bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of Embedded Sensor Data for Long-Term Care Residents Before and After Onset of the COVID-19 Pandemic
Authors: Robinson Erin , Wu Wenlong , Park Geunhye , Tefera Gashaye M , Lane Kari , Skubic Marjorie , Keller James , Popescu Mihail
Published: December 2021

Older adults have experienced greater isolation and mental health concerns during the COVID-19 pandemic. In long-term care (LTC) settings, residents have been particularly impacted due to strict lockdown policies. Little is known about how these policies have impacted older adults. This study leveraged existing research with embedded sensors installed in LTC settings, and analyzed sensor data of residents (N=30) two months pre/post the onset of the U.S. COVID-19 pandemic (1/13/20 to 3/13/20, 03/14/20 to 5/13/20). Data from three sensors (bed sensors, depth sensors, and motion sensors) were analyzed for each resident using paired t-tests, which generated information on the resident’s pulse, respiration, sleep, gait, and motion in entering/exiting their front door, living rooms, bedrooms, and bathrooms. A 14.4% decrease was observed in front door motion in the two months post-onset of the pandemic, as well as a 2.4% increase in average nighttime respiration, and a 7.6% increase in nighttime bed restlessness. Over half of our sample (68%) had significant differences (p<0.05) in restlessness. These results highlight the potential impact of the COVID-19 pandemic and social distancing policies on older adults living in LTC. While it is not surprising that significant differences were found in the front door motion sensor, the bed sensor data can potentially shed light on how sleep was impacted during this time. As older adults experienced additional mental health concerns during this time, their normal sleep patterns could have been affected. Implications could help inform LTC staff, healthcare providers, and self-management of health approaches among older adults.
Large Scale Survey Research with Older Adults/Persons with Disabilities in a Public Health Crisis
Authors: Dys Sarah , Huebner Hannah , Van Tongeren Norma Carrillo- , Sirk Courtney , Urman Harold , Coddington Cathy
Published: December 2021

Best practice for measuring quality improvement and consumer satisfaction of health and human services for older adults and people with disabilities relies on in-person survey administration. This poster highlights adaptation strategies undertaken across three large-scale evaluation studies of program/service delivery conducted during the COVID-19 pandemic, necessitating a departure from in-person techniques: 1) Integrated Satisfaction Measurement for the Program of All-Inclusive Care for the Elderly (I-SAT-PACE), 2) National Core Indicators- Aging and Disabilities/Intellectual and Developmental Disabilities (NCI-AD/IDD), and 3) Assisted Living Resident Quality of Life (AL-QOL). Data collection for these projects occurred from September 2020 to August 2021, providing an opportunity to showcase project adaptation over the course of the pandemic. Using project implementation examples across 15 states and approximately 10,100 participants, we discuss implications for successful survey coordination, interviewer training, data collection, and participant/stakeholder engagement during a public health emergency. Strategies included pivoting to phone, Zoom, and paper-based data collection and increasing technical assistance for field staff and participants. Project teams were able to increase access to participation by implementing multimodal survey delivery, mitigate coronavirus exposure, continue collecting older adults and people with disabilities’ experiences, and compare results based on method of delivery. Technology barriers, field staff dropout, need for larger sample sizes, and inclusion of participants with dementia, hearing, and speech impairments present important tradeoffs to consider. These examples indicate it is possible to administer hybrid data collection methods across populations with varying cognitive and physical abilities without compromising data quality.
Measuring Covid-related Ageism
Authors: Sokan Amanda , Fain Mindy , Harwood Jake , Insel Kathleen , Chen Zhao , Phillips Linda
Published: December 2021

