together the delivery and financing of long-term care. Replacing family care with paid care would cost roughly $470 billion each year. But family caregivers are struggling. They face many challenges – most notably the financial stress and the need for services and supports. Other challenges include lack of respite care, need for caregiver training, and lack of access to quality paid workforce. In order to address these challenges, Congress authorized the RAISE Family Caregiving Advisory Council. The RAISE (Recognize, Assist, Include, Support and Engage) Family Caregivers Act directs the Secretary of Health and Human Services to develop a national family caregiver strategy. This session presents the findings of two years of focus groups and interviews with family caregivers and hundreds of stakeholder organizations that support them, providing concrete input to the Biden administration on how to deliver on the broad objectives of the RAISE Act.
AGING COUPLES’ SATISFYING RELATIONSHIPS AND WE-TALK PROMOTE CARDIOVASCULAR HEALTH DURING CONFLICT
Authors: Shrout M Rosie , Wilson Stephanie , Renna Megan E , Madison Annelise A , Kiecolt-Glaser Janice K
Published: December 2022

Marital conflict poses health risks that intensify as couples grow older. Dyadic stress theories suggest spouses’ marital satisfaction and communication patterns alter cardiovascular function, a key pathway from troubled relationships to poor health. Despite these risks, older spouses are more likely to have a strong couple identity where they think and talk in relational terms. This communication pattern, termed we-talk, is shown when spouses use words like “we” rather than “you” or “me,” reflecting that they are thinking about resolving conflict as a couple rather than as two separate individuals. We examined how both spouses’ relationship satisfaction and we-talk reduced conflict’s cardiovascular toll, and if the health benefits were greatest when both spouses were satisfied and used we-talk. Married couples (n=107) ages 40-87 engaged in a 20-minute conflict discussion while wearing heart rate monitors to assess heart rate variability (HRV), a measure of cardiac flexibility. Couples’ conflicts were transcribed to measure we-talk, or the proportion of first-person plural pronouns, such as we, us, and our. Results showed a person’s HRV was higher and thus healthier when both spouses were satisfied and their partner used we-talk more often. In contrast, HRV was lower and less healthy when neither or only one spouse was satisfied and their partner used we-talk less often. Thus, a couple’s mutually satisfying relationship along with a partner’s we-talk provided a health advantage during conflict. Talking in relational terms may help reduce conflict’s biological toll in aging couples, particularly when their relationships are satisfying.
DEATH FEARS AND ANXIETY ACROSS THE LIFE COURSE: IMPLICATIONS FOR DEATH REFORM
Authors: Thompson Amber , Utz Rebecca
Published: December 2022

Western culture is experiencing a movement for death reform which includes aspects such as death acceptance and supporting individual choice concerning how one wishes to experience end-of-life (EOL). The underlying goal of this reform is to foster natural curiosity about death and dying in order to soothe death fears and anxiety. Over the past few decades in the U.S. there has been an increase in public support for the EOL option of medical-aid-in-dying (MAID), or legally prescribed pharmaceuticals intended to cause death. There have been mixed findings regarding the effects of age on attitudes and perspectives towards death and dying. The aim of this study was to determine the relationship between age, death fears and anxiety, values and perspectives, demographic characteristics, and approval of MAID at EOL in a U.S. nationally representative sample (N = 1994), using a partially latent structural equation model (SEM). Results show that age has a curvilinear effect on death fears and anxiety, and that as death fears and anxiety increase support for MAID decrease. This suggests that the ability to provide person-and-family-centered care at EOL must address the biopsychosocial aspect of death fears and anxiety across the life course. These findings demonstrate the need for more research documenting changes in attitude and perspectives towards EOL for different populations (i.e., ages). The potential benefits of this approach provide a basis for expanding education and awareness of both death and dying in general, and EOL needs and wants for older adult populations.
FAMILY DECISION-MAKING IN SERIOUS ILLNESS SCENARIOS: ACCURACY AND PERCEIVED ACCURACY OF ADULT CHILD SURROGATES
Authors: Hahne Jessica , Carpenter Brian
Published: December 2022

