bluuebunny/crossref_metadata_2025 huggingface dataset:
DEMENTIA CAREGIVERS, BURDEN, AND EMERGENCIES
Authors: Crawford Nicole , Levin Bruce , Gum Amber , Tyson Dinorah Martinez , Masys Anthony , Huntington-Symons Makeba
Published: December 2023

Caregivers of people living with dementia face multiple barriers, including social isolation, mental health problems, limited time for themselves, and limited support services. Navigating emergencies, including hospitalization, financial loss, and natural disasters, can exacerbate the burden that dementia caregivers face. This study examined dementia caregivers’ perspectives on burden, emergencies, and emergency preparedness. Semi-structured interviews were conducted with a predominantly female sample of fourteen dementia caregivers living in Florida. Data were analyzed using thematic analysis methods to define codes and identify themes. Results showed all dementia caregivers identified the term burden as having a negative connotation about their experience and the person living with dementia. Dementia caregivers predominantly stated that they cared for their family members out of love and a sense of responsibility. Findings also showed individual and caregiving experiences (e.g., being a single mom or having a previous caregiving role) prepared dementia caregivers to define and encounter emergencies. Understanding caregivers’ perspectives of burden, emergencies, and emergency preparedness is essential to developing evidence-based interventions and support services that aim to mitigate the adverse effects of emergencies on caregivers. Implications of using preferred terminology and recommendations for providing person-centered emergency planning will be discussed.
FAMILY CAREGIVERS’ REFLECTIONS ON FAMILY SUPPORT AND PREPAREDNESS FOR END-OF-LIFE CAREGIVING
Authors: Fox Aimee , Fruhauf Christine , Sharp Julia
Published: December 2023

Family caregivers often report not having the knowledge or skills to provide care needed at their care receiver’s end of life (EoL), leaving them vulnerable to emotional, psychological, physical, and financial stress. These stressors may be due to increasingly complex caregiving responsibilities, difficult medical decisions, and anticipatory grief. Studies have also found a higher incidence of adverse effects among dementia caregivers. Few studies have examined how family support is associated with preparedness for EoL caregiving. Thus, the purpose of this study was to explore family caregivers’ feelings of preparedness and family-member support for EoL caregiving, comparing responses between dementia care providers with all other caregivers. A sample of family caregivers were recruited to complete an online, self-report survey. Open-ended questions were included to explore caregivers’ feelings of preparedness and family support. Of all participants, 206 family caregivers responded to the open-ended questions. Nearly 40% (n=79) of these caregivers were providing care to a family member with Alzheimer’s disease or related dementia. Qualitative methods were used to analyze data, develop a coding scheme, and identify themes. Findings suggest that most family caregivers are providing care without adequate help, support, or communication from other family members. This lack of support seems to leave dementia caregivers feeling less prepared and more frustrated than other caregivers. Our findings highlight the importance of family communication about advance care planning and caregiving responsibilities to promote family caregiver preparedness and well-being, and effective care and quality of life for an individual at the end of their life.
MENTAL HEALTH AND WELLBEING ACROSS THE COVID-19 PANDEMIC AMONG OLDER PEOPLE IN ENGLAND
Authors: Beach Brian , Zaninotto Paola
Published: December 2023

Numerous studies have identified declines in mental health and psychosocial wellbeing over the course of the COVID-19 pandemic across the world and in different age groups, including older people. A key question for researchers, health practitioners, and policymakers alike is whether the influence of the pandemic on these outcomes is temporary or more long-lasting. The lived experience of the pandemic, such as lockdowns, likely played a role in shaping mental health and wellbeing, but recovery is not always immediate following the removal of such negative stimuli. Our recent work using the English Longitudinal Study of Ageing (ELSA) identified that depression, anxiety, and quality of life demonstrated statistically significant worsening trajectories between ELSA Wave 9 (2018/19) and through two assessments during the pandemic, i.e. June/July and Nov/Dec 2020. Because depression and anxiety are also common neuropsychiatric symptoms among people with dementia or mild cognitive impairment, we also examined differences according to cognitive function, finding a convergence among cognitive function groups in the risk for poor mental health through the pandemic. This paper expands on this work to incorporate ELSA Wave 10, the first survey assessment after the easing of key pandemic-related restrictions and health crisis measures, to assess how older people are faring since the acute phase of the pandemic in terms of mental health and wellbeing. It highlights key subgroup dynamics, including cognitive function group, that are associated with patterns of recovery in mental health and wellbeing to pre-pandemic levels and those linked to more long-lasting adverse experiences.
DISPARITIES IN LONELINESS AMONG OLDER ADULTS IN THE UK: AN EVIDENCE OVERVIEW AND CRITICAL EVALUATION
Authors: Victor Christina
Published: December 2023

