bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effects of the COVID-19 Pandemic on the Work and Financial Outcomes of Older Black and Hispanic Adults
Authors: Jason Kendra , Carr Dawn , Chen Zhao
Published: December 2021

This study investigates how older Black and Hispanic adults’ work engagement is impacted by the effects of COVID-19. Using intersectionality and cumulative (dis)advantage as complementing theoretical frameworks, data from the Health and Retirement Study, and series of logistic regression models, we measure work engagement changes pre- and post- COVID-19. Preliminary findings suggest that net of other controls, there were no substantial or significant reductions in resilience as the result of COVID-19 itself for any racial/ethnic group. White older adults, and to some degree Hispanics older adults, experienced erosion in resilience related to financial hardships, but the resilience of Black older adults remained stable in the face of increased hardship. Future work in this area will improve our limited understanding of older Black and Hispanic adults’ experiences of managing and coping with COVID-19- related work and financial risks– information that will be critical for planning intervention and support services.
Physical and Cognitive Correlates of GPS-Derived Life-Space Characteristics in Older Adults
Authors: Moored Kyle , Crane Breanna , Carlson Michelle , Rosso Andrea
Published: December 2021

Life-space mobility, movement within one’s living environment, is important for functional independence in later life. It is unclear which life-space characteristics (i.e., space, duration, shape) are most affected by physical and cognitive limitations. GPS-derived measures mitigate recall bias and offer novel ways to characterize life-space. We examined associations between physical and cognitive performance and GPS-derived life-space characteristics. Participants were 164 community-dwelling adults (Age: M=77.3±6.5) from baseline data of a clinical trial to improve walking in older adults. Participants carried a portable GPS for 7 days, which passively collected real-time location. Standard deviational ellipses (SDEs) and minimum convex polygons (MCPs) were derived for each day. Area and compactness of these measures quantified activity space and shape, respectively. For each measure, 7-day medians and median absolute deviations (MAD) were computed to capture both central tendency and variability of weekly activity. Activity duration was quantified as percentage of time outside home. Adjusting for age and sex, percent time outside home was associated with lower mobility performance (i.e., 6-minute walk (6MWT), figure 8 walk, ρ’s=.17-.18, p’s<.05) and executive functioning (i.e., Trail Making Test, Part A: ρ=.16, p=.04, Part B: ρ=.19, p=.01). Median MCP and SDE areas, but not compactness, were associated with 6MWT performance (ρ’s=.18-.20, p’s<.05). MCP area MAD was associated with greater global cognition (3MSE, ρ=.15, p=.05). Life-space characteristics were differentially associated with performance measures, suggesting physical and cognitive limitations may constrain life-space mobility via different mechanisms. Variation in these associations by neighborhood walkability and active versus passive travel will also be examined.
Social Activity and All-Cause Mortality in Older Black Adults of the Minority Aging Research Study
Authors: Lamar Melissa , James Bryan , Capuano Ana , Wilson Robert , Barnes Lisa
Published: December 2021

Negative social stressors (e.g., perceived loneliness and/or social isolation) predict mortality in older adults; less is known about the role of positive social activities. What research does exist focuses on White adults, leaving gaps in knowledge regarding specific activities that may decrease mortality risk in Black adults. We investigated whether self-reported late-life social activity, generally and by type, predicted mortality risk in 768 Black adults (age~73yrs; non-demented at baseline) participating in MARS. Over ~6.5 follow-up years, 25% of participants died (n=192; age-at-death~83yrs). In fully-adjusted Cox models including demographic, health, and relevant psychosocial covariates, mortality risk decreased by 32% (HR=0.68,95%CI=0.49,0.93) in those with higher compared to lower social activity generally, and with higher volunteer-, church- and group-related activities specifically. Engaging in social activity, especially altruistic or faith-based activities, reduces mortality risk in older Blacks regardless of overall health or social stressors pointing toward community-based approaches to increase longevity in this population.
Grandmothers Raising Grandchildren: Predictors of Healthcare Access and Financial Security During COVID-19
Authors: Musil Carol , Jeanblanc Alexandra , Burant Chris
Published: December 2021

Grandmothers living with or raising grandchildren who had just completed the final data point of an NIH-funded, national, behavioral RCT were asked to complete an additional data collection point to capture the effects of the Covid-19 pandemic on their families’ access to healthcare and financial security. In Spring 2020, 258 grandmothers completed measures of access to healthcare and financial security (3 and 4 item composite scales), family strain, family functioning, and psychosocial and demographic variables. Financial security (Adj. R2=.52) was explained by knowing other grandfamilies; better family functioning; and fewer financial worries, unmet service needs, and depressive symptoms. Access to healthcare (Adj. R2=.24) was explained by being married, employed and having fewer financial worries and unmet service needs. Findings that family functioning, knowing other grandfamilies and depressive symptoms contributed to financial security, and that marital and employment status affect access to healthcare show the importance of support.
Implementing an Intervention Program During the COVID-19 Pandemic: Challenges and Successes
Authors: Mendoza Nancy , Park Cherrie
Published: December 2021