Prejudice, discrimination, and negative stereotypes based on age (ageism) are long-standing and strongly implicated in poor health outcomes and limited access to health care for older adults. Recent writings suggest the COVID-19 pandemic raised the specter of ageism to an entirely new level. Do these observations reflect an exaggeration of “usual” ageism or a unique manifestation of intergenerational tension rooted in resentments of younger people concerning COVID-related disruptions in their lives believed to be primarily a function of older people’s vulnerability to the disease phenomenon? To address this question, the purpose of this study was to develop and test an instrument to measure ageist tendencies associated with the COVID-19 pandemic. Scale items, written to reflect attitudes about paternalism, inconvenience, and sacrifice, were assessed for content validity. Then the 12-item scale was administered to 227 undergraduate and graduate students in the health and social sciences. Analysis showed items have strong internal consistency and concurrent and discriminant validity. Importantly the scale explained unique variance over and above other standard measures of ageism. Ageism is deeply embedded in global and U.S. culture and strongly related to negative outcomes. This scale will assist researchers investigating the ageist consequences of the current pandemic and help us to monitor what could be long-term residual ageist effects of the COVID pandemic.
Systematic Review of Psychological Aging Research in Nepal
Authors: Tshering Kezang , Shrestha Srijana , Kamholz Barbara
Published: December 2021

Nepal faces unprecedented levels of aging similar to trends in many less well-resourced countries. It has limited capacity to address the medical, social and psychological needs of older persons. Difficult choices regarding allocation of resources will be needed. In this review, we hope to clarify what is already known in aging research in Nepal. The databases APA PsychINFO and PubMed were searched. The inclusion criteria were peer-reviewed articles on i) psychological constructs and mental illnesses, ii) use of original data, iii) inclusion of senior participants and iv) studies conducted in Nepal. Studies that included mixed age group and cross-country comparisons were excluded from this review. The initial search resulted in 76 articles from APA PsychINFO and 590 articles from PubMed. Articles were reviewed independently for inclusion and exclusion criteria. A total of 49 articles were included in the final list. Preliminary results showed that the largest share of articles focused on depression (32.1%), followed by quality of life/life satisfaction or loneliness(18.9%). A large number of studies also examined prevalence rates of psychiatric and neurocognitive disorders (22.6%). Common conditions, like dementia and delirium were studied only in 1.9% and 3.8% of published studies respectively. All of the studies were cohort-based and none focused on evaluations of psychosocial/medical interventions. Robust intervention studies are needed to help improve the lives of seniors in Nepal. To our knowledge this is the first comprehensive review of published articles on psychological construct in aging populations in Nepal.
The Heritability of Cognitive Aging: A Systematic Review of Longitudinal Twin Studies
Authors: Kim Alice , Kam Alyssa , Kofman Maxwell , Beam Christopher
Published: December 2021

Heritability of cognitive ability changes across late adulthood, although whether genetic variance increases or decreases in importance is not understood well. We performed a systematic review of the heritability of cognitive ability derived from longitudinal twin studies of middle-aged and older adult twins. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, articles were identified in APA PsycINFO and Clarivate Web of Science electronic databases. Identified articles were screened by title and abstract; remaining full-text articles were then fully evaluated. Reference sections served as an additional method for identification of relevant articles. In total, 3,106 articles were identified and screened, 28 of which were included and were based on data from 10 longitudinal twin studies published from 1994-2021. There are large genetic influences on an initial level of cognitive performance across domains whereas there are small to moderate genetic influences on change in performance with age. Evidence was less definitive about whether the same or different genetic factors contribute to both level and change. Non-shared environmental influences appeared to drive individual changes in cognitive performance. Heritability tended to either be stable or decline after 65 years, possibly because of the increasing importance of non-shared environmental influences on cognitive ability. Recent studies report increases in heritability across specific subtests and domains. Shared environmental variance accounted for little variance in cognitive ability. Emerging research questions and future directions for understanding genetic and environment influences in the context of gene-environment interplay are highlighted in this review.
The impact of HCBS use patterns on older aduts’ physical function among continuous service users
Authors: Chen Ya-Mei , Wu Shih-Cyuan , Chen Kuan-Ming , Hsiang Chen-Wei , Chao Shiau-Fang , Lin Ming-Jen , Hsieh Ji-Lung , Chou Yu-Hsuan
Published: December 2021