We propose that there are three elements to healthy ageing: physical, mental and social. As a concept social health is less well researched although there is a significant literature on specific aspects of this concept such as loneliness or isolation. Researchers in the USA and Europe focussing on inequality in later life health outcomes have predominantly emphasised inequalities in physical and/or mental health. It is only comparatively recently that attention has been given to addressing disparities in aspects of social health because of the wide-spread stereotype that ‘all older adults’ are lonely and isolated. UK studies consistently demonstrate that specific individual characteristics such as gender, marital status, household composition, physical/mental health, ethnicity and socio-economic status are associated with higher risk of loneliness. Interventions for loneliness are rarely effective. We critique this evidence base on three grounds. First analysis of loneliness disparities focuses on individual characteristics rather than considering an intersectional approach that addresses the complexity and multiplicity of characteristics and identities that each of us embody and how these are associated with loneliness and other social health outcomes. Second research evidence is predominantly cross-sectional with some longitudinal studies. We argue that to fully understand loneliness and other late life social health disparities we need to adopt a lifecourse approach. Thirdly analysis of disparities in loneliness emphasises individual characteristics rather than adopting an ecological perspective which incorporates these, the effects of time as well as macro-level factors such as cultural norms and meso neighbourhood type, urban design and community cohesion.
TESTING MULTICOMPONENT DIGITAL THERAPIES TO PROMOTE HEALTHIER LIFESTYLE BEHAVIORS IN OLDER ADULTS: A PILOT STUDY
Authors: Evangelista Lorraine , Reyes Andrew-Thomas , Tran Dieu-My , Serafica Reimund
Published: December 2023

Multicomponent digital interventions to encourage healthy diet and physical exercise in older persons at risk for cardiovascular disease are understudied. We compared the feasibility and effectiveness of Get FIT vs. Get FIT+, two digital-based therapies, to encourage healthier lifestyle behaviors in this high-risk population. Fifty-four older adults (66.6 ± 5.9 years, 61% females, 61% married, 50% Asians, 39% Whites) were randomized to Get FIT (n=24), which included a health app, an activity tracker, and one 45-minute behavioral counseling session on healthy eating and exercise, or Get Fit+ (n=30), which added three months of health coach-personalized text messaging. We assessed retention, engagement, satisfaction, diet, physical activity, weight, cardiometabolic risks, and psychological well-being pre-and post-intervention. At three months, both groups had a 100% retention rate. Get FIT+ participants expressed high satisfaction, with 92% reporting that they would recommend Get FIT+. Individuals in both groups increased their physical activity and reduced their caloric consumption from baseline to three months. However, these changes were significantly greater in the intervention group (p .0001). Get Fit+ participants averaged a three-pound weight loss, whereas their counterparts averaged a three-pound weight gain (p .0001). Get FIT+ individuals had significantly lower systolic and diastolic blood pressure, triglycerides, total cholesterol, and HgbAa1C than Get FIT participants from baseline to three months. Both groups showed similar psychological well-being over time. Our findings imply that the Get Fit+ intervention may be more effective in lowering cardiometabolic risk in this cohort, although longer-term trials are needed.
RESIDENTIAL SEGREGATION AND DEPRESSIVE SYMPTOMS IN OLDER CHINESE IMMIGRANTS: MEDIATING ROLE OF SOCIAL PROCESSES
Authors: Li Ke , Tang Fengyan , Jiang Yanping , Rosso Andrea
Published: December 2023

Older Chinese immigrants are particularly at risk for depression due to acculturative stress and language barriers. Residential segregation with respect to language use may play an important role in mental health of historically marginalized immigrant populations. Previous research provided mixed evidence about the segregation effect among older Latino and Asian immigrants. Guided by a model of social processes, we examined the direct and indirect effects of residential segregation on depressive symptoms via multiple mechanisms of acculturation, discrimination, social network, social support, social strain, and social engagement. Four waves of depressive symptoms were assessed in the Population Study of Chinese Elderly (2011-2019, N=1,970), and linked to the 2010-2014 American Community Survey estimates of neighborhood context. Residential segregation was measured by the Index of Concentrations at the Extremes that simultaneously assesses Chinese and English language use within a given census tract. Latent growth curve models with adjusted cluster robust standard errors were estimated after controlling for individual-level factors. Residents of segregated Chinese-speaking neighborhoods had fewer baseline depressive symptoms but a slower decline rate than those living in segregated toward English-only speaking neighborhoods. Racial discrimination, social strain, and social engagement partially mediated the association between segregation and initial level; social strain and social engagement also partially mediated the association with decline in depressive symptoms. This study demonstrates the importance of residential segregation and social processes in shaping mental well-being among older Chinese immigrants and suggests potential mechanisms to alleviate mental health risks.
SOCIAL SUPPORT, RESIDENTIAL SEGREGATION, AND HEALTH OF OLDER CHINESE AMERICANS
Authors: Ma Yiming , Jiang Yanping , Bergren Stephanie , Tang Fengyan
Published: December 2023

