bluuebunny/crossref_metadata_2025 huggingface dataset:
OLFACTORY DYSFUNCTION AND DEPRESSION TRAJECTORIES IN COMMUNITY-DWELLING OLDER ADULTS
Authors: Kamath Vidyulata , Jiang Kening , Manning Kevin , Mackin R , Walker Keenan , Brenowitz Willa , Simonsick Eleanor , Deal Jennifer
Published: December 2023

Olfactory dysfunction has been linked with all-cause mortality and neurodegenerative disease risk, though less is known about the association between olfaction and late-life depression (LLD). We examined the relationship between baseline olfactory performance and incident significant depressive symptoms and longitudinal depression trajectories in well-functioning older adults from the Health, Aging, and Body Composition study. Older adults (n=2,125, age 71-82, 51% women, 37% Black) completed an odor identification task at Year 3 (our study baseline). Cognitive assessments and depressive symptoms were ascertained across multiple visits over 8 years. We employed discrete time complementary log-log models, group-based trajectory models and multivariable-adjusted multinomial logistic regression to assess the relationship between baseline olfaction and incident depression and longitudinal depression trajectories. Mediation analysis assessed the influence of cognition on these relationships. Individuals with lower olfaction had increased risk of developing significant depressive symptoms at follow-up (hazard ratio [HR]=1.04, 95% CI:1.00, 1.08). Of the three longitudinal depression score patterns identified (stable low, stable moderate, stable high), poorer olfaction was associated with a 6% higher risk of membership in the stable moderate (relative risk ratio [RRR]=1.06, 95% CI:1.02, 1.10) and stable high (RRR=1.06, 95% CI:1.00, 1.12) groups, compared to the stable low group. Poor cognitive status only partially mediated the relationship between olfaction and incident depression severity. Suboptimal olfaction may serve as a prognostic indicator of vulnerability for development of LLD. These findings underscore the need for a greater understanding of olfaction in LLD and the demographic, cognitive and biological factors that influence these relationships over time.
TEACHING IN THE TUNDRA: LESSONS LEARNED AT THE UNIVERSITY OF ALASKA ANCHORAGE
Authors: Howell Britteny , Rosich Rosellen , Easley Mikki
Published: December 2023

UAA is an open-enrollment, public university of about 12,000 students. The gerontology minor was formed in 2005 as a result of the Geriatric Education Center (GEC). However, the loss of the GEC and most gerontology faculty, coupled with low student enrollment in the minor, led to its deactivation in 2014. Since then, several new faculty have been hired with an interest in gerontology. The Gerontology Faculty Workgroup, instituted by the GEC, remains active and the university now has 4 new courses on aging, including a geriatric Interprofessional Education (IPE) course. This forward momentum in recent years has led to the development of a new Occupational Endorsement Certificate program in gerontology. Training the future workforce and working professionals, the new program is poised to be more sustainable than a minor. In this presentation, we share details of past challenges and current successes within the College of Health.
EXAMINING AWARENESS AND USE OF COMPREHENSIVE GERIATRIC ASSESSMENTS IN CANCER CARE: A QUALITATIVE STUDY
Authors: Seaman Aaron , Wickersham Karen , Rowland Julia , Fairman Ciaran , Hebert James , Thomson Cynthia , Vogel Rosi , Friedman Daniela
Published: December 2023

Comprehensive geriatric assessments (CGAs) are critical tools for identifying the needs of older cancer survivors and planning effective treatment and follow-up care. Research on CGA implementation in clinical settings remains limited. We interviewed primary and cancer care providers to better understand current CGA practices, their potential, and the challenges of clinical use. Eight semi-structured interviews, lasting ~60 minutes, were conducted with participants identified through Cancer Prevention and Control Research Network partner listservs. Analysis was conducted iteratively. Providers reported that CGAs were useful and administering them with all incoming patients would be ideal but was not always possible. Instead, they used brief screening tools, which meant CGA domains were inconsistently assessed. Implementation was facilitated by clinic champions, multidisciplinary care teams, and institutional resources and buy-in. Findings from this research will provide potential solutions to addressing barriers to using CGAs related to staff capacity and competing demands, provider experience, and institutional priorities.
EXTENDING HOLISTIC, MULTIDISCIPLINARY SLEEP HEALTH INTERVENTION TO OVERLOOKED GROUPS OF OLDER ADULTS
Authors: Niemiec Stacey Schepens
Published: December 2023