During the COVID-19 pandemic, the implementation of intervention programs for grandfamilies are facing multiple challenges. In this paper, we will present some of the challenges and successes of introducing the GRANDcares Plus Project (GRANDc+) during the COVID-19 pandemic. As an intervention program, GRANDc+ has demonstrated positive outcomes for grandfamilies, such as increased satisfaction with life, knowledge of services, self-care practices, and supportive social networks. Due to the pandemic, the implementation of GRANDc+ has been met with many challenges including, training of facilitators, following CDC’s COVID-19 guidelines/recommendations, and considering grandfamilies needs, concerns and safety. The pandemic has and continues to have detrimental effects on grandfamilies; this makes it more vital than ever to support grandfamilies through interventions like GRANDc+, despite what challenges we may face. Our presentation will provide insights into identifying, managing, and overcoming the challenges of implementing interventions during the COVID-19 pandemic.
The Need for Person-Centered Measures for Dementia Research and Care
Authors: Fazio Sam , Zimmerman Sheryl , Gitlin Laura
Published: December 2021

The importance of person-centered medical and psychosocial care has become widely recognized, but there is abundant evidence that care is not always person-centered. In 2018, the Alzheimer’s Association published their evidence-informed Dementia Care Practice Recommendations, which address nine domains all grounded in a person-centered perspective. Following that work, the Association launched LINC-AD -- Leveraging an Interdisciplinary Consortium to Improve Care and Outcomes for Persons Living with Alzheimer's and Dementia. An early effort of LINC-AD, and the focus of this symposium, examined what measures are available to guide care and assess outcomes, and the extent to which they embrace person-centeredness. The results have been disappointing. This session will highlight the importance of person-centered measures in five domains of the Dementia Care Practice Recommendations, based on comprehensive reviews of literature. Each paper, presented by LINC-AD research advisors, will examine available measures and raise questions about gaps using a person-centered lens. Katie Maslow will describe frequently used measures and identify person-centered measures that could be added to studies of alternate procedures intended to increase detection and diagnosis. Drs. Mast and Molony will discuss a person-centered approach to item development and testing for assessment. Emilee Ertle will discuss the need to measure interpersonal and contextual factors associated with behavioral expressions. Drs. Prizer and Zimmerman will compare measures of dressing ability and their person-centered components. Dr. Calkins will examine the strengths and limitations of environmental assessment tools. As Discussant, Dr. Gitlin will integrate the findings from all five presentations, suggesting directions for the future.
Person-Centered Assessment of Behavior Changes in People With Dementia
Authors: Ertle Emilee , Mast Benjamin , Mountain Gail , Kolanowski Ann , Moniz-Cook Esme , Halek Margareta
Published: December 2021

Behavioral and psychological symptoms of dementia are increasingly being reconceptualized as expressions of distress and unmet needs. Measures that evaluate context are needed to increase our understanding of factors that influence these expressions. This review evaluated measures for two common behavioral states that are experienced as challenging for caregivers: apathy and resistance to care. A systematic literature search identified measures of apathy or resistance to care for people living with dementia. Eight measures of apathy and three measures of resistance to care were identified. Reliability and validity of these measures were evaluated using the COSMIN framework, as well as reported contextual factors within which the behavior occurs. The identified measures had fair to good reliability and validity in people living with dementia. However, available measures need to move beyond symptomatic constructs for this complex paradigm, and toward the varied interpersonal and contextual factors associated with behavioral expression.
Privacy Concerns Among Older Adults Using Voice Assistant Systems
Authors: Spangler Hillary , Driesse Tiffany , Roth Robert , Liang Xiaohui , Kotz David , Batsis John
Published: December 2021

Voice Assistant Systems (VAS) are software platforms that complete various tasks using voice commands (e.g., Amazon Alexa), with increasing usage by older adults. It is unknown whether older adults have significant privacy concerns with VAS. 55 participants were evaluated from ambulatory practice sites for a study on VAS detection of early cognitive decline. The mean age was 73.3±5.6 years, 58% female, 93% white, and 53% had mild cognitive impairment. Privacy concerns were assessed via Likert-based surveys. Participants believed data was used with consent (71%) and stored properly (67%); however, 71% wanted new privacy regulations, 43% were comfortable with daily activity monitoring, and 85% thought the data needs to be highly protected. Qualitative themes included “listening-in”, “tracking”, and unwanted sharing of information. Findings suggest that older adults do not have significant privacy concerns for VAS use, but requested additional regulations. Future research can compare VAS privacy concerns between age groups.
Older Adult User Feedback on Design and Functionality of EngAGE, a Voice-Activated Exercise Program
Authors: Nicholson Roscoe , Montoya Yadira , Shervani Saira , Smith Chelsea , Hawkley Louise , Huisingh-Scheetz Megan
Published: December 2021