The limited but increasing body of research on residential segregation among U.S. older Asian Americans shows inconsistent findings on the health impact of residential segregation. These mixed findings suggest that the relationship between residential segregation and health may depend on some individual characteristics. This study aimed to investigate the moderating effect of perceived social support on the relationship between residential segregation and the two health outcomes: depressive symptoms and cognitive function among older Chinese Americans. Data were drawn from 3,097 older Chinese immigrants from the PINE Study in 2011-2013. Residential segregation was measured by the Index of Concentrations at the Extremes (ICE) at census tract level, which captured the concentration of Chinese-only speakers and English-only speakers at extreme. The social support measurement was the perceptions of social support provided by spouse, family, and friends. Depressive symptoms were measured by Patient Health Questionnaire (PHQ-9). Cognitive function was assessed by Mini-Mental State Examination, executive function, working memory, and episodic memory measures. Results showed a positive and significant moderating impact of social support on the relationship between ICE and depressive symptoms (β=0.086, p=0.034). Specifically, living in neighborhoods segregated towards Chinese-speaking was associated with fewer depressive symptoms at high, but not low levels of perceived social support. There were no moderation effects of perceived social support on the relationship between ICE and cognitive function. These results indicate the protective effect of living in neighborhoods segregated towards Chinese-speaking on depression, but only when older Chinese immigrants have high levels of perceived social support.
ASSOCIATIONS BETWEEN SHARED TIME AND MENTAL HEALTH IN MARRIED COUPLES
Authors: Karakose Selin , Ledermann Thomas , Sutin Angelina , Terracciano Antonio
Published: December 2023

Spending time with the partner has been found to be beneficial in many ways for both the relationship and the individuals. However, little is known about the associations between time spend together and the partner’s mental health. The present study examined the dyadic associations between time spent with spouse and mental health, particularly depressive symptoms, anxiety, and stress. Using data from 145 married couples from Turkey (M wives = 39.84 years, M husbands = 42.97), we investigated whether time spent with the spouse is associated with the mental health of both the individual and their spouse. Actor-Partner Interdependence Model (APIM) analyses indicated that both husbands’ and wives’ perception of time spent together was associated with lower stress. Additionally, for wives, time spent together was negatively associated with their own depression. These findings revealed that spending time together can help to cope with stress and have a positive effect on wives with elevated depressive scores.
ADAPTATION OF THE PPC APPROACH FOR HISPANIC OLDER ADULTS
Authors: Samper-Ternent Rafael , Perez Gilberto , Hladek Melissa deCardi , Fonseca Carolina
Published: December 2023

Older Hispanics have a high prevalence of MCC, contributing to a higher risk for dementia. As a result, there is a rapid increase in the number of young Hispanics assuming caregiver roles. The caregiver role is a cultural expectation among Hispanics and caregiving by the family is preferred over professional caregiving. There is limited information on how the unique context of Hispanics impacts the dyadic interactions between older adults and their care partners. There is a gap in the literature on how health values among Hispanics frame their healthcare goals and preferences and whether care partner involvement impacts the identification of these goals and preferences. There is also a limited number of evidence-based interventions that can help shift the current healthcare paradigm from clinical-guideline-based care to patient-centered care for underrepresented older adults. Thus, we used the Heuristic Framework to culturally adapt PPC for Hispanics with MCC and cognitive impairment living in Texas and embed it in two Geriatrics Clinics. We will describe the adaptation and implementation process and share findings from a pragmatic pilot study with 25 older Hispanics that participated in the PPC approach. We will share the outcomes from this pilot and the feedback received from patients, caregivers, and clinicians on the implementation of PPC at these clinics. We will conclude by sharing the current plans to expand the outreach of PPC for diverse older adult populations.
LONGITUDINAL FACTORS ASSOCIATED WITH LIVING WELL IN PEOPLE WITH MILD TO MODERATE DEMENTIA
Authors: Clare Linda , Gamble Laura , Martyr Anthony , Matthews Fiona
Published: December 2023

Understanding the factors associated with quality of life can help us become more effective in optimizing the potential for people with mild-to-moderate dementia to ‘live well’. Identifying individuals at risk of declining quality of life could help to target support more appropriately. We used longitudinal data from 1749 individuals with mild-to-moderate dementia participating in the IDEAL cohort. Assessments took place on entry and at 12, 24, 48, 72 and 96 months. Using mixed effects modelling we examined change in quality of life, as measured by QoL-AD, since time of diagnosis, and looked at time-invariant and time-varying measures and their association with decline in quality of life at 6 years. Mean quality of scores life were stable over our six year follow up period. However, we were able to identify some individuals whose quality of life declined by varying amounts over this period. A larger decline was associated with being male and older, and those with a decline in quality of life had worsening cognitive function and increasing depression in the years following diagnosis. Our results show that quality of life does not decline for most people following a diagnosis of dementia. However, for those that did decline we were able to identify key factors associated with this decline. This model allows us to investigate further factors that may influence living well in people with dementia, and identify, at diagnosis, those most ‘at risk’ of decline and identify potential remediating factors that could inform potential intervention to mitigate this decline.
FACILITATING GROWTH VIA INDEPENDENT LEARNING PLANS FOR PSYCHOLOGISTS TREATING OLDER VETERANS WITH CHRONIC ILLNESS
Authors: Gregg Jeffrey , Rodriguez Rachel , Mehta Priyanka , Kramer Josea , Gould Christine
Published: December 2023