Sleep health and overall well-being across the lifespan are inextricably linked. Sleep difficulties are a common occurrence in older adulthood, with disturbed sleep ranking only second to pain as a problematic symptom interfering with older peoples’ daily lives. Exacerbating the issue are sleep health disparities such that sleep disturbances disproportionately affect members of under-represented, marginalized, and resource-poor communities. Building, implementing, and mobilizing knowledge from sleep-promoting interventions with potential to effect change on sleep health and quality of life disparities are urgently needed. From an occupational therapy lens, “rest and sleep” is classified as one of nine fundamental “occupations”—other more widely recognized occupations include those such as ADL and work. The Person, Environment, Occupation-Performance (PEOP) Model, an occupation-centric guiding framework that considers multiple layers of dynamic and interacting factors pertinent to individuals’ occupational performance, has been applied to sleep intervention. From this model, one can appreciate the myriad facilitators of and barriers to realizing healthy and restorative rest and sleep, directing attention to a wide range of relevant issues such as cultural practices, societal attitudes, and resource scarcity. This presentation will overview the need for addressing inequities in sleep health and extending socio-culturally responsive services to traditionally overlooked subgroups of older people. Examples will be provided of holistic, multidisciplinary intervention research and programming that work to transform the landscape of sleep health disparities in later life.
CUMULATIVE LONELINESS AND ALL-CAUSE MORTALITY AMONG MIDDLE-AGED AND OLDER ADULTS IN THE UNITED STATES, 1996–2019
Authors: Yu Xuexin , Cho Tsai-Chin , Westrick Ashly , Chen Chen , Langa Kenneth , Kobayashi Lindsay
Published: December 2023

Recent studies have linked increased mortality to loneliness measured at a single point in time or over a short period of time, omitting the cumulative and dynamic nature of loneliness and its health effects. This study aimed to investigate long-term exposure to loneliness over an eight-year period in relation to subsequent all-cause mortality over 15 years. Data were from 9,032 individuals aged 50+ in the US Health and Retirement Study (HRS) from 1996-2019. Self-reported loneliness (yes; no) was measured biennially from 1996-2004. Cumulative loneliness was defined according to loneliness duration as never, intermittent (1-2 time points), and sustained (3+ time points). Mortality from 2004-2019 was identified from the HRS exit interviews and other sources (e.g., spouse). In the crude analysis, intermittent and sustained experience of loneliness was respectively associated with 137 (95%CI, 104-170) and 288 (95%CI, 233-343) excess deaths per 10,000 person-years, compared to those never feeling lonely. In the fully adjusted Cox proportional hazards model, a longer duration of loneliness was associated with additional 9% (HR=1.09, 95%CI, 1.02-1.17, intermittent vs. never) and 14% (HR=1.14, 95%CI, 1.03-1.27, sustained vs. never) mortality risk, indicating a dose-response relationship (P trend=0.009). Sustained loneliness may be a risk factor for mortality in mid-to-later life, and could be a potential intervention target to increase life expectancy.
PSYCHOSOCIAL CARE AFTER STROKE AS PROVIDED BY MULTIDISCIPLINARY TEAMS IN STROKE SERVICES
Authors: van Nimwegen Dagmar , Schoonhoven Lisette , Visser-Meily Johanna , de van de van Ginkel Janneke M de Man-van
Published: December 2023

About 18-31% of all persons with stroke develop one or more psychosocial impairments, such as depression or anxiety. They receive care in stroke services from multidisciplinary teams, consisting of several different healthcare professionals. Currently, it is unclear how psychosocial care is provided within these stroke services, what roles healthcare professionals play in this, and what psychosocial needs persons with stroke experience. Therefore, in this study the following research questions were answered: How do persons with stroke and healthcare professionals experience the current psychosocial care after stroke, and what psychosocial needs do persons with stroke experience? A qualitative study was conducted, which consisted of observations of care moments between 44 persons with stroke and 74 healthcare professionals, and individual interviews with ten persons with stroke. The observations showed that most care moments mainly focus on physical care. Healthcare professionals tend to focus on the care they give at that particular moment. In contrast, persons with stroke asked attention for a broader perspective on the whole rehabilitation process. In addition, the interviews showed that persons with stroke mostly need: clarity about the rehabilitation process, the ability to make their own decisions, a personal approach in stroke care, and to recover as fast as possible. To be able to provide care that fulfills the needs of persons with stroke, awareness about the differences in perspective between healthcare professionals and patients is essential in care programs, possibly leading to the necessity to change such programs to better fit these needs.
VA’S EXPERIENCE IN BUILDING CAPABILITY TO CONDUCT OUTREACH TO VULNERABLE PATIENTS DURING EMERGENCIES
Authors: Wyte-Lake Tamar , Brewster Pete , Hubert Terrence , Gin June , Davis Darlene , Holmes Chad , Dobalian Aram
Published: December 2023

The United States (US) has sustained more than 340 weather and climate disasters since 1980. Older adults with complex medical conditions, increasing in numbers, are typically most severely impacted by such events. A growing population of older, medically complex, individuals residing at home, and an increased frequency of severe natural disasters creates a compounded burden on local communities to reduce potential harm to these community-dwelling members during disaster response and recovery. In response, the Veterans Health Administration (VHA) established the Vulnerable Patient Care, Access, and Response in Emergencies (VP CARE) program to provide standardized data tools and guidance to assist VA medical facilities in conducting outreach to and care coordination of medically frail and older Veterans during major emergencies. VP CARE utilizes geographic information system (GIS) tools to allow outreach prioritization based upon geographic proximity to an event and patient clinical needs. In response to Hurricanes Ian and Fiona, the VP CARE team, with the support of the national VEText team, successfully deployed a new 2-way patient texting communication capability. During an emergency, patients receive a text from VEText, are asked whether they require assistance, and the specific help they need. The new VEText capability helped VA staff reduce outreach call volume by 20% and allowed for triage and prioritization of those indicated as needing assistance to the top of the outreach list. This presentation provides an overview of VP CARE approaches and what VHA has learned through its implementation to assist other healthcare systems with establishing similar capabilities.
EXPANDING THE ENGAGEMENT OF OLDER PERSONS IN CLIMATE CHANGE ACTION
Authors: Pillemer Karl , Luebke Matthew
Published: December 2023

