bluuebunny/crossref_metadata_2025 huggingface dataset:
What’s Race got to do With it? How Palliative Care Consultation may Mitigate Racial Disparities in Future Care
Authors: Starr Lauren , Ulrich Connie , Perez G Adriana , Aryal Subhash , Junker Paul , O'Connor Nina , Meghani Salimah
Published: December 2021

It is unknown if care and cost outcomes differ by race and ethnicity following discharge from a hospitalization involving palliative care consultation to discuss goals-of-care (PCC). In this secondary analysis of 1,390 seriously-ill patients age 18+ alive at discharge who self-identified as Black, Hispanic, Asian, white, or other race and received PCC at an urban, academic medical center, we used binomial logistic regression and multiple linear regression controlling for demographic and clinical variables to identify factors associated with care experiences and costs following discharge from a hospitalization with PCC. In adjusted analyses, discharge to hospice was associated with Medicaid (p=0.016). Thirty-day readmission was associated with age 75+ (P=0.015), Medicaid (P=0.004), admission 30 days prior (P<0.0001), and Black race compared to white (P=0.016). Number of future days hospitalized was associated with Medicaid (P=0.001), admission 30 days prior (P=0.017), and Black race compared to white (P=0.012). Having any future hospitalization cost was associated with patient ages 65-74 (P=0.022) and 75+ (P=0.023), Medicaid (P=0.014), admission 30-days prior (P<0.0001), and Black race compared to white (P=0.021). Total future hospitalization costs were associated with female gender (P=0.025), Medicaid (P=0.009), admission 30 days prior (P=0.040), and Black race compared to white (P=0.037). Race or ethnicity was not a predictor of hospice enrollment. Randomized controlled trials are needed to understand if PCC is an intervention that reduces racial disparities in end-of-life care. Qualitative insights are needed to explain how PCC and socioeconomic factors such as Medicaid may mitigate future acute care use among racial and ethnic groups.
Moderators of Dual Task Gait Effects in Mild Cognitive Impairment and Dementia
Authors: Ofori Edward , James Dara , Kaczmarek Olivia , Gudesblatt Mark
Published: December 2021

Spatiotemporal gait parameters may provide indication about the cognitive status of individuals. Dysfunction in specific gait features has been associated with increased risk of cognitive decline. Here we use spatiotemporal gait patterns to determine whether specific cognitive domain scores moderate the effects during dual-tasking on individuals with mild cognitive impairment (MCI) and dementia. Participants (n=46; mean age: 77.0±8.9 years) with a diagnosis of cognitive impairment (n=16), or dementia (n=30) were included. They performed validated computerized cognitive assessment battery (CAB, NeuroTrax BrainCare) to obtain cognitive domain measures of executive function (EF), attention, memory, visual-spatial processing (VSP), information processing speed (IPS), and a global cognitive score (GCS) measure. Using the Zeno Walkway Gait Analysis System (Protokinetics), measures of velocity, stride width (SW), stride time (ST), stride length, cadence, double support (DS), and gait variability were obtained for both single-task and DT gait. Data analysis was conducted using SPSS 26 and PROCESS 3.5. As expected, the dementia group had lower cognitive domain scores and slower walking speed than MCI group. Results also indicated that visual-spatial processing skills was the only cognitive domain that did have a moderation effect on gait velocity (F=4.2, p<0.05, R-square change 10%). Our results indicate that differences between walking speed in MCI and dementia groups are moderated by visual spatial skills. Improvement in visual spatial skills could improve the dual task effects of individual gait measures.
Racial and Ethnic Disparities in Pain Management for Nursing Home Residents: A Scoping Review
Authors: Dictus Cassandra , Cho Youngmin , Baker Tamara , Beeber Anna
Published: December 2021

Within nursing homes, residents commonly experience pain that unfortunately goes underrecognized and undertreated, having a dramatic negative impact on residents' quality of life. Nursing homes are becoming more racially and ethnically diverse, and there is concerning evidence documenting disparities in the quality of nursing home care. In other healthcare settings, people of diverse race groups often receive less optimal pain management, but the evidence regarding racial disparities has not been synthesized for nursing homes. Thus, the purpose of this review was to investigate what is known about racial disparities related to pain management (e.g. assessment, treatment, preferences) in US nursing homes. We completed a scoping literature review using PRISMA-ScR guidelines and searching PubMed, CINHAL, and Scopus for peer-reviewed, empirical studies. Most studies were older large retrospective cohort studies of administrative data documenting that White residents were more likely than residents of diverse race groups to have pain documented and treated. Only a few studies looked at possible reasons to explain the disparities; differences were not found to be related to nursing staff racial bias nor differences in pain-related diagnoses. However, there was evidence of racial differences in resident behavior and attitudes related to pain management. None of the studies examined systemic factors related to differences among nursing homes, which has been implicated in studies looking at other outcomes including COVID-19. More research is needed which examines the causal mechanisms behind the documented racial disparities in pain management so that gaps in care can be reduced.
Age Differences in the Use/Efficacy of Emotion Coping Strategies among Adults with Chronic Pain: A Scoping Review
Authors: Fennell Gillian , Wethington Elaine , Reid M Carrington , Sluys Erica , Donovan Kelsey , Cardenas Valeria , Zelinski Elizabeth , Enguidanos Susan
Published: December 2021