The VA Geriatric Scholars Program-Psychology Track (GSP) is a national post-licensure geropsychology training program for VA psychologists caring for rural-dwelling older veterans with complex physical, cognitive, and psychological comorbidities. In 2019, GSP developed an advanced workshop model to invest in the continued growth its alumni. The workshop focused on enhancement of geropsychology competencies in treating older veterans with chronic mental and physical illnesses (e.g., PTSD, dementia, diabetes). To facilitate ongoing and individually tailored learning following the workshop, participants developed and executed Independent Learning Plans (ILPs) during a 6-month window with consultation from an experienced geropsychologist. Upon completion, participants submitted final reports and responded to three prompts assessing overall experience, usefulness, and future plans. We examined these qualitative data using a rapid analysis approach with summary templates. Fourteen of 19 participants (73.7%) submitted both final reports and responses to the prompts. All 14 respondents endorsed clinical and/or personal usefulness of the ILPs, with emerging themes including increased confidence, enhanced skills for use with patients with complex needs, and career advancement. Regarding overall experience, most participants noted positive outcomes, including feelings of fulfillment, and noting that ILPs were feasible and learning resources were accessible. A minority (35.7%) identified meaningful barriers most often associated with not having enough time. Future directions included plans to learn new assessment/treatment approaches, read relevant literature, and pursue additional career advancement (e.g., board certification in geropsychology). Overall, our findings suggest ILPs are a viable way to enhance psychologists’ experience and effectiveness in treating older veterans with complex needs.
EVALUATING THE BEHAVIORAL RECOVERY OUTREACH (BRO) TEAM MODEL: TEAM MEMBERS’ PERSPECTIVES
Authors: Peeples Amanda , MacDonald Elizabeth , Matthews Kathleen
Published: December 2023

The VA’s Behavioral Recovery Outreach (BRO) Team model seeks to address the unmet needs of aging Veterans with complex behavioral, psychological, neurocognitive, and medical concerns. Consisting of a core team of a social worker, nurse, and psychologist, BRO teams collaborate with the broader VA Community Living Center or inpatient team on behavioral assessment and treatment planning to help stabilize the Veterans’ behaviors and ready them for discharge to the community. Then, upon discharge the BRO Team provides ongoing behaviorally focused transitional support services to help ensure the Veterans’ sustained stability in the community and prevent unnecessary rehospitalizations. While dissemination efforts have demonstrated positive clinical outcomes for the Veterans served, little was known about the factors that support or hinder successful implementation of this complex program. This paper presents results from qualitative interviews with ten members from seven BRO Teams (out of ten active teams at the time) undertaken in late 2021 as part of a larger BRO program evaluation. The BRO Team model, including the goals and core components of BRO, are defined. Determinants of successful BRO implementation and team operations, including staffing, inter-departmental relationships, model clarity, and support, are described. BRO Team members’ views of the impact on and response of BRO recipients (BRO-enrolled Veterans, family members, and VA and community care partners), such as helping family members understand dementia, assistance with navigating the VA system, and support with behavioral health care planning and modification leading up to and following transitions to community care, are also detailed.
RECRUITMENT SUCCESSES AND CHALLENGES OF EMPLOYING IN-HOME SENSOR TECHNOLOGY WITH OLDER AFRICAN AMERICAN ADULTS
Authors: Calloway Shayla , Raulston Journie , Barnes Lisa
Published: December 2023

Older African Americans are under-represented in clinical research studies of aging. Many previous studies have shown results of in-home monitoring technologies to collect objective data for aging in place but few studies include minoritized populations. The CART platform uses home-based sensor technology to unobtrusively assess activity in the home and was embedded in homes of participants from the Minority Aging Research Study (MARS), an ongoing longitudinal study of cognitive decline in older African Americans. This presentation will highlight efforts to engage, recruit, and retain older African American participants in Chicago, with a particular focus on challenges and lessons learned. Recruitment consisted of presentations and mailings to potentially eligible MARS participants based on pre-specified inclusion criteria. Of 153 participants who met initial eligibility criteria, 36 refused before consent, 34 were ineligible after screening, and we enrolled 76 non-Hispanic African Americans participants (80% women; mean age = 80.4 (6.3) years); mean education = 16 (2.8) years; 78% without cognitive impairment). Enrolled participants were slightly younger, more likely to be female, and had higher education. There was no difference in cognitive impairment between those who enrolled compared to those who were ineligible after screening. Since enrollment, 11 have withdrawn and 7 are no longer active. The most common challenges include privacy concerns, broadband internet issues, emerging medical conditions, or changes in residency or resident occupancy. These results demonstrate that older African Americans participating in an ongoing longitudinal study can be recruited and retained in an ancillary study that involves home-based sensor technology.
THE HIDDEN TOLL OF INCARCERATION: EXPLORING THE LINK BETWEEN IMPRISONMENT HISTORIES AND PAIN AMONG OLDER ADULTS
Authors: Yang Yulin , Lutz Gabriel , Chen Chixiang , Kheirbek Raya
Published: December 2023

Objective

Incarceration is linked to poor health outcomes across the life course. However, little is known whether and to what extent incarceration histories shape pain in later life. This study aims to examine the link between incarceration histories and pain outcomes among middle-aged and older adults in the United States.

