bluuebunny/crossref_metadata_2025 huggingface dataset:
A Scoping Review of Aging in Place: Is the Current Literature Inclusive of African American Women?
Authors: Tucker-Seeley Reginald , Davis Carlene , Ahazie Jubilee , Robi Matti , Steinberg Leora
Published: December 2020

Approximately 80% of adults aged 50+ report a desire to stay in their homes as long as possible, or to “age in place.” Yet, as the US aging population becomes more racially and ethnically diverse, the frameworks used to describe “aging in place” will require explicit recognition of the issues specific to racial/ethnic minorities. For example, given the intersection of historical discrimination related to race, gender, age, and lower socioeconomic status, older African American women are at increased risk for poor health outcomes as they attempt to “age in place.” We conducted a scoping review of “aging in place” studies in the US (N=479), to determine whether current “aging in place” frameworks included issues relevant to racial/ethnic minorities generally, and African American women, specifically. Our inclusion criteria for articles were as follows: 1) a definition of “aging in place”; 2) a conceptual framework related to “aging in place” and/or 3) the incorporation of racial/ethnic minorities generally and African-American women specifically in the research sample. We adapted the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) framework for our review to search the PubMed database for “aging in place” studies. After applying our inclusion/exclusion criteria (N=244), the findings from our review showed that approximately 40% of studies included an explicit definition of “aging in place” (N=100), but few studies focused on African American women (N=20). Future studies on “aging in place” should consider the unique challenges that African American women face as they navigate the challenges of “aging in place.”
Creating an Age-Friendly Community in Affordable Housing Using a Resident Health Risk Assessment Focused on the 4Ms
Authors: DeGennaro Jennifer , Pomerantz Sherry , Avallone Margaret , Handberry Melonie , Perweiler Elyse
Published: December 2020

The NJGWEP team in partnership with Fair Share Housing/Northgate II (NGII), an affordable housing complex in Camden, NJ, employed an iterative quality improvement process to collaboratively develop a Resident Health Risk Assessment (RHRA) to meet the needs of the housing facility and incorporate the essential elements of the 4Ms framework (Mentation, Medication, Mobility, and What Matters). Using the RHRA, NG II social services staff and Rutgers School of Nursing (RSoN) students were trained to collect health information and administer several evidence-based screening tools (i.e., MiniCog, TUG, PHQ-2). A final element of the RHRA still in development is the documentation process of referral and follow-up based on personalized care plans. Since July 2019, 43 RHRAs have been completed (60% female, mean age 66, age range=43 to 88). Almost all residents (94%) have at least 1 chronic condition (HTN, DM, COPD, CHF), although only 26% have an advance care plan. Most (81%) were screened for future fall risk; function (ADLs/IADLs) was assessed for all (100%). Every resident who was able or did not refuse (88%) was screened for cognitive impairment. Just 7% were taking a high-risk medication (i.e., an opioid or benzodiazepine). The NJGWEP team has initiated an age-friendly community at NGII by providing education on geriatric-focused topics and implementing the 4Ms-focused RHRA to detect issues impacting the resident’s well-being. Establishing a follow-up process to track referrals to available resources will enable NGII to allow residents to age in place with appropriate supports.
Factors That Influence Length of Membership in a Customer-Driven Organization: A Village
Authors: Cho Joonyoung , Dunkle Ruth , Harlow-Rosentraub Karen
Published: December 2020

Membership is a critical feature of the survival of customer-driven organizations. As a membership-driven organization based on neighbors helping neighbors, many Villages express difficulty in having enough members and lack confidence in sustainability. This is the first study examining the association between length of membership and motivation for becoming a Village member. ShareCare, the first Village, was founded in 1994. We used an open-ended questionnaire to gather information from a representative sample of current Sharecare members (N=100). Three researchers were involved in coding responses with discrepancies resolved via collaborative discussion. Length of membership was categorized as: less than 10-years, and more than a 10-year membership. Motivations to join membership in ShareCare were categorized as: instrumental, social, and altruistic. We conducted three separate logistic regressions with covariates controlled to examine associations between length of membership and various motivations to become a ShareCare member. While the most frequent reason for joining was instrumental where the member would receive service (e.g., care coordination, and home visit), the least motivation for joining was altruism, where the member could help other members (e.g., running errand, and lawn care). More than a 10-year membership was not associated with social or instrumental motivation to join ([OR] 0.50, p = 0.27, [OR] 0.94, p = 0.95) whereas more than a 10-year membership was associated with altruistic motivation to join ([OR] 5.31, p = 0.02). Our findings provide guidance regarding motivating members to join and maintain membership in a consumer-driven organization.
Creative interventions: increasing enrollment, serving students & community, reaffirming gerontology education
Authors: Abushakrah Jan , Faber Mike
Published: December 2020