Background Taiwan, one of the fastest aging countries in the world, provides home-and community-based services (HCBS) care recipients through the second 10-Year Long-Term Care Plans (LTC Plans 2.0). The current study aimed to examine the impact of continuous use of HCBS offered by LTC plan 2.0 on older adults’ physical function change overtime. Methods This study used the LTC Plan 2.0 database and the National Health Insurance Plan claim dataset, and included 157,682 clients who had applied for and were evaluated for LTC services for the first time from 2018 through 2020 and continuously used any LTC Plan 2.0 services for six months. Outcome variables were measured by activities ofdaily living (ADLs) and instrumental activities of daily living (IADLs) between baseline assessment and the assessment after the six months of serivce utilization. Latent class analysis and generalized estimating equations were used to investigate the influences of different service use patterns on the changes in physical functions. Results Three subgroups of LTC recipients with different use patterns, including home-based personal care (home-based PC) services (n = 111,976; 71.01%), professional care services (n = 31,584; 20.03%), and community care services (n = 14,122; 8.96%) were identified. When compared to care recipients in the community care group, those in the home-based PC group improved more in IADL scores, and the professional care group improved more ADL scores. Conclusion Those receiving more professional services made more progress in ADL ability, but those in home-based PC made more progress in IADL ability.
Understanding Barriers to Healthcare Access for Heart Failure Patients during the COVID-19 Pandemic
Authors: Xu Hanzhang , Miller Julie , Thompson Roy , Granger Bradi , Dupre Matthew
Published: December 2021

Early outpatient follow-up within two weeks after hospital discharge is an effective strategy for improving transitions of care in older patients with heart failure (HF). However, implementing timely follow-up care for HF patients has been challenging, especially during the COVID-19 pandemic. This convergent mixed-methods study identified patients’ barriers to accessing care and ascertained their recommendations for addressing these barriers. We enrolled 264 HF patients admitted to the Duke Heart Center between May 2020 and August 2021. A standardized survey and electronic health records (EHR) were used to collect patients’ sociodemographic, psychosocial, behavioral, and clinical data. For patients who reported some difficulty accessing their healthcare (n=30), semi-structured interviews were conducted to understand these barriers. Data were analyzed using rapid analysis techniques. Barriers to accessing care varied across participants, with scheduling an appointment being the most common barrier (12 of the 30 responses). Participants indicated that job-related conflicts, providers’ availability, or COVID-19 contributed most to the difficulty in scheduling an appointment. Some participants experienced more difficulties during the pandemic due to fewer appointments available for non-acute and non-COVID-19 related needs. Transportation was another critical barrier, which was often associated with the participants’ physical functional status. Participants identified the benefits of using telemedicine to address access to care barriers; however, they shared their concerns that telemedicine visits may not be sufficient to assess their HF conditions. Study findings highlight the need for more continual, tailored, and patient-centered interventions to improve access to care in older HF patients.
A trend of Korean older adults’ awareness as a threat to society during the COVID-19 pandemic
Authors: Kwon Soonhyung , An Jaesung , Shin Oejin
Published: December 2021

Background: Unlike ageism that consists of one’s prejudice, stereotype, and discrimination toward older adults, age-based threats are one’s negative cognition (Levy, 2001). Previous studies indicated that the younger generation stigmatizes the older generation as unworthy during the COVID-19 pandemic (Meisner, 2021). However, there is no study looking at how older adults perceive themselves as threats to society during this time of the pandemic. Thus, our study aimed to understand the varying trend of older adults’ awareness as a threat to society in association with socio-economic profiles before and during the pandemic. Method: This study included 637 Korean older adults who answered the older generation’s threats to society from 2018 to 2020. We used Latent Class Analysis (LCA) to categorize participants into different subgroups that shared distinct patterns of threats to society. Multinomial logistic regression examined how the subgroups in threats to society were associated with socio-demographic characteristics in each year. Results: For three waves, three clusters of threats to society (low, mid, and high) were identified. Although the mid-level of threat remained the same (60% of the sample for three years), the high level of threats has been doubled in 2019 (25%) compared to 2018 (11%) and 2020 (13%). Regarding the associated socio-demographic characteristics with threats to society, those who being female in 2018 and younger age in 2020 were more likely to be associated with mid-level of threats to society. Discussion: Further study needs to identify the relationship between awareness as a threat to society and health outcomes.
Acculturation moderates cognitive performance in adults at risk of autosomal dominant Alzheimer's Disease.
Authors: Tureson Kayla , Beam Christopher , Ringman John
Published: December 2021

