bluuebunny/crossref_metadata_2025 huggingface dataset:
Factor Analysis of the Short Form Cohen Mansfield Agitation Inventory and Measurement Invariance by Gender
Authors: Paudel Anju , Resnick Barbara , Galik Elizabeth
Published: December 2020

Background: The Cohen-Mansfield Agitation Inventory (CMAI), available in both long and short versions, is a widely used measure to assess and evaluate agitation among older adults. There has been less psychometric testing of the short-form CMAI particularly with regard to the factor structure of this shorter measure. Purpose: The purpose of this study was to test the internal consistency, reliability and validity of short-form CMAI in a sample of nursing home residents and examine if it is invariant across gender. Specifically, it was hypothesized that consistent with the long form CMAI, the short-form CMAI would have three factors with acceptable internal consistency and item reliability. In addition, it was hypothesized that there would be no difference in factor structure and factor means across gender. Methods: This study utilized baseline data from a randomized trial including 553 residents from 55 nursing homes. Data was analyzed using structural equation modeling. Results: Confirmatory factory analysis supported the three-factor structure of short-form CMAI including aggressive (α= 0.794), physically non-aggressive (α= 0.617), and verbally agitated (α= 0.718) behaviors; three items loading on physically non-aggressive behaviors had R2 close to 0.3 suggesting low reliability. Invariance testing confirmed that the shortened measure is invariant across gender. Conclusions: Short-form CMAI is a valid and reliable scale to assess agitation and gender differences in agitation in nursing home population. However, it could benefit from rewording the items with low reliability or, merging them with other similar items. Future work could also consider a four-factor structure for this shortened measure.
Organizational Factors Associated With Retention of Certified Nursing Assistants and Direct Care Workers
Authors: Kennedy Katherine , Applebaum Robert , Bowblis John , Straker Jane
Published: December 2020

Low retention of certified nursing assistants (CNAs) and direct care workers (DCWs) continues to be an unresolved problem for nursing homes (NH) and assisted living (AL) settings. While numerous studies have examined predictors of CNA retention in NHs, little attention has been paid to differences between settings of long-term care. To inform practice and policy related to growth in the AL industry, this study compares the predictors of CNA and DCW retention rates. The 2017 Ohio Biennial Survey of Long-Term Care Facilities provides facility-level information from 968 NHs (91% response rate) and 708 ALs (88% response rate). Using regression analysis, we compare the factors that predict retention rates among providers with complete data on retention and controls. The same covariates relating to structural and financial characteristics, as well as staffing, management, and a number of retention best practices are used. Average DCW and CNA retention rates were 66% and 61% in ALs and NHs, respectively, with some settings reporting very low (and even 0%) retention over a year. AL and NH providers rated the problem’s severity highest (6 out of 10) compared to retaining other licensed nurses. Similar and different predictors were found across financial, environmental, and managerial practices supporting retention. CNA and DCW retention strategies may not be equivalently meaningful between settings, given differing working environments, resources, and regulations. Aging services managers should be attuned to practices supporting retention in their industry.
Personality Disorders and System Use Among Older Veterans Using the Veterans Health Administration
Authors: Jedele Jenefer , Griffin Cameron , Nelson Sharon
Published: December 2020

Personality disorders (PD) are defined by longstanding patterns of dysfunctional behavior and associated with higher risk for adverse outcomes, such as suicide and comorbid mental health (MH). Despite recognition that PDs manifest differently as individuals age, few studies have examined PDs in older adults. VHA serves a significant population of older Veterans, providing a valuable opportunity to explore PD in older ages. Using FY2019 administrative data, we compare documented PDs, MH, and VHA use in a cohort of recent Veteran VHA users 50 years and older, across six age groups. At least one PD was documented for 0.8% of the total cohort, decreasing with age from 1.8% (50-54) to 0.2% (75+). Among those with PD, 98% had a comorbid MH disorder with the greatest percent having a major depressive disorder (69.7%). Except for dementia, comorbid mental health disorders generally decreased with age. Suicide risk flags were documented for 8.2% of cohort Veterans with PD compared to 0.7% with MH only. Behavior risk flags were documented for 4.3% of cohort Veterans with PD compared to 0.3% with MH only. The presence of both flags decreased with age. Compared to cohort Veterans with MH only, those with PD had more than twice the number of outpatient MH encounters and 1.5 times more psychiatric hospitalizations and ED visits for MH. Differences in care were consistent across age. However, differences in use were greatest for Veterans ages 55-64. The need to address crises resulting in the use of inpatient and ED is discussed.
Neighborhood Socioeconomic Position and Social Support in a Clinical Population of Older Adults
Authors: Berg Kristen , Perzynski Adam , Krieger Nikolas I , Einstadter Douglas , Dalton Jarrod
Published: December 2020