Environmental volunteerism and civic engagement have been found to promote physical and mental well-being among older adults as well as helping communities address environmental issues. Despite the growing need for citizen action to address disasters and other climate change effects, however, little is known about how to promote such engagement. At present, few climate change organizations actively recruit or provide specific opportunities for older persons. Academics and policymakers have focused on how older people are particularly susceptible to the impact of climate change. Limited attention has been paid, however, to the ways in which older people can be actively involved on their own behalf in climate change mitigation, including engagement in disaster preparation and response. In this presentation, I review barriers to widespread mobilization of older adults in climate change action, including their lower levels of environmental concern and their systematic lack of access to opportunities for climate change activism. I report on findings from a recent international survey of local and regional organizational efforts to engage older persons in climate change prevention and mitigation. This survey identified successful models for mobilizing older persons to address climate change mitigation, and in particular in low- and middle-resource countries. Recommendations for effective program design to bring older persons more fully into climate change action are presented, as well as ways environmental organizations can expand their focus to include systematically older persons in their activities.
RACIAL/ETHNIC DISPARITIES IN ALZHEIMER’S DISEASE RISK: ROLE OF EXPOSURE TO AMBIENT FINE PARTICLES
Authors: Espeland Mark , Younan Diana , Wang Xinhui , Gruenewald Tara , Gatz Margaret , Serre Marc , Vizuere William , Chen Jiu-Chiuan
Published: December 2023

Whether racial/ethnic disparities in Alzheimer’s disease (AD) risk may be explained by ambient fine particles (PM2.5) has not been studied. We conducted a prospective, population-based study on a cohort of Black (n=481) and White (n=6004) older women (aged 65– 79) without dementia at enrollment (1995–98). Cox models accounting for competing risk were used to estimate the hazard ratio (HR) for racial/ethnic disparities in AD (1996–2010) and the association with time-varying annual average PM2.5 (1999–2010) estimated by spatiotemporal model. Over an average follow-up of 8.3 (±3.5) years with 158 incident cases (21 in Black women), the racial disparities in AD risk (range of adjusted HRBlack women=1.85–2.41) observed in various models could not be explained by geographic region, age, socioeconomic characteristics, lifestyle factors, cardiovascular risk factors, and hormone therapy assignment. Estimated PM2.5 exposure was higher in Black (14.38±2.21 µg/m3) than in White (12.55±2.76 µg/m3) women, and further adjustment for the association between PM2.5 and AD (adjusted HRPM2.5=1.18–1.28) slightly reduced the racial disparities by 2%–6% (HRBlack women=1.81–2.26). The observed association between PM2.5 and AD risk was ~2 times greater in Black (HRPM2.5=2.10–2.60) than in White (HRPM2.5=1.07–1.15) women (range of interaction Ps: <.01–.01). We found similar results after further adjusting for social engagement (social strain, social support, social activity, living alone), stressful life events, Women’s Health Initiative’s clinic sites, and neighborhood socioeconomic characteristics. PM2.5 may contribute to racial/ethnic disparities in AD risk and its associated increase in AD risk was stronger among Black women.
TRANSCENDING BOUNDARIES AND BARRIERS: END-OF-LIFE CARE AND QUALITY OF LIFE FOR ASIAN POPULATIONS
Authors: Wang Kaipeng , Sun Fei , Carrion Iraida
Published: December 2023

End-of-life care and quality of life are critical issues for older Asian populations, as they face unique cultural, linguistic, and health-related challenges. This symposium will bring together scholars in this field to discuss the latest research and practices for improving end-of-life care planning and quality of life for older Asian populations. The symposium consists of four papers that focus on different Asian ethnic groups. Zhang and colleagues will use survey data to examine the barriers and sociocultural factors of advance care planning among older Chinese Americans. Xu will present a systematic review on non-medical factors that affect quality of life in the last year among older Chinese. Wang will compare the completion of advance directives and examine its psychosocial factors among older Vietnamese, Filipino, and Indonesian Americans. Using a case study of Somang Society, Lee will discuss how non-profit organizations can navigate social media to provide education and volunteer training to promote advance care planning and healthy aging for older Korean Americans. Collectively, these four papers compare the values, barriers, and resources related to end-of-life care between these groups and propose effective strategies for enhancing end-of-life care planning and quality of life for Asian communities. Findings will inform the development and adaptation of culturally sensitive interventions to promote end-of-life health outcomes for diverse Asian populations. Carrion, the discussant, will address the strengths and limitations of these papers and discuss their contribution to theories, practices, policies, and future research on end-of-life care for minority aging populations.
RELATIONSHIPS BETWEEN PERCEIVED HOUSING, HEALTH, AND QUALITY OF LIFE: DATA FROM AGES 65–70 IN SWEDEN
Authors: Eriksson Erik , Kylén Maya , Schmidt Steven
Published: December 2023