The EngAGE Alexa app is a socially motivated exercise program targeting older adult-caregiver dyads to promote mobility independence. EngAGE provides exercise routines that older adults can perform in the home in conjunction with a messaging component to facilitate motivation from caregivers and a tracking component to monitor progress. This presentation will describe the qualitative results that have informed the app’s design and evaluation of its feasibility and functionality following a 14-week feasibility study in 10 dyads of older adult exercisers and their caregivers. The presentation will cover the perceived benefits of EngAGE’s older adult users (including “real world” clinically relevant improvements, the comprehensiveness of the exercises, and exercise knowledge gained), as well as likes and dislikes that contributed to our assessment of the app’s functionality. Finally, we will discuss how the feedback contributes to future directions in the development of the app’s features, supporting materials, design and content.
Comfort and Data Sharing With Artificial Companion Robots Among an Online Cohort
Authors: Berridge Clara , Zhou Yuanjin , Robillard Julie , Mattek Nora , Gothard Sarah , Kaye Jeffrey
Published: December 2021

Results from a June 2020 survey on comfort with two forms of artificial companion (AC) robots in normal compared with pandemic times will be presented. 1,082 adults age 21-92 (mean 64) completed the online survey for a response rate of 45%. Significantly greater comfort is reported with small AC robots relative to larger human-shaped robots in both normal and pandemic times. In bivariate and adjusted models, younger age and male gender were most commonly associated with greater comfort with AC robots. Most participants (68.7%) did not think an AC robot would make them feel less lonely. About half (52.8 %) of the participants reported that they probably or definitely would want their facial expressions to be read, while a minority (15.0%) were at least somewhat comfortable with AC robots recording their conversations. The most common person participants wanted these data types shared with is themselves, a spouse/partner, and medical provider.
CATCH-ON Connect: A Program to Increase Technology Access Among Older Adults During COVID-19
Authors: Emery-Tiburcio Erin , Sayer Janis , Golden Robyn , Castaneda Salvador , Newman Michelle
Published: December 2021

During the COVID-19 pandemic, technology became an essential tool to maintain connections to social support, health professionals, and services. However, many older adults do not have access to technology or do not feel comfortable using it. CATCH-ON Connect provides cellular-enabled tablets and individual, personalized technical assistance to older adults. Adults age 65+ in project partner primary care clinics who do not have an internet-ready device or who lack digital literacy are eligible to participate. Older adults learn how to access their electronic health record portal, use pre-installed apps (e.g., Lyft, Zoom), and receive education about COVID-19 and the 4Ms. Of the 40 participants enrolled to date, 46% have never accessed the internet with a tablet or smartphone. Initial qualitative outcomes indicate high satisfaction and increased electronic socialization. Quantitative results of participant technology challenges, loneliness, and utilization of telehealth services will be discussed.
Diagnosis of Behavioral Symptoms of Dementia and CNS-Active Drug Use Among Diverse Persons Living With Dementia
Authors: Thunell Johanna , Joyce Geoffrey , Qato Dima , Guadamuz Jenny , Zissimopoulos Julie
Published: December 2021

Approximately 90% of persons living with dementia (PLWD) experience behavioral and psychological symptoms of dementia (BPSD). Studies demonstrated high use of central nervous system (CNS) active drugs in nursing homes; one recent study documented high use among community-dwelling PLWD. Racial/ethnic disparities in BPSD diagnosis and CNS-active drug use, however, are unknown. We quantified disparities in BPSD diagnoses and CNS-active drug use using 100% Medicare Part A and B claims, 2017-2019, and Part D, 2018-2019. Beneficiaries were ages 65 and older in 2017, community-dwelling, and had a dementia diagnosis (n=801,597). We estimated models of CNS-active drug use to quantify racial/ethnic differences adjusting for confounders. Among PLWD, 66% had a BPSD diagnosis and 65% were taking a CNS-acting drug. Asians/Pacific Islanders were less likely to have a BPSD diagnosis (55%) than other groups, particularly affective diagnoses (40%). Whites were most likely to have any diagnosis (67%). Blacks were most likely to have hyperactivity diagnoses (7%). Antidepressants were most commonly used drug class (44%). Thirteen percent used an antipsychotic. Models adjusted for age, sex, comorbid conditions, dual-eligibility and BPSD diagnoses, showed non-Whites were less likely to use any CNS-active drug than Whites, but Blacks and Hispanics were slightly more likely to use antipsychotics. We found racial/ethnic differences in BPSD diagnoses and CNS-active drug use. Whether these disparities are due to differences in BPSD symptoms, health-care access or care-seeking remains an important question. Further study of disparity in outcomes associated with use will inform risk and benefit of CNS-active drugs use among PLWD.
Investigating Elder Abuse and Neglect in Diverse Refugee Communities in Greensboro, NC
Authors: Sudha S , Khadka Narayan
Published: December 2021