Active coping strategies (e.g., exercise and pharmacological treatments) typically do not leave chronic pain patients completely pain-free. Therefore, individuals turn to emotion-focused strategies to cope with associated impairment and psychosocial consequences. General coping strategy use has been shown to differ by age. This scoping review explored age differences in the use and effectiveness of emotion-focused strategies in adults experiencing chronic pain. Studies were located via advanced searches in PubMed, PsycINFO, CINAHL, Embase, Web of Science, and Proquest Dissertations and Theses Global and referral. Two reviewers independently conducted abstract screenings and full-text extractions. Conflicts were discussed and resolved by the PI. We identified 15 studies that met our inclusion criteria, of which 14 met criteria for high methodologic quality. The majority of studies utilized the Coping Strategies Questionnaire to assess differential use of pain-coping strategies. The remaining studies used one of five other questionnaires. Only one study examined the differential effect of age on the efficacy of emotion-focused strategies. Five of the eight studies that examined hoping/prayer coping reported the strategy’s positive association with age. Age was not associated with ignoring pain or reinterpreting pain sensations in any of the eight studies in which these strategies were measured. We concluded that older age was associated with the use of praying/hoping as a means of coping with pain. No other consistent associations between age and other measured coping strategies were identified. Future research should account for auxiliary stressors and pain characteristics while investigating the differential effect of age on pain coping efficacy.
Self-Reported Pain and Symptoms in Community Dwelling Older Adults: Results from the Study of Aging II
Authors: Allen-Watts Kristen , Rumble Deanna , Brown Cynthia , Kennedy Richard
Published: December 2021

Pain is a common concern for community-dwelling older adults. There are a range of symptoms that may occur with pain that can be recurring and severe, which are associated with decreased quality of life. This study aims to characterize overall symptom load by utilizing the Brief Symptom Scale in community dwelling older adults who experience mild to severe pain. Data were extracted from the UAB Study of Aging II, a prospective, population-based study of mobility among community-dwelling older adults 75 years and older. Self-reported pain in the past 4 weeks and symptoms (e.g., pain, tired, nausea, depression, anxiety, shortness of breath) were included. The SPSS version 27.0 statistical package was used for analysis. Sixty-six percent were Non-Hispanic White, 58% were female, 40% lived in housing designed especially for the disabled, 49% were widowed, and 30% had a High School degree or GED. The mean age was 81 years (standard deviation 4.8). Of interest, over one third of the sample (38.1%) experienced moderate to severe pain, upper back pain was the most common area where pain occurred and feeling tired was the most common symptom. As the aging population continues to increase, so will the prevalence rates for pain. Findings suggests older adults with pain have multiple concomitant symptoms. Because the elderly represents a fragile and large group of the population, it is important to pay close attention to these symptoms.
Neuropsychiatric Symptoms and Hearing Loss in Dementia: Unmet Need and Opportunity for Intervention
Authors: Nieman Carrie , Kim Alexander , Morales Emmanuel Garcia , Lyketsos Constantine , Reed Nicholas , Cotter Valerie , Mamo Sara , Oh Esther
Published: December 2021

Hearing loss is one of the most common comorbidities among persons with dementia, with prevalence of 60->90%. Most go untreated and disparities exist. However, sensory impairment may influence the health of individuals and care partners. We will share findings from a clinic-based cohort of persons with dementia (n=101). Controlling for demographic and clinical factors, we found that every 10 decibel increase in hearing loss was associated with nearly an additional neuropsychiatric symptom (b = 0.7 per 10 dB; p = 0.01) and 1.3-point increase in severity (b = 1.3 per 10 dB; p = 0.04). These findings provide the first estimates that utilize objective audiometry. Furthermore, hearing aid use appeared to be protective. Hearing care may represent an additional, but underutilized, non-pharmacological intervention. We will discuss these findings in the context of the epidemiology of hearing loss in dementia and highlight new opportunities for managing hearing loss through community-based approaches.
A policy mapping analysis of the U.S. Congressional approach to medical aid-in-dying
Authors: Kusmaul Nancy , Cheon Ji Hyang , Gibson Allison
Published: December 2021

Oregon was the first state to legalize medical aid-in-dying (MAID), in 1994. Since then eight states and Washington, DC have legalized MAID through legislation. Despite literature exploring the legal and ethical aspects of MAID, very little research examines MAID policy at the federal level. This study aimed to 1) examine the objectives of MAID legislation introduced to the US Congress, and 2) investigate whether these bills increase or decrease access to MAID. This study used the congress.gov website to search for bills related to MAID introduced by the US Congress between 1994 and 2020. From the 98 bills identified, we excluded bills that were not directly related to MAID or were introduced in subsequent congresses. In total, 23 bills were retained and analyzed. The greatest number of bills aimed to restrict funds for MAID, followed by bills that sought to regulate the drugs used for MAID. Other bills prohibited the development of policies supporting MAID, regulated penalties for practitioners related to the drugs used for MAID, and restricted legal assistance for accessing MAID. These bills intended to block or limit patient access to MAID by restricting drugs, funds, health care services, legal assistance, policy, and research. These findings suggest that the federal approach is incongruous with the growing numbers of states that have legalized MAID. Federal policymakers must develop policies to 1) prevent discrimination against vulnerable groups, 2) support funds to study MAID, and 3) build a system to allows eligible individuals to access MAID equally.
Caring for Persons With Dementia in Audiology
Authors: Reed Marilyn
Published: December 2021