Theoretical and empirical advances have supported the notion of the importance of the perceived environment, and in particular the housing environment, as we age. For instance, previous research has found significant associations between aspects of perceived housing, such as control beliefs and meaningful aspects of home, and health and wellbeing. These associations have been found for both younger older, and older older, adults. However, much of previous research has been cross-sectional, in particular for younger older adults, leaving the question whether this association remains over time as we age. By using data from a Swedish longitudinal study (N=371, 57 % women) we analyzed associations between Meaning of Home (MOH) and two external subscales of Housing-Related Control Beliefs (HCQ), to a 6-year change in 31 self-reported health symptoms and health-related quality of life, measured by SF-12, using linear regression and modelling for demographic and housing characteristics. Significant results were found between both housing-related control beliefs and meaning of home, to changes in metabolism symptoms (MOH, R2 = 0.07, F(9, 259) = 3.258, p = .001; HCQ, R2 = 0.072, F(9, 281) = 3.494, p < .000 and R2 = 0.066, F(9, 280) = 3.263, p = .001). However, for all other health symptom groups and for health-related quality of life, no significant associations were found. Our results show that while perceived aspects of housing are associated with health at a given point in time, they may not be predictive of future changes in health status.
EXPLORING THE ASSOCIATION BETWEEN CONTRACT NURSE STAFFING AND NURSE TURNOVER IN NURSING HOMES
Authors: Dayama Neeraj , Davlyatov Ganisher , Pradhan Rohit , Weech-Maldonado Robert
Published: December 2023

NHs face a significant problem with nurse staffing---a critical factor in providing high-quality care to residents. Although contract nurse staffing in NHs may provide a relatively flexible option to address acute nurse shortages, it raises its own challenges including requirement of increased supervision, lower levels of teamwork, and increased workload for the permanent staff. This may lead to disenchantment of the remaining nursing staff, increased turnover---a perfect vicious cycle. Therefore, we examined whether higher ratios of contract nurse utilization were associated with higher nurse turnover rates (RNs, LPNs, and CNAs). Employing a pooled cross-sectional observational study design, we extracted secondary data from PBJ nurse staffing, Nursing Home Compare, Rural-urban commuting area (RUCA) codes, and American Community Survey (ACS) for the period 2017-2021. We employed multivariate mixed-effects maximum likelihood regression to estimate the relationship between the ratios of contract nurses and nurse turnover rates while controlling for organizational/community variables. We ran three separate regressions for RNs, LPNs, and CNAs. Our results suggest that NHs with a high proportion of contract nurses had higher nurse turnover rates for all the three types of staffing (RNs, LPNs, and CNAs). Moreover, NHs with high RN turnover rates had low RN staffing, higher CNA staffing, lower occupancy rates, and higher share of Medicaid residents. High nurse turnover can adversely affect resident outcomes—for instance, due to reduced continuity of care. As such, it is important to closely monitor contract nurse staffing levels and their implications on staffing and resident outcomes.
INTERDISCIPLINARY APPROACHES TO EPIDEMIOLOGY AND PREVENTION OF FALLS IN OLDER ADULTS
Authors: Li Wenjun , Li Wenjun
Published: December 2023

Prevention of falls is important to independent living and good health in older age. This symposium brings together five interdisciplinary studies on falls among community-dwelling older adults. The first presentation examines the relationship between multisite pain and fear of falling among older adults with dementia. The second discusses the differential effects of anxiety on indoor vs. outdoor falls. The cohort study found that anxiety was associated with higher rate of indoor but not outdoor falls. The third investigates racial differences in association of accelerometer measured physical activity with indoor and outdoor falls. The study found that a 30-minutes increase in moderate-to-vigorous intensity physical activity was associated with 25% lower rate of indoor falls and 42% higher rate of outdoor falls among non-White but not White participants, an interesting example of effect modification by race and location of falls. The fourth reports findings of a cross-sectional survey of older adults in Thailand which observed high prevalence of falls, and substantial differences in fear of falling, daily activities and quality of life between fallers and non-fallers, and between persons with and without fear of falling. The fifth reports rural-urban differences in circumstances and correlates of falls from the same study in Thailand. The study found higher fall rates, higher level of fear of falling and worse general health in urban than rural residents, highlighting the need for considering urban-rural differences in falls prevention. Together, these studies demonstrate the complexity and promises of interdisciplinary approaches to falls research.
A FRAMEWORK FOR CONSIDERING SOCIAL AND STRUCTURAL DETERMINANTS OF HEALTH IN ALZHEIMER’S DISEASE RESEARCH AND CARE
Authors: Stites Shana
Published: December 2023