Elder abuse and neglect (EAN) comprises multiple dimensions, is experienced by about 10% of older adults in the U.S in diverse communities, and is severely detrimental to older adults’ (OA) health and wellbeing. However, documentation of EAN among refugee OA is greatly lacking as are services for these communities. Refugee OA are overall underserved members of marginalized communities. This paper reports on a community-engaged study to collect information and raise awareness of EAN among OA in 2 North Carolina refugee communities - Nepali-speaking Bhutanese and Congolese. Research partners included University researchers and community refugee-serving organizations. Surveys and focus group interviews were conducted. 17 Nepali-speaking Bhutanese and 13 Congolese filled out survey questions, including the Elder Abuse Suspicion Index. They participated in focus group discussions (FGDs), separately for men and women of each community. Survey results indicated EAN more among Congolese than Nepali-speaking Bhutanese. FGD results showed both communities prefer to depend on family members, and experience difficulties with language, transportation, and economic insecurity. No EAN was reported in the FGDs. In line with principles of community-engaged approaches, a capacity-building event to increase awareness of EAN was held, attended by 25 persons from the two communities. This study adds documentation on an under-researched area and marginalized communities. Action recommendations include disseminating culturally appropriate EAN information, strengthening English language and job skills and transportation options, encouraging cooperation across state, nonprofit, educational, and service organizations to address needs of older refugee adults.
Optimizing the Geriatric Mental Health Workforce Through Innovative Approaches
Authors: Alfaro Ana Jessica , Rodriguez Rachel , Karel Michele
Published: December 2021

The drastic demand for geriatrics-trained providers in medical and mental healthcare persists years after the Institute of Medicine first highlighted this need (2008; 2012). New innovative approaches must instead optimize the current workforce through leveraging existing geriatric experts’ knowledge and skills related to working aging adults. This symposium will highlight four approaches spanning post-licensure education to using technology to deliver specialized services and training. First, Dr. Gregg will discuss the evaluation of an advanced topics workshop in Geropsychology which has significantly enhanced depth of Geropsychology competencies for psychologists working in primarily rural areas. Next, Dr. Asghar-Ali will describe the multi-modal interactive geriatric educational opportunities for interprofessional staff developed by the South East Texas Geriatric Workforce Enhancement Program (SETx GWEP). He will discuss how these training opportunities have been tailored to address the impact of COVID-19 and healthcare disparities among older adults. Third, Dr. Filips will present an evaluation of a consultation model in which a geriatric psychiatrist provides tele-consultation in a 5-state region to rural aging Veterans with complex medical and behavioral comorbidities. Finally, Dr. Beaudreau will describe adaptations to a national VA Problem Solving Training program for mental health clinicians of older Veterans with complex comorbidities. Dr. Karel, VA National Geriatric Mental Health Director, will serve as discussant and comment on the ways in which these novel approaches are meeting the ever-growing need for competent geriatric mental health providers.
Decomposition of Disparities in Alzheimer’s Disease and Related Dementia
Authors: Akushevich Igor
Published: December 2021

This study uses Medicare data to non-parametrically evaluate race- and place-of-residence-related disparities in AD/ADRD prevalence and incidence-based mortality, separate them out into the epidemiological causal components including race-related disparities in incidence and survival, and finally explain these in terms of health-care-related factors using causal methods of group variable effects (propensity scores and the rank-and-replace method) and regression-based analyses (extended Fairlie’s model and generalized Oaxaca-Blinder approach for censoring outcomes). Partitioning analysis showed that the incidence rate is the main predictor for temporal changes and racial disparities in AD/ADRD prevalence and mortality, though survival began to play a role after 2010. Arterial hypertension is the leading predictor responsible for racial disparities in AD/ADRD risks. This study demonstrated that Medicare data has sufficient statistical power and potential for studying disparities in AD/ADRD in three interacting directions: multi-ethnic structure of population, place of residence, and time period.
Disparities in Disease-Specific Remaining Life Expectancy Among Medicare Beneficiaries in the United States
Authors: Kravchenko Julia , Yu Bin
Published: December 2021

Racial and geographic disparities in life expectancy (LE) in the US are a persistent problem. We used 5% Medicare Claims for 2000-2017 to investigate the patterns of remaining LE (RLE) in the U.S. with the highest and the lowest LE. RLEs in race-/ethnicity specific populations aged 65+ were calculated in patients with specific diseases and in the total population using the area under the Kaplan-Meier estimator. The Cox model was used to investigate the effect of state-specific residence on total LE and RLE. Between-the-states differences in RLE were most pronounced for cerebrovascular disease, atherosclerotic heart disease, breast and prostate cancer. RLE was the lowest for lung cancer and sepsis, followed by Alzheimer’s disease, dementia, pneumonia, and heart failure. RLE for myocardial infarction and cerebrovascular disease decreased over time, while for renal failure, diabetes, atherosclerotic heart disease, and cancers of breast and prostate RLE increased.
Mental Health and Resilience Among the 85+ Lifestyle Leaders Throughout the COVID-19 Pandemic
Authors: Miller Julie
Published: December 2021