Models of successful aging underscore the critical role of external social resources in older adults’ health and well-being. Neighborhood socioeconomic position is known to influence health, but little is known about the linkages between neighborhood conditions, social relationships and health among older adults. We identified a cohort of 12,434 adults (aged 65+) who attended a Medicare Annual Wellness Visit from the NEOCARE Learning Health Registry. NEOCARE includes electronic health record (EHR) and neighborhood data from 1999-2017 on over 3 million unique Northeast Ohio individuals. The study population was 60% White, 32% Black or African American, 64% female, and 90% non-Hispanic. Over 60% were ages 65-74, 29% 75-84, and 10% 85 years or older (range from 65 to 101). We used ANOVA and chi square tests to examine variation in social support by quintile of the census tract area deprivation index. Compared to those in less disadvantaged neighborhoods, older adults in more disadvantaged neighborhoods were more likely to report needing help with care needs (Bonferroni-corrected x2=95.21, df=4, n=8,967, p<.001) but were less likely to report having help at home (x2=85.72, 4, n=12,354, p<.001). Similarly, adults in more disadvantaged neighborhoods reported less help available to them compared to those in more advantaged communities (F=39.31, df=4, n=12,099, p<.001). Furthermore, older adults living in more disadvantaged neighborhoods experienced significantly less functional independence (F=3.68, df=4 , n=8,571, p<.01). Our results suggest that the pathway from neighborhood socioeconomic conditions to successful aging includes perceived social needs and social support.
Profile Groups Based on Lifestyle and Differences in Mental Health and Cognition
Authors: Kim Joseph , Kim Kyuree
Published: December 2020

The purpose of this study was to identify the profiles of older adults according to lifestyle. Data for the study were from the 2017 Consumption and Activities Mail Survey (CAMS). CAMS 2017 is a questionnaire mailed to a sub-sample of respondents from the Health and Retirement Study. Participants were limited to older adults 65 and older, and the final sample consisted of 1136 older adults. The sample included 443 men and 693 women. Caucasians comprised 82.0% of the participants. Lifestyle was measured through items assessing the amount of time spent on activities. Due to high skewness, the items were dichotomized, 0=no time spent on activity and 1=time spent on the activity. Latent class analysis (LCA) was performed to identify groups based on lifestyle. LCA is a person-centered approach for identifying unobserved subgroups based on similarity in responses to items. Three lifestyle groups were identified. Group 1 was “Outgoing” with 471 individuals. Group 2 was “Adequate” with 229 individuals. Group 3 was “Inactive” with 436 individuals. An ANOVA was then conducted to assess mean differences in self-rated health, cognition, depressive symptoms, and loneliness for the three lifestyle groups. The “Outgoing” and “Adequate” groups had significantly higher scores on self-rated health and cognition, and in addition, significantly lower scores on depressive symptoms and loneliness compared to the “Inactive” group. No significant differences were observed between the “Outgoing” and “Adequate” groups. An implication from this study is the importance of maintaining an active lifestyle in later life for better mental health and cognition.
Factors Related to Workplace Well-Being: Occupational Health and Safety of Older Workers in Hong Kong
Authors: Lee Vincent , Lai Daniel W L , Cheung Kin , Luk Calvin , Bai Xue , Li Jessica J , Wu Joan
Published: December 2020

As Hong Kong is undergoing rapid population ageing over the past few decades, and this trend is expected to persist due to low fertility rates and extended life expectancy. This trend has significant implications for Hong Kong’s labor market and workforce. This study aims to gain a better understanding of the experiences, needs, and definitions of older workers in Hong Kong. It helps to draw attention to issues of occupational safety and health (OSH) risks and help identifying and promoting strategies and interventions for effectively supporting the ageing workforce in the workplace. The major objective of this research is to identify the OSH problems and challenges perceived by the older workers, employers and other stakeholders. Both quantitative and qualitative research methods are applied. A qualitative study with focus groups and individual in-depth interviews have been conducted with a representative sample of 70 stakeholders, including employees, employers, representative of labour unions, policymakers, NGO representatives and researchers in the related disciplines. We obtained their views on age-related changes within the older workforce and how such changes would affect their work ability, the OSH issues facing the older workers in different industries, and the facilitators and barriers associated with remaining in or joining the labour force. Feasible intervention strategies for effectively supporting the ageing workforce in the workplace are also being identified.
Financial Resources and Later-Year Relocation From the Annuitized Assessment of Income and Assets
Authors: Chen Jun-Hong , Park Sojung
Published: December 2020

