bluuebunny/crossref_metadata_2025 huggingface dataset:
INTERDISCIPLINARY DEMENTIA CARE WORKFORCE TRAINING AND QI IMPLEMENTATION: LEARNINGS FROM 25 HOSPICES
Authors: Brody Abraham , Gaugler Joseph
Published: December 2022

To build and sustain a dementia-capable clinical workforce and care delivery organizations, it is essential to systematically disseminate evidence-based, interdisciplinary dementia care programs. The outbreak of COVID-19, clinical staff shortages, and competing priorities experienced by healthcare organizations including staff vaccination and other regulatory requirements, pose significant challenges to the continuation of agency-wide, interdisciplinary dementia care workforce training and quality improvement. In this symposium, we present our experience Implementing Aliviado Dementia Care, a comprehensive, interdisciplinary dementia care workforce training and quality improvement program amid COVID-19 across 25 U.S. hospice agencies, as part of an embedded pragmatic clinical trial. Aliviado Dementia Care consists of interdisciplinary dementia care workforce training, treatment algorithms, assessments, care plans, caregiver education, and clinical workflow changes. The symposium begins with a discussion of the training, knowledge improvement, turnover, and replenishing strategies of hospice champions during COVID-19. We then discuss how we tailored dementia care training for each of the skilled hospice disciplines (i.e., medicine, nursing, social work, spiritual care) and provide two case studies elucidating how additional tailoring was performed to fit local agency culture and needs during COVID-19. Furthermore, we discuss how we developed and iterated training for home health/hospice aides, the usability and training results, and specific considerations for training aides during COVID-19. Lastly, we conclude the symposium with a discussion of salient strategies and technologies that help sustain our nationwide implementation despite the ongoing COVID-19. Throughout each of these abstracts we also discuss how COVID-19 affected, and created differential implementation of components of the intervention.
THIS TOO SHALL PASS: WEATHERING THE STORM AS OLDER FEMALE FAMILY CAREGIVERS FOR THOSE WITH AD/ADRD DURING COVID-19
Authors: Harrington Candace , Witt Dean
Published: December 2022

Background

Older female caregivers of persons with AD/ADRD are under-represented, under-reported, and understudied. Purpose: This qualitative study aimed to understand how COVID-19 affects older female caregivers' lived experience, ongoing capacity, and willingness to provide care for their loved one(s) with AD/ADRD. Specific Aims: Aim 1: Explicate older female caregivers' lived experience in the context of caring for family members with AD/ADRD during COVID-19. Aim 2: Elucidate how COVID-19 affected older female caregivers' relationships with their family members with AD/ADRD. Method: 172 units of meaning were extracted from 327 pages of transcripts and 972 minutes of interviews with urban (n = 10) and rural caregivers (n = 10). Thematic analysis was then conducted.

Results

Respondents, recruited with purposive and snowball sampling, saw hastened AD/ADRD progression in their family member(s) attributed to social isolation. For many, long-term placement was not an option for financial reasons. Respondents providing full-time caregiving depended heavily on their care recipients' financial resources for basic living expenses, reporting placement in long-term care would leave them at risk of homelessness. Black caregivers expressed an "unspoken" cultural taboo about placement. For all, caregiver disability was the only impetus for placement. Respondents in rural communities more often reported faith-based gratefulness, moments of joy, relational harmony resulting from "being stuck together", and less availability of resources allowing virtual support. Urban caregivers reported more social isolation, less awareness of resources, more intentional family member distancing, and higher pandemic-related distress. Implications: These findings have broad economic, social, policy, research, and practice implications.
APPLICATION OF QUALITATIVE METHODS IN THE DEVELOPMENT OF AN INFORMANT-REPORTED MEASURE OF LUCIDITY
Authors: Ramirez Mildred , Teresi Jeanne , Ellis Julie , Gonzalez-Lopez Paloma , Silver Stephanie , Bhatti Usama , Devanand Davangere , Luchsinger Jose
Published: December 2022

The aim was a qualitative evaluation of a lucidity measure for front-line staff or family informants. A sequential approach to item development and evaluation was followed: refinement of the operationalization of the construct; review of seminal items, modification, and purification; confirmation of the feasibility of reporting methodology. Modified focus groups were conducted with 20 staff and 10 family members who participated using a web-based survey. Sample themes included: reaction when hearing the term; words that come to mind; description of and first reaction to referenced or observed “lucidity” events. Data were extracted from Qualtrics for analysis using NVivo. Semi-structured cognitive interviews were conducted with10 health professionals working with older adults with cognitive impairment. An external advisory board reviewed the clarity, breadth, and scope of the conceptual definition and item content. Suggestions for item modification derived from the focus groups and cognitive interviews resulted in the final lucidity measure.
POSITIVE SELF-PERCEPTIONS OF AGING AS PREDICTORS OF COVID-RELATED PREVENTIVE BEHAVIOR AND RESILIENCE
Authors: Giasson Hannah , Chopik William , Carrillo Alejandro
Published: December 2022