Recent research suggests older adults may be uniquely able to cope and cultivate psychological resilience during the COVID-19 pandemic. This presentation will describe how the Lifestyle Leaders’ overall mental health (including worries and experiences of social isolation and loneliness) and thoughts about the future have changed throughout the pandemic, as well as the ways in which they remained resilient throughout. For example, a survey in March 2020 indicated that 68% of Lifestyle Leaders were very or extremely worried about COVID-19, compared to only 33% in November 2020. Interviews with Lifestyle Leaders revealed that the pandemic led many to engage in more focused thinking about their own mortality and, for some, presented or compounded challenges of older age (e.g., widowhood, downsizing, etc.). The presentation will also highlight ways in which Lifestyle Leaders’ past experiences and current activities have contributed to their mental health and fortitude during the ongoing pandemic.
Lifestyle Leaders’ Experiences in Senior Housing During the COVID-19 Pandemic
Authors: Chan Kathryn , Patskanick Taylor , Miller Julie
Published: December 2021

Millions of older adults living in close communal contact in senior housing communities remain vulnerable during the COVID-19 pandemic. Approximately 30% of Lifestyle Leaders currently live in senior housing. This presentation will cover the unique challenges these participants have encountered, including experiences with and the impact of changing norms and pandemic-related policies within communities over time. In March 2020, 75% of Lifestyle Leaders rated the response of their senior housing community to COVID-19 as “Excellent” or “Very Good.” In August 2020, they reported they believed they were less likely to contract COVID-19 living in senior housing compared to people not living in senior housing (80%). Interview data revealed Lifestyle Leaders in these environments held favorable views toward their communities. This presentation will further discuss how the Lifestyle Leaders who do not live in senior housing perceive senior living and how these perceptions have shifted during the pandemic.
Continuity of Caregivers’ Ensuring Medical Care and Care-Transition Preparedness: A Mediation Model
Authors: Rayan-Gharra Nosaiba , Tonkikh Orly , Gur-Yaish Nurit
Published: December 2021

Studies show that informal support provided during hospitalization is essential for communicating with the healthcare team and explaining medical care. Less is known about factors explaining family caregivers' Ensuring and Explaining Medical Care (EEMC) during hospitalization and its impact on care-transition-preparedness of patients in terms of their understanding of the explanations and instructions for continued care. This study examined whether EEMC during the current hospitalization mediates the association between involvement of the caregiver in ensuring and explaining medical care prior the current hospitalization and patients’ care-transition-preparedness for discharge. A prospective cohort study includes 456 internal-medicine-patients at a tertiary medical center in Israel, who were accompanied by an informal caregiver. Involvement in EEMC prior and during the hospitalization, covariates such as health literacy (HL) levels, demographic, health, and functional status were reported by the patients during the hospitalization; and care-transition-preparedness was reported by the patients in a week after discharge. After controlling for covariates, only high HL levels of patients and their caregivers were positively associated with EEMC during hospitalization and care-transition-preparedness (P<0.05). Moreover, mediation analysis indicated significant direct (B(unstandardized)=1.69; p=0.003) and indirect effect (Mediated effect (ME)=1.28; CI= 0.81 to 1.87) of prior involvement in EEMC on care-transition-preparedness through high EEMC during the current hospitalization, controlling for baseline characteristics of patients and their caregivers (total effect: B=2.95; p<0.001). These findings suggest that caregivers' experience and involvement prior the hospitalization may be an essential factor in improving EEMC during the current hospitalization, and in turn improve transition outcomes.
Health Disparities in Alzheimer's Disease: A Wakeup Call for Transformation
Authors: Gibson Allison , Smith Lenora , Turner Robert
Published: December 2021

It is well documented in the scientific literature that health disparities exist within the Alzheimer’s disease and related dementias (ADRD) population, particularly among socially disadvantaged individuals experiencing limited opportunities to achieve optimal health. In this symposium, presenters will introduce some of the significant health disparities observed across varying ADRD research. The first presentation, by Robinson-Lane and colleagues, examines caregiving coping and health among Black ADRD families. Findings suggest in addition to traditional stress and coping strategies, additional interventions are needed that improve physical health for family caregivers. Next, Yu and colleagues will discuss the higher levels of emotional distress reported among individuals diagnosed with mild cognitive impairment, compared to their cognitively normal counterparts. In the third presentation, Lin and colleagues share their work on changes in dementia-related behavioral symptoms observed by hospice staff during COVID-19. The pandemic has affected nearly every aspect of healthcare delivery, and many hospice staff are reporting patients diagnosed with dementia have also felt the effects. Next, Xu et al identified that non-Hispanic Black older adults in their help-seeking behaviors and diagnosis process of ADRD, and often were not seen in healthcare settings by an ADRD specialist compared to their White counterparts. In the final session, Agboji will speak on the issue on findings from a systematic examination of the literature that demonstrates apathy being underrecognized and undertreated in healthcare settings. This symposium will conclude with a discussion on how researchers can disrupt these disparities by promoting health equity across ADRD healthcare and social services.
Barriers to and Facilitators for Optimal Intervention for Apathy in Older Adults With Dementia
Authors: Agboji Aderonke , Freeman Shannon
Published: December 2021