Solid evidence has shown financial resources play important roles in housing decisions among older adults. Despite the growing research on the joint assessment of income and assets as valid economic well-being, little attention is paid to its role in relocation in old age. Drawing from the Behavioral Model of Elderly Migration, this study examined to what extent financial resources are associated with the likelihood of moving in later years. The data came from the 2017 Panel Study of Income Dynamic (PSID). A sample of 1354 people, 65 years and older, was used in the analyses. We used the annuitized approach, which is different from conventional approaches that assume people draw down all available assets to satisfy daily needs and leave no assets for use in later years. We (1) assessed annuitized assets based on the 2019 IRS Mortality Table, (2) assessed yearly income using supplementary income (i.e. income plus non-discretionary expense). A final indicator of the summed score was used in a logistic regression to predict the likelihood of moving. A set of covariates known to affect later- year relocation at an individual level (e.g. health condition, living arrangement change), environmental level (e.g. rural, non-metro area) are controlled for. In clear conflict with previous studies, we found annual financial resources did not significantly influence relocation among older adults. The notable absence of the well-known role of the economic factor provides critical initial evidence about the importance of simultaneous assessment of financial resources for the literature on later year relocation.
Age-Friendly Initiatives at Arizona State University: Building Transformative Learning Systems for All
Authors: Knopf Richard , Talmage Craig , Baker Abby
Published: December 2020

The AFU global initiative begin with a collaborative agreement by Arizona State University (ASU), Dublin City University (DCU), and the University of Strathclyde in 2012. The vision was to spur other universities to be fully inclusive of all generations. In 2013, ASU and DCU created a Trans-Atlantic Catalyst Fund to spur AFU initiatives at each institution, with an early focus on research in on dementia, technologies for “aging in place,” challenges of caregiving, healthy and active aging, and retirement community design. Since then, ASU has embedded Age Friendly practices throughout the institution via creation of a new foundational charter (success is “measured not by whom ASU excludes, but by whom ASU includes”), creation of ASU-wide Center for Innovation in Healthy and Resilient Aging, a re-purposed Osher Lifelong Institute, construction of the Mirabella community (twenty-story gateway for older adults into ASU), new inter-generational learning platforms, and implementation of universal learning systems.
Increasing Outreach and Expanding Inclusion: Community-Based Educational Gerontology
Authors: Sasser Jennifer
Published: December 2020

Gerontologists have the opportunity to step into an increasingly significant role as public educators who convene gatherings focused on expanding aging awareness and literacy, inter-generational inquiry and collaboration, and age inclusion, equity and justice. The purpose of this presentation is to share creative design principles and keen take-aways from several ongoing community-based educational interventions connected to these themes. As well, we will discuss the role such public-facing initiatives might play in making a compelling case for the importance of supporting and participating in various kinds of formal educational pathways in the field of aging. Part of a symposium sponsored by the Community College Interest Group.
Age-Friendly Community Education: Fostering Health Behavior Change in a Medically Underserved Community
Authors: Thompson Katherine
Published: December 2020

The University of Chicago GWEP, SHARE Network (Supporting Healthy Aging Resources and Education), is located on the South Side of Chicago, an urban medically underserved community. SHARE Network partners with a variety of community based organizations (CBOs) to support Age Friendly care through an Age Friendly Community Education Curriculum. In a one year period, 28 events were held in 13 CBO sites. Each of these events addressed the 4Ms of Age Friendly care with a specific content focus on Mentation (5 events), Mobility (5), Medications (4), and What Matters (10), and 4 events focused on multiple domains. There were 458 attendees, 290 completed surveys (63% response rate). Eighty-eight percent of participants planned to make a healthy behavior change after participation. Age Friendly Community Education can complement health system transformation to lead to health behavior change for community-dwelling older adults in medically underserved communities.
Age Differences in Discrete Emotional States During Risk Taking
Authors: Young Nathaniel , Mikels Joseph
Published: December 2020

Emotions often guide risk-taking. For example, anger tends to lead to increased risk-taking. However, older and younger adults differ in their emotional experiences: older adults tend to report more positive emotions, fewer experiences of anger, and relatively similar or increased experiences of sadness relative to younger adults. As such, differences in emotional experience may manifest in the integral emotional responses of older and younger adults as they take risks. The current work examined the discrete integral emotional responses of older and younger adults as they completed the Balloon Analogue Risk Task (BART). For the BART, participants completed 40 trials. Prior to each trial, participants reported how much anger, sadness, contentment, and excitement they felt. The results indicate that younger adults experienced more anger and less contentment than older adults in response to the BART. Importantly though, age differences also emerged in how discrete emotions predicted subsequent risk-taking.
From Infantilizing to Collaborating: Interactions in an Adult Day Center in Taiwan
Authors: Lin Shumin
Published: December 2020

Many studies have found that interactions in long-term care settings are characterized by infantilizing speech towards older adults, which was principally interpreted as detrimental to older adults’ health and self-esteem. These studies, however, focused on how caregivers talked to older adults and were conducted primarily in Western countries. How older adults respond to and make sense of such speech has received little empirical investigation (Marsden & Holmes, 2014). In this paper, I re-examined issues related to infantilizing speech based on 6 months of fieldwork in an ADC in Taiwan, which serves 33 older adults (aged 66-94), including 16 diagnosed with dementia. My data (including observational fieldnotes, 72 hours of video-recordings of naturally-occurring interactions, and conversations/interviews with caregivers, older adults and their family members) show that the ADC was discursively co-constructed as a learning place with frequent didactic interactions that occurred both ways. Many older adults (those with dementia included), with little or no education before, cherished the opportunity to be “students” for the first time. Caregivers also appreciated learning various things from the older adults. Furthermore, didactic interactions co-occurred or were interspersed with relational interactions, including teasing, humor, and bodily interactions that show mutual friendliness and care. By taking into account the wide variety of interactions, attending to the contributions of all parties, and situating these interactions in the personal as well as social histories, this study demonstrated that even didactic or so-called infantilizing interactions were used by caregivers and older adults as they collaborated to create strong positive relationships.
Perceptions of Aging and Inflammation in the Context of Older Adult Married Couples
Authors: Ermer Ashley , Segel-Karpas Dikla
Published: December 2020