While hearing loss is highly prevalent among patients with dementia, it frequently goes unidentified and unmanaged. It has been a commonly-held belief that older adults with dementia are unable to benefit from hearing rehabilitation, but recent evidence shows that many individuals with dementia can successfully use amplification, helping to improve communication, social interaction and quality of life for these individuals and their caregivers. This presentation will describe how modifications to practice led to successful outcomes for the majority of patients of a geriatric audiology clinic with co-morbid hearing loss and cognitive impairment. In a study of hearing aid use in 67 patients with these comorbidities, over 90% used hearing aids successfully with measurable benefit for both patients and caregivers. Furthermore, we will discuss approaches to improving communication for LTC residents with dementia and hearing loss through the support of audiologists during remote visits with physicians and families during the pandemic.
Preparing Effective InterProfessional Teams to Meet the Needs of Older Adults in Integrated Healthcare Settings
Authors: Bullock Karen , Stansbury Kim , Fitzpatrick David , Anderson Gloria
Published: December 2021

Background: Gerontology education has evolved from focusing primarily on the individual practitioner outcomes to promoting integrated, inter-professional team approaches to integrated care. Practicum training and service learning are effective pedagogy for paraprofessionals in integrated care settings to support clinicians and advance their effectiveness in meeting the needs of older adults. Interprofessional education (IPE) aims to enhance the capacity of practitioners to work collaboratively as integrated team members. Yet, little is known about the implementation of IPE in colleges and universities that are not affiliated with a medical center or medical school. This presentation will describe the implementation of IPE in a School of Social Work without a medical school system. We will explore students’ experiences with the implementation, facilitation, and evaluation of this workforce development model, and will discuss both challenges and successes. Methods: Narrative data collected over the past two-year period with social work student participants in IPE reflect their perspectives on the selection process for the specialized training, placement in an interprofessional integrated care setting, and the learning experience. Participants represented cohorts of more than 200 trainees. Results: Challenges of effective interprofessional health care teams include the approach taken to integrating the teams, level of knowledge and skills required to be an effective team member, and the need for supervision within integrated care experiences. Successes include increased professional self-efficacy. Participants reported post-completion of IPE, (1) desirable outcomes achieved for their patients, such as care satisfaction and role satisfaction for themselves as practitioners.
Development of International Practice Recommendations for Persons With Hearing, Vision, and Cognitive Impairment
Authors: Weinstein Barbara , Littlejohn Jenna , Leroi Iracema
Published: December 2021

Many older adults being evaluated for dementia have unrecognized hearing and/or vision problems which can confound results of neuropsychological assessment(s) and can impact care recommendations. International care standards for detection, assessment, and management of people living with dementia (PwD) are rarely addressed yet are critical. We propose a set of recommendations crafted to foster the highest quality health care to enable PwD to live well with these combined impairments. The focus is detection, diagnosis, treatment, and support of PwD who have age-related hearing and/or vision impairments. The guiding principles underlying the recommendations was a focus on promotion of a person-centered approach, but to be pragmatic in considering all contextual levels including professional care pathways and socio-economic/policy factors internationally. The recommendations are inclusive of all stakeholders who work together to promote equity and mutual respect across the domains. The guidelines are designed to be pragmatic, implementable, resource sparing, and sustainable.
The Role of Age, Religion/Spirituality, and Humor in the Optimism of Community-Dwelling Older Adults
Authors: Kenaley Bonnie , Kim Eun hae , McClive-Reed Kimberly , Gellis Zvi
Published: December 2021

Current literature reveals that perceived optimism decreases with age (D’Argembeau et al., 2011; Newby-Clark & Ross, 2003). However, replication of these studies is limited. In particular, a lack of investigations exists in examining optimism as individuals transition across older adulthood. Considering the dearth of literature that examines the influence of religion/spirituality and humor on the optimism of older adults, 203 members of Osher Lifelong Learning Institutes, age 65 years and older, from Idaho and California completed pen and paper or electronic surveys. The study used hierarchical multiple regression analysis to examine the impact of age, positive religion/spirituality coping skills, and humor on the optimism of community-dwelling older adults. The participant’s gender significantly explained a 19.3% variance in the optimism scores, whereas age did not significantly contribute to the model (R Change =.000). Positive religious or spiritual coping skills and humor significantly contributed to the variance in optimism scores, explaining a 2.3% and 21.6% variance, respectively. In the final model (F (1, 202, = 13.78, p = .000), all variables except age significantly contributed to the model with humor revealing the highest beta value (beta = .467, p = .000). The findings suggest that optimism is perceived differently by gender but does not change with age. While positive religious coping skills influence optimism, internal or external humor strategies may be more helpful to instill, promote or maintain optimism in older adults. The addition of humor assessment items in wellness evaluations and humor-infused interventions may foster optimism in community-dwelling older adults.
Socioeconomic Status, Time Scarcity and Well-Being in Retirement
Authors: Bo Boroka
Published: December 2021