Acculturative processes via persistent exposure to a set of cultural practices and behaviors can influence cognitive functioning (Park & Huang, 2010). The impact of acculturation on populations at risk for Alzheimer’s disease (AD), however, remains understudied. Persons with or at-risk for early-onset autosomal dominant AD (ADAD) offer a known AD pathogenesis and the opportunity to study whether acculturation moderates their cognitive performance. The present study used a latent variable model to test whether effects of latent cognitive ability on observable cognitive performance depend on acculturation. Participants included 119 adults with or at-risk for ADAD, the majority of whom were of Mexican origin with various levels of U.S. acculturation. Participants completed the Cognitive Abilities Screening Instrument (CASI) and the Acculturation Rating Scale for Mexican Americans-II (ARSMA-II). Confirmatory factor analysis was used to estimate a latent general cognitive ability factor from nine domains (e.g., attention, abstraction and judgment). The ARSMA-II was used to test whether factor loadings depended on level of acculturation, covarying for mutation status. Results revealed ARSMA-II scores nearly significantly moderated the effects of general cognitive ability on abstraction and judgment (λ = 0.20, SE = 0.11, p = .070). Individual differences in general cognitive ability at lower levels of acculturation likely predict lower abstraction and judgment performance. Cognitive assessments may not equally represent true cognitive ability in Mexican-Americans. Although the CASI was developed as a cross-cultural measure of cognitive functioning, caution should be exercised in inferring true cognitive functioning in Mexican-Americans who may not be acculturated to the U.S.
Brest Cancer Screening and Mobile Web App Intervention: Perceptions, Knowledge, and Needs among Native Women
Authors: Roh Soonhee , Lee Yeon-Shim
Published: December 2021

American Indian (AI) women have the highest breast cancer mortality and lowest breast cancer screening rates in the U.S. The present study, in collaboration with the Yankton Sioux Tribe (YST) in South Dakota, sought to (1) identify the general public/professionals’ knowledge, attitudes, and needs for a mobile web app for breast cancer screening (wMammogram) intervention, and (2) inform development of the wMammogram intervention to improve Breast Cancer screening among YST women. Following a community-based participatory research approach, two focus groups were conducted in October 2020 with a total of 22 YST women aged 40-70 years, including 17 elderly women. Each group consisted of 11 community leaders, members, healthcare professionals. Qualitative analysis was conducted using grounded theory. Participants in both groups were generally favorable toward the wMammogram intervention, and noted a potential health benefit, particularly for women in their 50s to 60s. Key areas identified by participants for intervention include: (1) needs for better knowledge of breast cancer, screening, and prevention/early detection, (2) culturally tailored educational materials rooted in AI cultural values and beliefs (e.g., holistic wellness approach, Native lifestyles), (3) barriers (e.g., fear), (4) motivators (e.g., reminders), and (5) suggestions for acceptability (e.g., content and structure of messages). These results suggest that the wMammogram intervention, which is culturally tailored and addresses the community’s concerns, can be a feasible, acceptable, and effective tool to promote breast cancer screening among YST women. The results informed the development of an innovative health intervention to help reduce health disparities experienced in Indian Country.
COVID-19 Vaccines in Skilled Nursing Facilities: Recurring Interviews with Administrators
Authors: Meehan Amy , Brazier Joan , Shield Renee , Madrigal Caroline , Gadbois Emily
Published: December 2021

