bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of the COVID-19 Pandemic on Participation in Community-Dwelling Older Adults: A Cross-Sectional Analysis
Authors: Nguyen Khang , Macedo Luciana , Vrkljan Brenda , Kirkwood Renata , Ma Jinhui , Beauchamp Marla
Published: December 2021

Public health guidelines to prevent spreading COVID-19 place older adults at risk of loneliness and social isolation. Evidence suggests that participation protects older adults from such detrimental outcomes, therefore we aimed to identify the factors associated with participation in life roles among older adults living in the community during the COVID-19 pandemic. We conducted a telesurvey on a random sample of community-dwelling older adults living in Hamilton, Ontario, Canada, between May and July 2020. Outcome measures included participation in life roles, physical function, physical activity, mobility, mental health, nutrition, and demographics. We conducted two multivariate regression analyses with the Late Life Disability Instrument’s (LLDI) frequency and limitations scales as the dependent variables. Candidate factors were organized by International Classification of Functioning, Disability, and Health (ICF) framework domains; personal factors, body functions and structures, activities, and environmental factors. A total of 272 older adults completed the telesurvey (mean age 78 ±7.3 yrs, 70% female). Age, using walking aids, driving status, household income, education, mental health, nutrition, physical function, and dwelling type explained 47.1% (p<0.001) of the variance observed in LLDI frequency scores. Using walking aids, driving status, receiving health assistance, mental health, and physical function explained 33.9% (p<0.001) of the variance observed in LLDI limitation scores. These findings highlight factors from multiple ICF domains that are associated with participation limitation and frequency among older adults during the pandemic. Our findings have implications for developing public health initiatives to mitigate the effects of the pandemic on the participation of older adults.
Higher Star, Better Performance in US Nursing Homes during the Covid-19 Pandemic ?
Authors: Yu Lei , Qiu Xiao , Rose Tara
Published: December 2021

The Covid-19 pandemic has brought terrible difficulties to nursing homes, as they were locations with the highest number of confirmed Covid-19 cases and deaths in the US. The Centers for Medicare & Medicaid Services (CMS) applies the Five-Star Quality Ratings to indicate the quality of care in nursing homes based on health inspection survey, staffing, and resident outcome. Studies to date have contradictory findings regarding the relationship between nursing home reported Quality Ratings and Covid-19 cases and deaths based on US regional data. The purpose of this study is to examine whether nursing homes’ Quality Ratings were related to the total number of resident Covid-19 cases and deaths at the US National level. The study examined US nursing homes (N=13,494) linked with CMS Nursing Home Compare data and Covid-19 Nursing Home data. Using multiple linear regression analyses, results showed nursing home Quality Ratings were significantly associated with Covid-19 residents’ cases and deaths controlling for ownership type, size, occupation rate, and years of operation (p<.001; p<.001). Five-star nursing homes were less likely to have Covid-19 cases and deaths. Further, comparing lower Star Ratings nursing homes, 1-Star nursing homes showed no significant difference to 2-Star and 3-Star nursing homes when examining Covid-19 cases and deaths. Overall, the Five-Star Quality Ratings is a useful measure when investigating nursing homes’ performance during the Covid-19 pandemic. Future policymakers and administrators should also focus on nursing homes with lower star ratings when improving the quality of nursing homes, particularly with regard to resident health.
Relationship between Social Determinants of Health and Loneliness during COVID-19 Pandemic
Authors: Padala Kalpana , Crawford Christina , Gauss Clinton , Wright Benjamin , Phillips Olive , Dennis Richard , Lum Hillary , Padala Prasad
Published: December 2021

Background: Older adults are most vulnerable to social isolation and loneliness during the COVID-19 pandemic compared to other populations. Risk factors for loneliness include old age, rural living, number of medical comorbidities, and poor social networks. The objectives of this study were to examine the prevalence of loneliness in older adults during COVID-19 and determine the correlation between social determinants of health and loneliness. Methods: A cross-sectional study was conducted in community dwelling older Veterans (N=132). Demographic data were collected along with variables related to social determinants of health. Loneliness data were collected with the 3-item loneliness questionnaire, and social network was assessed using the 6-item Lubben social network scale. Results: Demographic data included: mean age 73.3 (±7.5) years, 93.2% male, 53.5% rural, 84.1% Caucasian, and 13.6% African American. The majority of the participants reported loneliness (65.6%). Mean Lubben social network score was 14.6 (±6.6). There was a strong negative correlation between loneliness and social network (p<0.0001, r=-0.57; 95% CI: -0.67, -0.44). The prevalence of loneliness was significantly greater in those living alone compared to those not living alone (p=0.017; 83.9% vs. 60.6%) and those lacking internet access compared to those with internet access (p=0.025; 86.4% vs. 61.5%). Conclusion: Loneliness was found to be highly prevalent in an older cohort during the COVID pandemic. Routine inquiry about loneliness is important. Social determinants of health are likely correlated with the presence of loneliness in older adults and could be greatly impacted by policy decisions made to control community disease transmission.
Looking for a bright side: Tales from a recreational therapy virtual service-learning project during a pandemic
Authors: Doughty Alyssa , Taylor Jennifer
Published: December 2021