Individuals have faced extraordinary challenges throughout the COVID-19 pandemic. Psychosocial strengths may promote individuals’ resilience during this time. Positive self-perceptions of aging (SPA) have been found to predict a variety of health and well-being indicators. We examined SPA as a predictor of COVID-19-related behavior, adaptation, and resilience in a sample of 3,620 adults (Mage=65.88; 61.1% women; 65.4% white) from the 2016 and 2020 waves of the Health and Retirement Study. Linear regression results revealed that more positive SPA in 2016 was associated with more preventative health behavior (β=.03, p=.04), a higher likelihood of staying at home (β=.07, p<.001), less worry (β=-.27, p<.001), less stress (β=-.24, p<.001), less loneliness (β=-.27, p<.001), and greater resilience (β=.20, p<.001) during the first year of the pandemic (2020). Associations held after controlling for demographic covariates. Findings support SPA theories, suggesting linkages between SPA and adaptive behaviors and outcomes in the face of external challenges.
THE FAMILY-CENTERED FUNCTION-FOCUSED CARE INTERVENTION: IMPLEMENTATION AND MEASUREMENT CONSIDERATIONS
Authors: Boltz Marie , Flanagan Jane
Published: December 2022

Family care partners can play an important role in promoting the functional recovery of hospitalized older adults living with dementia. Family-centered function-focused care (Fam-FFC) aims to create an “enabling” milieu for the person with dementia through, staff education, unit-based champions, environmental and policy assessment/modification, and individualized goal setting. In this patient/family-centered care approach, nurses purposefully engage family care partners in the assessment, decision-making, care delivery and evaluation of function-focused care during hospitalization and the 60-day post-acute period. Staff are provided with techniques to support positive interaction with patients and families and respect the role of care partners as advocates. The goal is to promote functional recovery and well-being in the patient, and prevent unnecessary long-term care admissions, while improving care partners’ preparation for caregiving and well-being. Fam-FFC was developed with the input of patients, families, nurses, and rehab therapists. This symposium focuses on key factors associated with the implementation of Fam-FFC, and relevant measures. After an introductory overview of Fam-FFC, the nature of staff/patient interaction during hospitalization, including the influence of gender, will be discussed in the first presentation. Two presentations will address the planning for transition to the post- acute setting, including the intrinsic factors associated with preparation for caregiving, in contrast to the decision to seek long-term care. The final presentation will describe the approach to promoting fidelity to the Fam-FFC intervention, within the context imposed by COVID-19 restrictions. Our symposium will conclude with a discussion of future direction for policy, practice, and research.
ADDRESSING THE MENTAL HEALTH NEEDS OF HOMEBOUND OLDER ADULTS IN AGING SERVICE SETTINGS
Authors: Choi Namkee
Published: December 2022

Despite significant and urgent mental health needs among low-income homebound older adults, the existing mental health service systems’ reach for these older adults is almost nonexistent. Given the current and projected geriatric mental health workforce shortages, innovative approaches are needed to better serve these underserved older adults. This presentation will focus on a series of randomized clinical trials that tested acceptable and feasible mental health service delivery models for homebound older adults who are served by aging service network agencies that provide hot meals and case management. Findings from the real-world effectiveness trials of tele-delivered behavioral activation treatment for depression and loneliness by bachelor’s-level lay counselors who are embedded in aging service agencies will be shared. Ways to promote a wider adoption of scalable and sustainable mental health service delivery models for homebound older adults will be discussed.
HUMAN AGING INTERVENTIONS
Authors: Parker Daniel
Published: December 2022

Biological aging is the greatest risk factor for multiple non-communicable diseases affecting multiple organ systems. Evidence from animal studies suggest that the rate of biological aging is modifiable and that slowing the rate of biological aging may decrease the incidence of age-related morbidity and mortality. Based on these findings, several approaches are currently being studied to slow the rate of biological aging in humans. This symposium features internationally renowned aging research scientists whose work focuses on clinical interventions to modify biological aging in humans. We will hear from Rajagopal Sekhar from the Baylor College of Medicine who will present his research on “Improving oxidative stress, mitochondrial dysfunction, inflammaging, aging hallmarks and muscle strength in older adults: the novel role of GlyNAC and the 'Power of 3'”; Jamie Justice from the Wake Forest School of Medicine will present her work on “Response to dietary restriction interventions in older adults: biomarkers of cellular senescence and biological aging”; Reem Waziry from the Columbia University Mailman School of Public Health will present her work “Does Caloric Restriction Slow the Process of Biological Aging in Non-Obese Healthy Adults? Evidence from the CALERIE™ Trial”; and Daniel Parker from the Duke University School of Medicine will present his work “Does APOE genotype moderate the impact of diet modification and exercise training on age-related outcomes?”. Attendees will learn about recent advances in interventions targeting human aging.
OLDER ADULTS' PERCEPTIONS OF CANNABIS AND OPIOIDS USE
Authors: Bobitt Julie
Published: December 2022