Adult children often help older adults make important decisions in serious illness situations, but previous research suggests adult children are not uniformly accurate in predicting parents' preferences. In this project we examined the accuracy with which adult children (N= 68; M age= 45; 69.1% female) were able to predict medical preferences of their parents (N= 34; M age= 75; 94.1% female). Parents expressed their preferences in four serious illness scenarios, and children predicted parents' preferences. Parents and children also estimated the accuracy of children's predictions and the frequency of communication about medical care. On average across all scenarios, children predicted parents' preferences accurately 42.3% of the time. Parents were willing to take more risk with treatment for more severe disease, as their children predicted, although children generally overestimated parents' willingness to live with increasing disability (M difference = 9.77%). Overall, children were poor at predicting their own accuracy (Rs = -.017, p= .893). Parents were slightly more insightful about their children's accuracy (Rs= .261, p=.034), but there was no association between accuracy and parent or child estimate of frequency of conversations about medical preferences (Parent Rs= .067, p=.586 ; Child Rs= .164, p= .182). These findings suggest that neither are adult children highly accurate at predicting parents' medical preferences, nor do they or their parents have a precise sense of their accuracy. Results from this study may inform interventions to help families communicate about advance care planning.
ENGAGING ADULTS LIVING WITH COMMUNICATION CHALLENGES IN RESEARCH: EXAMPLES AND PRACTICAL TIPS
Authors: Douglas Natalie , O'Sullivan Roger
Published: December 2022

This symposium contends that the engagement of older adults living with a variety of communication challenges in research about interventions designed to support them results in better translation and adoption of research findings. While engaging older adults in research often takes time, effort, and systematic tools, the benefits have been recognized by multiple stakeholders including policy makers, funding agencies, practitioners, older adults, and their families. Adults living with communication challenges may have difficulty expressing or comprehending language; however, that does not preclude their engagement in research activities, especially when this research involves interventions that concern them. This symposium will illustrate three exemplars of engaging adults living with communication challenges in research activities across international initiatives. First, qualitative data from 25 interviews from a project designed to engage persons living with stroke-based aphasia in friendship programming with be discussed. Then, mixed methods data from a community-based approach to support adults living with stroke-based aphasia, mild cognitive impairment, and traumatic brain injury will be described including the process of developing and using a multi-stakeholder advisory board. Finally, involving adults living with Frontotemporal Lobar Degeneration (FTLD) in research with a focus on building trust, staying connected between meetings, being transparent about expectations and applying a narrative approach will be described. Our discussion led by Dr. Roger O’Sullivan will focus specifically on the ethical implications of engaging adults living with communication challenges in research.
ASSOCIATION OF LIVER STIFFNESS BY TRANSIENT ELASTOGRAPHY WITH MOBILITY DIFFICULTY IN OLDER ADULTS WITH NO CIRRHOSIS
Authors: Chaves Paulo H
Published: December 2022

Growing experience with non-invasive ultrasound transient elastography (TE) offers now a major opportunity to improve understanding about the functional impact of non-advanced, asymptomatic liver dysfunction. We assessed the relationship of liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) obtained by TE, surrogates for liver fibrosis and steatosis, respectively, with mobility difficulty, an early stage of the disablement process. Cross-sectional study utilizing National Health and Nutrition Examination Survey 2017-2018 data. Analytic sample (n=1,203) included participants aged 60 years and older without known cirrhosis with available LSM and CAP. Logistic regression assessed the odds of mobility difficulty (walking ¼ mile or climbing stairs) according to LSM and/or CAP, with adjustment for demographics, diseases, metabolic syndrome, body mass index, aminotransferases, gamma-glutamyl transferases, albumin, and platelets. LSM and CAP were linearly, positively associated with the probability of mobility difficulty. In the fully adjusted model, LSM, though not CAP, remained strongly associated with mobility difficulty. Those with LSM in the top (>7 kilopascals [kPa]) and intermediate quintiles (4-7 KPa) had higher odds of mobility difficulty; i.e., odds ratio (OR): 1.81; 95% confidence interval (CI): 1.15-2.86; p=0.01) and OR:1.45; 95%CI: 1.01-2.08; p=.046), respectively. LSM was independently associated with early mobility disability in older adults without known cirrhosis. A direct effect through sarcopenia promotion pathways might be speculated. Whether TE screening could be useful to identify adults with non-advanced liver fibrosis who might benefit from preventive interventions – e.g., diet and exercise for non-alcoholic fatty liver disease patients vis-à-vis mobility disability prevention remains to be tested.
HOME-BASED TRANSCRANIAL DIRECT CURRENT STIMULATION AND CLINICAL PAIN IN OLDER ADULTS: A RANDOMIZED CLINICAL STUDY
Authors: Ahn Hyochol , Martorella Geraldine , Mathis Kenneth , Miao Hongyu
Published: December 2022