The current study takes a dyadic perspective to understand how self-perceptions of aging are associated with C-reactive protein, an inflammation marker, among older adult married couples. The potential moderating role of marital support and strain are also examined. Respondents include 668 married couples who participated in the 2014 wave of the Health and Retirement Study. Actor-Partner Interdependence Models were conducted in Mplus. Age, functional limitations, income, and race served as covariates. Husbands’ greater positive perceptions of aging were significantly associated with their own lower levels of inflammation. Husbands’ greater positive perceptions of aging were significantly associated with lower levels of inflammation for women who reported lower levels of marital strain; this was not the case for women who reported higher levels of marital negativity. This study exemplifies how relationship factors are necessary to consider when examining age perceptions and health among marrieds.
Health Justice as the Catalyst for Improving Health in Underserved Settings
Authors: Wiese Lisa , Williams Ishan
Published: December 2020

Older adults face an increased incidence of Alzheimer’s disease and related dementias (ADRD) due to higher prevalence of risk factors such as lack of awareness of ADRD and reduced access to care. Furthermore, African American and Hispanic communities, which often reside in rural areas, face 1.5-2 times the risk of ADRD. The purpose of this research was to address this disparity. We conducted three studies investigating stakeholder perceptions about screening and ADRD knowledge from six diverse rural sites. Survey results revealed that regardless of rurality and education, most rural (71%) older adults believed heart disease and poor diet increased ADRD risk and were willing to be screened. Yet only 15% had been tested for memory loss by their provider. Rurality was the only significant predictor of willingness to participate in screening. It is important to maintain a focus on pursuing health justice among rural older adults facing multiple health disparities.
Go Local: Innovating Local Health Departments' Engagement on Alzheimer’s
Authors: Shean John , French Molly
Published: December 2020

The aging Baby Boom generation is a major force behind projected increases in the prevalence of Alzheimer’s, which is expected to grow from 5.8 million (2020) to 13.8 million (2050). Local health departments play a major role connecting people living with dementia (and their caregivers) to services, supports, and education, and to ensure safe, accessible environments where they can flourish. From September 2019-July 2020, two local health departments (from San Diego County and the City of Boston) participated in a yearlong collaborative pilot project with the Alzheimer’s Association to advance cognitive health, dementia, and caregiving issues in their local jurisdictions. The National Association of County and City Health Officials (NACCHO) provided expert guidance and input throughout the collaboration. As part of the project, the local health departments: scanned their current work on healthy aging, identified existing data sources, and examined how existing healthy equity initiatives can apply to cognitive health, dementia, and caregiving issues. Action plans were developed, with a focus on policy mechanisms to initiate and sustain these projects and workforce development initiatives. Plans corresponded to actions of the Healthy Brain Initiative Road Map, helping elevate recommendations to change systems, policies, and environments. In fall 2020, LHDs will be able to use best practices, case studies, and tools developed from San Diego’s and Boston’s pilots to address Alzheimer’s as a chronic condition. The tools will help them engage health officials, develop action plans, and train the public health
Becoming More Open: Increasing Rigor and Reproducibility of Gerontological Science
Authors: Taylor Brad , Lee Lewina , Isaacowitz Derek
Published: December 2020

“Open science” refers to a collection of practices with the broad goal of increasing the transparency and reproducibility of scholarly research. The purpose of this symposium is to illustrate the application of open science practices to gerontological research and address barriers to adopting such practices. Drawing from his experiences in leading a research network that conducts integrative analysis of longitudinal aging studies (IALSA), Hofer will describe challenges posed by multiple sources of heterogeneity in conducting coordinated analyses, and ways of handling these challenges to maximize reproducibility. Next, Mroczek will illustrate these issues by providing two examples of coordinated analyses. This talk will highlight design features that promote openness and transparency in conducting research on longitudinal data. Third, Lodi-Smith will provide practical guidance and examples on preregistering complex projects, strategies for transparently reporting deviations from preregistrations, considerations in sharing sensitive data, and tips on transparent documentation of analysis code. She will also emphasize the pedagogical value of preregistration. Finally, Seaman will describe ongoing efforts to establish open science practices as the default in her laboratory, with the goal of providing a model for both junior and more established researchers wanting to build transparency into their research practices. Discussant Isaacowitz, editor for the Journal of Gerontology, Series B: Psychological Sciences, will evaluate the presentations from the lens of how journals can encourage more transparent and replicable scientific practices.
Benevolent Ageism’s Relationship to Self-Compassion and Meta-Memory in Older Adults
Authors: Sublett Jennifer , Bisconti Toni
Published: December 2020