The session will focus on innovative ways to increase student enrollment, better meet the needs of students and the communities served, and raise awareness of the crucial role of gerontology education in addressing the needs of a rapidly aging society. A panel of Community College and University gerontology professionals will share the innovative ways that they are working to address the three focus areas of this symposium. We will also include opportunities for discussion with participants about their experiences with and ideas for addressing these issues. Community College Interest Group Sponsored Symposium.
Strategies to Overcome Enrollment Barriers
Authors: Cummins Phyllis
Published: December 2020

The importance of postsecondary education for economic vitality and individual opportunity has received increased focus with over 40 states embracing postsecondary attainment goals for their populations in alignment with Lumina Foundation’s goal that 60% of individuals ages 25-64 have a recognized credential by 2025. Credentials that both meet the needs of an aging society and move the country towards achieving attainment goals are widely available at community colleges. Community colleges are not only important sources of training and education for adult learners, they also work closely with employers to meet their workforce needs. However, adult learners face many barriers to college enrollment, including poor pre-enrollment advising and lack of understanding of financial aid options. Examples of successful strategies to facilitate enrollment will be discussed, including navigators who serve as holistic advisors and work with students from pre-enrollment to graduation, and also guide the prospective student through the financial aid process. Part of a symposium sponsored by the Community College Interest Group.
Advocacy Training as a Way to Increase Dementia Literacy Among College Students
Authors: Kuo Tsuann
Published: December 2020

In 2017, WHO passed the Global Action Plan on Dementia and declared the effort to increase dementia literacy around the world. Although dementia is mostly associated with older adults, the prevalent rate of the early on-set and the need to take care of people with dementia has mostly fallen on younger family members. Therefore, the purpose of this paper is to develop an intervention aiming to increase dementia awareness among college students. Through training and action plans, 85 university students from 9 different departments formed 12 groups to develop creatively and to conduct advocacy or public education in various communities. A questionnaire of pre- and post-test was conducted after students had completed their action plans. The response rate was 86% and the results were three-folds: (1) 31% of the students had someone in the family with dementia; (2) 35% of the students indicated that they were familiar with dementia; and (3) the pre- and post-scores on dementia awareness (p<0.001) and dementia attitudes (p<0.001) had significant improvement. This study demonstrated that there is a need to start the effort to increase dementia literacy because one-third of college-age students might be potential caregivers for their family loved ones with dementia. Preparing the students before graduating from college is a good entry because they can become health professionals to take better care of dementia patients and their family members. In conclusion, policy and practice implications will be discussed so the communities can become more dementia friendly in the future.
The Development of a Stakeholder Member Organization to Advocate for Geriatrics Education
Authors: Waters Leland , Perweiler Elyse
Published: December 2020

The National Association of Geriatric Education Centers organization was established in 1990, to promote interdisciplinary geriatric education and to provide a unified voice for Geriatric Education Centers (GECs). In 2005, the GECs voted to form two non-profit organizations due to restrictions related to lobbying activities. An umbrella organization was created, the National Association for Geriatric Education, that includes all geriatric related education programs, and maintain a lobbyist in Washington DC to protect the GECs interests. It was a pivotal time, as we had a year (2006) without federal funding that summarily dismantled the DHHS-HRSA geriatrics programs, including the entire GEC network, the geriatric fellowship program, and Geriatric Academic Career Awards. This resulted in a GEC-wide and national geriatrics movement that succeeded in restoring the geriatrics line item in the President’s budget. Our advocacy efforts not only had the line item restored, but obtained an increase in funding for geriatrics.
An Update on Recent Geriatric Education Advocacy Efforts
Authors: Carrico Catherine , Bennett Katherine
Published: December 2020

The National Association for Geriatric Education (NAGE) has maintained consistent education and advocacy efforts since 2006. In recent years NAGE has implemented formal and grassroots advocacy strategies. At the federal level NAGE has increased collaboration with other aging advocacy organizations and coalitions. At the request of Congress, NAGE leadership and stakeholders have testified before Congress and regularly submit testimony to the House and Senate. NAGE staff maintain strong working relationships with congressional staff. Strategies for effective grassroots education and advocacy have been taught to members, and membership has mobilized to educate elected officials about the essential work of the Geriatric Workforce Enhancement Programs across the country. This presentation will provide a thorough review of NAGE’s advocacy work over the past 4 years.
Why Age Matters to Higher Education: Age-Friendly Tools and Techniques for Culture Change
Authors: Burdick David , Rose Karen , Bradley Dana
Published: December 2020