The everchanging policies and inability to utilize university students due to COVID-19 impacted both residents living in long-term care as well as the next generation of students pursuing careers in the field. University Wisconsin-La Crosse (UWL) faculty strategized solutions as restrictions threatened to impact hands-on opportunities for students. Was there a safe and effective solution to offer residents evidence-based programming while also providing students with vital field experience? Simply stated, the answer was yes. Thus, the UWL Happiness Project was born. This session will outline the UWL Happiness Project, a ten-week, telehealth program implemented between a skilled nursing facility in rural Wisconsin and the UWL Therapeutic Recreation Program, an AGHE Program of Merit for Health Professions designated program. The evidence-based curriculum was developed by an emerging UWL graduate student scholar with faculty mentorship. The innovative curriculum focuses on increasing feelings of happiness using PERMA, a theoretical model grounded in positive psychology. During virtual sessions, older adult residents (ages 65-85) and students built connection while working through weekly focus areas (e.g. vitality, mindfulness, friendship). An overview of AGHE competencies addressed within the project, online course demonstration, and assignment development will be discussed along with information about how these connections fostered an opportunity for students to see aging from a different perspective. This is the first time we are presenting results from the newly developed program. In this, we look forward to sharing student measurements and outcomes, as well as lessons learned during this meaningful, stimulating, and insightful educational session.
Changes in well-being during the COVID pandemic: A longitudinal study of older adults
Authors: Huseth-Zosel Andrea , Fuller Heather
Published: December 2021

The COVID-19 pandemic is a public health crisis the world has not seen in a century, with older adults faced with unique impacts due to their increased vulnerability and need to social distance. This research examines changes in physical and mental health and quality of life among older adults in the upper Midwest during the COVID-19 pandemic. Seventy older adults aged 70-97 participated in three phone interviews (April [Time 1], June [Time 2], and October [Time 3] 2020) focusing on experiences coping with the pandemic and understanding overall changes in well-being. Participants rated their quality of life, physical health, and mental health on a scale from 1 to 5 with 1 being “Poor” and 5 being “Excellent.” Self-reported quality of life, mental health, and physical health initially declined between retrospective pre-COVID and Time 1 scores, with gradual increases seen across all three variables for Time 2 and Time 3 scores. Thematic analysis of qualitative responses for each interview wave identified salient themes of: 1) reduced quality of life, 2) distraction and routine, 3) loss and uncertainty, and 4) resilience and adaptation. The significance and meaning of these themes shifted across each time point. For example, the reduced quality of life theme initially encompassed loss of activities, later shifted to concerns about struggles to maintain relationships, and finally focused on hope for the future. Findings will be discussed in light of the significance of change over time as well as policy and practice implications for older adults.
Memory Problems During COVID in Low-income Older Adults
Authors: Zanjani Faika , Rhodes Annie
Published: December 2021

Prevention, with widespread lifestyle risk reduction at the community-level, is currently considered an effective method to decrease Alzheimer’s disease (AD). As part of the Virginia Commonwealth University iCubed Health and Wellness in Aging Core, diverse older adults (60+) living in Richmond, VA, with incomes below $12,000/year and managing either diabetes/cardiovascular symptoms, were offered weekly lifestyle telephone-health coaching for 12-weeks, providing education, motivations, self-efficacy, and referral services for AD lifestyle risk. The study sample (n=40, mean age 68 years (range: 60-77 years) was 88% African American/Black (n=35), 100% Non-Hispanic, and 45% males (n=18)). Thirty-nine (95%) of subjects successfully participated in coaching sessions; on average 91.9% (11) sessions/subject were completed. Participants provided positive anecdotal feedback and the need for continued health coaching during COVID. N=30 (75%) of the original sample consented for continued health coaching during the Covid pandemic, 63% female, 88% African American/Black, 60-77 age range (mean age 69 years), and 47% reporting memory problems. Baseline Covid interviews indicated poorer health status associated with reporting memory problems for poor physical health days (F=7.03;p=.01); poor mental health days (F=6.88;p=.01); total mental/physical health poor days (F=2.76;p=.11); sad days (F=15.52;p=.001); worried days (F=6.27;p=.02); tired days (F=9.77;p=.004); feelings of emptiness (F=10.09;p=.004); feelings of rejection (F=3.382;p=.08); feelings of failure (F=7.58;p=.01); little interest/pleasure (F=7.84;p=.009); and feeling down (F=6.75;p=.02). In conclusion, this preliminary work creates the impetus for future large-scale AD prevention investigations to improve the lives of AD-risk, low-income, diverse older adults reporting memory problems. This research indicates the subjective reporting of memory problems requires health intervention.
Dementia Caregiver Surrogate Decision Making Self-Efficacy:Distress, and Quality of Life
Authors: Pilonieta Giovanna , Geldmacher David
Published: December 2021