Benevolence directed towards older adults can cross the line between respect and overaccommodation that undermines their physical and cognitive capabilities (Mehrotra & Wagner, 2009); however, little research has examined the subtleties of the influence of benevolent ageism on older adults’ ratings of their own functioning. Because stereotypes about older adults include the decline of mental abilities, this study examined whether their (N= 155) experiences with benevolent ageism, or overaccommodative offers of assistance and protection, influenced their own appraisals of memory abilities through their feelings of self-compassion. Older adults with fewer benevolent ageist experiences had higher rates of self-compassion, which in turn translated into better evaluations of their memory abilities. Future research should consider the potential pernicious influences that benevolent ageism has on older adults’ self-evaluations and performance, consider self-compassion as a buffer in these relationships, and test whether these relationships have downstream consequences on well-being outcomes.
Communication and Language: Why Age Matters
Authors: Chasteen Alison , Tagliamonte Sali
Published: December 2020

In line with this year’s 75th anniversary theme, we will show why aging matters for communication and language. Specifically, in this symposium we will show how aging affects communication and language across a variety of social contexts, social roles, and cognitive abilities. Pabst & Tagliamonte discuss the effects of aging on language use by examining an individual’s daily diary entries over 30 years, including the onset and progression of dementia. Saunders considers language and communication in the context of social interaction among persons with dementia living in a long-term care setting. Savundranayagam et al. test the efficacy of a communication intervention for personal support workers who work with persons with dementia. Chasteen & Tagliamonte consider how ageism is communicated to middle-aged and older adults in everyday life. Taken together, these presentations will provide a multidimensional lens to understanding language and communication in later life.
Racial Differences in Post-Acute Utilization After Hip Fracture in Medicare Beneficiaries With ADRD
Authors: Roy Indrakshi , Karmarkar Amol , Kumar Amit , Warren Meghan , Pohl Patricia , Rivera-Hernandez Maricruz
Published: December 2020

BACKGROUND: The incidence of hip fracture in patients with Alzheimer’s disease and related dementias (ADRD) is 2.7 times higher than it is in those without ADRD. Care complexity, including extensive post-acute rehabilitation, increases substantially in patients with ADRD after hip fracture. However, there are no standardized post-acute care utilization models for patients with ADRD after hip fracture. Additionally, there is a lack of knowledge on how post-acute utilization varies by race/ethnicity, in this population. OBJECTIVES: To investigate racial differences in post-acute care utilization following hip fracture related hospitalization in patients with ADRD. METHODS: A secondary analysis was conducted on 120,179 older adults with ADRD with incident hip fracture, using 100% Medicare data (2016-2017). The primary outcome was post-acute discharge dispositions (skilled nursing facility [SNF], inpatient rehabilitation facility [IRF], and Home Health Care [HHC]) across various racial groups. Multinomial logistic regression examined the association between race and post-acute discharge dispositions after accounting for patient-level covariates. RESULTS: Compared to non-Hispanic Whites, minority racial groups have significantly lower odds of being discharged to SNF, IRF, or HHC, as compared to home. Adjusted odds ratio for Hispanics discharged to SNF was 0.28 (CI=0.24-0.31), to IRF was 0.46 (CI=0.39-0.52) and HHC was 0.64 (95% CI =0.54-0.75), as compared to home. CONCLUSION: ADRD patients have higher risk of hip fracture. Findings from this study will provide insight on how to reduce racial and ethnic disparities in post-acute care utilization in vulnerable populations and improve quality of care and health outcomes.
Social Integration and Depression of Older Adults in Rural China: Do Family or Friendship Ties Make a Difference?
Authors: Zhang Dan , Lin Zhiyong , Li Shuzhuo
Published: December 2020

Despite increasing acknowledgement that social integration/isolation is an important determinant of health in later life, relevant evidence for older adults in less developed social contexts is still limited. Data derived from 2015 and 2018 waves of a longitudinal study of 976 older adults, aged 60 and older, living in rural areas of Anhui Province, China. We analyzed how the level of social integration/isolation (measured as family and friendship ties) impacted depressive symptoms of older adults. Our results showed that more than half of older adults in our sample were either isolated from family or friends. Further analysis demonstrated that older people who were isolated from friends were more depressed in comparison with those who were closely integrated into friendship ties, while no such association was found in relation to family ties. Assessments of social integration among older adults should account for both family and friendship ties.
Is Loneliness After Widowhood Less Prevalent in Recent Times Than Decades Ago?
Authors: Suanet Bianca , van Tilburg Theo
Published: December 2020