We tend to think of retirement as a great equalizer when it comes to relief from the pernicious time scarcity characterizing the lives of many individuals in the labor force. Puzzlingly, this is not entirely the case. Using data from the MTUS (N=15,390) in combination with long-term participant observation (980 hours) and in-depth interviews (N=53), I show that socioeconomic characteristics are important determinants of retiree time scarcity. Neighborhood disadvantage gets under the skin via time exchanges that are forged by both neighborhood and peer network characteristics. The SES-based ‘time projects of surviving and thriving’ undergirding the experience of time scarcity lead to divergent strategies of action and differing consequences for well-being. For the advantaged, the experience of time scarcity is protective for well-being in later life, as it emerges from the ‘work of thriving’ and managing a relative abundance of choices. For the disadvantaged, the later life experience of time scarcity is shaped by cumulative inequality, further exacerbating inequalities in well-being. The final section of the article offers an analysis and interpretation of these results, putting retiree time scarcity in conversation with the broader literature on socioeconomic status and well-being.
Daily Evening Electronic Media Use and Sleep in Later Life
Authors: Kim Yijung , Zhang Shiyang , Fingerman Karen
Published: December 2021

Sleep complaints and disorders are one of the most common disturbances to health and well-being in later life. Evening electronic media use has been shown to influence the subsequent quantity and quality of sleep, but most research focused on younger age groups who are more likely to use new media (e.g., social media) to replace or complement traditional mass media such as television. To investigate how different types of evening media use is related to sleep in later life, we used ecological momentary assessment data from the Daily Experiences and Well-being Study (N = 231; Mage = 73.61) to examine how evening computer use and television viewing affect subsequent sleep hours and perceived sleep quality. Across all evening assessments, 43% of the evenings were spent using computers, and 80% of the evenings were spent watching television. Findings from a series of within-between random effects models indicated that evening computer use and television viewing had independent associations with sleep quantity and quality. That is, older adults reported fewer hours of sleep, more difficulty falling asleep, and worse overall sleep quality on nights following the evening computer use. In contrast, evening television viewing was associated with feeling less tired the next day morning. The results highlight the continued presence of television viewing in older adults’ daily lives and their distinction from general computer use. The social context in which older adults watch television in the evening may potentially explain how different electronic media use influences sleep in later life.
Adult Protective Services Study on the Impact of COVID-19
Authors: Roberto Karen , Teaster Pamela , Savla Jyoti , Fua Imogen , Urban Karl , Hoyt Emily
Published: December 2021

The purpose of study was to explore changes in implemented of APS programs in response to the COVID-19 pandemic. This three-phase study began with telephone interviews with eight state-level APS administrators of early phase “hot-spots” that were used to inform questions for the Phase II national survey of state APS programs. Forty-seven states completed an on-line survey on the effects of the pandemic on work and workload, policy and practice, staff, partnerships, and preparedness. Phase III interviews with 7 local APS programs provided an “on-the-ground” view of challenges of meeting clients’ needs. Although most APS programs reported fewer reports of adult maltreatment than before the pandemic, the stress and disruption of COVID-19 required new work arrangements, to which programs adapted technological and managerial support to care for the needs of both APS staff and the clients they served. Finding provide insight for policy and planning requirements for future catastrophic events.
Evaluation of a Web-Based Wellness Program to Reduce Loneliness Among Older Adults
Authors: Tkatch Rifky , Wu Lizi , Albright Laurie , Yeh Charlotte
Published: December 2021

Background: Loneliness has been associated with adverse health outcomes, including increased mortality risk. Interventions aimed at addressing maladaptive social cognition have documented efficacy in reducing loneliness among older adults. Purpose: The purpose of this study was to determine the feasibility and efficacy of a web-based wellness program in reducing loneliness and improving psychosocial health among older adults with an AARP® Medicare Supplement plan insured by UnitedHealthcare Insurance Company. Methods: Eligible individuals were 65 years and older, who self-identified as lonely on a prior survey, and indicated that they had access to the internet through a computer or smartphone. Participants completed up to eight online modules comprised of a short lesson on an aspect of maladaptive social cognition, followed by a comprehension quiz, selection of a short-term goal, and a phone or text chat with a program coach. Four surveys were administered to assess the effects of program participation: (1) prior to the start of the program, (2) after completion of four online modules, (3) after completion of all eight modules, and (4) 30-60 days later. Results: Attrition was high. Overall, 220 (42%) program participants completed both T1/T2 surveys, 193 also completed a T3 survey, and 177 also completed a T4 survey. Post-survey data indicated that loneliness and perceived stress decreased while mental wellbeing, resilience, and perception of aging improved. Conclusion: Digital interventions aimed at addressing maladaptive social cognition offer potential to reach lonely older adults and support psychosocial wellbeing through reduced loneliness.
Enhancing Group Bonding in an Acting Class of Older Adults in Urban Subsidized Housing
Authors: Sutherland Laura , Dunkle Ruth , Pace Garrett
Published: December 2021