We assessed the relationship between caregiver self-efficacy and caregivers’ ratings of care recipient’s health-related quality of life, the severity of neuropsychiatric symptoms, and associated caregiver distress for persons with Alzheimer’s dementia (AD). Methods: The 31-item DEMQOL-Proxy, Neuropsychiatric Inventory (NPI-Q), and the Self-Efficacy for Surrogate Decision-Making scale (SDM-SES) were collected from 26 family caregivers of people with AD expressing care resistant behaviors. We used Spearman correlations to assess relationships between SDM-SES, NPI-Q severity, and NPI-distress and DEMQOL-proxy. Among enrolled caregivers, 14 (54%) were women; mean age was 64.5 years, and 24 (92%) were college-educated. Their care recipients were 61% women, 77 % white, with a mean age of 76 years, and mostly college-educated (88%). Mean scores were DEMQOL-Proxy 91.27 (+/- 14.16), SDM-SES 16.38 (+/- 2.74), NPI-Q Severity score 14.23 (+/- 6.04), and NPI-distress 17.42 (+/-6.90). There were moderate correlations between DEMQOL-Proxy and SDM-SES (r=0.54), NPI severity (r= -0.42) and NPI-distress (r= -0.49). Secondary analysis showed a moderate correlation between SDM-SES and NPI-distress (r= -0.40). We identified associations between caregiver self-efficacy, quality of life, and caregiver distress. A higher baseline SDM-SES was associated with greater health-related quality of life for the care recipient. Lower self-efficacy scores were related to more caregiver distress related to neuropsychiatric symptoms. Higher NPI severity and caregiver distress were associated with lower quality of life for the care recipient. Interventions targeting self-efficacy may promote improved QOL and decrease caregiver distress in AD dyads.
Exploring Paradoxical Lucidity Stories: Working Towards Promoting Meaningful Engagement when Least Expected
Authors: Robnett Regula , Meuser Thomas
Published: December 2021

Lucidity is the typical cognitive state of adults. However, conditions such as Alzheimer Disease and major neurocognitive disorders can rob people of their usual clarity. Episodes of “paradoxical lucidity” (PL) happen when there is a spontaneous return of lucidity in people who are assumed to have lost the capacity to engage and communicate. These often take place near the end of life. Anecdotal stories depicting PL have been shared for centuries, but the etiology and mechanisms of PL rarely have been examined scientifically. The purpose of this mixed-methods project was to “gather the stories,” of witnessed episodes of PL, to describe them, including potential triggers and contextual supports. Sixty witnesses of episodes have shared their experiences. Two-thirds those displaying PL were female. Most had died within six months of the episode. Episodes generally lasted under an hour (range: “moments” up to 5+ hours). Illustrative descriptions about PL emerged: 1) A trusted person or professional, perhaps unknowingly, saying or doing the right thing could trigger an episode; 2) PL frequently took place in a sacred environment involving ritual spiritual practices (e.g., saying the rosary and singing hymns); 3) meaningful music was often a trigger; and 4) PL sometimes involved the return of one’s professional or familial/friend role. Familiar sounds (e.g., music, voices) were the most common sensory antecedents. A deeper understanding of PL events could potentially drive interventions to promote these valued episodes. The possibility that end-stage neurocognitive impairments could be reversible, even for a short period, is thought-provoking and inspiring.
Psychological Challenges Among Older Adults with Early Stage Dementia: A Narrative Literature Review
Authors: Jeong Mijin
Published: December 2021

Due to rapid expected growth in the population of older adults with dementia, exploring the issues and experiences related to early stage dementia (ESD) is a fundamental step toward helping individuals adjust to their diagnosis and transition into treatment. The purpose of this paper is to review the extant literature regarding how older adults adjust to and cope with the onset of dementia through major situations and difficulties. A narrative approach was applied to review 120 articles focused on ESD that were published in the U.S. and other western countries between 1995 to 2020. There were four apparent themes in the literature, which align with key chronological experiences related to ESD: diagnosis of dementia; stigma related to dementia; the development of identity with ESD; and social and service-related experiences of older adults with ESD. Stigma related to dementia was a powerful risk factor that hindered psychological adjustment to ESD. Varied cultural perspectives on dementia and a lack of knowledge of dementia symptoms among diverse older adults and their families were also major risk factors. In the U.S., there was a lack of literature, especially around the development of identity with dementia and older adults’ perspectives on available services, Also, there were insufficient U.S.-based studies that explored the challenges of psychological adjustment among racial and ethnic minority groups. Future research could benefit from taking a life course perspective to assess ESD within the context of one’s life and examine challenges associated with ESD across all four themes to promote empowerment.
A dyadic study of depression, capitalization patterns, and leisure activities in retirement
Authors: Shulyaev Ksenya , Segel-Karpas Dikla , Gur-Yaish Nurit
Published: December 2021