Knee osteoarthritis (OA) is one of the leading causes of pain in older adults. Previous studies indicated clinic-based transcranial direct current stimulation (tDCS) was effective to reduce pain in various populations, but no published studies have reported the efficacy of home-based self-administered tDCS in older adults with knee OA using randomized clinical study. Thus, the purpose of this study was to evaluate the efficacy and safety of tDCS on clinical pain intensity in adults with knee OA pain. One hundred twenty participants aged 50–85 years with knee OA pain were randomly assigned to receive fifteen daily sessions of 2 mA tDCS for 20 min (n = 60) or sham tDCS (n = 60) over 3 weeks with remote supervision via telehealth. Clinical pain intensity was measured by asking participants to rate their knee pain using a numeric rating scale from 0 (no pain) to 100 (worst pain imaginable). Participants (68% female) had a mean age of 66 years and the mean body mass index in the sample was 32.59 kg/m2. There have been no adverse events. Active tDCS significantly reduced pain intensity compared to sham tDCS after completion of the fifteen daily sessions (t = 6.57, df = 110, p < .001). We demonstrated that home-based self-administered tDCS was safe and reduced clinical pain intensity in older adults with knee OA, which can increase its accessibility. Future studies with multi-site randomized controlled trials with various populations are needed to validate our findings.
HOSPICE UTILIZATION AND PLACE OF DEATH BY DEMENTIA DIAGNOSIS AND RACE/ETHNICITY
Authors: Jarrín Olga , Lin Haiqun , Wu Bei , Duberstein Paul , Lopez Maria , Zafar Anum
Published: December 2022

Timing of hospice referral is critical to patient’s and family’s quality of life and satisfaction with hospice care. This study examined racial/ethnic variation in hospice use and factors associated with death at home among Medicare beneficiaries aged 50 years and older who died in 2018 (n=1,998,282). Hospice use was most frequent among non-Hispanic white beneficiaries (55.8%) followed by Hispanic (46.2%), Asian American (44.5%), Black (42.7%), and American Indian (42.1%) beneficiaries. Among decedents diagnosed with dementia, initiation of hospice prior to the last day of life was significantly associated with death at home among all racial/ethnic groups: non-Hispanic white (OR=2.62), Black (OR=2.04), Hispanic (OR=2.17), Asian American (OR=2.54), and American Indian (OR=2.76). Among decedents not diagnosed with dementia, initiation of hospice prior to the last day of life was less strongly associated with death at home: white (OR=1.33), Black (OR=0.83), Hispanic (OR=1.32), Asian American (OR=1.69), and American Indian (OR=1.56).
PLACE OF DEATH AND CARE SATISFACTION AMONG THE HEALTH AND RETIREMENT STUDY DECEDENTS
Authors: Malatyali Ayse , Rahemi Zahra , Cidav Tom , Dye Cheryl , Jarrín Olga , McMahan Christopher
Published: December 2022