Older adults in the U.S. are increasingly using cannabis as a method to manage pain. Some studies have linked increased cannabis use with an increase in prescription opioid use while others have suggested that older adults may be using cannabis as a way reduce/replace opioids. From April 2018 - January 2019 we conducted 12 focus groups throughout Illinois with 82 cannabis users aged 60+. To examine the relationship between cannabis and opioid use we used an inductive thematic analysis to code and theme the focus group transcripts. We found three themes 1) medical culture around opioids influences cannabis use; 2) past negative experiences with opioids influences cannabis use, and 3) aversion to ever trying opioids out of fear of an anticipated harm that may be brought about by opioid use such as overdose. In this session we present these findings and discuss cannabis use relative to opioids by older adults.
MEDICAL MARIJUANA LAWS AND OUT OF POCKET EXPENSES AT END OF LIFE
Authors: Bhagianadh Divya , Arora Kanika
Published: December 2022

Resource intensive and costly End-of-Life (EOL) care is a significant healthcare policy concern in the U.S. In addition to the high Medicare spending, out of pocket (OOP) expenses are also high during EOL adding considerable stress during terminal days. The Medical Marijuana Laws (MMLs) is a significant policy in this context. Previous studies have shown increased use of MM among older adults, better pain management, influence on site of death as well as evidence of reduction in Medicare expenditure on drugs in states with MMLs. In this study, we explore the association between MML and OOP expenses during EOL using data from the Health and Retirement Study exit and core interviews from 1995 to 2018. We use a difference in differences (DD) and event study models to examine this question. We find evidence of increased OOP expenses on drugs and doctor visits with the effects concentrated among the early implementing states, among decedents who are White and among cancer patients. Despite its growing acceptance in palliative medicine, affordability of MM could pose a significant hurdle to terminally ill patients especially since MM and related costs are not covered by insurance.
A DUTY TO CARE: MALE PERSPECTIVES ON THE CAREGIVER ROLE FOR PERSONS WITH ALZHEIMER’S OR RELATED DEMENTIA
Authors: Bueno Michael , Chase Jo-Ana
Published: December 2022

The population of family caregivers (FCGs) of persons with Alzheimer's Disease and related Dementias (ADRD) is growing, as is the proportion of males taking on this traditionally female role. Most caregiving research has mainly focused on females. Although female caregivers have reported more negative outcomes, men still report significant levels of burden. With the aging population and increased need for caregivers, there is a gap in knowledge exploring the male caregiving experience. Understanding male caregiving experiences can inform clinicians on developing future strategies to tailor support for this underrepresented group. The purpose of this qualitative descriptive study was to explore the experiences of male FCGs of people with ADRD. The Caregiver Identity Theory (CIT) was used to guide the study exploring participants’ perception of self-identity within their caregiving relationship and self-identity as a male. Eleven male caregivers, recruited through social media and community resources, were interviewed by telephone or Zoom. Interviews were recorded, transcribed, and analyzed using thematic analysis. Four major themes emerged highlighting males’ struggles with the unfamiliar caregiving role and changing identity; their acknowledgement of personal growth and discovery through caregiving, challenges in finding the “right” kind of support, and perceived reshaping of masculinity through the caregiving role. Male caregivers express unique experiences as FCGs suggesting future research is needed to explain gender differences in caregiving and identify additional factors that influence male caregivers’ experiences. Furthermore, findings indicate clinicians should tailor support strategies for male FCGs’ as they fulfill this potentially unfamiliar role.
DISCRIMINATION TRAJECTORIES, RESILIENCE CHARACTERISTICS, AND MULTIMORBIDITY AMONG MIDDLE-AGED AND OLDER BLACKS
Authors: White Kellee , Robinson-Ector Kaitlynn , Wei Melissa , Ma Tianzhou , Bell Bethany , Quinones Ana
Published: December 2022

Discrimination is a chronic psychosocial stressor that can accelerate aging. While strong empirical evidence demonstrating linkages between discrimination and adverse health outcomes, the role of discrimination in multimorbidity burden has received less attention. Prior research on discrimination and health largely uses a single, static, cross-sectional measure to predict health at a second time point, that may mask significant heterogeneity in the dynamic nature of repeated exposures to discrimination. Characterizing longitudinal patterns of discrimination may be a better predictor of health risk and provide insight on resilience processes that influence aging-related outcomes such as multimorbidity. However, this relationship is not well understood. We investigate the association between discrimination trajectories, resilience characteristics, and multimorbidity burden among a sample of middle-aged and older black adults. Specifying discrimination trajectories and resilience characteristics that differentially predict multimorbidity burden may inform the design of culturally-relevant interventions to delay the development and progression of multimorbidity.
ALASKA NATIVES AND GENERATIVITY: BENEFITS AND CHALLENGES OF GENERATIVITY IN A RAPIDLY CHANGING ARCTIC
Authors: Lewis Jordan
Published: December 2022