Late-life relationships, and specifically spousal relations, are increasingly recognized as an important factor shaping the wellbeing, health, social and emotional health of older people. Therefore, a better understanding of the health and well-being trajectories of older adults requires considering the characteristics of their spouses and couple dynamics. This study focused on the actual problem of engagement of recently retired older adults in the community and various leisure activities and examined how both older adults' and spouses’ depression level influence their activities. We also consider the quality of relationships in a couple: how a partner generally responds when the participant discloses good news (capitalization). Fifty-three Israeli couples participated in the current study with one member of the couple 60 or older and retired within the last five years. Recently retired spouses rated their engagement in leisure activities, both spouses reported their level of depression, and partners of retired persons completed the Perceived Responses to Capitalization Attempts Scale. Results show that depression level of recently retired spouses had a direct negative effect (b(SE)=-7.8(3.38), CI(-14.65,-1.04), p=0.02) on their engagement in leisure activities, while the level of their partners' depression had no significant direct effect on retired persons' leisure activities. However, partners’ depression associated (p=0.001) with negative capitalization patterns and mediation analysis showed an indirect effect of partners’ depression via the capitalization (b(SE)=-2.77(1.7), CI(-6.41,-0.04), p=0.03). These results indicate that in encouraging newly retired people to participate in leisure activities it is important to consider both spouses' depression level and capitalization patterns in the couple.
Developing an Educational Program on Aging for High School Students
Authors: Davis Tracy , Sokan Amanda
Published: December 2021

College students in disciplines that might provide services or work with older adults, such as medicine or social work, are usually the target of most educational programs on aging. High schools provide an untapped opportunity to engage students earlier. This project is the next step following a pilot study conducted in New Jersey and Kentucky to better understand high school students’ attitudes and knowledge regarding aging. That study also reviewed current high school curriculum for aging-specific content and perceived barriers among teachers to incorporating aging education into the curriculum (Davis & Sokan, 2019). Study findings indicate inter alia, a need to educate high school students about aging, increase interactions among older and younger adults, incorporate education about careers on aging, and educate teachers on how to infuse more aging content into their courses. To that end, this project’s goal was to develop both a training module and educational program on aging for high school students. Also, we propose a plan to develop, implement, and evaluate both the training module and the educational programs. We hypothesize that the training module will increase high school teachers’ confidence in their ability to teach their students about aging. The educational program’s delivery will increase students’ knowledge of aging-related issues and awareness about careers in aging. Upon completing the project, we will use feedback from students and teachers to revise the educational program, for implementation among a larger sample of high schools.
In the Eye of the Beholder: Using Photography to Teach Gerontology
Authors: Hash Kristina , Naleppa Matthias , Rogers Anissa
Published: December 2021

Due to the widespread access to smart phones and similar technology, photography and photographic images have become an ever-present part of contemporary social life. Photographic methods are also growing in their use in higher education pedagogy. As a specific application, photography can be a powerful tool to educate students about aging processes and issues that impact older adults. This poster will explore the use of photographic methods and tools to teach and integrate aging-related concepts into gerontology and social work courses, at both undergraduate and graduate levels. Specifically, the use of digital storytelling, photo mapping, photo voice, and photo therapy will be highlighted. Descriptions of and consideration for assignments along with example student projects will be displayed and discussed as will other potential projects and uses of photographic methods. Attention will be paid to how photographic methods can help students explore the diversity and intersection of individual characteristics and experiences with the aging process and how intersectional identities can influence, and be influenced by, aging and external factors and processes.
An Inter-University Virtual Geriatric Case Competition to Build Interprofessional Collaboration Skills
Authors: Talley Kristine , Berg-Weger Marla , Stallings Devita , Schicker Teresa , Pesja Laura , Wyman Jean
Published: December 2021