Social and structural determinants of health (SSDoH) refer to the conditions in which individuals live, work, and age. SSDoH can have cumulative effects across the life course that can have an impact on outcomes for persons with Alzheimer’s disease and Alzheimer’s disease related dementias (AD/ADRD) and their family members. In our two-part presentation, we first describe the theoretical and empirical underpinnings of core SSDoH constructs in AD/ADRD research and practice. We review empirical support for the specific SSDoH that we include and highlight their relevance in the care of older adults. The core set of SSDoH that we focus on have been identified as being important across a broad range of socially and culturally heterogeneous populations and we walk through the strengths and limits of this. We also report results from data obtained during a pilot test of these measures in the UPenn Alzheimer’s Disease Research Center (ADRC), which offer empirical support of their cultural appropriateness. We outline a rationale for the consideration of SSDoH in aging and AD/ADRD research, policy, and practice. In the second part of our presentation, we offer a case example of how sex, gender, and sexual orientation operate as core SSDoH in the healthy, aging population and in the care of older adults. In our case example, we also overview definitions, clinical considerations, and policy applications.
ONEIDA HELPING ONEIDA: DECISION MAKING ABOUT SERVICE USE BY ONEIDA NATION FAMILY CAREGIVERS
Authors: Wyman Mary , Buerger-Cole Haley , Lambrou Nickolas , Perzynski Joseph , Lawrence Sacheen , Miller Debra , Petri Florence , Lewis Jordan
Published: December 2023

Native American communities are disproportionately impacted by Alzheimer’s disease and related dementias and are more likely to identify as family caregivers compared to other racial groups. Caregiver resources such as educational, supportive, and respite services have been shown to decrease burden and improve health outcomes. However, government and tribal services to support caregivers are underutilized. Using a CBPR approach, within the framework of an existing partnership between the Oneida Nation of Wisconsin and the Wisconsin Alzheimer’s Disease Research Center, all phases of research were conducted with Oneida partners. We used a mixed-method approach to gain a better understanding of the cultural and community-related factors impacting resource utilization by Native American dementia caregivers. Ten caregivers of older adults with memory loss completed surveys followed by in-depth interviews. Caregivers were aged 38-69 years, 90% female, and living on or near the Oneida reservation; time caregiving varied from <1 to >10 years. Most care recipients had not received a formal diagnosis of memory disorder. Interviews revealed barriers to service use including low awareness, complexities of service funding structures, and care recipient preferences. Perceptions of alignment of traditional cultural values with service use were nuanced and varied. Our findings underline the multiple factors impacting Native families coping with dementia and contribute to the scant literature on ADRD caregiving among Native Americans. Results can inform public health initiatives to address ADRD disparities and improve outcomes for Indigenous persons with ADRD.
RESPONDING TO THE HEALTH CARE ENVIRONMENT: DEVELOPMENT OF CBO NETWORKS TO ADDRESS SOCIAL DETERMINANTS OF HEALTH
Authors: Blair Beth , Kunkel Suzanne , Lackmeyer Abbe , Graham Robert , Scala-Foley Marisa
Published: December 2023

AAAs, with their wide array of community partnerships and ability to respond to local needs and context, are an important connection between social and health care. Recent research describes the impact of AAA services and partnerships on population health, and AAAs are increasingly contracting with health care systems and payers to provide a variety of supportive services that enable older adults to live at home and in the community. To better meet the needs of health care partners, and to maximize their service reach and impact, AAAs and other community-based organizations (CBOs) are increasingly forming networks to contract with health care entities. Data from the 2021 CBO-Health Care Contracting Survey shows that 44 percent of AAAs are part of a network that provides contracted services to health care entities, but little is known about how these networks are formed and sustained. Findings from a new qualitative study on CBO networks, which consisted of 23 semi-structured interviews with network leads (also known as community hubs) and member organizations, describe how AAAs and other CBOs are developing networks and contracting with health care entities. This session will share findings from the qualitative study to describe the opportunities and ongoing challenges of network participation. Networks allow CBOs to serve more people and contract with health care partners to provide integrated care, but ongoing challenges include lack of data infrastructure and financial viability for members that may have fewer clients to serve. This session will also discuss the policy implications of these findings.
FINANCIAL EXPLOITATION OF OLDER CLIENTS: EXPLORING FINANCIAL PROFESSIONALS’ ROLES AND EXPERIENCES
Authors: Cerino Lauren , Miller Julie , Balmuth Alexa , Felts Adam , Coughlin Joseph
Published: December 2023

Research shows that financial exploitation of older adults can be difficult to detect and underreported (Deane, 2018; Sullivan-Wilson & Jackson, 2014). Financial exploitation of older adults is both prevalent and costly, with estimated annual losses in the billions (Wood & Lichtenberg, 2017). Initiatives such as AARP’s BankSafe training program demonstrate that the financial services industry can prevent and address cases of financial exploitation (DeLiema & Deevy, 2016). But it is worth exploring how financial professionals perceive their own ability to support older adults in cases of financial exploitation. The MIT AgeLab conducted an exploratory study to examine financial professionals’ experiences with, and preparedness for, addressing financial exploitation against aging clients and their families. Data are inclusive of a sample (N=30) of financial professionals who completed an online questionnaire in April 2022. Participants’ encounters with financial exploitation in their work were wide-ranging in frequency and nature. Most participants reported that they felt well-prepared to support a client who was experiencing financial exploitation. Despite high levels of individual preparedness, participants often felt that the financial industry’s policies and services could better address elder financial exploitation. Results from this study suggest that, although financial professionals feel well-prepared as individuals to address financial exploitation, other entities—especially the financial services industry—could instill more confidence by increasing attention to the topic, implementing training, and providing resources. With additional knowledge, training, and resources, financial professionals may be able to more confidently address situations of financial exploitation.
RACIAL AND ETHNIC DISPARITIES IN THE EFFECTS OF COVID-19 ON EMPLOYMENT DISRUPTION AND FINANCIAL PRECARITY
Authors: Carr Dawn , Sonnega Amanda , Carpenter Rebekah , Cao Katy (Qiuchang) , Chen Qize
Published: December 2023