Generativity is not often associated with successful aging, but aligns with the cultural values and practices of Alaska Native Elders. This study explored the concept of generativity, why elders share their knowledge, how it makes them feel, and what they want everyone to know. This study interviewed 108 Alaska Native Elders across Alaska, ages ranging from 48 - 93 years old, and willing to share their knowledge of successful aging. Employing content analysis, we explored themes related to each research question on generativity. Elders felt motivated, happy, and good about sharing their knowledge, but only when others listened. Their motivations were to teach the real history of Alaska, leave a community or family legacy, and help youth engage in healthy behaviors. Knowing cultural values, your history, practical skills, and how to listen to your Elders were things they want to share with youth and fellow Elders. Participants also shared the challenges to being generative, including technology, lack of interest by others, and age differences in experiences and knowledge sought. We learned the importance of addressing the generative mismatch between generations and to improve quality of life for Elders and help youth age successfully, we need to create culturally meaningful activities to bring all generations together. Programs to teach youth to be healthy and develop a healthy identity through cultural practices and values, and provide Elders outlets to share and improve their quality of life will ensure cultural survival and foster and strengthen the cultural practice of Indigenous cultural generativity.
NEIGHBORHOOD QUALITY AS IT RELATES TO HEALTH AND WELL-BEING IN OLDER AFRICAN AMERICANS
Authors: Wright Regina , Gamaldo Alyssa , Lee Anna
Published: December 2022

With the burgeoning older adult population, there will be an increased demand for neighborhood environments that are conducive to successful aging. For example, the need for affordable and usable housing developments for older adults that provide greater opportunities for social engagement, social services, and convenience to neighborhood resources (e.g., grocery stores, healthcare) will continue to rise. Several initiatives have sought to develop age-friendly neighborhoods, which focused on improving accessibility and affordability of community resources. However, limited effort has focused on the health and cognitive effects of neighborhood-level socioeconomic disadvantage, with respect to neighborhood income, education, employment, and housing quality. This symposium will include presentations from two studies that explored how neighborhood disadvantage (measured by the Area Deprivation Index) relates to health and cognition. The objectives of the proposed symposium are the following: (1) discuss how neighborhood disadvantage relates to subjective and objective measures of physical health; and (2) discuss how neighborhood disadvantage relates to cognitive functioning. Allan and colleagues explored the association between neighborhood disadvantage as it relates to changes in self-reported health and objective measures (i.e., blood pressure) of health among older Black adults. Wright and colleagues explored the association between neighborhood disadvantage and measures of subclinical cardiovascular disease in older Black and White adults. Aiken-Morgan and colleagues examined associations between neighborhood disadvantage and cognitive functioning among Black older adults. Lastly, McCain and colleagues explored associations between neighborhood disadvantage and mobility among Black older adults.
DYADIC LONELINESS AND COGNITIVE HEALTH AMONG OLDER MARRIED COUPLES: LONGITUDINAL EVIDENCE FROM THE HRS
Authors: Stokes Jeffrey , Prasad Anyah , Barooah Adrita
Published: December 2022

Loneliness is associated with numerous poor health outcomes, including mortality. Additionally, loneliness is not merely an isolated individual’s experience; rather, loneliness occurs regularly even among the married, and can affect both spouses’ health. We analyze 3-wave dyadic data from the Health and Retirement Study (2008-2018; N = 7,907 dyads) to determine (a) whether loneliness is associated with participants’ own and/or their partner’s verbal fluency and episodic memory over a nearly decade-long period, and (b) whether these measures of cognitive health predict older spouses’ own or their partner’s loneliness over the same period. Results indicated that (1) loneliness, episodic memory, and verbal fluency were all “contagious” within couples, such that baseline levels of each predicted participants’ own and their partner’s values at follow-up; (2) participants’ own loneliness was associated with poorer verbal fluency and episodic memory at follow-up; and (3) neither participants’ own nor their partner’s cognitive functioning predicted future loneliness.
RELATIONSHIP QUALITY AND OLDER PARENTS' COGNITIVE TRAJECTORIES: A NATIONAL LONGITUDINAL STUDY IN THE UNITED STATES
Authors: Zhang Yan , Liu Hui
Published: December 2022

This study aims to assess the impact of the relationship quality between parents and children on parents’ cognitive function in later life, with an additional focus on variation by parents’ gender. We analyze data from a nationally representative longitudinal panel survey of participants age 50 and older. We employ latent growth curve models (LGCM) to estimate how changes in parent-child relationship quality are related to cognitive trajectories over time. Maintaining frequent contact with children and receiving more support from children are associated with a slower rate of cognitive decline for older parents whereas experiencing relationship strain with children is associated with a faster rate of cognitive decline for older parents. These associations are stronger for mothers than fathers. This study highlights the importance of the “linked lives” of aging parents and their children. The findings have implications for the development of interventions and strategies to protect cognitive function in later life.
CO-CREATING WITH OLDER PEOPLE CULTURALLY SENSITIVE INCLUSION/EXCLUSION MEASURES
Authors: Waldegrave Charles , Cunningham Chris , Love Catherine , Mercury Monica
Published: December 2022