Skilled nursing facilities (SNFs) are on the front lines of changing policies regarding the COVID-19 pandemic. The most recent development is a potential vaccine mandate for staff working in SNFs. We use ongoing findings from 130 of 160 in-depth, semi-structured interviews in progress with administrators at 40 SNFs in eight diverse healthcare markets across the United States to understand the current landscape of COVID-19 in SNFs. Four repeated interviews at 3-month intervals provide a unique longitudinal perspective on the impact of COVID-19 and SNFs’ response to vaccinations, including the vaccine mandate. Rigorous thematic analysis reveals insights into administrator responses and creative approaches to address vaccine hesitancy, and future expectations for SNF operations in light of the vaccine and the mandate. Administrators express cautious hope that the vaccine will allow SNFs to return to a new normal of daily life for residents in terms of family visitations, communal dining, and resident activities. Overriding questions include how to overcome persistent vaccine hesitancy from SNF staff who cite fear of side effects despite education initiatives and how to stem staff retirement or transition to other healthcare settings. SNFs represent a microcosm of the country’s concerns as a whole. Insight into the evolving and complex dynamics shed important light on national trends and help provide solutions for moving forward. Findings from this study have implications for policymakers and SNF leadership as they consider ways to promote vaccination and retain staff amid vaccine mandates.
Declining Trend in Use of Sleep Medications Among Older Adults in the United States
Authors: Kaufmann Christopher , Spira Adam , Wickwire Emerson , Mojtabai Ramin , Ancoli-Israel Sonia , Fung Constance , Malhotra Atul
Published: December 2021

Recent initiatives to discourage over-prescription of sleep medications have increased awareness of their potential adverse effects in older adults; however, it is unknown whether these efforts translated into a decline in use of these medications in the United States. We assessed recent national trends in the use of medications for sleep disorders. Data came from the 2013-2018 National Health and Nutrition Examination Survey. At each of three waves of in-person assessments, participants presented prescription bottles for all medications used in the prior month. Interviewers recorded each medication and participants self-reported duration and indications for use. We identified all medications used for a sleep disorder and categorized medications into two groups: FDA-approved sleep medications, and medications used off-label (i.e., any other medication reported to be used for sleep disorders). We examined changes in the prevalence in use of these medications across the study period. The odds of using medications for sleep disorders decreased 31% between 2013 and 2018 (odds ratio [OR]=0.69, 95% confidence interval [CI]=0.51-0.92). This trend was driven by declines in use of FDA-approved sleep medications (OR=0.45, 95% CI=0.34, 0.59). Of note, among those age 80+ years, we observed an 86% decline (OR=0.14, 95% CI=0.05-0.36) in the odds of using FDA-approved sleep medications over the study period. Results suggest a possible effect of efforts to curb over-prescription and encourage judicious use of these agents. Future research needs to examine whether these changes have coincided with improved sleep health in the growing population of older adults.
Feasibility of Using a Commercial Board Game to Assess Upper Extremity Function in Older Adults
Authors: Niemiec Allison , Hernandez Yareli Lopez , Mulayh Ejlal Bin , Logue Rachel , Brown Susan
Published: December 2021

Upper extremity function, particularly the hand, declines with aging and is predictive of executive ability and independence. Standard assessments typically focus on strength partly due to a lack of easily administered functional tasks requiring multi-joint coordination and precision grasp. This study aimed to determine the feasibility of using an inexpensive board game to assess upper extremity function in older adults. Six healthy older adults (77 +/- 5.1 years) completed reaching tasks using the Connect4® game that requires grasping and placing small discs into a vertical board. Tasks included different hand configurations (unilateral, bilateral), and two dual-task conditions (serial subtraction by 7s and placing colored discs to match specific color patterns). The time to complete each task was recorded. For comparison purposes, participants completed a standardized pegboard test (Purdue Pegboard) using one or both hands. Connect4 results were similar to age-normative findings reported for the Purdue Pegboard. Dominant versus non-dominant hand performance did not differ while bilateral coordination tasks were slower than unilateral tasks for both the Purdue Pegboard (p<0.05) and Connect4 (p<0.01). Pegboard and Connect4 times were moderately to strongly correlated for all hand configurations. Dual-task conditions using Connect4 led to longer completion times (p<0.05). Preliminary results support the use of Connect4 as a functional upper extremity assessment tool for older adults. It is inexpensive, engaging, easy to use, and allows for cognitive-motor assessment using dual-task protocols, a critical factor in maintaining functional independence in older individuals. Further research will include a formal validation study across a wider age range.
Heterogeneous patterns of old-age vulnerability and loneliness from the cross-national comparative perspective
Authors: Shin Oejin , park sojung , Kang Ji young , Kwak Minyoung , Baek Jihye
Published: December 2021