Momentum is growing for the Age-Friendly University Network as proponents, primarily gerontology educators, have successfully encouraged university presidents to sign nonbinding pledged to become more age-friendly in programs and policies, endorsing 10 Age-Friendly University Principles. While this trend is inspiring, more is needed to fully achieve benefits for universities, students, communities, and older adults. Four presentations discuss innovative ways of deepening university commitment, weaving the principles into the fabric of the university. The first paper describes thematic content analysis from five focus groups with admissions and career services staff at Washington University in St. Louis and the recommendations that emerged for the provision of programs and services for post-traditional students. The second paper describes efforts to utilize community-impact internships and community partnerships to build support for Age-Friendly University initiatives at Central Connecticut State University, particularly in the context of the university’s recent Carnegie Foundation Engaged Campus designation. The third paper describes how Drexel University became Philadelphia’s first Age-Friendly University and current efforts in the Drexel College of Nursing and Heatlh Care Profession’s AgeWell Collaboratory to convene university-wide leadership for an AFU Steering Committee working on four mission-driven efforts to ensure AFU sustainability. The fourth paper describes steps taken by AFU proponents at Western Oregon State University to gain endorsement from university leadership and community, including mapping the 10 AFU Principles to the university’s strategic plan, faculty senate endorsement, and survey/interview results of older community members’ use of the university, which collectively have enhanced deeper and broader campus buy-in of AFU.
Social Roles, Subjective Age, and Gender: Exploring the Links in Later Life
Authors: Kornadt Anna
Published: December 2020

Subjective age (SA) is strongly linked to positive developmental outcomes and successful aging. The social roles people assume are supposed to impact SA, since they incorporate age-graded social experiences and age-stereotypic role expectations. Social roles are also strongly gendered, providing the opportunity to understand gender-specific processes of SA. This study investigates a broad range of social roles and their relation to older men and women’s SA in later life. N = 285 participants aged 50 to 86 years (Mage = 65.04, SD = 8.88) reported on 19 social roles and their SA. Higher commitment to social roles of continued development and engagement was related to a younger subjective age, above and beyond sociodemographic variables, physical and mental health, but only for younger men. Commitment to family roles was related to a younger subjective age only for older men. Implications for the gender-specific understanding of antecedents of SA are discussed.
Optimizing and Compensatory Functions of Social Decision-Making Preferences
Authors: Smith Kelly , Strough JoNell , Parker Andrew , de Bruin Wandi Bruine
Published: December 2020

When making decisions, older people may prefer to work with others to optimize their performance or to compensate for declines in decision-making ability. Using participants from RAND’s American Life Panel (N=1075, Mage = 53.49, we investigated associations among self-reported preferences to make decisions alone and with others, perceived ability to make decisions (compared to age peers and over time), and perceived benefits of aging for decision-making. Older age and perceiving better decision-making abilities relative to peers were associated with greater preferences to make decisions alone and lesser preferences to make decisions with others. Greater preferences for making decisions with others were associated with perceiving improvements in decision-making ability over time and more positive beliefs about aging and decision making. Women were more likely than men to report preferring to make decisions with others. We discuss optimizing and compensatory functions of social preferences for decision making.
Aging in Context: The Past, Present, and Future of Research on Older Adults’ Social Ties
Authors: Marini Christina , Wilson Stephanie , Fiori Katherine
Published: December 2020

This symposium will examine positive and negative aspects of older adults’ relationships and their impacts on health and well-being. We will begin by reviewing the past decade of research on family gerontology. Seidel’s meta-analysis of 995 articles will identify prominent theories and methods, as well as remaining research gaps. The subsequent presentations provide current, cutting-edge research. Marini examines how associations between rumination and sleep unfold within a social context. The findings highlight how spousal support protects older adults’ sleep quality from rumination, whereas support from family and friends is vulnerable to rumination. Using an actor-partner approach, Novak investigates the dynamics of support and control on health among older gay couples. Results reveal the benefits of support and risks of control for partners’ diet quality and depression. Ermer adopts a dyadic perspective to examine links between self-perceptions of aging and inflammation. Results highlight how wives’ inflammation is sensitive to husbands’ aging perceptions, particularly if marital strain is low. Finally, Wilson characterizes age-graded patterns of relationship narratives and their protective effects on emotional well-being. The findings demonstrate how older-adult couples’ narratives are less self- and present-focused, which helps explain protective linkages between age and negative mood. The symposium will conclude with remarks from discussant Katherine Fiori, a GSA Fellow and internationally recognized scholar on older adults’ social networks. She will synthesize the research and put forth her new theory about the importance of peripheral ties in later life to help direct the future of research on older adults within a social context.
Ascertaining Consciousness in Identity Formation: Best Medical Practices in Dementia Care
Authors: Duncan Angel
Published: December 2020