Apathy is a persistent symptom in brain disorders. It affects 84% of people with brain disorders. Those affected are more than two times likely to die early than those without. Yet it is often ignored and undertreated. An integrative review guided by Whittemore and Knafl's (2005) framework was carried out to identify the factors that inhibit or facilitate the diagnosis and management of apathy among older adults with dementia. The result of the findings revealed five barriers and three facilitators. Barriers included inconsistencies in the definition and diagnostic criteria, lack of awareness, overlap with other neuropsychiatric disorders, a paucity of evidence-based information, and lack of familiarity. Facilitators were standardized definition and assessment tools, good communication among the interdisciplinary team, and adequate training, education, and experience. In conclusion, efforts should be geared towards raising awareness and developing a practice guideline to aid healthcare professionals in detecting and managing apathy optimally.
Perceptions of Partner Affect Mediate Affect Contagion in Older Couples' Daily Life: An Experience-Sampling Study
Authors: Weber Elisa , Hueluer Gizem
Published: December 2021

Intimate relationship partners dynamically covary in their affective states. One mechanism through which intimate relationship partners experience and shape each other’s affective states is affect contagion, i.e., the spread of affective states from one person to another. The degree to which social-cognitive processes are involved in affect contagion in daily life remains unclear. The majority of older adults live together with a spouse/partner, and intimate relationships are one of the most important social contexts in their daily lives. Expanding on previous research, we focused on contagion of positive and negative affect between older relationship partners, and examined whether processes of affect contagion were mediated by perceptions of partner affect, i.e., how individuals thought their partners felt at previous moments. We used data from an experience sampling study with 152 older heterosexual couples (304 participants; 65+ years old) who reported on their positive and negative affect, perceptions of their partner’s positive and negative affect, and presence or absence of partners 6 times a day for 14 days. Dyadic multilevel mediation models were used to evaluate our hypotheses. We observed strong evidence that processes of positive affect contagion between partners were mediated by perceptions of partner’s affective states. Negative affect contagion was directed from men to women, but not vice versa, and mediated by perceptions of partner’s affective states. Partner presence was unrelated to processes of affect contagion. Our findings help identify underlying mechanisms of affect contagion and support the notion that perceptions of close others’ emotions might shape our own feelings.
Romantic Attachment, Stress, and Cognitive Functioning in a Large Sample of Middle-Aged and Older Couples
Authors: Weidmann Rebekka , Chopik William
Published: December 2021

Romantic relationships are a key factor contributing to health across the lifespan. Within this research line, attachment theory has been a useful framework to understand how relationships impact health. One primary health concern in late adulthood is reduced cognitive functioning: Alzheimer’s disease and related neurodegenerative disorders become increasingly prevalent with age affecting millions of people. Even though much research has identified various sociodemographic, medical, and behavioral risk factors, little knowledge exists on romantic attachment’s psychosocial role for cognitive decline. The purpose of this study was to examine the link between insecure attachment, stress, and cognitive functioning in a large sample of middle-aged and older couples. In particular, we wanted to investigate how insecure attachment is linked to both partners’ cognitive functioning and whether stress mediates these associations. To that aim, we used data of 1,043 romantic couples (Mage = 64.7 years; 38.5% same-sex couples) who reported on their attachment anxiety and avoidance, their stress levels, their cognitive decline, and their and their partners’ dementia symptoms. Couple members also participated in a memory performance task. The results suggest that anxiety is linked to participants’ cognitive decline, while avoidance was linked to partners’ cognitive decline and poorer memory performance. We also detected significant mediational effects for stress in the association between insecure attachment and cognitive functioning. We conclude that potentially malleable psychosocial factors, such as insecure attachment and stress, are important research objects when understanding cognitive functioning in middle and late adulthood.
The Crush: A Proto-Romantic Relationship Across the Life Course
Authors: Kotarba Joseph , Couve Amanda
Published: December 2021

This presentation describes the “crush” experience as it occurs among older adults. A basic definition of a crush is a one-sided, proto-romantic relationship. The scholarly and commonsense understanding in American culture focuses on the crush as most commonly occurring during the developmental phases of adolescence and pre-adolescence. Symbolic interactionists view life course as a somewhat fluid process of adapting to changing situations in life. Experiences like the crush can potentially occur at almost any age at which romantic thoughts and feelings are possible. Our ethnographic research on older adults residing either in group facilities or in domiciliary locations indicates that crushes are fairly common. These crushes follow the same general narrative as crushes among younger people: a beginning, a middle and an end. There are two narrative styles among older adults: face-to-face and mediated. The crush in a group facility is encouraged by interaction during social hours, meals, entertainment, and religious/spiritual activities. Crushes are more observable among women who do not have to delve into their past for objects of their affection. Available paramours from the mass media include young celebrities such as Michael Buble and Josh Groban. These crushes differ from those among younger women in the denouement, to the degree affection generally fades away from memory rather than comes to a distinct end. Factors such as increased access to electronic media and music, and increased sociality in the community and in residential environments will create situations in which the security, excitement and rewards of a crush are plausible.
The Association Between Midlife Education and Depressive Symptoms in Late Life: The AGES-Reykjavik Study
Authors: Chang Milan , Nishizuka Chiharu , Eymundsdottir Hrafnhildur , Sigurdardottir Sigurveig , Ramel Alfons , Gudnasson Vilmundur , Jonsson Palmi
Published: December 2021