Loneliness has been extensively examined as a major risk factor for mortality and morbidity among older adults. In this research, we identified multi-dimensional patterns of old-age vulnerability in five countries (U.S., Korea, Sweden, Germany, Italy) guided by the welfare regime framework and examined how the patterns of vulnerability are associated with loneliness in old age in each country. Data were drawn from comparative national aging data: HRS for the U.S. (n=4331), KLOSA for Korea (n=3721), SHARE for Sweden (n=2746), Germany (n=2271), and Italy (n=2988). We used three vulnerability constructs: 1) material vulnerability (poverty, high out-of-pocket expenses for health care, unaffordability for housing), 2) health vulnerability (multiple chronic condition, depression), and 3) social vulnerability (living alone, contact with children and friend, social participation). Latent Class Analysis and regression analyses were used for data analysis. The relative proportion of the least vulnerable group varies substantially (from 11.88% in Italy to 59.33% in the U.S). In Sweden and Germany, around 7% of the sample belongs to the most vulnerable group, while in other countries the most vulnerable group was not found. Notably, in Italy, older people in the social vulnerable group were more likely to feel lonely when compared to least vulnerable, suggesting the country-specific significance of social supportive environment. This study is the first research to examine the empirical structure of the concept and how it may vary across countries related to their loneliness. A full discussion of country-specific discussion and policy implication will be presented.
Loneliness, Social Support, and Psychological Wellbeing Among Older Adults
Authors: Dahal Poshan , Kahana Eva , Bhatta Tirth , Ermoshkina Polina
Published: December 2021

Social support in old age has been linked to psychological wellbeing outcomes, such as depressive symptoms. However, insufficient attention has been paid to implications of social support for different domains of psychological wellbeing. In this study, we explored these associations among 797 older adults (mean age = 78.61 years) living in a retirement community in Florida from the ECRC study. Our findings show that measures of social support and connectedness have varying influences on psychological wellbeing. Loneliness was associated with lower life satisfaction (b=- -1.12, p<0.001) and higher depressive symptoms (b=3.52, p<0.001). Higher self-rated social support was associated with higher life satisfaction (b= 1.66, p<0.001) but did not predict depressive symptoms. Depressive symptoms, however, were significantly higher (b=-1.45) among individuals who reported that they don’t have anyone who they can turn to if they feel lonely and want to talk. Feeling lonely also predicted lower positive affects among these older adults (b=-0.65, p<0.001). Similarly, loneliness also predicted higher negative affects (b=1.28, p<0.001). Negative affects were also significantly higher among women (b=-1.15, p<0.001) but lower among those who were living alone (b=-1.06, p<0.001). Overall, our findings underscore the importance of social support and connectedness for psychological wellbeing in later life. This finding is consistent with prior research demonstrating significance of social support in later life for the overall psychological wellbeing of the older adults.
Older Black Americans and Depressive Symptoms During the COVID-19 Pandemic
Authors: Chae David , Martz Connor , Chung Kara , Thorpe Roland , Lincoln Karen
Published: December 2021

Black Americans have experienced multiple health threats during the COVID-19 pandemic, including greater risk of infection compared to Whites. In addition, older adults are more susceptible to worse disease consequences including hospitalization and mortality compared to those who are younger. Racism and economic costs are additional public health crises during this time that have disproportionately impacted Black Americans. Using data from the Uncovering COVID-19 Experiences and Realities (UnCOVER) Study, we examined depressive symptoms in relation to: (1) worry/fear of COVID-19; (2) work loss among household members (being laid off, reduced work hours); and (3) vicarious racism, a particularly salient source of psychosocial stress during the COVID-19 pandemic, including hearing about or seeing acts of racism committed against other race group members. Participants were Black Americans aged 50 years or older (n=300) from five cities (Atlanta, Chicago, Los Angeles, New Orleans, and New York) from May-July 2020. Depression was assessed using the Patient-Reported Outcomes Measurement Information System Short Form. In multivariable linear regression models, all three public health threats were significantly associated with depressive symptoms. When in the model simultaneously, worry/fear of COVID-19 (b=0.30, SE=0.12, p<0.01) and vicarious racism (b=0.62, SE=0.15, p<0.001) showed positive associations; work loss was no longer statistically significant (b=0.62, SE=0.43, p=0.15). When added, the corresponding three-way interaction term was significant (b=0.12, SE=0.04, p<0.01). Synergistic epidemics (“syndemics”) among older Black Americans amplify mental health tolls. Multi-pronged public health strategies are required to address depression in this population.
Perceived Neighborhood Disorder, Social Cohesion, and Depressive Symptoms among Spousal Caregivers
Authors: Choi Yeon Jin , Ailshire Jennifer
Published: December 2021