Creative arts such as acting can promote social contact and bonding among socially isolated populations. Yet the benefits of art programming among older adults in low-income urban settings remain unexplored. A professionally administered theater group comprised of older adults living in urban low-income housing met for 12 weeks to learn acting skills and perform a play. The purpose of this study was to identify: 1) why participants enroll in a residence-based acting and improvisation course, and 2) what aspects of the course contribute to group bonding. Participants (n=14) were African American. The average age was 63 years, 14% were men, 57% had a high school degree or less, 79% reported good to excellent health, and the mean ADL score was 1.45 (range: 1-2.5). A researcher was present at each class session to observe and take field notes. Pre-post interviews included closed and open-ended questions. The researchers reviewed field notes and interview transcripts for a priori themes and emergent themes through independently coding data, discussing similarities and discrepancies, and coming to consensus on themes. Results showed that participants were motivated to enroll to meet new people, come out of themselves, learn something new, and gain artistic skills. Participants indicated the course contributed to group bonding via teaching techniques, course structure, the teacher’s use of self, the expression of self, and mutually enhanced coping skills. Results from this study provide guidance for the design of theater groups in similar settings and inform recruitment efforts of older adults in creative arts programs.
Addressing physical, functional, and physiological outcomes in older adults via integrated mHealth intervention
Authors: Hernandez-Tejada Melba , Balasubramanian Sundaravadivel , Bian John , Madisetti Mohan , Nagel Alexis , Bernstein Samantha , Kelechi Teresa
Published: December 2021

Objective: We evaluated components of an integrated mobile (m)Health-based intervention "Activate for Life" (AFL) on health outcomes in lower-income older adults (65 years and older). Method: AFL incorporates balance (Otago; OG), physical strength (Gentle Yoga and Yogic Breathing; GYYB), and mental engagement (Behavioral Activation; BA) components. Thirty participants were randomly allocated to one of three Arms (n=10 per each arm): OG (Arm 1), (OG+GYYB (Arm2), or OG+GYYB+BA (Arm 3, or full AFL). Groups were evaluated for physical, functional and physiological endpoints at baseline, and posttreatment (12-weeks and/or 3-month follow up). Results: Improvements over time in pain interference and 1,5 Ag biomarker were noted for all groups. No significant changes were observed in other physical, functional and physiological measures. DiscussionThis study illustrated potential benefits of the AFL intervention on the health of lower-income older adults and lessons learned from this pilot will be used to make improvements for a large-scale randomized controlled trial.
An Environmental Contributor to Parkinson’s Disease Causes a Hormetic Lifespan Effect in C. elegans
Authors: Thies Jennifer , Kim Hanna , Caldwell Guy A , Caldwell Kim A
Published: December 2021

Only 5-10% of Parkinson’s Disease (PD) cases have a direct genetic origin; however, exposure to herbicides, pesticides, and interactions with soil are potential risk factors. PD is characterized by the loss of dopaminergic (DA) neurons and the formation of protein inclusions that contain α-synuclein (α-syn). Conversely, a soil bacterium, Streptomyces venezuelae (S. ven), produces a secondary metabolite that causes age- and dose- dependent DA neurodegeneration in C. elegans; it also exacerbates α-syn-induced DA neurodegeneration. Previous studies from our lab determined that exposure to the S. ven metabolite caused oxidative stress, mitochondrial fragmentation and enhanced reactive oxygen species (ROS). Here we report that exposure to S. ven metabolite causes a hormetic effect on C. elegans lifespan, where low concentrations (5X) extend lifespan in N2 animals, but at higher concentrations (20X) lifespan is decreased. To further examine this hormetic response, we examined daf-16 mutants in this assay. daf-16 mutants displayed no significant differences between solvent and metabolite at both high and low concentrations, suggesting the hormetic response is daf-16 dependent. We also studied S. ven metabolite on C. elegans aging mutants. We investigated mutants in the AMPK signaling pathway and found when exposed to the 20X concentration of S. ven metabolite, aak-2 mutants displayed no significant difference between solvent and metabolite over lifespan. However, when aak-2 mutants were exposed to solvent control and the 5X concentration, mutants displayed a decreased lifespan. This suggests that functional aak-2 might be important for increased lifespan when combating toxicants following chronic exposure.
Care Experiences and Expectations of Older Sexual Minority Adults
Authors: Singleton Mekiayla , Enguidanos Susan
Published: December 2021