Developing positive learning experiences in team-based geriatric care is challenging. This presentation will highlight an inter-University geriatric case competition for developing interprofessional competencies in health professional students sponsored by the Geriatric Workforce Enhancement Programs at Saint Louis University and the University of Minnesota. The virtual competition involved teams of 4-5 undergraduate and graduate students from multiple health professions who designed a comprehensive care plan using a simulated complex geriatric patient case. Students were assigned to an interprofessional team with a faculty or community expert coach, attended an orientation, and developed a 20-minute recorded presentation. A panel of judges rated team presentations using a scoring rubric based on the Core Competencies for Interprofessional Collaborative Practice. Local competitions included a first and semi-final round, with the winning teams presenting at the inter-university competition held via live videoconferencing that involved a question-and-answer session. Prizes were given to the top teams. Students, coaches, and judges completed evaluation surveys focused on satisfaction with the competition format/procedures and achievement of interprofessional competencies. Twenty-one teams and 117 students from 12 disciplines participated. Team scores ranged from 2.2 to 4.3 (overall mean 3.1) on a 1-5 scale. Judge, coach, and student evaluations were positive, indicating students learned valuable lessons in group dynamics, team-based care, and geriatric care. Most students (82%) preferred the virtual competition format or had no preference on format. The virtual case competition provided a positive, engaging experience to introduce health professional students to geriatric team-based care and develop their readiness for collaborative practice.
Experiential Service Learning: Promoting Competency-based Education for Gerontology Students
Authors: Abah Theresa , Paumer Linda
Published: December 2021

Service-learning is an effective pedagogical approach meant to deepen learners understanding of course content by linking scholarship and social action when structurally organized based on attainment of professional core competencies. The recent COVID-19 pandemic caused a rethinking of the way service learning practicum is delivered, especially as it relates to training health professionals who engage collaboratively with older persons (individuals aged 65 years and older). This poster examines the challenges faced by gerontology students as they transitioned to fully virtual learning and practicum format, the lessons learned, and how to close the gap between theory and practice for better programmatic processes. The data used to gather students experiences include; student reflective journals, class discussions and survey questions to students (n=44). The analytic framework utilized is the Social Cognitive Theory, (SCT)- which explains how individuals can master concepts through verbal and physical persuasion, including peer modelling. The goal is to promote leaners self- regulatory skills to achieve the course learning objectives, as obtained from the SCT six strategies for setting achievable goals, through: Feedback, self-instruction, self-monitoring, use of support and goal setting. Some of the lessons learned suggest students benefit more from service learning when they receive continuous feedback about how to develop intergenerational relationships with older adult partners assigned to in the community (68%), than from goal setting strategies (24%). The implication for practice is: there is a need to develop structured service-learning guidelines for undergraduate students in gerontology program to be prepared to better serve older adults.
Implementing a Community-Based Collaborative Project During the COVID-19 Pandemic: A Process Evaluation
Authors: Pond Brittney , Ross Leslie , Yeh Jarmin , Hollister Brooke , Cheang Tiffany , Yu Susie , Eldridge Corinne
Published: December 2021

In-Home Supportive Services (IHSS) caregivers are critical linchpins in our long-term care system, but little research exists to examine the strategies for enhancing their role working in the homes of persons living with dementia (PLWD). The aim of the IHSS+ Alzheimer’s Disease and Related Dementias Training Project (IHSS+ ADRD Training Project) is to implement a competency-based dementia training program for 600 IHSS caregivers and their consumers; and evaluate the training program’s impact on caregiving, long-term services and supports, and health systems. This project is a partnership between the University of California, San Francisco, Institute for Health & Aging; Center for Caregiver Advancement, a nonprofit organization founded by home care workers; and Alameda Alliance for Health, a non-profit managed care plan created by and for residents of Alameda County, California. The research design and funding of the project was established just prior to the COVID-19 pandemic. As the pandemic evolved, the IHSS+ ADRD Training Project underwent many revisions and pivoted to remote strategies to ensure progress could be made toward the aims. This poster describes a process evaluation of how various challenges were addressed and subsequent changes were made to the methodology. Using a community-based participatory research and program evaluation hybrid model, this project remained nimble, configuring an online dementia training program and evaluation methods that accommodated safety needs of community partners. Benefits and limitations of implementing the IHSS+ ADRD Training Project, using remote strategies, to ensure IHSS caregivers and their consumers could continue receiving education and support, are highlighted.
Examining the Experiences of Adult Learners in Higher Education
Authors: Kalavar Jyotsna , Magda Kirsten , Ariyo Raquel
Published: December 2021

In the last decade, there has been a shift of more non-traditional adult learners returning to pursue undergraduate education. Though traditional age students are in the majority, a rising population of adult learners has been steadily increasing. They are typically students who are 25 years and older, attend part-time, work full-time, and tend to juggle family or dependent demands with schoolwork. Studies show that these adult learners are at high-risk for academic underachievement and dropping out. However, educational institutions still operate with the same traditional learning paradigm that they previously used (without acknowledging the wealth of life experiences that adult learners bring), leading us to the question of how adult learners perceive their academic learning experiences. In this study, 171 adult learners (students aged 25 and older at the time of matriculation) at a regional college in Atlanta, participated in an online survey that examined their academic experiences, specifically meaningfulness of coursework, course delivery approaches, and the advantages as well as disadvantages of being an adult learner. Majority were females (83%), and the ethnic breakdown was as follows: White (41%), African American (26%), Hispanic (12%), and 22% reported other. Results of this study indicate that academic institutions need to pay attention to the learning experiences of this burgeoning student population. Understanding their perspectives on their academic experiences hold major implications for long-term meaningful change in academia.
Cognitive Overload: How to Protect Older Adults From Diminished Financial Decision-Making Capacity
Authors: Heye Christopher , Loewy Elizabeth , Wade Katie
Published: December 2021