This session identifies common misconceptions about identity for persons living with Alzheimer’s disease and related dementias (ADRD). Going beyond diagnostic brain imaging and neurocognitive testing, case studies and research in creativity from around the United States highlights consciousness of persons living with ADRD. Reviewing and discussing artworks is aimed to set dialogue in the question of where memory deposits emerge when engaged in creativity. Through art therapy techniques, this type of self-expression may provide new avenues in treatment for dementia care. Exploring the arts from those with Mild Cognitive Impairment to late stage Alzheimer’s and other forms of dementia, such as frontotemporal dementia, consciousness seems to remain intact despite neural death. This session aims to discourage poor spending allocations and establishing meaningful care. From clinical research trials to creativity of self-expression, the importance of why the arts and sciences matter are demonstrated as effective modalities that enhance quality of life.
Making Open Science the Default: Creating Lab Practices to Promote Transparency
Authors: Seaman Kendra
Published: December 2020

Many factors disincentivize researchers, particularly junior faculty members, from implementing open science practices. One way to make open science less burdensome is integrate open science methods with existing procedures. I will describe my ongoing efforts to establish open science practices as the default in my laboratory. These strategies include (1) creating and updating a lab manual to set expectations for openness, (2) articulating a standard operating procedure for creating, preregistering, and managing a new project, (3) establishing clear organizational structures for data, code, and data products, and (4) training lab members on the use of these and other open science tools like GitHub. These strategies provide a model for both junior researchers starting a lab and more established researchers who want to build transparency into their research practices. Ultimately, implementing open science methods will improve lab workflows and improves the overall quality of our science.
Which Contextual Features Predict Physiological Stress Reactivity in Midlife to Late Life?
Authors: Kalesnikava Viktoryia
Published: December 2020

Chronic stress creates vulnerability to adverse mental and physical health outcomes in later life. While claims about the negative effects of stress on health are primarily based on self-report, it is unclear how subjective stress measures (chronic or perceived stress) and other environmental or individual characteristics (neighborhood, social and health behaviors) relate to physiological stress response. This study examines which contextual features contribute to differences in physiological stress reactivity among adults at risk of type II diabetes (Richmond Stress and Sugar Study, n=125, aged 40-70). Psycho-social stress was induced via Trier Social Stress Test. Using advanced selection methods, we simultaneously explore multiple predictors and illustrate how different sets of risk and protective factors contribute to normal or abnormal stress reactivity profiles. Preliminary results suggest that the top five important predictors are education, contact with friends, perceived stress, ruminative coping, and sedentary behavior. Implications for research and targeted interventions are discussed.
Age of Migration and Cognitive Life Expectancies Among Older Latinos: Evidence From the Health and Retirement Study
Authors: Garcia Marc
Published: December 2020

This study used data from the Health and Retirement Study (1998-2014) to estimate Sullivan-based life tables of cognitively intact, cognitively impaired/no dementia (CIND), and dementia life expectancies by nativity, age of migration, and sex for older Latinos residing in the United States. Results show foreign-born Latinos, regardless of age of migration or sex, spend a greater number of years after age 50 with CIND compared to U.S.-born Latinos. Furthermore, we document an advantage in total life expectancy and cognitively intact life expectancy among mid-life immigrant men relative to their U.S.-born counterparts. The robust relationship between nativity, age of migration, and cognitive health suggests that the foreign-born may place particularly serious burdens on families and the government. This issue merits special attention in the development of community-based long-term care programs to appropriately target the specific needs of different subgroups of older Latinos who are entering into their last decades of life.
Diabetes, Disability, and Dementia Risk: Results From the HEPESE
Authors: Vasquez Elizabeth , Gadgil Meghana , Zhang Weihu , Angel Jacqueline L
Published: December 2020

The relationship between cognitive function, diabetes and disability among the oldest-old remains largely unexplored, particularly in the Latino population. This study examines dementia risk and diabetes status in a Mexican-origin older adult sample. The data are drawn from eight waves (1993 -2013) of the Hispanic Established Populations for the Epidemiologic Study of the Elderly (HEPESE; N=3,039, mean age at baseline=73.6 (±6.8)). We use multivariable Cox proportional hazards models to predict the relation between diabetes and time to incident dementia (MMSE<24, 1+ IADL), with risk adjustment for age of migration, socioeconomic status, acculturation, and health. Diabetes prevalence at baseline was 27.8 %. Diabetes was associated with a higher risk of developing dementia (HR)=1.22, p<0.001). Foreign-born older adults who migrated at ages 20- 49 had a higher survival probability of being dementia-free (HR=0.84, p=0.001). Our results further highlight the importance of evaluating differences in the cognitive outcomes of Mexican origin older adults.
Cognitive Enrichment Through Emotion Regulation: A Model of Successful Cognitive Aging
Authors: Nelson Niccole , Bergeman Cindy , Rose Nathan
Published: December 2020