Sexual minority (SM) adults have unique care needs and experiences, partially because they receive and give care by and to “chosen family”. This study examines the care experiences and expectations of diverse SM adults. Using data from the 2018 AARP Survey “Maintaining Dignity: Understanding and Responding to the Challenges Facing Older LGBT Americans,” logistic and ordinal regressions were conducted to examine associations with care experiences (i.e., provided caregiving and received caregiving) and care expectations (i.e., likelihood of having to provide care and need care) among SM respondents. Gender was highly associated with care experiences, with female respondents being 70% and 74% more likely to have provided caregiving [OR:1.71, SE=.26; p<0.001] and received caregiving [OR:1.74, SE=.22; p< 0.001]. Relationship status was significantly associated with care expectations, with those who were married/civil union/domestic being 4 times [OR:4.0, SE=.52; p<0.001] and those in a relationship being 3 times [OR:3.3, SE=.51; p<0.001] more likely to expect that they will provide care in the future. Those same respondents had a 64% [OR:1.64, SE=.21, p<0.001] and 55% [OR:1.55, SE=.23, p<0.01] greater odds of reporting being “very likely” that they will need care in the future. Additionally, older age, being a racial minority, having higher education, and being employed were significantly and positively associated with care experiences and expectations. These findings provide a deeper insight into how SM individuals of different backgrounds experience and anticipate different aspects of caregiving. Moreover, we will discuss how our findings compare to non-SM individuals and implications of these findings.
Risk Factors of Financial Exploitation Versus Scam
Authors: Liu Pi-Ju , Wood Stacey , Wang Aining , Hanoch Yaniv , Hengerer David , Muskat Mary
Published: December 2021

Financial exploitation (FE) perpetrators are usually seen in a position of trust, such as family members or friends, whereas perpetrators of scam tend to be unknown individuals. Few empirical studies have examined victim risk factors, and this study aimed to systematically compare risk factors of FE versus scam. One-hundred-and-ninety-five adults (ages 18-89) were recruited to complete a 60-minute survey and interview at Purdue University in Indiana (n1=97) and Scripps College in California (n2=98). Risk factors assessed included cognitive tasks (overall cognition, memory, and executive decision), socio-emotional questionnaires (depression, resilience, ostracism, and social integration), financial measures (numeracy, objective financial knowledge, retirement worries, and financial well-being), physical health and demographics (age, gender, education level, marital status, ethnicity). Additionally, participants reported experiences of FE and scam, including (1) the 11-item short-form Older Adult Financial Exploitation Measure, (2) seven questions on scam from the Health and Retirement Study, and (3) likelihood to contact a scammer after reviewing lottery scam materials. The three dependent variables were log-transformed before OLS regression models were built. Each dependent variable was associated with different risk factors. Lower standard of living (p=.02) and ostracism (p<.05) independently predicted FE. Lower physical health (b=-.02, p=.003) was the strongest predictor of scam, with lower level of financial well-being (p=.02) serving as an independent predictor. For lottery scams contact likelihood, ostracism (b=.04, p=.005) and being male (b=-.23, p=.04) were the strongest predictors. Since risk factors differed between FE and scam, prevention and intervention programs should target the unique profiles of risk factors for each.
Experiences and Perceived Origins of Compassionate Ageism Among Older Adults During the COVID-19 Pandemic
Authors: Ju Catherine , McDarby Meghan , Picchiello Matthew , Carpenter Brian
Published: December 2021

During the COVID-19 pandemic, there was a rise in media messages (MMs) and interpersonal behaviors (IBs) that could have been considered as reflecting compassionate ageism (i.e., ageism that stems from perceptions of older adults [OAs] as warm but incompetent). However, it is unclear how OAs experienced these MMs and IBs during the pandemic. The current study examined how OAs perceived pandemic-related MMs and IBs. We recruited 74 community-dwelling OAs (Mage = 73.18, 58% female). Participants completed a survey in which they reported the extent to which they had encountered five MMs and nine IBs throughout the COVID-19 pandemic. Then, participants rated whether they believed each MM and IB was motivated by care and how offended they were by it. Nearly all participants had encountered MMs about OAs’ vulnerability to COVID-19 (e.g., more likely to contract COVID-19, 97%; more likely to die from COVID-19, 97%). Furthermore, most participants experienced IBs emphasizing their vulnerability to COVID-19 (e.g., told by another person they had a higher likelihood of contracting COVID-19, 64%; someone had checked in on them unprompted, 63%). However, across MMs and IBs, most participants (59–100%) perceived them as motivated by care and concern, and a relatively small proportion (0–20%) reported being offended by them. Our findings underscore the importance of understanding nuances of ageism from the perspective of OAs themselves. Different forms of ageism (i.e., compassionate ageism, hostile ageism) rooted in certain stereotypes about older adults (i.e., high warmth-low competence) may uniquely shape the lived experiences of OAs.
Exploring the Patient-Provider Relationship in Older Adult Pain Management
Authors: Sheikh Sophia , Brailsford Jennifer , Beneciuk Jason , Patel Monika , Johnson Brittany , Li Robin Moorman , Hendry Phyllis , Mitchell Natalie
Published: December 2021