Due to increased longevity, widowhood occurs much later in life. When comparing over decades, we hypothesize that the increase in loneliness after losing the spouse at an early age is currently higher due to the lack of role models and knowledge of what helps in this situation, and that the recovery of loneliness after widowhood is faster because the widowed get more network attention in that exceptional situation. We analyze data from the Longitudinal Aging Study Amsterdam on 232 widowers and 468 widows with an average of four observations before and four after widowhood, spread over 21 years. The younger and recent widowed had a greater increase in loneliness, but also better recovery than the older widowed and those widowed years ago. The loneliness of widowed people has decreased regardless of age at the event, indicating the greater potential for bouncing back from this life event in today’s society.
A Longitudinal Reservoir Model of Stress Dissipation and the Influences of Concomitant Perceptions of Control
Authors: Bergeman C S , Joiner Raquael , Nelson Niccole , Deboeck Pascal
Published: December 2020

To characterize the stress regulation system, we use a reservoir to reflect how much stress an individual “holds” over time. Factors affecting what is contained in a stress reservoir are incoming stress (Input), accumulation/dissipation (Strdiss), and actions taken to discharge stress (e.g., Control). At the within person level, time-varying control predicts better Strdiss (β= -0.03±0.01, p <.001), even when controlling for between person differences (e.g., age, neuroticism) and between and within person impacts of Input. Thus, control reflects an important stress dissipation tool. Further analyses indicated a significant 2-way interaction between time-varying effects of Input and Control (β= 0.14±0.03, p <.0001) and Strdiss and Control (β= 0.60±0.18, p <.001) on self-reported health and a significant 3-way time-varying interaction of Input, Strdiss and Control on depression (β= -0.173±0.07, p <.012). Studies of this type move beyond the static assessments of risk and resilience to a more dynamic one.
Cognitive Disability Among Arab Americans by Nativity Status: Lack of Evidence for the Healthy Migrant Effect
Authors: Kindratt Tiffany , Dallo Florence , Zahodne Laura
Published: December 2020

Limited research exists on cognitive disabilities among foreign-born adults, particularly non-Hispanic Arab Americans. We analyzed 10 years (2008-2017) of data from the American Community Survey (ACS) Public Use Microdata Samples (PUMS) (n=5,011,469; ages >45 years). In US-born adults, the age- and sex-adjusted prevalence of cognitive disability among non-Hispanic Arab Americans was 5.3%, which was lower than non-Hispanic whites (6.5%), blacks (10.8%), and Hispanics (10.0%). Among foreign-born adults, the prevalence of cognitive disability was highest, 7.3%, for non-Hispanic Arab Americans compared to all other racial and ethnic groups. Among foreign-born adults, non-Hispanic Arab Americans had 1.24 times greater odds (95% CI=1.12, 1.37) of having a cognitive disability compared to foreign-born non-Hispanic whites. This is the first study to examine cognitive disabilities among US- and foreign-born Arab Americans. More research is needed to better understand factors that may contribute to the increased prevalence of cognitive disabilities for foreign-born adults.
Exclusion and Inequality in Late Working Life–On the Gendered Risks for Old-Age Exclusion in Sweden and Poland
Authors: Motel-Klingebiel Andreas , Perek-Białas Jolanta , Genelyte Indre , Kelfve Susanne
Published: December 2020

The labour market activity of older workers and their ability and disposition to maintain it depend on institutional conditions, age norms, labour demand and shifting overall economic conditions. The paper discusses exclusion and inequality in later working life from a European comparative perspective and emphasises shifts in late work and retirement patterns as well as later-life outcomes in Sweden and Poland. An emphasis is on changing institutional conditions on the national and branch level. Gendered risks for economic exclusion and later life precarity are stressed. Analyses for the two countries are contrasted with Germany and the UK. The analyses are part of the research program ‘Exclusion and Inequality in Late Working Life: Evidence for Policy Innovation Towards Inclusive Extended Work and Sustainable Working Conditions in Sweden and Europe – EIWO’ (2019-24). Analyses use data from SHARE and EU-SILC and address older workers of age 60 and older in Sweden, Poland, German and the UK. They find increasingly heterogeneous preretirement and transition patterns, new gender gaps and increasing risks of economic exclusion in retirement. Situations differ between countries with the prolongation of late working life in Sweden having a mostly positive effect on gender inequalities with low education and specific migrant groups as an exception. Poland is specific case due to unequally low retirement age for woman (60) and for men (65) with consequently large structural gender differences and increases in the process of increasing labour force participation of older workers and increasingly gendered risks for old-age economic exclusion.
Function-Focused Care in the Dutch Nursing Home Setting: Past and Current Practices
Authors: Vluggen Stan , Metzelthin Silke , de Man-van Ginkel Janneke , de Waal Getty Huisman , Zwakhalen Sandra
Published: December 2020