Most prior research on caregivers’ mental health focused on individual or household factors, we know much less about the influence of neighborhood factors on mental health of spousal caregivers. The current study fills the gap in our knowledge by examining the association of neighborhood characteristics (i.e., perceived neighborhood disorder and neighborhood social cohesion) and depressive symptoms among spousal caregivers. We used data from 2006 to 2016 waves of the Health and Retirement Study, which includes 2,362 spousal caregivers. Negative binomial regression models were estimated to examine the association of perceived neighborhood disorder and neighborhood social cohesion with depressive symptoms. A greater perceived neighborhood disorder was associated with higher CES-D scores, which indicates more depressive symptoms. On the other hand, a higher level of neighborhood social cohesion was associated with lower CES-D scores. When they were included in the same model, the association between neighborhood disorder and depression disappeared, while respondents who reported higher levels of neighborhood social cohesion continue to exhibit lower CES-D scores than those lived in less cohesive neighborhoods. This study highlights the importance of neighborhood contexts in understanding caregivers’ well-being. Findings of this study suggest that neighborhood social cohesion may attenuate the negative effects of neighborhood disorder. Therefore, enhancing positive characteristics of the neighborhood may promote well-being of spousal caregivers.
Reality or a Dream: Barriers and Facilitators for Nursing Assistants Pursuing a Nursing Career
Authors: Trotter Stephanie , Richardson Leah
Published: December 2021

Certified nursing assistants (CNAs) serve a critical role in the care of older adults. However, CNAs often experience significant professional and personal burdens related to caregiving work. Professionally, CNAs experience exorbitant workplace stress (e.g., physical injury, burnout, emotional exhaustion, staffing shortages, turnover). Personally, CNAs may have only a high school education, are subjected to low-paying jobs, and little opportunity for career advancement. Further, CNAs are disproportionately of minority race. Clearly, CNAs are negatively impacted by many social determinants of health. Ultimately, these burdens negatively impact older adults’ care provision and quality of life. Transitioning to a nursing career may alleviate some of these complex problems, but this has scantly been explored. A qualitative descriptive study was designed to 1) identify interest in a nursing career, and 2) explore perceived barriers and facilitators of transitioning into a nursing profession. CNAs from nursing facilities participated in private, semi-structured interviews. Recorded interviews (n = 6) were transcribed verbatim. Preliminary thematic analyses yielded two overarching themes: The Dream and The Reality. Rich subthemes began emerging from both overarching themes. Example subthemes from The Dream were: family legacy in healthcare, and finding purpose. Example subthemes from The Reality were: versus (CNAs vs. nurses; nurses vs. nursing care), and work-life balance. These preliminary findings suggest that CNAs express desire in becoming a nurse, although a range of personal and professional barriers and facilitators exist. Making the nursing dream become reality may improve CNAs’ social determinants, workplace outcomes, and resident outcomes, but further exploration is warranted.
Relationship Between Severity of Comorbidities and Self-Perceptions of Aging
Authors: Chang DaJung
Published: December 2021