Methods

We used data from a nationally representative sample of community-dwelling adults aged 50+ in the 2012-2018 biennial waves of the US Health and Retirement Study (HRS) to estimate pain trajectory in U.S. older adults with and without a history of incarceration. We fit generalized estimating equation (GEE) models adjusting for socio-demographic covariates and early life experience to estimate the risk of reporting moderate-to-severe pain and related limitation.

Results

We included 12,394 respondents aged 68.76 on average (SD= 10.34), 59% female, and 7% with incarceration histories (n= 870). Persons with incarceration histories have a greater risk of reporting moderate-to-severe pain (PR=1.38, 95% Confidence Interval [CI]: 1.24, 1.53) and pain-related limitation (PR=1.50, 95% CI: 1.34, 1.67) even after adjusting for socio-demographic covariates and early life experience.

Discussion

In a nationally representative sample of older adults (with or without incarceration history), our study demonstrates an independent association between a history of incarceration and pain in later life. Our findings highlight the far-reaching impact of incarceration and the need for developing optimal pain management strategies to reduce the burden of disabling symptoms. Interventions should prioritize socioeconomically vulnerable groups, who may have the least access to pain treatment in later life.
A TALE OF TWO EXPERIENCES: NAVIGATING END-OF-LIFE CARE WITH A HISTORY OF INCARCERATION
Authors: Lutz Gabriel , Yang Yulin , Chen Chixiang , Kheirbek Raya
Published: December 2023

Objectives

The negative health effects of being imprisoned are well-documented throughout one’s lifetime, but the impact of incarceration on end-of-life experience is not fully understood. Thus, this study aims to explore the relationship between a person’s history of incarceration and their end-of-life experience

Methods

The Health and Retirement Study, a survey of Americans aged 50 and above that is nationally representative, provided the data for this study, which involved a secondary analysis of existing information. The dataset included individuals who had participated in the HRS but had deceased between 2012 and 2018.

Results

Among 1710 respondents aged 78 (SD10 years) on average at baseline, there are 53% female, and 8% with incarceration history (n=139). We found incarceration history to be positively associated with caregiving and lower risk of dying alone OR 1.84 (95% CI: 0.64-5.21) higher chance of using hospice OR 1.16 ( 95% CI: 0.72- 1.87) and dying at home, but lower levels of quality of life at the end of life OR -0.44 (95% CI: -1.88, 1.01) and utilization of palliative care services OR 0.49 ( 95% CI: 0.21, 1.12).

Conclusion

Our study, which included representative sample of older adults from across the country has revealed an association between a person’s past imprisonment and their end-of-life experience . The study highlights the pervasive effects of incarceration and underscores the importance of developing effective palliative care strategies for early identification of the needs to alleviate suffering and improve quality of life for this vulnerable population.
EVALUATING A MICROLEARNING INTERVENTION ABOUT NUTRITIONAL CARE FOR OLDER PEOPLE TARGETED AT NURSES
Authors: ten Cate Debbie , Dikken Jeroen , Ettema Roelof , Schoonhoven Lisette , Schuurmans Marieke
Published: December 2023

Nurses play a pivotal role in the care of older people with malnutrition or who are at risk. However, research shows that they lack the motivation to give adequate nutritional care. To change this motivation, an educational intervention targeted at nurses would be desirable. To optimize learning efficacy, we developed a microlearning intervention and conducted a first evaluation. The aim of this study was to evaluate the microlearning intervention on reaction, learning and behavioral change among nurses. The evaluation was assessed with focus groups, a questionnaire, participant observations and patient records. The data was both qualitatively and quantitatively analyzed. Two focus groups were held with a total of seven nurses. They mostly mentioned positive experiences, stated that their knowledge about nutritional care increased and that their behavior in daily practice changed. Of the 306 participants, who received the intervention, 94 filled in the questionnaire of which 66% was satisfied with the microlearning intervention and over 69% agreed that they learned something new. Five nurses were observed while giving care to a total of twelve older care recipients. No clearly detectable changes in behavior during care moments or in reporting in patient records were observed. Nurses had a mainly positive experience with the microlearning intervention. They confirmed learning and changing behavior in daily practice. However, from observations this behavioral change was not visible. The intervention may be potentially useful in education for (future) nursing professionals. With the microlearning intervention, nurses may be better equipped to provide nutritional care to older people.
EMERGENCY DEPARTMENT USE AMONG OLDER ADULTS RECEIVING MEDICAID HOME- AND COMMUNITY-BASED SERVICES
Authors: Fortinsky Richard , Robison Julie , Wakefield Dorothy , Grady James , Steffens David , Migneault Deborah , Lee Chae Man
Published: December 2023