In recent years, Function Focused Care (FFC) interventions have been developed and implemented in Dutch home care, nursing homes and acute care. These interventions aimed to train nursing staff to adapt their level of support to the capabilities of elderly and to maintain/optimize their self-reliance and physical functioning. After synthesizing knowledge and experiences from the existing FFC-interventions, an advanced FFC-intervention was developed for application in long-term care: ‘SELF’. SELF comprises seven interactive sessions, is theoretically grounded, primarily focuses on behavior change in nursing staff, is tailored to the ward’s needs, is multidisciplinary in nature, and focuses on all care interactions. Currently, SELF is pilot-tested in one psycho-geriatric ward with 17 nursing staff members. Questionnaires on outcome-expectations, self-efficacy and intention to stimulate elderly are assessed at baseline and after 3 months. Field notes and interviews are used to assess its feasibility and acceptability. Experiences will guide the further refinement of ‘SELF’. Part of a symposium sponsored by Nursing Care of Older Adults Interest Group.
Reducing Ageism: PEACE (Positive Education about Aging and Contact Experiences) Model
Authors: Levy Sheri , Lytle Ashley , Macdonald Jamie , Apriceno MaryBeth
Published: December 2020

Drawing on interdisciplinary theorizing and research, the PEACE (Positive Education about Aging and Contact Experiences) model points to two interrelated factors that reduce ageism: providing education about aging and positive intergenerational contact experiences with older adults (Levy 2016). Evidence supporting the model will be discussed including a semester-long pre-posttest intervention with undergraduates (non-gerontology course) who learned about aging and had face-to-face and Instagram contact with older adults (Lytle, Nowacek, & Levy, 2020), brief online pre-post test experimental-control group studies with undergraduates and a community sample who learned about aging and positive intergenerational contact experiences (Lytle & Levy, 2017), and an online experimental-control group study with undergraduates who viewed brief videos addressing PEACE model components (Lytle, Macdonald, Apriceno, & Levy, under review). Across studies, PEACE model interventions promoted increased aging knowledge as well as reduced negative stereotyping of older adults, aging anxiety, and concerns about aging. Future directions will be discussed.
Caregiving Intensity and Caregiver Burden Among Dementia Caregivers: The Moderating Roles of Social Support
Authors: Xu Ling , Liu Yiwei , He Hui , Fields Noelle , Kan Chen , Ivey Dorothea
Published: December 2020

Objective: Using the stress-coping theory, the aims of the present study were to test what levels of caregiving intensity (hours actually spent on caregiving every day) posed the most negative influence on caregiver burden as well as how social support moderated such associations among dementia caregivers. Methods: Data from the baseline assessment of the Resources for Enhancing Alzheimer’s Caregiver Health (REACH II) (N = 637) were used. Caregiver burden (12-item Zarit caregiver burden scale), caregiving intensity (caregiving hours), and social support (Lubben social network, received support, satisfaction with support, and negative interactions) were the main measurements. Separate multivariate regression models were conducted with Stata 16. Results: The results showed that the relationships between caregiving hours and caregiver burden were nonlinear after controlling all of the socio-demographic variables. Further analyses showed that when caregiving hours reached 13.50 hours per day, the levels of burden were the highest. In addition, received social support, satisfaction with social support, and social network significantly moderated the relationship between caregiving hours and caregiver burden among dementia caregivers when they were examined separately. However, only social network played a significant moderator role when examining the four social support indicators simultaneously. Discussion and conclusion: These findings suggest the need for programs and practices on educating caregivers regarding how to identify, approach, and gain social support/s, especially in how to broaden the caregivers’ social network while caring for a family member with dementia.
Longitudinal Trends and Predictors of Medicaid Utilization Among Middle-Aged and Older Adults
Authors: Tavares Jane , Cohen Marc
Published: December 2020

Over fifteen million older adults in the United States rely on the means-tested Medicaid program for healthcare coverage (accounting for approximately 20% of total Medicaid beneficiaries according to the Centers for Medicare and Medicaid Services). With the older adult population growing exponentially, there has been concern that steadily rising Medicaid spending will skyrocket among this group and that there may be a need to reconfigure coverage of the program. However, few studies have longitudinally examined which factors are related to utilization of the program over time among older adults in order to better understand how any future coverage changes might impact this group. This study used the 1998 to 2014 waves of the Health and Retirement Study (N=8,162) to analyze a representative sample of those 50 and older regarding demographic, health, and economic trends associated with Medicaid utilization over a sixteen-year period. Descriptive analyses showed stable longitudinal patterns such that those who utilized Medicaid had significantly poorer health and fewer financial resources compared to those who never accessed Medicaid. Multivariate analyses further revealed those who were older, female, minority race/ethnicity, less educated, in poorer health, below the federal poverty line, and with lower net wealth had a higher proportional risk of utilizing Medicaid during the observed time period than their counterparts. The findings from this study highlight the importance of monitoring changes in the documented risk factors over time in terms of their impact on Medicaid utilization and underscore the need to consider how these factors may be interrelated.
Turnover Intention Among Direct Care Workers of Older Adults in Chinese Hospitals and Nursing Homes
Authors: Zhang Zhenzhen , Wang Shuangshuang , Yao Nengliang (Aaron) , Zhenzhen Zhang
Published: December 2020