The aging population in the US poses a major threat to the financial security of older adults and their families. Millions of older adults will need to successfully navigate a multitude of financial and legal issues if they are to safely manage their assets while they are alive, and then securely transfer trillions of dollars to their heirs in accordance with their wishes. But most older adults are less healthy than their younger counterparts, and 25% or more over 65 are likely to suffer from diminished decision-making capacity. In short, older adults in the US will have to make some of the most important financial decisions of their lives just as their decision-making capacity is in decline. We offer recommendations to make it easier for financial services firms, medical professionals, non-profit organizations, and technology companies to work together to find better solutions for managing the complex issues around diminished decision-making capacity that is only likely to worsen in the years ahead.
Awareness of Hospice Care Among Rural Residents: Findings from Social Determinants of Health Framework
Authors: Luo Yan , Noh Hyunjin , Lee Lewis , Lee Hee
Published: December 2021

Although the demand for hospice care increases as our society ages, the awareness of hospice care among adults in the southern rural region of the US has not been documented. This study aims to assess the rate of hospice care awareness among rural residents living in the Black Belt Region and examine social determinants of health (SDH) associated with the awareness. A cross-sectional survey was conducted among a convenient sample living in rural Alabama (N=182, age=18-91). Participants’ awareness of hospice care, demographic characteristics (i.e., age, gender), and SDH (i.e., financial resources strain, food insecurity, education and health literacy, social isolation, and interpersonal safety) were assessed. Lastly, a binary logistic regression was used to examine the association between SDH and awareness of hospice care among participants while controlling for demographic characteristics. The majority of participants had heard of hospice care (82.4%), and older participants (over 50 years old) were more likely to report having heard of hospice care (OR=7.35, p<0.05). Participants reporting worries about stable housing (OR=0.05, p<0.05) and higher social isolation were less likely to have heard of hospice care (OR=0.53, p<0.05), while participants with higher health literacy had a higher likelihood to have heard of it (OR=2.60, p<0.01). Our study is the first study assessing the status of hospice care awareness among residents living in the Black Belt Region. This study highlighted that factors including age and certain SDH (i.e., housing status, health literacy, and social isolation) might be considered in the intervention to improve hospice care awareness.
Investigating Sequential and Simultaneous Changes in Trajectories of Cognitive Decline and Depressive Symptoms
Authors: Klee Matthias , Leist Anja
Published: December 2021

Background. The role of depression as risk factor or early symptom of cognitive decline and dementia is still debated. Exploiting longitudinal trajectories of memory recall in a large European sample, we sought to better understand the nature of simultaneous versus sequential changes in depressive symptoms alongside memory recall at older ages. Method. A total of 4,865 respondents to the SHARE survey, mean age at t1 61.5 years (SD = 7.53), completed the EURO-D depression scale and a delayed recall task across six waves spanning ~13 years. We applied k-means clustering to distinguish trajectories of depressive symptoms and delayed recall. Clusters indicating depressive and recall trajectories were included in logistic regressions to assess likelihood of parallel versus sequential change, controlling for age, gender, employment status and education. Results. Analyses revealed six distinct trajectories each for depressive symptoms and delayed recall. Visual inspections indicated that only declining recall trajectories showed increases in depressive symptoms, occurring simultaneously rather than sequentially. Using grouped declining recall trajectories as outcome, the low-increasing depressive symptoms trajectory was associated with cognitive decline (OR = 1.52 [1.11, 2.06]), whereas the stable-high depressive symptoms trajectory was associated with cognitive decline in respondents aged 60-69 years (OR = 1.78 [1.01, 3.16]). Discussion. Distinguishing trajectories in depression and recall incorporates longitudinal information able to further elucidate relationships between depression and cognition. While the findings suggest depression as a co-morbidity, attention needs to be given to a comparatively small high-stable depressive symptoms trajectory group with elevated risk of cognitive decline in their 60s.
Caregiver Task Difficulties at the End of Life: A Latent Cluster Analysis
Authors: Litzelman Kristin , Kizza Irene , Berghoff Ashley
Published: December 2021