Cognitive Enrichment Through Emotion Regulation (CENTER) is a theoretical framework of development that emphasizes the role of individuals finding their proverbial “centers” in shaping their cognitive aging trajectories. Within the CENTER framework, dynamic interactions between emotion regulatory processes that occur in real time (i.e., micro-level time), and global psychological well-being that develops over several years (i.e., macro-level time), aid in the optimization of cognitive aging. Indeed, by successfully regulating emotional reactions to stress in real time, which is supported by global psychological well-being, individuals will minimize their accumulation of allostatic load across the lifespan. Such minimization of allostatic load is key to optimizing cognitive aging through emotion regulation under the CENTER framework. CENTER will be motivated by fusing research on cognitive aging, emotion regulation, stress-and-coping, allostatic load, and psychological well-being.
A Follow-Up Content Analysis of Aging Network Conference Proceedings: Aligning Research and Practice
Authors: Becker Todd , Moone Rajean , Davitt Joan
Published: December 2020

The federal government established a collective of agencies tasked with providing support and services to older adults and their caregivers known as the Aging Network. In order to effectively provide these services, the Aging Network must identify and disseminate current best practices. To this end, the Aging Network hosts three annual conferences: the National Association of Area Agencies on Aging (n4a), the Alliance of Information and Referral Systems (AIRS), and the National Association of States United for Aging and Disabilities (NASUAD). This content analysis of key themes emerging from Aging Network conference abstracts (N = 2,392) from 2009 to 2019 expanded upon a similar study analyzing the preceding decade of conference materials (Moone & Cagle, 2011). Reflexivity, analyst triangulation, and confirmability and dependability audits were used to enhance trustworthiness. The most common themes included planning and program development (n = 260), general policy (n = 166), and long-term services and supports system reform (n = 162). Although some themes, such as consumer-directed support (n = 122) and advocacy (n = 111) were consistent with the original article (Moone & Cagle, 2011), others, such as managed care (n = 124) and financial exploitation (n = 50), demonstrated a societal shift in older adult supports and services. These results offer an additional effort towards disseminating current best practices and emerging issues to advance translation between research and practice. Researchers can use these results to better align their research agendas with the needs of the Aging Network for evidence-based interventions.
Successful Adaptation in the Context of Care Environments: Promise and Challenge From a Career in Geropsychology
Authors: Meeks Suzanne
Published: December 2020

My first clinical exposure to older adults was in a psychiatric hospital, to people with life-long severe mental illnesses; I was drawn to their perseverance. The older people we see clinically interact with care environments that may or may not effectively use patients’ personal histories. I have studied the affective experiences of older people in care environments--the mental health system and long-term care--to improve mental health care and well-being. Solutions seem obvious, and difficult. Theory and abundant empirical research tell us that environments can support adaptation through nurturing strengths, offering compensatory tools, and acknowledging losses. My work on depression is a simple example of how this can work in psychotherapy. Yet implementing simple solutions means overcoming barriers of training, resources, and institutional inertia. The promise is understanding age as the dynamic representation of a life span; the challenge is making this understanding work for older people.
Relationship Between Sleep and Function in Older Adults With Mild Cognitive Impairment
Authors: McPhillips Miranda , Li Junxin , Petrovsky Darina , Hodgson Nancy
Published: December 2020

Our objective was to examine relationships between sleep characteristics and function in community-dwelling older adults with cognitive impairment. Sleep measures included actigraphy (total sleep time, wake after sleep onset, efficiency, awakenings), Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale. Promis Physical Function Short Form and Promis Item Bank Social were used to measure physical function and social activity. We used Spearman’s correlation and multivariate linear regression. In bivariate analyses, physical function was significantly related to daytime sleepiness, wake after sleep onset and awakenings; social activity was significantly related to sleep quality, daytime sleepiness, total sleep time, wake after sleep onset and number of awakenings. Controlling for cognition and age, sleep quality was independently associated with physical function (β= -0.80; p= 0.002). Relationships between sleep and social activity did not remain significant in multivariate analyses. Preliminary results suggest subjective sleep quality is most related to physical function.
Influence of Neighborhood Factors on Sleep in Home Dwelling Multiethnic Older Adults With Dementia
Authors: Perez Adriana , Boateng Augestine , Talwar Sonia , Hodgson Nancy
Published: December 2020

Current scientific paradigms inadequately capture complex clinical, behavioral, and sociocultural factors impacting health and well-being in persons living with dementia (PLWD). The purpose of this study was to identify differences in individual and neighborhood-level factors contributing to sleep among multi-ethnic PLWD. Wrist actigraphy measured objective sleep characteristics. Subjective sleep was assessed using the PROMIS sleep measure. GIS mapping analyzed neighborhood-level factors (walkability, green space, crime index, density). Walkability was significantly associated with subjective sleep (p.006) controlling for age and dementia stage. Number of night awakenings was significantly associated with density, crime and housing value (p<.001). PLWD in neighborhoods with higher population density, annual crime, low median home and low walkability would benefit from interventions targeting unsupportive neighborhood environments to improve sleep.
Suicide Prevention in Older Adults: Evidence-Based Approaches for Care
Authors: Li Luming
Published: December 2020