High retention rates among direct care workers (DCWs) affect the quality of aged care. However, limited research has explored factors associated with retention in the Chinese aged care industry. This study compared turnover intention and job satisfaction among DCWs in Chinese hospitals and nursing homes. A total 370 DCWs from 7 hospitals (297 contractual, 73 non-contractual) and 311 DCWs from 7 nursing homes (27 contractual, 284 non-contractual) located in Fujian, China were recruited to fill out a questionnaire. Overall, DCWs from hospitals reported lower turnover intention (20.5 % vs 37.0%) and higher levels of job satisfaction (31.1% vs 16.4%) than DCWs from nursing homes. Specifically, contractual DCWs from hospitals indicated lower turnover intention (14.8%) than non-contractual DCWs from hospitals (43.8%) and both types of DCWs from nursing homes (36.3% and 44.4%). Higher job satisfaction was associated with lower turnover intention, but did not mediate the association between DCW types and turnover intention. Findings suggested that the government and institutions should help DCWs complete the identity transformation from non-contractual DCWs to contractual DCWs to enhance job security and benefits. For nursing home DCWs, licensing and registration requirements shall meet the standards for hospital DCWs. Attention is also to be paid to working conditions and staff welfare of DCWs, including social insurance, pensions, and trainings, to improve job satisfaction and reduce turnover intention.
“Me Cuido Activo Manizales”: A Community Care Model Based on an Active Aging Framework for Elderly People in Colombia
Authors: Ballesteros Lina Gonzalez , Zuluaga Santiago López , Hoyos Ana María Ortiz , Gómez Oscar , GonzalezBallesteros Lina
Published: December 2020

Colombia, as other countries in the Latin American region has aged at a higher rate than countries from developed ones. This challenges the way these countries decide how to attend the ageing of their population. “Me cuido activo Manizales” is a community care model based on an active ageing framework developed in Manizales, Colombia in 2017. It is based on collaborative and experiential learning activities for elderly people and their caregivers in the areas of care and self-care, writing and memory, healthy habits, physical activity, resilience and rights, and economic productivity. A before and after analysis of the 88% of enrolled subjects that participated through 2017-2019 (Median age = 70; IQR = 76 years) show stable results in independency (Barthel before = 97,23 Vs Barthel after = 94,68; t = 1,48; p = 0,14), instrumental activities of daily living (Lawton-Brody before = 3,63 Vs Lawton-Brody after = 3,58; t = 0,748; p = 0,47), resilience (CD-RISC10 before = 28,61 Vs CD-RISC10 after = 28,28; t = 0,40; p = 0,69) and MMSE scores (before = 25,72 Vs after = 24,62; t = 1,67; p = 0,10). Qualitative analysis evidenced increased awareness of self-care lifestyles and active ageing, and the need for institutional presence providing logistic and personnel support and better ways to engage groups rather than the individual. We believe this is a holistic approach that focuses on key aspects of the current perception of elderly functionality and that it engages individuals and communities along in a self-aware healthy ageing.
Adult Children’s Migration and Health-Related Quality of Life Among Older Nepalese Adults
Authors: Ghimire Ghimire , Singh Devendra , McLaughlin Sara , Nath Dhirendra , McCarren Hannah , Subedi Janardan , Ghimire Saruna
Published: December 2020

Traditionally, adult children have served as primary caretakers and providers for older Nepalese adults. However, out-migration of adult children for employment and other opportunities is increasing. Health-related quality of life (HRQOL) in older Nepalese adults in general and in the context of adult children’s migration is poorly understood. This study aims to assess HRQOL of older Nepali adults and its relationship with adult children’s migration. We used existing cross-sectional survey data on 260 older adults from the Krishnapur municipality, which has witnessed a high rate of adult migration. HRQOL was assessed using the SF-12, which provides a physical (PCS) and mental (MCS) health component. Scores for PCS and MCS range from 0-100; a higher score indicates better HRQOL. Simple and multiple linear regression were used to assess correlates of HRQOL. Participants had suboptimal HRQOL [mean (±SD): PCS =40.4±9.2 and MCS=45.2±7.7]. After adjusting for covariates, adult children’s migration was associated with lower MCS scores (β: -2.33, 95%CI: -4.21, -0.44). Individuals with more than one child had higher MCS scores (β: 2.14, 95%CI: 0.19, 4.09). Females (β: -3.64, 95%CI: -7.21, -0.06) and those with a history of unemployment (β: -6.36, 95%CI: -10.57, -2.15) had lower PCS scores than their respective counterparts. The presence of one or more chronic conditions was associated with significantly lower PCS and MCS. Our findings suggest that out-migration of adult children may negatively effect HRQOL among older Nepali adults, specifically their psychological well-being. Additional research is needed to investigate potential moderating factors that may serve as important buffers.