Medicaid-funded home and community-based services (HCBS) for older adults aim to prolong independent living despite physical and cognitive disabilities. Medicaid-eligible HCBS populations are racially and ethnically heterogeneous, with multiple chronic conditions. Clinical threats to continued independent living among older adult HCBS recipients include acute illnesses, injuries, and exacerbations of chronic conditions, which could trigger a pathway of emergency department (ED) visits, hospitalization, and long-term nursing home admission. Despite its importance in the pathway from independent living, little is known about the rate of, or risk factors for, ED use in this target population. Accordingly, we determined predictors of ED use in a statewide cohort (N=5,651) in Connecticut’s Medicaid HCBS program for adults age >65, who were clinically assessed using a uniform tool between April 2020-March 2021. ED use, (0 vs 1+ visits), was ascertained over 12 months following clinical assessment using Medicare and Medicaid claims data. Predictor variables were racial and ethnic group, primary language, age, sex, educational attainment level, dementia diagnosis or moderate-severe cognitive impairment, depressive symptom severity, and Charlson comorbidity index. Cohort members were 76% female, 30% Hispanic, 15% non-Hispanic Black, 4% non-Hispanic Asian, 33% age >85. Forty-one percent had 1+ ED visits. Multivariate logistic regression analyses revealed that ED use was associated with (adjusted odds ratios p<0.05): high school education, more severe depressive symptoms, and more chronic conditions. Non-Hispanic Asian individuals had lowest ED visit likelihood. ED use among older adults receiving Medicaid HCBS might be reduced if depressive symptoms and multiple chronic conditions are optimally managed.
EXPLORING SECTORAL REACH IN AGE-FRIENDLY COMMUNITIES
Authors: Black Kathy , Oh Patricia
Published: December 2023

There is increasing interest in better understanding the sectoral reach of age-friendly community practice. Action across a wide variety of actors is central to achieving age-friendly societal change according to the World Health Organization and an explicit goal for governmental participation in its Global Network of Age-Friendly Cities and Communities. However, there is limited knowledge regarding the scope of sectoral reach by age-friendly communities. We used qualitative inquiry to assess sectoral efforts reported by American age-friendly communities that completed a five-year cycle of participation (n=40). We employed directed content analysis using a priori indicators by sectoral actors: public (i.e., government), private (i.e., business), and civil society including nonprofit organizations and volunteers. We classify sectoral actions by type (i.e., intersectoral, multisectoral) and by clustered domain community foci (i.e., built, social, service). Our study identifies the extent and types of sectoral actors and actions reported by age-friendly communities with the greatest efforts reported in the public sector, and while similarly distributed across all the domains, slightly more efforts were noted in the built environment. We also found greater intersectoral efforts (i.e., explicitly working towards shared goals) than multisectoral (i.e., not necessarily in collaboration on shared goals), particularly across government. While our study substantiates the breadth of actions towards age-friendly change, additional research is needed to examine the ways in which the public and other sectoral actions are further linked to outcomes in communities in the United States and in other countries.
ALTERNATIVE PATHS TO AN AGE-FRIENDLY COMMUNITY
Authors: Gleason Shayna , Oh Patricia , Coyle Caitlin , Somerville Ceara
Published: December 2023

While the age-friendly community movement has seen tremendous progress in the past decade, with over 700 U.S. member communities in the Network of Age-Friendly States and Communities (NAFSC), many more U.S. communities have not yet joined the network. Joining NAFSC can spur activity to improve local conditions for older residents, as well as allow communities access to informational resources and contacts from peer communities that have undertaken similar initiatives. A better understanding of the barriers preventing communities from joining NAFSC, the hesitancy about joining, and the age-friendly work being done outside of NAFSC is critical to extending age-friendly work nationally. The present study explored factors that inhibit communities from joining NAFSC. We conducted 12 semi-structured virtual interviews with community leaders in Maine and Massachusetts whose communities are not NAFSC members but are actively working on aging-related issues. Participants were recruited through the researchers’ professional networks. We intentionally cultivated diversity of community size during recruitment. Transcripts and interview notes were coded thematically. Resulting themes included a lack of knowledge/misconceptions about what joining NAFSC requires, a perception that there are few benefits to joining, political concerns, insufficient personnel capacity, other financial priorities (e.g., children’s programming, COVID relief), and a desire to retain local control over aging-related initiatives. Recommendations include clearer communication of NAFSC membership requirements and benefits, additional technical assistance to communities, and loosening of reporting requirements for small communities.
THE USE OF THE “TIME TRAVEL” PARADIGM OF ALZHEIMER’S DISEASE FOR FAMILY CARE PARTNER EMPOWERMENT
Authors: Johnson Christopher , Johnson Roxann , Sun Fei
Published: December 2023