Caregivers engage in myriad tasks from household help to complex medical care. However, little information is available on how caregivers experience individual tasks – particularly key end-of-life tasks such as managing breathing problems or patients' sadness and anxiety. The purpose of this study was therefore to assess task difficulty. Using data from the National Health and Aging Trends Survey and the National Survey on Caregivers (2015-2017), we assessed eleven caregiving tasks in 241 primary caregivers of care recipients in their last month of life. A latent cluster analysis revealed three key clusters: 1) pervasive difficulties, in which caregivers reported difficulty across most or all of the tasks; 2) minimal difficulties; and 3) emotional management difficulties, in which caregivers reported difficulty with managing sadness and anxiety and lower levels of difficulty on the other tasks. Weighted frequency analyses revealed that caregivers in the pervasive difficulties cluster were most likely to be filial caregivers (85% versus 63% of the full sample, p<0.05) or co-residing with the care recipient (49% versus 37% of the full sample, p<0.05). Caregivers identified as having pervasive difficulties were also more likely to report providing intensive care, more than 100 hours per week (54% versus 36% of the full sample, p<0.05). Care recipient condition was not associated with cluster membership. The findings highlight the need to consider caregiver coping at the task-level and have implications for understanding unmet needs. Future research will assess predictors of cluster membership and how task difficulties are associated with symptoms and well-being outcomes.
Change in medical and health care decision-making patterns at the End-of-Life: A cohort of the very old people
Authors: Liu Xinran , Albert Steven
Published: December 2021

How does medical and healthcare decision-making among the very old people change in their last year before death? We explored patterns of decision-making in the Health ABC cohort study in 2011-14 (years 15-17), which involved 12 waves of quarterly phone interviews. When the participant was unable to do the interview, a proxy completed it instead. We identified a sample of 291 decedents (aged 90.0±2.9 at death, 35.7% Black, 52.6% female) with at least 1-year follow-up before death. Percentages of decedents who have made medical or healthcare decisions in the last four quarters before death were 32.0%, 31.2%, 32.6%, 41.9%, respectively. Decedents made more healthcare decisions in the last quarter before death (P<0.01), compared to the baseline. Across all quarters, decision-making is most in need for medications (17.6%), hospital admission (13.2%), and ER/urgent care visit (13.2%). We matched a 1:1 sample of survivors at the time of death by race, sex, and age (within ±3 years). In random effects models with multiple imputations of missing data, we found that decedents were more likely to make healthcare decisions than survivors across all four quarters before death or censor (Odds ratio=1.99, 95%CI: 1.49-2.65, P<0.01). The significance still held after adjusting for age, female, race, education, and interview methods. Overall, compared to matched survivors, the frequency of making medical and healthcare decisions among the very old decedents has already been high in the last year before death. This frequency rose sharply in the last quarter before death.
Length of Stay in Hospice Care across Racial/Ethnic Minorities over 65 Years of Age: A Descriptive Analysis
Authors: Yu Heshuo , Brown J Scott
Published: December 2021

Purpose: This study aims to explore the relationship between race/ethnicity and length of stay in hospice care among adults over 65 years of age in the United States. This topic is understudied within a population-representative sample, particularly among non-White decedents. Methods: Secondary analysis of data from the 2007 NHHCS (n=3,918). Race/ethnicity included Hispanics/Latinos, Non-Hispanic Whites, African Americans, and other races. Length of hospice stay was measured by the number of days that patients received hospice care from hospice agencies. Results: The study found that African Americans have a longer length of stay in hospice agencies than Whites, even after controlling for all other factors in the model. Female gender, older age, and several diseases are covariates that significantly impact length of hospice stay. Discussion: Compared to other races/ethnicities, the long length of stay in hospice among African Americans may negatively impact the quality of end-of-life care and quantity of skilled staff visits. Future research is recommended to further explore potential consequences of longer hospice stays, especially within African American communities. Studies with larger samples of minorities that integrate socioeconomic factors need to be done to better study the relationship between length of hospice stay and race/ethnicity.
Role of Home-Modification Training for Care Managers
Authors: Nishino Akiko , Harazono Yoritaka , Tanaka Moeko , Yoshida Kazunori , Funaki Toko , Takada Ryosuke , NASU Takenori , TOBIMATSU Taketo
Published: December 2021

With the aging of society, the long-term care insurance system -which includes home modifications to continue living at home- was established in 2000. However, the quality of home modifications has been persistent issue, and effective training is expected to conclusively solve this problem. To this end, the purpose of this study is to clarify the rational for training care managers who plan home modifications. A survey comprising two sets of questionnaires was conducted; one set encompassed is all 62municipalities in Tokyo, whereas the other involved care manager who participated in training program. The results of the first questionnaire showed that, out of 62 municipalities, 9 (14.5%) provided training on home modification, of which 8 (88.9%) provided training on administrative procedures. In one municipality that provided training on practical aspects of home modification, we provide questionnaires to 59 care managers participating in the training. -Lectures on administrative procedures, physical conditions of invalids, and reading drawings were conducted by administrative staff, occupational therapists, and architects, respectively. Afterwards, the participants attended a planning workshop. According to the questionnaire conducted after the workshop, 80.4% of the participants could understand home modifications in the system, 85.5% understood how to modify homes based on the occupants’ symptoms and physical conditions, 81.6% could interpret drawings, 90.2% could plan modifications, and 81.6% found the training useful. These findings indicate that the training of care managers has indeed been effective in actual practice. Improving the quality of home modifications through multidisciplinary cooperation is significant in maintaining home life.
Cardio-Dance Exercise to Improve Cognition and Mood in Older African Americans: A Propensity-Matched Cohort Study
Authors: Fausto Bernadette
Published: December 2021