BACKGROUND: Disability and depression are associated with cumulative health adversities such as socioeconomic status (SES), nutrition, medical care, and education among older adults. However, there is little evidence on the longitudinal association between mid-life education level with a disability and depressive symptoms in older adults in Iceland. The aim of the study was to examine the association between mid-life education and prevalence of activity of daily living (ADL) dependency and high depressive symptoms in late-life. METHODS: A large community-based population residing in Reykjavik, Iceland (n=4991, 57.3% women, 76.9±5.8 yrs) participated in a longitudinal study with an average of 25 years of follow-up. Mid-life education was categorized into 4 groups (primary, secondary, college, and university). ADL dependency and high depressive symptoms were assessed on average 25 (±4) years later. The 5-item ADL dependency score ranged between 0 (no difficulty) and 18. Depressive symptoms were assessed by the 15-item Geriatric Depression Scale (GDS). RESULTS: After controlling for demographic and health-related risk factors, those with higher education at mid-life were significantly less likely to have high depressive symptomatology (6 or higher GDS scores, Odds Ratio (OR) = 0.65, 95% Confidence Interval (CI): 0.52 ~ 0.82, P < 0.0001). However, mid-life education was not associated with ADL dependency in later life. CONCLUSION: Our study shows that mid-life education is associated with depressive symptoms 25 years later, while no association found with ADL dependency among Icelandic older adults.
Multiple Perspectives on Disaster Preparedness in Long-Term Care: From Heat to Hospice
Authors: Dosa David , Andel Ross , Brown Lisa
Published: December 2021

Preparedness of residents in long-term care (LTC) exposed to disasters continues to warrant concern. Prior work by our research team highlights explicit evidence of the profound vulnerability of Florida nursing home (NH) residents exposed to Hurricane Irma in 2017. This research adds to our knowledge of the profound effect of disasters on long term care residents. This symposium will utilize mixed methodologies to discuss the varied effects of Hurricane Irma on vulnerable older adults residing in Florida NHs and Assisted Living communities (ALCs). Using a novel methodology for identifying a cohort of ALC residents, the first presentation will present the morbidity and mortality effects of Hurricane Irma on Florida ALC residents and identify high risk groups by health condition. The second presentation will document the effect of Hurricane Irma on NH Residents previously enrolled in Hospice and expound on the effect of the disaster on hospice enrollment after the storm. The third presentation will present qualitative results of interviews with ALC administrators highlighting the effect of the storm on both large and small ( <25 beds) facilities. The fourth presentation will address the issue of heat exposure in the days after Hurricane Irma and consider the preventative effect of generators on morbidity and mortality. Finally, a fifth presentation will examine NH staffing level variation in the days leading to the hurricane. To conclude, this symposium offers a multi-faceted view of a disaster’s effects on LTC residents across Florida, including novel data from the NH environment and lesser-examined ALCs.
Older Adult Substance Use, Support, Health, and Well-Being: Understanding a Complex Picture
Authors: Bareham Bethany , Cimarolli Verena , Kuerbis Alexis
Published: December 2021

Substance Use Disorders (SUDs), particularly hazardous alcohol use and Opioid Use Disorder (OUD), are increasingly common in older populations. Both are associated with poor mental and physical wellbeing. Alcohol use can also contribute positively to older people’s social and emotional wellbeing, and may be used by older people in managing pain. Health concerns can make older people more aware of the impact of their lifestyle, including substance use, for their health. The relationship between substance use, health and wellbeing in old age is complex, raising questions for how older people with SUDs are best supported. We aim to give insight into this complexity, drawing on five recent studies. Our first presentation examines the impact of health concerns in old age on alcohol use. Our second presentation explores the complicated relationship between experiences of pain, and alcohol use with age. Our third presentation considers wellbeing in older people with OUD, and the impact of Adverse Childhood Experiences, psychosocial, health and sociodemographic factors; and what this means for how wellbeing is promoted in this population. Our fourth presentation explores how those supporting people with dementia navigate alcohol use amongst older residents, in a care context where autonomy is prioritised, but health risk behaviours must be managed. Our final presentation considers alcohol use in ‘the new normal’; examining the impact of the COVID-19 pandemic on older people’s alcohol use, and motivations to engage in healthier/unhealthy use. We consider implications of these complex considerations around addressing substance use amongst older people for practice.
Age Effect on the Bidirectional Relations Between Alcohol Consumption and Pain
Authors: Yeung Ellen , Lee Matthew , Sher Kenneth
Published: December 2021