Successful health outcomes in older patients are linked to the quality of the patient-provider relationship. Our study objective was to further understand the role of this relationship specific to pain management through perspectives from older adults and healthcare providers. Semi-structured interviews and focus groups were conducted with 9 older adults and 11 multidisciplinary healthcare providers. Transcripts were analyzed using a thematic analysis. Three main concepts emerged: (1) defining pain management goals — differences in providers and patients’ goals for pain and function, with sub-themes of realistic goal setting and a shift in pain treatment to minimize opioids as a first-line medication; (2) communication — perceived gap in providers communicating and coordinating across disciplines and with patients, with sub-themes of improving positive communication and inconsistent messaging among providers; and (3) therapeutic alliance — all parties feel that developing a relationship is built on consistent trust and open dialogue. Although providers and older adults often expressed similar perspectives, there were several areas of misalignment identified within each concept, representing areas of disconnect within the patient-provider pain management relationship. Our findings indicate providers could benefit from education on improving communication around realistic goals and patient-centered outcomes and incorporation of more holistic pain management approaches when working with older adult patients. Further study should focus on developing educational interventions to address the identified shortcomings.
Factors Related to the Care Management Practice for Old Public Assistance Recipients in Osaka City of Japan
Authors: Ayabe Takako , Takemoto Yoshihito , OKADA Shinichi , Kiener Johannes , SHIRASAWA Masakazu
Published: December 2021

The research was conducted between January 22 and February 25, 2021. The data was collected by self-administered questionnaires mailed to the participants at 800 care management centers and comprehensive community support centers in Osaka City. The centers were randomly selected. The response rate was 19.1%. The independent variables were: obtaining the qualification of a Senior Care Manager (SCM), who was a qualified person that acquired advanced knowledge and skills in care management by advanced training; experience years in Social Work (SW); experience years in care management; experiences in training programs for team approach; and experiences in training programs for supporting Old Public Assistance Recipients (OPAR). The dependent variables were the categorized contents in the Care Management Practice for old public assistance recipients. They were: Care planning and Implementation (CI); Assessment; Financial Support and Evaluation (FSE); Contract and Explanations in care management; Coordinating Informal support and Formal services in Care planning; and Arrangements in Financial supports for Formal service costs. The Structural Equation Modeling was performed for the examinations of the relationships. As a result, the goodness of the fit indices was acceptable, and we retained the models. In correlational analyses, CI and Assessment were significantly correlated with SCM (p<.05). FSE was significantly correlated with SW (p<.001) and OPAR (p<.05). In conclusion, the results implied that advanced qualification of a Senior Care Manager and a specified training program for supporting old public assistance recipients were effective in providing appropriate care management services.
Housing Cost Burden and Well-Being in Older Adults Moderated by Neighborhood Cohesion and Disorder
Authors: Cheon Ji Hyang , Park Min Kyoung , Becker Todd
Published: December 2021

Although aging in the community promotes well-being in older adults, contextual factors (e.g., housing cost burden, neighborhood cohesion, neighborhood disorder) may impact this relationship. Identifying such risk factors represents a first step toward improving older adult well-being. NHATS data (Rounds 5–8) were used to answer two research questions (RQs). RQ1: “Is housing cost burden significantly associated with well-being?” RQ2: “Is this association further moderated by neighborhood cohesion and neighborhood disorder?” Participants were 18,311 adults ≥ 65 years old. Well-being was assessed by summing 11 commonly identified indicators. Two items were merged to assess housing cost burden (categories: “no burden,” “no money for utilities,” “no money for rent,” and “no money for utilities or rent”). Neighborhood cohesion and disorder were combined (categories: “no cohesion, no disorder,” “yes cohesion, no disorder,” “no cohesion, yes disorder,” and “yes cohesion, yes disorder”). Both RQs were assessed through a random coefficient model controlling for established covariates. RQ1 results revealed that, compared to “no burden,” “no money for utilities or rent” (B = −1.22, p = .003) and “no money for rent” (B = −1.50, p = .007) were significantly associated with well-being. RQ2 results revealed that “no cohesion, no disorder” significantly moderated the association between “no money for utilities or rent” and well-being (B = −2.44, p = .011). These results indicate that increased housing cost burden is associated with decreased well-being, especially for those reporting no neighborhood cohesion. Future research should examine neighborhood-level protective factors promoting cohesion for older adults to support well-being.
National Family Caregiver Support Program Participants' Recommendations to Boost Caregiver Supports
Authors: Menne Heather , Mulmule Natalie , Gasdaska Angela , Costilow Emily , Robinson Kristen
Published: December 2021

For more than 20 years, family caregivers have been supported through the National Family Caregiver Support Program (NFCSP) of the Older Americans Act (Title IIIE). The NFCSP provides information to caregivers about available services; assistance in gaining access to services; counseling, support groups and caregiver training; respite care; and supplemental services. In the 2019 National Survey of Older Americans Act Participants, 1,909 NFCSP caregivers were asked “What recommendations do you have for improving the service?” The resulting 748 open-ended responses were thematically coded. The thematic analysis yielded six major themes: Additional Resources, Staffing, Communication, Care Coordination, Quality of Services, and Eligibility. Sub-themes were identified for Additional Resources and Staffing. The most common sub-themes for Additional Resources were requests for more help or services (e.g., grocery shopping), increased funding or financial assistance, and more service hours (e.g., overnight or holiday care). The most common sub-theme for Staffing was the need for consistent staffing due to high turnover of staff. Chi-Squared tests and Fisher’s Exact tests indicated that there were no significant associations between any of the recommendation themes and the gender of the caregiver, employment status of the caregiver, or whether the care recipient has Alzheimer’s or dementia. Many of the themes align with results from a recent RAISE Family Caregiving Advisory Council Report. Recommendations from both sets of findings indicate ways that programs, services, and policies can be enhanced to support the needs of care recipients and caregivers.
Nepali Older Adults With Pre-existing Conditions and Their Healthcare Access Amid COVID-19 Pandemic
Authors: Shrestha Aman , Ghimire Saruna , Chapadia Bunsi , Yadav Uday Narayan , Mistry Sabuj Kanti , Yadav Om Prakash , Harris Mark Fort
Published: December 2021