The COVID-19 pandemic disproportionately influenced minoritized individuals, with significantly higher rates of infection and death. One reason for this higher rate is hypothesized to relate to occupational environments of older minoritized populations had going into the pandemic, which also make them more likely to experience disruption in employment due to factors such as illness, and consequently, more financial consequences of the pandemic than their white counterparts. The current project evaluates race and ethnicity differences in disruptions in employment among older workers during the pandemic, and the extent to which those disruptions were related to the inability to pay monthly bills such as rent/mortgage, utilities, medical bills, food, or debt-related payments. Using data drawn from the Health and Retirement Study, including a COVID-19 survey collected in September 2021, this study evaluates older workers who were employed prior to the start of the pandemic to evaluate differences by race-ethnicity in whether and for what reasons they experienced job disruptions, and the extent to which these disruptions were associated with an inability to pay monthly bills. We further evaluate the extent to which being unable to pay monthly bills is moderated by pre-pandemic financial vulnerabilities. Results indicate that Black and Hispanic older people experience more significant financial consequences of job disruptions, and that pre-pandemic financial vulnerabilities significantly moderate the relationship between race-ethnicity and COVID-related financial consequences of job disruptions. To conclude, the policy-implications of these results will be discussed, particularly potential factors that may decrease financial vulnerability during retirement among minoritized populations.
ACCELERATED AGING IN MID LIFE: BEHAVIORAL, EMOTIONAL, AND PHYSIOLOGICAL MARKERS OF AGING
Authors: Agmon Maayan
Published: December 2023

The aging process starts at midlife and is multifactorial, involving behavioral, emotional, and biological pathways. Most studies to date have focused on either older ages, when age-related diseases already are present, or a single mechanism, thus missing the full scope of the aging process. The proposed symposium aims to fill this gap by highlighting the many-sided nature of aging among midlife adults, especially the contributions of behavioral, emotional, and biological markers. We will discuss how physical capacity, sensory modulation, and exposure to violence are associated with biological age, reflecting the true state of the body and the diversity of aging. Understanding these relationships can both illuminate early markers of the aging process and support the design of tailored interventions to reduce the prevalence of accelerated aging. The symposium will present the latest research on the combined markers to gain insight into normal and accelerated aging. Professor Agmon will give an overview of newly developed behavioral markers that quantify the aging process, such as the photogrammetry-based analysis of posture and physical capacity battery. Roy Tzemah-Shahar will discuss the relationships between physical capacity metrics and rate of aging, Merav Asher will explicate the association between one’s sensory profile and the rate of aging, and Khalil Iktilat will share how exposure to violence explains the accelerated aging of midlife Muslims. Finally, we will discuss the need for more research on midlife adults and the potential benefits of early interventions.
GREATER ADHERENCE TO DAILY HEALTH BEHAVIORS RELATE TO BETTER COGNITIVE FUNCTION
Authors: Hamada Fumiko , Lee Soomi
Published: December 2023

Healthy life habits cannot be formed overnight; therefore, adherence to optimal sleep, physical activity, and healthy eating behaviors is vital. This paper examined the relationship between the adherence rate of the three key health behaviors (i.e., sleep, physical activity, and healthy diet) and cognitive function in adulthood. Data were retrieved from Midlife in the United States third wave (MIDUS 3) Project 2, National Study of Daily Experiences (n=1,061). For eight consecutive days, participants reported nightly sleep duration, daily amount of physical activity, and daily consumption of fast food. Adherence rates of health behaviors were calculated by the sum of having optimal sleep (6 < sleep hours ≤ 9), any intensity of physical activity (60 min.≤), and not eating fast food (yes/no) across the study period. Participants also completed a Brief Test of Adult Cognition by Telephone (BTACT). A series of general linear models examined the associations of the three adherence variables with the overall BTACT cognition score adjusting for sociodemographic and health covariates. Greater adherence rates of optimal sleep (𝛽=0.02; SE=0.01; p=0.01), physical activity (𝛽=0.03; SE=0.01; p<0.01 ), and not eating fast food (𝛽=0.02; SE=0.01; p=0.02) were each and associated with higher BTACT score. Among the three adherence variables, adherence to physical activity was the most important for cognition independent of other health behaviors. Consistent associations were found for executive function, but not episodic memory. These findings suggest that adults with greater adherence to a healthy lifestyle have better cognitive function, and consistency of healthy behaviors is vital for cognitive health.
SPIRITUALITY AND RELIGIOSITY IN BRAZILIAN AND AMERICAN OLDER ADULTS, CHARACTERISTICS AND NURSING CARE APPROACH
Authors: Bós Angelo Jose , Gallagher Amelia
Published: December 2023