This study describes how family carers are taught the Time Travel model of Alzheimer’s Disease (AD). As persons with AD experience cognitive, emotional, social, physical and functional time travel, families can learn to join them on their journey. Stage models (e.g., Reisberg and associates FAST and GDS) of AD clarify how changes through time occur using stage markers. Yet the disease is non-linear. Persons with AD don’t travel neatly in stages but fluctuate in recall of names, faces and events. They migrate in a non-linear downward spiral fluctuating back and forth through time, revisiting people, places, events and traumas of their distant past. Time Travel apps and other life history data are available to provide real person-centered care that’s time appropriate. Families are trained to connect in the approximate time frame in which the person has traveled. Hence, care partners are taught time appropriate communication and interventions (e.g., activities, pictures, music etc.) to respond to challenging behaviors. The Models use with family carers empowers them to validate their loved ones’ approximate time frame they are in. Family carers are inspired to become “best friends” of AD persons by understanding how this cognitive disability works. When a lady with travels to age 20 in her mind but sees an 80-year-old face in the mirror, she demands the person leave the bathroom. This behavior is puzzling to families. Time Travel model explains how this works driving care planning, redesigns (e.g., mirrors) and activities, and supports validation therapy, “Best Friends” and other pedagogy.
USING SIMULATION TO ASSESS THE FIDELITY OF ADVANCE CARE PLANNING IN THE CONTEXT OF A PRAGMATIC TRIAL
Authors: Cotter Valerie , Sloan Danetta , Scerpella Daniel , Wolff Jennifer , Smith Kelly
Published: December 2023

There is growing recognition of the importance of and challenges to maintaining fidelity in pragmatic randomized clinical trials. Simulations using standardized patients are a high-fidelity, low-stake, non-threatening opportunity to evaluate knowledge, skills, and competencies associated with high-quality healthcare delivery. We created standardized patient scenarios grounded in the Respecting Choices First Steps™ Advance Care Planning (ACP) curriculum to assess embedded trial ACP facilitators. Scenarios included simulations representing one-on-one encounters with a patient, and with a patient-family dyad. A standardized encounter observation checklist was used to assess and score relevant skills and behaviors including encounter set-up, ACP topics, and general communication. Each item was scored on a scale from not-done (0) to effective (2) with lower scores indicating lower fidelity. Six facilitators with varied backgrounds (social work, nursing, lay persons) each completed the two simulation scenarios. Group average domain scores across all six facilitators were moderately high. ACP Setup scoring averaged 75.5%; ACP Topics were 72.0%; and Communication were 77.4%. The lowest group scoring was observed in the coverage of ACP Topics (72%). The highest group average was observed in Communication skills at 84.9%. Lower individual scores were observed across all domains for staff who were newly hired at the time of the simulation exercise. Simulation using standardized patients and caregivers allowed investigators to monitor the fidelity of ACP communication to the trial design and provided targeted opportunities for improvement that were not readily available through usual care.
PRAGMATIC IMPLEMENTATION OF AN ADVANCE CARE PLANNING INITIATIVE: MOVING KNOWLEDGE INTO ACTION
Authors: Smith Kelly , Colburn Jessica , Scerpella Daniel , McGuire Maura , Walker Kathryn , Wolff Jennifer
Published: December 2023

Primary care is an important setting for patient and family-centered communication with older adults given the high frequency of interactions, longitudinal trusted relationships, and patient preferences for advance care planning (ACP). Increasing ACP conversations and documentation of advance directives in primary care is a focus of quality-of-care initiatives and is particularly relevant for older adults, including those with dementia. The SHARING Choices ACP program evaluation was designed to examine the fidelity of implementation with the two partner health systems. SHARING Choices includes a mailing (introductory letter, an agenda-setting checklist, a blank advance directive, and information about shared-portal access for family) sent two weeks prior to scheduled primary care visits for patients aged 65 and above along with access to an ACP facilitator in each practice. Embedding SHARING Choices within primary care practices involved a multi-step process, including onboarding of health system partners, facilitator identification and training, tailored onboarding, practice champion engagement, and practice orientation and ongoing support. Of 23,220 candidate patients, 17,931 outreach attempts by phone (77.9%) and the patient portal (22.1%) were made by ACP facilitators and 645 conversations occurred. Most conversations (94.8%) were less than 45 minutes in duration. Study findings reinforce the value of adaptable study design; co-designing workflow adaptations with frontline staff; adapting implementation processes to fit the operational and organizational priorities of the health system.
MULTILEVEL PERCEPTIONS OF IMPLEMENTING SHARING CHOICES: A QUALITATIVE STUDY
Authors: Saylor Martha Abshire , Hanna Valecia , Dy Sydney , Sloan Danetta
Published: December 2023

Reviews have found that ACP interventions alone, including those in primary care, improve advance directive documentation but have not shown effectiveness for person-centered or end-of-life outcomes. One potential reason is that these interventions may not be sufficiently comprehensive and do not address the wide scope of population, communication and systems issues needed to improve outcomes. We conducted semi-structured interviews to explore experiences with the SHARING Choices intervention through the perspectives of key stakeholders involved in the trial. We recruited all embedded ACP facilitators; the clinicians and practice managers from primary care practices from both participating health systems; and patients (and/or family) who participated in the intervention. Tailored interview guides addressed how implementation occurred and evolved, acceptability and key enablers/barriers/adjustments in implementation, and the use and perceived impact of different elements of the intervention. A multidisciplinary team generated a coding scheme based on these topics of interest and used thematic analysis to identify, analyze, describe, and report emergent themes from responses across interview groups. We interviewed 40 participants (all 9 facilitators, 11 patients and families, and 20 clinicians and administrators). We will present major themes and differences across interview groups, and how this informs the quantitative results of the pragmatic trial.
FROM COMFORT TO PROFITABILITY: RELATIONSHIP BETWEEN CARE QUALITY AND FINANCIAL PERFORMANCE IN US HOSPICES
Authors: Davlyatov Ganisher , He Mengying , Padakandla Deepthi , Weech-Maldonado Robert
Published: December 2023