COVID-19 has greatly impacted older adults with pre-existing non-communicable conditions (hereafter called pre-existing conditions) in terms of their access to essential healthcare services. Based on the theory of vertical health equity, this study investigated access to healthcare by Nepali older adults with pre-existing conditions during the COVID-19 pandemic. A cross-sectional study surveyed 847 randomly selected older adults (≥60 years) in three districts of eastern Nepal. Survey questionnaire, administered by trained community health workers, collected information on participants reported difficulty obtaining routine care and medications during the pandemic, in addition to questions on demographics, socioeconomic factors, and pre-existing conditions. Cumulative scores for pre-existing conditions were recoded as no pre-existing condition, single condition, and multimorbidity for the analyses. Chi-square tests and binary logistic regressions determined inferences. Nearly two-thirds of the participants had a pre-existing condition (43.8% single condition and 22.8% multimorbid) and reported experiencing difficulty obtaining routine care (52.8%) and medications (13.5%). Participants with single (OR: 3.06, 95%CI: 2.17-4.32) and multimorbid (OR: 5.62, 95%CI: 3.63-8.71) conditions had three and five-fold increased odds of experiencing difficulty accessing routine care. Findings were similar for difficulty obtaining medication (OR single: 3.12, 95%CI: 1.71-5.69; OR multimorbid: 3.98, 95%CI: 2.01-7.87) where odds were greater than three-folds. Older adults with pre-existing conditions in Nepal, who require routine medical care and medication, faced significant difficulties obtaining them during the pandemic, which may lead to deterioration in their pre-existing conditions. Public health emergency preparedness should incorporate plans for both managing the emergency and providing continuing care.
Partnering With African American Faith-Based Communities to Support Dementia Caregivers
Authors: Long Monica , Williams Shellie , Thompson Katherine , Molony Jason , Graupner Jeff
Published: December 2021

African Americans (AA) are twice as likely to develop Alzheimer’s Disease as Caucasians. Historically, houses of faith have been a center of the AA community and a trusted source of information and support. Based on these facts, as well as community needs, the SHARE Network (a Geriatrics Workforce Enhancement Program on the South Side of Chicago) in partnership with faith-based community leaders, created an opportunity for community members to train to become resource experts on Alzheimer’s Disease & Related Dementias (ADRD) and create sustainable caregiver support groups (CSGs). The resulting initiative, Dementia Resource Champions, is a train-the-trainer style health education initiative piloted in 2018, and subsequently expanded and modified due to COVID. Participants receive instruction on stress reduction, ADRD, and community resources. They discuss how to structure CSGs to meet community needs. Results of this initiative include development of five brand-new CSGs with faith communities on Chicago’s South Side.
Pathways to Reduced Overnight Hospitalizations: Evaluating 62 Physical, Behavioral, and Psychosocial Factors
Authors: Oh Jean , Nakamura Julia , Kim Eric
Published: December 2021

As healthcare costs rise steadily and rapidly, researchers and policymakers are increasingly interested in reducing healthcare utilization costs. Growing evidence documents many factors that may influence healthcare utilization; however, less is known about how changes in candidate predictors influence subsequent healthcare utilization. Using data from 11,374 participants in the Health and Retirement Study (HRS)—a diverse, longitudinal, and nationally representative sample of older adults in the United States, we evaluated a large range of candidate predictors of overnight hospitalizations. Using generalized linear regression models with a lagged exposure-wide approach, we evaluated if changes in 62 predictors over four-years (between t0;2006/2008 and t1;2010/2012) were associated with subsequent hospitalizations during the two years prior to t2 (2012-2014 (Cohort A) or 2014-2016 (Cohort B)). After adjustment for a rich set of baseline covariates, changes in some health behaviors (e.g., frequent physical activity), physical health conditions (e.g., no physical functioning limitations), and psychosocial factors (e.g., higher purpose in life, lower anxiety, more volunteering) were associated with decreased hospitalizations four years later. However, there was little evidence that other factors (e.g. smoking, obesity) were associated with subsequent hospitalizations. Notably, some psychosocial factors had effect sizes as large as some physical health conditions. Several indicators of physical health, health behaviors, and psychosocial well-being may predict subsequent hospitalizations, and these factors may be novel targets for interventions and policies aiming to reduce healthcare costs in older adults.