This paper demonstrates a research approach to co-creating social and wellbeing indicator scales through a qualitative methodology, and then applying them in survey format to develop quantitative statistical correlation and regression analysis. We have been co-creating with older Māori (indigenous New Zealanders) a range of scales that more adequately address their notions of wellbeing, social connection, loneliness, discrimination, abuse, and neighbourhood wellbeing than the standard universal scales commonly used in most research. They are designed to be much more inclusive of participants’ worldview and provide more authentic and accurate evidence for policy making and service provision. They draw on the knowledge and experience of the participant communities and reflect their understanding of the indicators. We compare the results with the more common universal indicators and highlight both the universal aspects of each indicator and the culturally specific features to provide more fine-tuned results for policy making and service provision.
THE COVID-19 EFFECT: ADAPTING FAMILY CARE TO A PANDEMIC CONTEXT
Authors: Leggett Amanda , Gitlin Laura
Published: December 2022

The COVID-19 pandemic carries risk for severe complications and mortality among older adults, placing their family caregivers in key support roles in helping their care recipients stay safe, maintain function, and abide by preventative recommendations. Yet such preventative safety precautions, changes to social support structures, and impacts on healthcare access may pose challenges with which caregivers must cope. This symposium considers how family caregivers adapted their care practices and adjusted to care-related challenges during the COVID-19 pandemic. First, Dr. Amanda Leggett presents data on pandemic-specific care-related challenges and supports experienced by dementia caregivers and their association with well-being and stress process outcomes. Ms. Sara Masoud shares mixed-methods data from persons living with dementia, caregivers, and healthcare professionals on their health and quality of life during the pandemic. Mr. Jiaming Liang presents dyadic findings from the National Study of Caregiving on persons living with dementia and their caregivers’ perceptions of COVID-19 and personal and social COVID-specific preventative behaviors. Finally, Dr. Sheria Robinson-Lane offers a diverse caregiving perspective by presenting dyadic qualitative data on COVID-19 patients who were intubated in the hospital and their family caregiver, and offering themes on how caregivers adjusted to their new care role. To conclude, our discussant Dr. Laura Gitlin will offer insight on cross-cutting implications across studies and offer perspective on how lessons learned through pandemic caregiving may inform the field more broadly and enhance caregiver well-being beyond pandemic contexts.
CHANGE IN PARENTAL DISABILITY AND INTERGENERATIONAL AMBIVALENCE: THE MEDIATING ROLE OF APPRAISAL
Authors: Koumoutzis Athena , Cichy Kelly , Kinney Jennifer
Published: December 2022

Adult children often report intergenerational ambivalence (i.e., positive and negative sentiments toward their parents) that may be exacerbated when parents need increasing support. Evaluations or appraisal of providing support may mediate the links between stress and outcomes. Using structural equation modeling, we assessed the relationship between change in parental disability and intergenerational ambivalence through adults’ perceptions of the stress and reward of providing help to parents. Participants included 369 adults (32% Black, 68% White) who provided information on 478 parents from Waves I and II of the Family Exchanges Study. The association between change in parental disability and intergenerational ambivalence was explained through stress appraisal; greater parental disability led to higher stress appraisal which led, in turn, to greater intergenerational ambivalence. The model did not significantly differ by race. Results show that stress, rather than reward, appraisal is an essential factor in determining relationship quality as parental care needs emerge.
THE ROLE OF GENDER IN FATHERS' AND MOTHERS' PREFERENCES FOR FUTURE ADULT CHILDREN CAREGIVERS
Authors: Meinertz Naomi , Gilligan Megan , Suitor J Jill
Published: December 2022

Previous caregiving research has focused on a single care recipient; however, no research has explored the potential simultaneous care needs of fathers and mothers in the same family. Drawing from gender role theory, we use qualitative data from 76 spousal dyads from the Within-Family Differences Study to compare fathers’ and mothers’ explanations of which adult child they prefer as their future caregiver. In 72% of families, fathers and mothers did not share the same care preferences suggesting that care preferences are dispersed among multiple adult children within the same family. In families in which fathers and mothers shared care preferences, 75% chose the same daughter. Additional findings showed that fathers’ explanations for a preferred caregiver aligned with mothers’ explanations; however, differences were identified based on children’s gender. These findings shed light on the similarities and differences in parental care preferences and underscore the influence of gender in family care networks.
UNDERSTANDING MOBILITY, HEALTH, AND WELL-BEING OF OLDER ADULTS USING SENSING TECHNOLOGIES
Authors: Röcke Christina , Luo Minxia , Wahl Hans-Werner
Published: December 2022