Hospice care is a critical aspect of end-of-life care in the United States, providing comfort and support to individuals with life-limiting illnesses. Quality of care is a key concern for hospice facilities, as it can impact both patient outcomes and financial sustainability. Poor quality of care can lead to negative patient experiences, increased hospitalizations, and even legal issues. It can also result in financial penalties or reduced reimbursement from payers. However, there is limited research on the relationship between quality of care and financial performance in hospice facilities. Employing a cross-sectional observational design, we examined the relationship between Hospice and Palliative Care Composite Process Measure (lagged by 1 year) and the total margin of hospice facilities across the United States. We used secondary data from Nursing Home Compare, Healthcare Cost Report Information System Dataset, and the American Community Survey for the period 2017-2021. We found a positive association between quality process measures and financial performance in hospice facilities after controlling for organizational and community factors that may influence financial performance, such as facility size and location. Specifically, a 10-unit increase in quality measure was associated with a 2% increase in total margin. The findings of this study have important implications for the management and financing of hospice facilities. Investments in quality improvement initiatives may lead to improved financial performance. Policymakers should consider these findings when designing payment systems for hospice care, and administrators of hospice facilities should prioritize quality improvement initiatives to ensure both high-quality care and financial viability.
THE EFFECT OF PATIENT-DRIVEN PAYMENT MODEL REIMBURSEMENT POLICY CHANGE ON NURSING HOMES
Authors: Orewa Gregory , Weech-Maldonado Robert , Davlyatov Ganisher , Feldman Sue , Becker David , Lord Justin
Published: December 2023

To promote more value in skilled nursing facility spending in the US, CMS modified the way it pays for nursing homes (NH) services on October 1, 2019. The new Medicare reimbursement methodology, the Patient Driven Payment Model (PDPM), moves away from the traditional system focused on therapist minutes to a value-based focused on resident clinical characteristics. Using contingency theory, this study explores NH responses to PDPM by: 1) examining whether NH’s therapist and nursing staffing patterns are aligning with the policy incentives; and 2) whether the adjustments are resulting in improved financial performance. Seven different datasets were merged for 2017– 2021: Medicare cost reports, Payroll Based Journal, NH Compare, Area Health Resource File, HHS Provider Relief Fund, CDC NH COVID-19 public file, and CDC COVID-19 Data Tracker. The data was modelled using random-effects regression, and we tested for potential moderation effect of staffing on the relationship between PDPM and financial performance. Dependent variables were nursing and therapy staffing intensity, while the independent variable was PDPM for model 1. Dependent variable was operating margin, moderator variable was staffing intensity, and independent variable was PDPM for model 2. Organizational, community level, and COVID-19 related variables were used as controls. Results suggest that PDPM was associated with an increase in RN and LPN staffing intensity, but a decrease in Physical Therapist, Physical Therapist Assistant, and Occupational Therapist Assistant staffing intensity (p< 0.05). PDPM had a positive impact on financial performance moderated by RN and PT staffing intensity (p< 0.05). Policy and managerial implications are discussed.
DIMINISHED RETURNS OF PARENTAL EDUCATION ON COGNITION: EVIDENCE FROM THREE POPULATION STUDIES IN THE US
Authors: Reynolds Addam , Greenfield Emily
Published: December 2023

Mounting evidence suggests that the protective effects of one’s own higher socioeconomic status (SES) on health is diminished among minoritized racial/ethnic groups in the United States (U.S.) with respect to outcomes such as mortality, hospitalization and mental health. Extending this area of research to childhood SES and later life outcomes, this study examines whether the protective effects of higher parental education on cognition is diminished among Black adults relative to their non-Hispanic White peers. Using data from the Health and Retirement Study, the Midlife in the U.S. Study, and the National Social Life, Health and Aging Project, I examine whether associations between parental education and two measures of cognition (episodic memory and global cognition) are moderated by race (non-Hispanic White or Black) using a random-effects individual participant data meta-analysis approach. I find evidence for a small, but robust, protective effect of higher parental education on both episodic memory and global cognition among White adults. Among Black adults, there was no association between parental education and neither episodic memory nor global cognition. This study provides evidence that the protective effect of higher parental education on cognition is not the same across racialized populations, consistent with the theory of Minority Diminished Returns. As scholars continue calls for life course-oriented efforts to reduce racialized cognitive disparities, it is important to consider early-life risk and protective factors in the context of structural racism.