The place of care at the time of death can influence the satisfaction, type, and cost of end-of-life care. This study investigated factors associated with place of death among older adults in the Health and Retirement Study (Exit files 2002-2018) with cognitive impairment (n=3,102). Black and Hispanic participants were more likely to die in the hospital (OR=1.80, 1.47) and less likely to die in a nursing home (OR=0.54, 0.37) than white and non-Hispanic participants. Hispanic participants were also 50% more likely to die at home than non-Hispanics. Compared to other places, participants who died at home were 43% more satisfied, and participants who died at nursing homes were 32% less satisfied with the care they received. There was no significant effect of ethnicity on the relationship between place of death and satisfaction with care. Investigating the moderating role of other demographic factors can shed more light on this relationship.
THE MASON CARES RANDOMIZED STUDY: ASSESSING CAREGIVER BURDEN FOLLOWING A STRESS MANAGEMENT PROGRAM
Authors: Gimm Gilbert , Pantleay Harveen , Ihara Emily , Inoue Megumi , Layman Shannon , Tompkins Catherine
Published: December 2022

OBJECTIVE

The Mason CARES study examines the impact of a virtual stress management program and personalized music intervention on the stress of family caregivers of older adults with dementia. This study presents early findings on 31 participants (Cohort 1) who enrolled in January 2022.

METHODS

Using primary data, we analyzed caregiver stress levels among 31 participants in Weeks 1 and 5 of a stress management program. Caregiver stress was measured using the Zarit Burden Interview (ZBI) score with a range from 0 to 48 (Bédard, 2001). Higher values (ZBI >=17.0) are associated with higher levels of stress.

RESULTS

Among the 31 caregivers, 51.6% were spouses and 48.4% were non-spouses (e.g., adult children, nephew, etc.). While mean ZBI scores in Week 1 were similar for spouses and non-spouses (24.2 vs. 24.9), caregiver stress was higher when older adults had advanced versus moderate dementia (26.2 vs. 23.2). Between Weeks 1 and 5, spouses reported a greater decrease in stress (-2.6 vs. -2.2) compared to non-spouses. However, caregivers of older adults with advanced dementia experienced less of an improvement (-1.5 vs. -3.0).

CONCLUSION

Findings show that all caregivers had high stress levels in Week 1 (ZBI score of 17 or more) with no difference between spouses and non-spouses. Between Week 1 and 5, spouses reported greater stress improvement than non-spouses. However, caregivers of older adults with advanced dementia had less improvement in stress. Future research will examine caregiver stress levels after random assignment to a Phase 2 music intervention group and control group.
INTERGENERATIONAL CONVERSATIONS AS GOOD AGE-FRIENDLY UNIVERSITY PRACTICE
Authors: Hancock Cynthia , Kutcher Katie
Published: December 2022

Service-learning is an established practice in gerontological education. At UNC Charlotte, our service-learning is embedded in our foundational gerontology course which is open to students across the University. Students engage in 10 hours of conversations utilizing topic prompts that align with course content to engage in comfortable conversations with an older adult they have never before met. Students then complete five reflective writings to process the experience. Our model aligns with the AFU principles of promoting “intergenerational learning” and increasing “the understanding of students of the longevity dividend and the increasing complexity and richness that aging brings to our society.” Through a qualitative analysis of student reflective writings, the authors will share how this service-learning model leads to increased student gerontological literacy and in particular a better understanding of their future aging selves.
UTILIZING POPULATION DATA TO CHARACTERIZE NURSING HOME DECEDENTS AND THEIR FAMILIES AT THE END OF LIFE
Authors: Stephens Caroline , Hollingshaus Michael , Kelly Brenna , Tay Djin , Ornstein Katherine , Smith Ken , Utz Rebecca
Published: December 2022

Over 2/3 of nursing home (NH) residents are eligible for palliative care (PC), but do not receive it. Utilizing the Utah Population Database, we examined EOL characteristics for 39,672 NH residents who died in Utah between 1998-2016. Dementia was the leading cause of death (36.6%), followed by cardiovascular disease (23.9%) and COPD (16.7%). Women were more likely than men to die in a NH (21.0 vs 15%) and more likely to die in a NH with heart disease (20.0% vs. 11.7%) or cerebrovascular disease (25.9% vs. 21.0%), compared to men. Use of PC, hospice, and life-sustaining treatments was low within this NH sample, particularly among persons with dementia. First-degree family characteristics varied at EOL with presence of a spouse exerting the greatest influence on EOL care utilization. Understanding population-based NH resident EOL life characteristics can help inform the development of resident- and caregiver-centered PC interventions and health policies.