Alcohol consumption reduces but pain rises over the life course. Thus, we hypothesized that developmental variability in the bidirectional association between alcohol consumption and pain would vary as a function of age. This hypothesis was tested across three age groups – younger (<29), middle (29-65), and older (>65) using NESARC wave 1 and 2 data (N=34,653). The effect of pain interference at baseline on alcohol consumption at follow-up was non-significant across the age groups, indicating that self-medication theory was unsupported. The effect of alcohol consumption at baseline on pain interference at follow-up was significant among the middle (Estimate -.007, p=.002) and older (Estimate -.019, p<.001) groups, but non-significant among the younger group. This latter effect differed significantly between the younger and older groups (p =.005) and the middle and older groups (p=.041). Results show that alcohol consumption reduces pain interference, especially later in life.
Dementia Care: Addressing Pain and Maximizing Comfort
Authors: Vinoo Deepa
Published: December 2021

Pain is common in older people who have Dementia, and is associated with a number of chronic and acute conditions. There is evidence that as many as 83% of nursing home residents experience pain that often goes unrecognized or inappropriately treated. Pain has a powerful effect on mood, sleep quality, functional ability, and overall quality of life. Rejecting care due to pain is very common among patients with Dementia. An association between pain and increased agitation has been noted, Significant reduction of agitation and psychotropic usage have been demonstrated by pain treatment in patients with moderate to severe dementia. This project was conducted in six memory care units with 150 residents at 815 bedded long-term geriatric care facility. All residents in memory care units from May 2018 to December 2019 were individually assessed for pain management, rejection of care, usage of psychotropics, falls and physical altercations. Trained interdisciplinary staff to evaluate pain by using PAIN AD. Educated interdisciplinary team on pharmacological and non-pharmacological pain management, and Pain management has improved from 40% to 90%, Rejection of care reduced from 80% to 30%. Usage of antipsychotics reduced by 12%. Falls reduced from 12% to 2%. Physical altercations reduced to zero. Staff call out due to work related injury significantly reduced. Staff verbalized improved job satisfaction and increased morale.
Evaluating Spaces for Older Adults Experiencing Homelessness: Findings From an Environmental Audit
Authors: Brais Hannah , Cormier Émilie , Serrano Diandra , Mahmood Atiya , Sussman Tamara , Bourgeois-Guerin Valérie
Published: December 2021

Homeless populations require spaces and services that take into account their life trajectories. The Aging in the Right Place - Environmental Checklist (AIRP-ENV) is an environmental audit tool developed by our team to evaluate the accessibility and overall design features of housing targeted for aging individuals experiencing homelessness. Researchers in Vancouver, Calgary and Montreal employed this tool in 2021 to evaluate environmental features in selected promising practices to identify built environment factors that promote aging in the right place. Preliminary findings reveal the following themes across sites: access to communal and recreational spaces encourage social inclusion and meaningful recreation opportunities; barrier-free built environment features foster independence and safety; and access to services and amenities encourage community mobility. Findings demonstrate a need to employ a broader evaluative lens that incorporates psycho-social factors to gain a nuanced understanding of aging in the right place for older adults who have experienced homelessness.
Temporary Housing for Older People: Addressing Housing Insecurity to Promote Aging in the Right Place
Authors: Gurung Shreemouna , Elkes Shelby , Mahmood Atiya , Lemme Holly , Modara Gelareh , Lam Emily , Mora Maria Juanita , Canham Sarah , Weldrick Rachel
Published: December 2021

The Aging in the Right Place (AIRP) project is a multi-year, multi-city partnership grant on aging, housing insecurity and homelessness. This paper presents findings from provider/staff interviews (N=5) at a Temporary Housing Program (THP) serving older people experiencing (or at risk of) homelessness (OPEH) in Vancouver, Canada. The researchers sought to understand the strengths and weaknesses of the program, scale-up (i.e., policies) and/or scale out impacts (i.e., on people and communities), as well as how the program promotes housing security and stability for OPEH. Narrative data reveals the program provided housing stability to OPEH by offering increased access to resources (food, pharmaceutical, transportation, social support and engagement). Additionally, through the promotion of client autonomy, privacy and security in their housing unit, the organization and staff work to support and foster AIRP among their clients and help to transform a temporary housing space into a secure home-type setting.
The STEP-HI Trial: Pragmatic Challenges and Design Issues
Authors: Binder Ellen
Published: December 2021

Multi-modal interventions present many implementation challenges, especially for studies of frail older adults. The STEP-HI study is an ongoing multi-center, randomized, controlled, double-blinded clinical trial that is evaluating whether six months of topical testosterone therapy combined with a supervised center-based exercise-training program can improve mobility, functional performance, and quality of life after hip fracture, compared to exercise training alone or Enhanced Usual Care. Female hip fracture patients ≥ 65 yrs. old who are living in the community or assisted living are being randomized within 26 weeks of surgical repair for the fracture, and re-evaluated 24 weeks later. This presentation discusses the rationale and study design, and modifications to the protocol in response to challenges, including the COVID-19 pandemic.