Suicide in older adults is a major public health concern. Data of suicide rates of older adults from the Centers for Disease Control suggests that suicide is more frequent in older adults and warrants further examination of treatment and public health prevention approaches. Risk factors for suicide in the elderly include functional disability, multiple chronic physical conditions, and social isolation. Several advances have been made in healthcare policy to address practical, evidence-based approaches to preventing suicide and treating behavioral health conditions such as depression, including collaborative care and the Zero Suicide model. This symposium will focus on reviewing the epidemiology and evidence-based approaches for suicide prevention and mental health treatment for older adults. In this presentation, the presenters describe the current trends in suicide rate in older adults in the United States, indicate risk factors (both modifiable and non-modifiable), and present about the collaborative care and Zero Suicide models. Speakers will emphasize the role of these two models in suicide prevention and population-based behavioral healthcare. The presenters will also highlight examples of policy changes and provide recommendations for regulators and hospital systems to adopt these evidence-based models of care for caring for older adults at risk for suicide.
Evidence-Based Approaches to Suicide in Older Adults—Zero Suicide
Authors: Li Luming
Published: December 2020

This individual symposium abstract will focus on evidence-based approaches to suicide in older adults, with particular focus on the Zero Suicide Model. Zero Suicide Model is a framework that applies seven essential elements of suicide care (Lead, Train, Identify, Engage, Treat, Transition, Improve). The model provides a systematic approach for quality improvement for suicide prevention and offers implementation strategies for “real-world” clinical settings using the Assess, Intervene, and Monitor for Suicide Prevention (AIM-SP) program for suicide-safer care. The authors will describe implementation of Zero Suicide in general healthcare settings that care for older adults, including health systems and outpatient clinics. The authors will also describe the value of Zero Suicide other settings such as long-term care centers, where older adults are cared for. In addition, the authors will describe future directions for research in the Zero Suicide Model and additional opportunities in public policy for suicide prevention.
Rising Above the Flood: Emergency Management and Gerontological Social Work
Authors: Beltran Susanny , Luigi Paola , Kusmaul Nancy
Published: December 2020

Older adults, particularly those from low-income communities, are disproportionately negatively affected by natural disasters. As the older adult population grows and natural disasters increase in frequency and intensity, social workers must consider their role in supporting the needs and safety of this population. Social workers practice in varied roles including policy advocate, service broker, and educator, all of which are crucial in disaster management. This systematic review summarizes the literature on the social work profession’s involvement with emergency management with older adults, and identifies gaps. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, authors searched AgeLine, CINAHL Complete, MEDLINE, PsycINFO, and Social Work Abstracts for peer-reviewed publications between January 1, 2009 and March 1, 2020. Examples of the terms searched include social work*, respon*, prepar*, disaster, crisis, emergency, geriatrics and older adults. The initial searches yielded 298 publications. After removing duplicates and screening articles for relevance based on titles and abstracts, 21 publications were retained for full review. A total of 11 articles met inclusion criteria. The body of literature identified was small. The majority of the publications constituted conceptual papers, textbook reviews, and letters to editors requesting greater emphasis on emergency management. Only three empirical studies were identified. Broadly, the publications discussed: (1) policies and resources; (2) needs; (3) capacity across practice settings; and (4) interventions. Findings reveal an underdeveloped area of social work practice, and highlight opportunities for researchers and practitioners to define gerontological social workers’ role in emergency management and detail best practice guidelines.
Polysomnographic Indicators of Restorative Sleep and Body Mass Trajectories in the Wisconsin Sleep Cohort Study
Authors: Reither Eric , Barnet Jodi , Palta Mari , Liu Yin , Hagen Erika , Peppard Paul
Published: December 2020

Previous research suggests that reductions in restorative sleep—i.e., slow-wave (N3) and rapid-eye movement (REM) sleep—are associated with weight gain and obesity in mid-to-late life. This study extends prior work by examining how within-person changes and between-person differences in restorative sleep are associated with body mass trajectories among participants in the Wisconsin Sleep Cohort Study (WSCS). We used data from 4,862 polysomnographic sleep studies and physical exams collected from 1,187 WSCS participants over an average follow-up duration of 15 years. For both men and women, we found that (1) below-average N3 and REM sleep is associated with above-average BMI, and (2) within-person loss of N3 and REM sleep is associated with larger gains in BMI, particularly between ages 30-50. Our findings highlight the importance of restorative sleep in mid-to-late life, suggesting that future clinical treatments and public health policies will benefit from heightened attention to sleep quality.
Biopsychosocial Determinants of Cognitive Health in Later Life: The Harmonised Cognitive Assessment Protocol
Authors: Cadar Dorina , Abell Jessica , Brayne Carol , Batty G David , Llewellyn David , Steptoe Andrew
Published: December 2020