Mobility has been identified as one important ingredient to older adults’ health and well-being and is considered a high priority in the global agenda of healthy and active aging. However, mobility is still a relatively understudied concept in aging research. This symposium, including three empirical studies and one concept paper, presents how different sensing technologies can be utilized to examine mobility, health and well-being in older adults. Using infrared motion sensors and contact sensors, Wu and colleagues examine indoor mobility and show its associations with physical, cognitive, and mental health in community-dwelling older adults living alone. Luo and colleagues use a custom-built mobile GPS sensor and a smartphone-based ambulatory assessment to examine daily mobility and well-being in community-dwelling older adults. They find that a day with larger life space area, more time spent in passive transport modes, and higher number of different locations is associated with higher daily life satisfaction. Similarly, using a GPS sensor combined with a smartphone-based ecological momentary assessment, Kamalyan and colleagues examine life-space mobility, social interactions, and well-being in older adults with and without HIV. They show that prior day’s at-home time is negatively associated with current day’s happiness and that prior day’s social interactions diminishes this association. Jansen presents a project combining sensor-based movement data, GPS-based geolocation data, and experience sampling to investigate relations between life-space mobility and social participation and the role of cultural and climatic differences across several European countries. Hans-Werner Wahl will discuss all papers from an ecological and contextualized aging perspective.
WHY LOOKING AT THE FUTURE? FROM PSYCHOLOGICAL TO CONTEXTUAL MOTIVATORS
Authors: Kim-Knauss Yaeji , Lang Frieder , Hoppmann Christiane
Published: December 2022

Human beings can represent future events, anticipate future consequences, and act in light of those representations to achieve the most favorable outcomes in the future. Although future-oriented thoughts or behaviors concern distant and delayed rewards than the present and instant ones, their roles in people’s well-being and successful aging have been well-reported. Therefore, what motivates or differentiates such future-oriented thoughts and behaviors has been a central focus in developmental psychology. With a particular interest in future-oriented phenomena regarding age and aging, we look at the roles of psychological or contextual factors that drive views on aging and old-age preparation. Cohn-Schwartz et al. examine how having contacts with older adults benefits self-views on aging via changes in aging stereotypes. Park & Hess explore how importance attached to functioning and perceived control over functioning in different domains predict old-age preparation and compare patterns across different age groups. Fung et al. propose that perceived control, self-relevance, and responsibility for old-age preparation could mediate the well-reported cultural differences in old-age preparation. Rupprecht et al. investigate the adaptivity of approach and avoidance motivation in old-age preparation across different life domains, cultures, and age groups. Kim-Knauss & Lang looks at how the experience of social restrictions during the pandemic functions as a ‘wake-up call’ and thus induces people to engage in old-age preparation. Taken together, we suggest that various psychological appraisals and contexts shape future-oriented thoughts and behaviors, but these may vary across cultures, age groups, and target domains.
PANDEMIC-RELATED SOCIAL RESTRICTIONS INCREASED THE URGENCY AND ENGAGEMENT IN OLD-AGE PREPARATION
Authors: Kim-Knauss Yaeji
Published: December 2022

We investigated whether people who perceive more restrictions on social contacts during the pandemic set an earlier deadline to prepare for social connectedness in old age (i.e., the latest still good age to start preparation) than they had perceived in the pre-pandemic time. We also looked at whether this change in the deadline induces the engagement in the preparation concerning the same domain. We first fit the data obtained from 356 German adults in 2018 and 2020 (aged 22─95 years) to a change score model. The deadline for preparing for social connectedness in old age was set about 23 years earlier in 2020 compared to that reported in 2018. We found that perceiving more social restrictions during the pandemic predicted this shorter deadline, which in turn, induced greater engagement in the preparation. A possible consequence of the pandemic may be related to an increased motivation to prepare for old age.
MODIFIABLE RISK FACTORS FOR ALZHEIMER'S DISEASE: CURRENT STATUS AND OPPORTUNITIES FOR ACTION
Authors: Omura John
Published: December 2022

In 2021, the National Plan to Address Alzheimer's Disease included a new goal to address risk factors for ADRD. The Behavioral Risk Factor Surveillance System (BRFSS) assesses several modifiable risk factors in its core survey and subjective cognitive decline (SCD), which may be an early indicator of developing ADRD, in the optional Cognitive Decline module. To assess the current status of modifiable risk factors in the US and identify opportunities for public health action, data from the 2019 BRFSS were examined. Prevalence of eight modifiable risk factors for ADRD and proportion of respondents with total number of risk factors was estimated among respondents aged ≥45 years, overall, by SCD status, and by selected demographic characteristics. Findings can inform strategies and priorities to support the National Plan’s new goal to reduce modifiable risk factors to help delay onset or slow progression of ADRD and its symptoms.
EARLY-LIFE PROTEIN TRANSLATION SPIKE DRIVES AGING VIA JUVENILE HORMONE/GERMLINE STEM CELL SIGNALING
Authors: Kim Harper , Parker Danitra , Hardiman Madison , Munkácsy Erin , Austad Steven , Bai Yi-dong , Mobley James , Pickering Andrew
Published: December 2022