This symposium aims to understand two aspects of spirituality and religiosity: the importance of religiosity for older adults, in a population-based study, and a proposal approach for nursing care in cancer patients: Lift the Spirit approach. In the Brazilian study, we will show that religiosity is significantly associated with sex, race, level of education, perceived health status and non-transmittable chronic diseases, including cancer. The results evidence the important role of religious faith in the Brazilian older adult’s health. We concluded that religion and spiritual approaches should always be considered for older adults. In the American study, we will show that preliminary findings suggested Lift the Spirit was feasible, acceptable, and positively impacted knowledge, skills, and self-efficacy. The innovative combination of synchronous and asynchronous online delivery of the intervention and data collection methods has implications for research, education, and clinical practice. Lift the Spirit delivered on an entirely online format is widely accessible and convenient to researchers, educators, and practitioners, as well as participants and students. Equipping nurses to conduct spiritual histories through an intervention like Lift the Spirit is crucial to overcoming a significant barrier to providing spiritual care.
WHO CARES? RETENTION STRATEGIES FOR DIRECT CARE WORKERS
Authors: Applebaum Robert , Janssen Leah , Applebaum Robert
Published: December 2023

More than 30 years ago the Gerontological Society sponsored a congressional briefing about a growing problem; concerns about the adequacy and quality of the direct care workforce in long-term care. In 2002 the Robert Wood Johnson Foundation sponsored the Better Jobs, Better Care demonstration, in response to this continued challenge. Today recruiting and retaining high quality workers in the long-term services system has moved beyond a challenge to an all-out crisis. The initial paper of the symposium presents recent retention and work culture data highlighting todays’ hurdles, collected from more than 80% of long-term care facilities across Ohio. The second presentation provides a comprehensive review of state-level initiatives and innovations aimed at improving recruitment and retention for direct care workers (DCWs) in both facility-based long-term care and home and community-based long-term services across the country. A third paper focuses on retention-promoting factors from the perspective of providers and DCWs working in high-performing long-term care facilities in Ohio. In-depth interviews with 37 providers and DCWs revealed an overarching theme of the importance of work culture, highlighting the modifiable, intangible aspects for promoting DCW retention. The final paper introduces a tip sheet with practical strategies for providers who are seeking to retain direct care workers. Symposium findings will include both practical implications for long-term care providers and ideas for future studies. The direct care workforce crisis is the result of an array of challenges, which means that there will not be one solution, but rather many ideas will be needed.
RESIDENT RIGHTS: BALANCING SAFETY AND AUTONOMY IN LONG-TERM CARE
Authors: Perone Angela
Published: December 2023

Long-term care regulations require staff to keep residents safe while also respecting their autonomy. Building on street-level bureaucracy theory (Lipsky, 2010), which focuses on how front-line workers use discretion to implement ambiguous policies, this study examines how staff at various levels (floor staff, mid-managers, top management) balance these rights. This study employs a multi-method qualitative extended comparative case study of three levels of staff in two long-term care facilities (independent, corporate structure). Data includes in-depth semi-structured staff interviews (n=80), participant observation (n=8 months), and review of facility policy documents (n=376) and legal data (i.e., laws and regulations). Autonomy and safety presented conflicting rights for staff in three situations: fall prevention, food intake/refusal, and medication management. Staff exercised discretion via interpersonal conversations, documentation, and organizational lenses/resources and used interprofessional team approaches across staff hierarchies, especially among floor staff and mid-managers. Even when upper-managers sought external guidance (e.g., attorneys/risk managers), they deferred to the discretion of floor staff and mid-managers to communicate and implement decisions. Team approaches across staff hierarchy were less common when conflicting rights arose in medication management. Differences in organizational structure became relevant only when conflicting rights regarding autonomy and safety arose for food intake. This presentation will discuss the study’s strategies for employing coding teams and data software to analyze large datasets across diverse methodological approaches. It will also discuss ethical dilemmas with sharing large qualitative datasets as secondary data of populations deemed “vulnerable” by IRB.
BIOLOGICAL AND SOCIAL DETERMINANTS OF LATE-LIFE DISABILITY AND ITS IMPLICATIONS FOR AGING WORKFORCE
Authors: Zhang Yuan , Duchowny Kate
Published: December 2023