Despite strong evidence for a socioeconomic gradient in many health outcomes, including cognition, substantial gaps remain in understanding these disparities. We investigated the biopsychosocial mechanisms underlying the associations between socioeconomic status (SES) and later-life cognitive health using the Harmonised Cognitive Assessment Protocol (HCAP), a sub-study of the English Longitudinal Study of Ageing (ELSA) which comprises of 1,273 ELSA participants aged 65+. A latent g factor was derived using 12 tests covering a broad range of cognitive domains (memory, language, executive function, and psychomotor speed). We estimated direct and indirect pathways between SES indicators, Apolipoprotein E, inflammatory markers, chronic conditions, and depression. We found that higher education was associated with better cognition, while wealth was not. Increased depressive symptoms were linked with lower cognition, while prior inflammation was indirectly associated with cognition via depressive symptoms and chronic conditions, supporting evidence for a psychosocial role in the context of a socioeconomic gradient.
The Role of Health, Social Network, and Race in Advance Care Planning Among Medicare Beneficiaries
Authors: Kwak Jung , Moon Heehyul , Roh Soonhee
Published: December 2020

Advance care planning (ACP) is linked with high-quality end-of-life outcomes. However, ACP engagement level among older adults varies significantly by demographic, social, and health characteristics. In this study, we sought to identify characteristics associated with informal and formal ACP, in order to inform development of targeted education and outreach efforts that are tailored to diverse groups of older adults. The data came from a nationally representative study of Medicare beneficiaries living in communities, the National Health and Aging Trends Study (Round 8, N= 5,547). Multivariable logistic regressions were conducted to identify individual characteristics (i.e., race/ethnicity, age, gender, income, functional disability, cognitive function, perceived health, and numbers of people in social networks) associated with ACP engagement. Rates of informal ACP (talking to someone), and formal ACP, completing a healthcare power of attorney (HPOA) and a living will (LW), were 56%, 60.5%, and 56% accordingly. Logistic regression showed that individuals who were married or had a larger social network, and had higher functional impairment and health needs were significantly more likely to engage in both informal and formal ACP. However, individuals with memory problems (only informal ACP) and African Americans and Hispanics were significantly less likely to engage in both informal and formal ACP. African Americans without dementia were more likely to have completed HPOA compared with Whites. Findings suggest an important role of social network, and functional and cognitive health in ACP with implications for developing targeted outreach efforts in faith-based or social group settings, and healthcare settings.
Caregiver-Provider Communication About Pain in Persons With Dementia
Authors: Riffin Catherine , Lee Sylvia , Reid M Cary , Herr Keela , Pillemer Karl
Published: December 2020

Pain in older persons with dementia (PWD) is severely under-detected and under-managed. Family caregivers can play an important role in addressing these disparities by acquiring the requisite skills to communicate PWD’s pain symptoms and behaviors to health care providers, but little is known about how caregivers of dementia patients and their providers approach such pain-related discussions. We employed qualitative methods to explore the perspectives of family caregivers of PWD (n=18) and health care providers (geriatricians, general internists, neurologists, emergency room physicians) involved in PWD’s treatment (n=16) regarding pain communication. We specifically focused on participants’: 1) priorities and expectations for communicating about pain and dementia, 2) challenges to communicating about pain and dementia, and 3) strategies and recommendations for optimizing communication about pain and dementia. Analyses revealed that caregivers and health care providers expected to receive accurate, detailed information from one another, but uncertainty in both groups around differentiating pain behaviors from dementia symptoms acted as a barrier to effective information exchange. Additional challenges to productive pain-related discussions were identified by caregivers, including provider fatalism and lack of interpersonal skills, and by providers, including patient-caregiver disagreement about pain symptoms and unreliable caregiver reporting. Participants endorsed using practical approaches, such as pain scales and logs, as well as rapport-building strategies, such as affirmation of caregivers’ input, to facilitate collaborative discussions.
Emotional Experiences of Dementia Caregiving Transitions
Authors: Ihara Emily , Tompkins Catherine , Kennedy William , Vance-Cheng Rhea , Kwan Bianca , Barrett Kendall
Published: December 2020

Research indicates that family caregivers of individuals living with dementia are at risk for high levels of stress, depression, physical health declines, and illness. The health and well-being of family caregivers is critically important to a long-term care system that is dependent on them to continue their caregiving role. In-depth individual and focus group interviews of 16 dementia caregivers were conducted to explore the emotional experiences of caregiving stress during transitions of individuals living with dementia to a higher level of care. Data were transcribed verbatim, checked for accuracy, and analyzed by at least two members of the research team. Line-by-line coding, memo writing, and constant comparative analyses were conducted until redundancy, when no new themes were discovered. Caregivers described various levels of feeling overwhelmed and symptom progression leading to the move to a nursing facility. Social isolation featured prominently, with caregivers describing a gradual erosion of their social network and socializing opportunities because of their caregiving responsibilities and the care recipient’s deteriorating symptoms. Caregivers described feeling isolated and stigmatized. One caregiver said, “…you’re being less invited, you’re being less involved. People don’t know how to deal with you…I don’t know if they become the pariah or I become the pariah.” At the same time, maintaining social connections and having help with caregiving featured prominently in the coping mechanisms described. The health of caregivers is equally as important as the person living with dementia, and programs, interventions, and resources should be a priority for supporting families through transitions.
Healthcare Experiences of LGBTQ+ Elders: Two Focus Groups
Authors: Foley Kierra , Hodgson Nancy , Bauermeister José
Published: December 2020