Protein translation (PT) is high in early-adulthood across invertebrates, rodents, and humans but sharply declines thereafter. It has been implicitly assumed that elevated PT at young ages is beneficial to health and PT ends up dropping as a passive byproduct of aging. However, whether this holds true and how dynamic fluctuations in PT over time impact aging remain unknown. In Drosophila, we show that a transient PT spike in early-adulthood exerts long-lasting negative impacts on aging trajectories and proteostasis in later-life. Conversely, blocking the early-life PT spike robustly improves life-/health-span and prevents age-related protein aggregation. Further, greater early-life PT rise strongly predicts shorter future lifespan across fly strains and is observed in neurodegenerative disorders long before symptoms/pathologies appear. Proteomics-guided investigations revealed that during the early-adulthood PT rise, juvenile hormone triggers proteostatic dysfunction and drives aging via aggregation-prone large lipid transfer proteins. The early-life PT spike also transcriptionally represses stress responses essential for proteostasis maintenance and drives aging via germline stem cell signaling. Our findings suggest that PT is thereby suppressed after early-adulthood as an adaptive response to alleviate proteostatic burden, slow down aging, and optimize life-/health-span. We thus propose that the rise and fall in PT over time impact aging in the opposite direction from what was previously assumed. Our work provides a novel theoretical framework for understanding how lifetime PT dynamics regulate the onset of aging. Further, our study provides a foundation for future research, including whether high early-life PT spike is an early biological event driving neurodegeneration/age-related diseases.
DEMENTIA TRAJECTORIES, MEDICAID COVERAGE, AND HEALTHCARE SERVICES USE
Authors: Tarraf Wassim , Garcia Marc
Published: December 2022

The evidence base linking dementia risk trajectories to transitions in Medicaid coverage and levels of health services is underdeveloped. We use Health and Retirement Study (2007/08-2015/16) data on adults 70-years and older (Unweighted N=8,227) at baseline to test how longitudinal dementia classifications (Langa-Weir), over 8-years, influence change in Medicaid coverage, nursing-home use (NHU) and inpatient hospitalizations (IH). We fit Joint Growth and Discrete-time Survival Mixture models to generate longitudinal risk classifications for dementia accounting for survival, and generalized linear models to test associations of these classifications with change in Medicaid coverage, NHU, and IH. Average baseline age was 78.4 years (SD=7.1), 3-in-5 were female, 1-in-4 had less than high school education, and 4-in-5 were non-Hispanic Whites. A three-class solution (C1=high dementia prevalence and mortality risk (8.6%), C2=low prevalence (68.3%), and C3=accelerated dementia prevalence and mortality risk (23.1%)) provided the best fit to the data. We observed substantial increase in rates of for Medicaid coverage for C1 (21%; 95%CI=[18-25] to 51%[36-65] among survivors) and C3 (12%; 95%CI=[10-14] to 32%[27-37]), but not C2 (6% to 8%). NHU also accelerated substantially from 10 to 37% in C1 and 7 to 38% in C2. Rates of inpatient hospitalizations remained stable over time for all groups, with C1 and C2 being more likely to be hospitalized and have multiple re-admissions. Estimates were differentially attenuated through adjustment to covariables. We report important longitudinal dementia risk classifications, profile their socioeconomic and health attributes, and identify differential associations with critical health policy outcomes (Medicaid coverage and healthcare utilization).
ADVANCING RESEARCH ON PERSON-CENTERED COMMUNICATION IN DEMENTIA CARE
Authors: Shaw Clarissa , Coleman Carissa , Savundranayagam Marie
Published: December 2022

Communication is an essential component to achieving person-centered care. However, few measures exist for measuring person-centered communication and methods vary widely on measuring communication. The purpose of this symposium is to provide an overview of methods and recent findings related to research on person-centered communication. Four presentations will highlight a variety of methods and a variety of populations. Presentation one compares the congruence of communication by hospital nurses in a simulated care setting to communication during actual care encounters with hospitalized patients with dementia. Presentation two evaluates the impact of validation by family caregivers to persons living with dementia (PLWD) using a time sequential analysis of second-by-second coding of the caregiver’s communication and the PLWD behavioral response. Presentation three introduces the Changing Talk Scale (CHATS) as a tool to measure gains in knowledge of person-centered communication in the nursing home setting. Presentation four determines the impact of person-centered care versus task-centered care on mealtime behaviors in nursing home residents with dementia using a psychometrically established behavioral coding scheme and time-sequential approaches. Communication strategies to use with PLWD frequently lack sufficient evidence to be deemed effective or person-centered. Advanced methods are needed to understand what constitutes person-centered communication based on behavioral responses and other health outcomes off PLWD. This symposium provides an overview of these methods with formal and informal caregivers and PLWD in varied care settings including the community, hospitals, and nursing homes.
ESTABLISHING THE VALIDITY OF SIMULATION TO CAPTURE ELDERSPEAK COMMUNICATION IN DEMENTIA CARE
Authors: Shaw Clarissa , Knox Katie , Bair Heather , Watkinson Erica , Weeks Delaney , Hanson Paige
Published: December 2022

Using simulation may be an innovative approach for evaluating dementia care in research and education. The purpose of this study was to determine if communication in the simulated environment is congruent to communication in the naturalistic environment. Nursing staff (n=10) were each audio-recorded caring for an actual hospitalized person living with dementia (PLWD), and in three simulations evaluating the use of a manikin, young nursing assistant, and trained older adult standardized patient acting as the PLWD. The audio-recordings were coded for elderspeak (i.e., infantilizing) communication. Reactions to each simulation were gathered and qualitatively analyzed. The amount of elderspeak and neutral communication in the actual care encounters did not significantly differ (p>.05) from the communication in any of the three simulations indicating that simulation may be a valid method to capture elderspeak by nursing staff. The nursing staff indicated that the standardized patient provided the most realistic simulation.
THE CHANGING TALK SCALE (CHATS): A TOOL TO MEASURE GAINS IN KNOWLEDGE OF PERSON-CENTERED COMMUNICATION
Authors: Perkhounkova Yelena , Shaw Clarissa , Hein Maria , Coleman Carissa , Williams Kristine
Published: December 2022