As the population continues to age, the number of people living with disability is increasing. Disability prevention is crucial for independent living and quality of life for older adults. Identifying biological, individual, and social factors that can delay the disablement process has significant policy and public health implications. This symposium comprises four papers examining critical determinants of old-age disability and the implications for the aging workforce. These papers use data from nationally representative biosocial surveys and cover a range of biological and social factors, including infection, immune aging, gender, social relationships, and work environment. First, Duchowny and Noppert will present findings on the association between advanced immune aging and physical disability in men and women. Their results suggest that immunosenescence may be a critical factor underlying gender differences in disability. Second, He will present her work on estimating the fraction of disability attributable to Cytomegalovirus (CMV) infection, highlighting the potential benefits of a vaccine for CMV in preventing disability. Third, Zhang will present results from a longitudinal study examining the pathways among various aspects of social relationships, physical limitations, and disability risk. Finally, Abrams will present educational disparities in health-induced work limitations and the importance of work characteristics in explaining such disparities. Together, the four studies presented in this symposium will enhance our understanding of determinants of the disablement process and provide valuable insights that can inform policies and interventions aimed at reducing disability and maintaining the productivity and well-being of older adults.
THE MAKING OF AFRICAN MADE: MEMORY AND DEMENTIA EDUCATION BY AND FOR THE AFRICAN IMMIGRANT COMMUNITY
Authors: Nkimbeng Manka , Aswani Truphosa , Russel Wynfred , Shippee Tetyana , Gaugler Joseph
Published: December 2023

African immigrants are a fast-growing segment of the U.S. Black population but dementia literacy and care needs of this population are not fully understood. A dementia care assessment in the community highlighted dementia education as a high priority need in the African immigrant community in Minnesota. This presentation will describe the collaborative process between the research team and a community project advisory board (PAB) to develop a culturally tailored dementia education program and booklet. Following several meetings and reviews, the PAB approved an interview guide that was used to conduct 10 key informant interviews (with leaders including priest, executive directors etc.) and three community conversations (30 participants). This data was used to identify important cultural dimensions for incorporation into the education program. Themes identified were need for respect, attitudes, beliefs and challenges related to dementia care. Identification and debunking of dementia and dementia care myths were also highlighted. The resulting educational content has been presented at 3 community events/organizations with many more scheduled in spring 2023. The African community in Minnesota is very receptive of the education program with many individuals noting that it truly captures African immigrant cultural norms and values. The collaborative process between the research team and the advisory board could serve as a model for creating culturally tailored dementia education programs in other communities. Additionally, successful implementation of this education program has implications for improving dementia care among African immigrants and reducing health disparities in this population.
DON’T STOP BELIEVING – MAKING AGE MATTER
Authors: Montepare Joann
Published: December 2023

As educators and scholars in the field of aging, many of us have seen how ageism operates in nuanced and powerful ways on many fronts and coming from different directions. In this presentation I will use examples from my personal experiences in higher education to describe how age biases can rear their heads and how they have guided me to respond. Beginning with my experiences as a junior faculty member in the 1980s when lifespan developmental approach was reshaping the traditional view of aging, I will share how attitudes about “age doesn’t matter” prevailed and warranted brave and creative responses. Reshaping courses from the inside out to integrate aging became my mission and passion. Whether it a traditional developmental psychology class, a core social psychology class, or a specialized class on face perception – aging could be shown to matter. Fast forward 40 years and much as come to fruition, as seen in the response to the Age-Friendly University (AFU) initiative that I have been helping to build with AGHE leaders, GSA colleagues, and AFU partners. However, there is much more work to be done as we see ourselves being the older adult in our courses about whom we have discussed and the older faculty member in an organizational structure built around people of a certain age. However, we know that if we “Don’t stop believin’, hold on to that feelin” we can continue to pave the way for age inclusivity in even more impactful ways.
IT’S OVERWHELMING FOR EVERYBODY: EXPERIENCES OF DEMENTIA CAREGIVERS WHO AREN’T CLOSE FAMILY
Authors: Lowers Jane , Datcher Ivree , Delk Michelle , Kavalieratos Dio , Perkins Molly , Hepburn Kenneth
Published: December 2023

One in three people with Alzheimer’s or other dementias lives alone, without a spouse/partner or nearby children (i.e., is aging solo). Friends, neighbors, and extended family often assist with tasks that preserve independence, but most dementia caregiving literature, and theory, to date focuses on spousal or parent/child dyads for whom reciprocity, indebtedness and self-interest are common motivators. This study seeks to address this knowledge gap. Design: Semi-structured interviews with caregivers of adults with cognitive impairment or dementia who were not the caregivers’ spouses or parents. Hybrid inductive/deductive thematic analysis incorporating social exchange and stress-coping theories.

Results: We interviewed 11 caregivers (100% female; age 54-85, mean 71; 91% white, 9% black; 27% friend; 27% church congregant; 27% sibling or in-law; 18% neighbor). Caregivers described altruism, empathy, and, in cases of extended family, duty as motivators to provide care for acquaintances with dementia. Caregivers who themselves lacked close family identified with their care recipient’s vulnerability and the possibility of needing similar care someday. Non-family caregivers described feeling unprepared and unqualified to make legal, financial, and guardianship decisions and looked to care recipients’ distant family, health care providers, and religious leaders to guide decisions that require balancing care recipients’ safety and autonomy, such as moving to a nursing home.

Conclusion: Dementia caregiving outside spouse or parent/child dyads can produce practical and emotional challenges for caregivers who are not immediate family. These caregivers may benefit from guidance about practical and ethical decisions in the absence of immediate family decision makers.