The current study sought to determine the influence of initial sleep quality and body mass index on the cognitive and mood outcomes of a community-based cardio-dance exercise program. Thirty-two older African Americans who participated in a five-month cardio-dance exercise program were propensity-matched to 32 no-contact controls (ages 60 to 88). Participants completed neuropsychological tests of attention, executive function, and memory and a self-reported depression measure at baseline and post-test. Among exercise participants, we observed significant improvements in depression (ηp2=.12, p=.009) and attention (ηp2=.12, p=.009) relative to controls. Improvements in executive function and attention were most pronounced among exercise participants with poor sleep quality (ηp2=.41, p=.04) and with obesity (ηp2 = .30, p=.001), respectively. This study provides novel evidence that cardio-dance exercise has the potential to improve depression in older African Americans. For those with poor sleep quality or obesity, exercise can also improve some cognitive outcomes.
Comparing the short and original versions of the Activities-specific Balance Confidence (ABC) scale in older adults
Authors: Tiernan Chad , Goldberg Allon
Published: December 2021

Balance confidence assessment in older adults has implications for falls and quality of life. It remains unclear whether the original Activities-specific Balance Confidence (ABC-16) scale or the shortened 6-item (ABC-6) scale is recommended. To further inform the decision-making process of balance confidence tool selection, a secondary analysis of an existing dataset consisting of 77 community-dwelling older adults was performed. ABC-16 and ABC-6 association and agreement, internal consistencies, and relationships with self-rated health (SRH) were assessed. Participants were primarily female (80.5%) between the ages of 60 and 87 years. Results indicated a strong association between the scales [r = .97, p<.001); ICC(2,1) = .80] but limited agreement (95% Limits of Agreement range = 22.1; mean difference of 7.2 points in the direction of the ABC-16). Cronbach’s alphas were .95 (ABC-16) and .89 (ABC-6), suggesting high internal consistency for both scales but possible item redundancy with the ABC-16. Regression model 1 (ABC-6 = primary predictor) explained more of the variance (R2=.36) in SRH compared to model 2 (ABC-16 = primary predictor; R2=.29). Hotelling’s t-test [t(74)=2.4, p=.008] indicated that the correlation coefficient (Multiple R) from the ABC-6 model was significantly higher than the correlation coefficient from the ABC-16 model. In conclusion, despite a high correlation, the two scales did not agree strongly and should not be considered interchangeable. Given that the ABC-16 takes longer to administer, does not relate to SRH as strongly, and could have redundant items, the ABC-6 should be considered for balance confidence assessment in older adults.
Caregiving Between Spouse and Adult Child Caregivers of Older Adults with Cognitive Impairment
Authors: Garcia Nicole , Papazyan Anna , Choi Sarah , Song Yeonsu
Published: December 2021

Prior studies of caregiving characteristics by type of caregivers are inconsistent, particularly those who are spouses and adult children. This study examined caregiving characteristics between spouses and adult children of cognitively impaired older adults. We analyzed phone-screening data from an ongoing trial of a dyadic sleep intervention program for persons with dementia and their caregivers. Data included spouse caregivers (n=52) and adult child caregivers (n=24). Nearly all participants (95%) lived with their care recipients (91% with dementia). Types of caregiving activities were measured by activities of daily living [ADLs] and instrumental ADLs [IADLs] with their levels of intensity (0 [total independent] to 3 [total dependent]). Care recipients’ sleep was measured by the Neuropsychiatric Inventory-Nighttime Behavioral Subscale (8 items). Analyses included Pearson correlations and t-tests. Adult child caregivers helped their care recipients at significantly higher levels as indicated by their measure of dependence in dressing (1.46±1.22 vs. 0.87±1.16, p=0.044), continence (1.22±1.38 vs. 0.54±1.04, p=0.021), laundry (2.87±0.46 vs. 2.13±1.24, p=0.007), and transportation (3.00±0.00 vs. 2.63±0.79, respectively; p=0.031) than spouse caregivers. Adult child caregivers also reported their care recipients having more difficulty falling asleep (56% vs. 19%, respectively; p=0.004) and having more numbers of sleep problems than spouse caregivers (3.54±2.08 vs. 2.48±1.51, respectively; p=0.014). The findings suggest that adult child caregivers may involve higher levels of caregiving responsibilities during daytime and nighttime, compared to spouse caregivers. Further research needs to explore complimentary ways to involve spouse and adult child caregivers in the care of this vulnerable population.