Assessment of knowledge gain from educational interventions is common in health care research. However, validity of tools developed to measure knowledge gains is often overlooked. For our current pragmatic clinical trial, we developed two 13-item parallel forms of the Changing Talk Scale (CHATS) to measure gains in knowledge of effective and person-centered communication due to the Changing Talk Online (CHATO) communication education for nursing home staff. This has been a multi-year, multi-study process of writing and editing test items in accordance with CHATO learning objectives and results of psychometric analyses of pilot data. Items were revised based on difficulty and discrimination. The tool has improved from an initial Cronbach’s alpha of .27 (pre-education) and .14 (post-education) to .63 (pre-education) and .64 (post-education). CHATS provides an exemplar of how measuring change in knowledge is a complex process that needs to be rigorously completed to accurately capture outcomes.
VISUAL IMPAIRMENT PREDICTS PHYSICAL FUNCTION DECLINE: THE HEALTH, AGING, AND BODY COMPOSITION (HEALTH ABC) STUDY
Authors: Thompson Atalie , Miller Michael , Webb Christopher , Williamson Jeff , Kritchevsky Stephen
Published: December 2022

The relationship between visual impairment (VI) and decline in physical function with age is poorly understood. We constructed separate linear mixed models to evaluate the relationship of self-reported (visual function question (VFQ) score) or performance-based (visual acuity (VA); log contrast sensitivity (LCS); stereoacuity (SA)) VI with change in performance on the Short Physical Performance Battery (SPPB) over 8 years in 2219 Health ABC participants. Mean age was 75.5 years (range 71-82); 52.4% were female, and 37.4% were black. For all measures of visual function, better vision was associated with loss of approximately -0.3 SPPB units/year which was similar to the unadjusted change in SPPB over time (-0.328 units/year 95%CI (-0.35, -0.31)). Participants with LCS ≤1.3 log units experienced 58% faster rate of decline versus those with better LCS (test of difference in slopes p< 0.0001). Those with poor VA ≥20/50 showed a 50% greater decline in SPPB (p=0.0029), and those with low SA ≤85 arcsec demonstrated a 33% faster decline (p< 0.001) relative to those with better visual function. Compared to the slope at the mean VFQ score, a 1 standard deviation lower score was associated with 23% greater decline in SPPB (p< 0.0001). The difference in SPPB slopes remained significant across VI measures after adjusting for longitudinal decline associated with age, sex, and black race (all p< 0.05). Both self-reported and performance-based VI predicted faster declines in SPPB over time. Whether older adults with VI might benefit from targeted intervention to prevent declining mobility function remains to be evaluated.
THE SHIFTING SOCIAL NETWORKS OF OLDER ADULTS: AN ANALYSIS OF VARYING TYPOLOGY BY RACE/ETHNICITY
Authors: Piedra Lissette , Iveniuk James
Published: December 2022

We explored whether network groupings change over time, and how they vary by race and ethnicity. We draw upon data from 6,489 respondents, collected across three rounds of National Social Life Health and Aging Project (NSHAP). Using Latent Class Analysis to identify groupings of social-relational characteristics, we arrive at: A ‘restricted’ class with overall low social connectivity, an ‘enriched’ class with strong connections across all domains and a ‘diverse’ class showing the greatest network range. In the first round, 49% of Hispanic respondents were in the ‘restricted’ class, compared to 24% of non-Hispanic Whites, and 37% of non-Hispanic Blacks. By the third round, the percentage of Hispanic respondents in the ‘restricted’ class dropped but rose for all other groups. We speculate that, over time, context-specific factors may be contributing to network resilience among Hispanics and network vulnerability among non-Hispanic Blacks.
EXPANDING HOME-BASED PRIMARY CARE FOR MEDICALLY COMPLEX PATIENTS: RUSH@HOME
Authors: Rosenberg Walter , Powell Nathaniel , Davis Elizabeth , Santana Leticia , Golden Robyn
Published: December 2022

Medically complex older adults from underserved communities experience multiple barriers to obtaining necessary health care and services. Often these individuals are largely unable to leave their homes due to a lack of community resources facilitating travel to and from provider appointments. Rush@Home is a home-based primary care program that focuses on the 4Ms by incorporating patient navigation and social work services for medically complex older adults. The majority of the patients enrolled in the Rush@Home program identify as Black and/or Latino (>50%) and reside on the West Side of Chicago which is historically underserved in terms of health care access. To date, Rush@Home has enrolled n=234 participants with n=176 patients who are currently active in the program. Among participants there less than a 10% readmission rate and an ED visit rate of approximately 5%. This presentation will discuss the Rush@Home data and the importance of community engagement.