LGBTQ+ elders experience significantly higher rates of disability, poor general health, and behavioral health problems than heterosexual and cisgender older adults; additionally, LGBTQ+ elders are less likely to seek medical attention or have a primary care provider than other older adults. In previous qualitative studies, LGBTQ+ elders have reported difficulties navigating healthcare systems due to provider incompetence in treating this population, financial barriers, systemic homophobia/transphobia, and high disease burdens. However, few qualitative studies have been conducted with this population from a nursing perspective, and little is known about the role of nurses in the health and wellness of LGBTQ+ elders. Nurses are uniquely positioned to help address both the physiological and psychosocial needs of older LGBTQ+ adults, and garnering an understanding of these needs directly from this community can help better direct future research. Accordingly, two focus groups were conducted with LGBTQ+ elders at different queer community centers in Philadelphia by a nurse scientist. This community engaged research aims to learn more about how nurses can serve this population through identifying their priorities. Through thematic analysis, it was found that LGBTQ+ elders reported being concerned about housing access, discrimination from healthcare providers, and challenges in accessing mental health care. Additionally, the researchers’ hypotheses were triangulated with the participants’ responses to demonstrate the utility of continued community engagement in addressing specific population needs.
Age Matters: Building Blocks Needed to Inform Nurse Staffing Hours Requirements in Residential Care for Older Adults
Authors: Wu Heng , Kelly Christopher , Holley Lyn
Published: December 2020

This study addresses the need for more complete information about the impact of nurse staffing hours (NSH) on nursing home quality of care. We used national data to examine the relationship between three types (Registered Nurse, Licensed Practical Nurse, and Nurse Aide) of hours, and long-stay quality of care measures over time, taking into account the possible confounding influence of regional differences. Data analyzed were from U.S. Nursing Home Compare datasets which reflect quarterly reports, July 1, 2018 - June 30, 2019 (14,768 facilities). The hours for each staff type in each facility were compared with the facility’s four-quarter quality average scores for each of the 12 measures. Results showed only one strong and statistically significant relationship (Beta= .548; p< .001) between Nurse Aide hours and the quality measure used in data sets to exemplify facilities that serve “lower-risk” residents. Analyzes using multiple R (.517) indicate that the linear combination of the three NSH types strongly and significantly (p< .001) predicted the four-quarter average scores and explained 27% of the variance in the scores. Holding the other two NSH types constant, the scores for that measure increased by 63 for each additional increase in the Nurse Aide nurse staffing hours per resident per day. There was no multicollinearity among the three types of staffing hours. This research adds information to the foundation needed for future research about process indicators to assess their efficacy as measures of actual quality of care, and will be submitted as a Technical Note to journals.
Longitudinal Changes in Functioning and Support After Initial Survey for Individuals With Severe Mental Illness
Authors: Finkel Deborah , Bulöw Per , Bulöw Pia , Torgé Cristina Joy , Wilińska Monika , Jegermalm Magnus , Bravell Marie Ernsth
Published: December 2020

After the Swedish Mental Health Care reform was enacted in 1995, many individuals with severe mental illness were released from long-term care institutions. As a result, they had new living and support situations. Following 236 individuals over time supported investigation of the effectiveness of social support services in caring for these individuals. Surveys were conducted in 1996, 2001, 2006, and 2011 and annual data were available from national registries. Primary diagnosis was psychosis (over 60%); depression was the second highest diagnosis (20%). Mean age in 1996 was 60.8 (range = 45 to 86) and 47% of the sample were women. Only 36% of the group had more than nine-year compulsory education. Compared with other groups in the larger study, this group was more likely to have never married (66%) and 18% had accumulated more than 10 years in an institution over their lifetime (mean = 6 years). Even after correcting for age, functioning as measured by the Global Assessment of Functioning and a 9-item measure assessing hygiene, economy, food preparation, etc. declined over time. As a result, although 49% were living independently (with or without support) at the first wave, only 34% were doing so at the last wave; by 2011 66% were living in a special home or institution. Examination of longitudinal trends in income indicated that disposable income and total income from all sources was constant between 1990 and 1995 but increased significantly over time after reform was enacted. Overall, results suggest mixed success of social support services.