An older adult with negative self-perceptions of aging (SPA) can lead to lower self-rated health and a higher risk of mortality. To stay a positive SPA, keep a healthier status is very important. However, evidence also proved that health conditions, like a physical limitation, could predict the level of SPA. Older adults usually have a higher prevalence rate of chronic diseases than the younger population, which can adversely impact them. The purpose of this study is to determine the relationship between the severity of comorbidities and the change of SPA during a time. I examined data in 7,034 people from the 2012 wave Health and Retirement Study (HRS) and followed the respondents who have answer the SPA scale in the leave-behind questionnaire in 2016. The generalized estimating equation was used to analyze the relationship between the severity of comorbidities and SPA in different waves. To measure the severity of comorbidities, a reduced index of the comorbidities severity scale (CmSS) was created to collect the health condition from HRS. Results statistical model shows that an individual with more severity of comorbidities may have a more negative SPA. However, the relationship does not follow through with the times. These findings enhance the previous study that there are relationships between severity of comorbidities and SPA. The benefit of this study is to use a different measurement to identify the severity of comorbidities and extend to more in-depth research.
ESPO and Health Sciences Section Symposium: Conducting Clinical Trial Research During the COVID-19 Pandemic: Transforming Research Practice for the Future
Authors: Morgan Brianna , Nguyen An , Nguyen An
Published: December 2021

The COVID-19 pandemic caused significant disruptions for people and institutions across healthcare settings. Clinical trials are an important research tool to test interventions in real-world healthcare settings and provide high quality evidence that supports older adults’ longevity and wellness. Clinical trialists must consider how to account for unpredictable and ever-changing environmental contexts. The COVID-19 pandemic is a specific example of a changing context that impacted all stages of the clinical trials process from planning, to administration, and outcomes. Reflecting on ways clinical trialists navigated their studies during the COVID-19 pandemic may unlock opportunities to design flexible clinical trials that meet the needs of older adults in real-world environments. This symposium highlights five clinical trials for older adults that occurred during the COVID-19 pandemic. Dr. Carpenter will discuss lessons learned in implementing a palliative care intervention in nursing homes. Brianna Morgan will describe the pivots needed to complete a clinical trial testing an advance care planning website for nursing home residents with dementia. Dr. Nuckols will describe obstacles and opportunities to implementing a randomized controlled trial on hospital nursing units, including implications for medication safety. Dr. Pevnick will highlight barriers and facilitators to implementing a pharmacist-led intervention to reduce hospital readmissions. Dr. Stark will share novel procedures for conducting clinical trials in the community that reduce burden for older adult participants while maintaining fidelity. Presenters will address practice transformations that researchers can bring forward to design flexible clinical trials that meet the needs of older adults in different healthcare contexts.
Daughters-in-Law in Negotiating the Intergenerational Contract in Rural China: A Qualitative Case Study
Authors: Li Yong-Zhen , Kwan Crystal
Published: December 2021

Daughters-in-law play a key role in intergenerational relationships, especially in Rural China. Albeit, their voices are less heard and examined. This study explores how daughters-in-law in Rural China view and negotiate intergenerational contracts with their older adult parents-in-law. A qualitative case study design was used, and multiple data collection methods (including semi-structured interviews, observation and document review) with thematic analysis were employed. Findings highlight that daughters-in-law play a key role in shaping the intergenerational contracts between their spouse and their spouse’s parents. In particular, the daughters-in-law provided instrumental support to their parents-in-law who were without self-care abilities or at risk when their adult child (the daughter-in-law’s spouse) went to the city/county for work. There were also unique findings highlighting diverse negotiations of the intergenerational contract between daughters-in-law and their older adult parents-in-law. In the context of growing austerity and the current pandemic, whereby informal social supports and networks become key to older adults’ wellbeing, identifying strengths and barriers of intergenerational support from daughters-in-law, is significant to support both the individual members and family wellbeing.
Does Money Matter? Characteristics Associated With Joint Pain Medication Access Among Older Adults
Authors: Tur-Sinai Aviad , Bentur Netta , Shuldiner Jennifer
Published: December 2021

The experience of pain is a widespread phenomenon among adults, especially older adults, and entails high costs to both individuals and society. The objective of the current research is to determine if the ability to pay and supplementary insurance are factors associated with pain medication among individuals over 50. Data came from Survey of Health, Aging and Retirement in Europe (SHARE). The sample included 64,281 individuals 50+ from nineteen European countries and Israel. Joint pain was common with one out of three reporting joint pain. Prevalence of pain was similar among different age groups, and more women reported joint pain. Among those in pain, about 21.5% of the individuals reported mild pain, 52.9% moderate and 26% severe pain. In the multivariate logistic regression, we found that men and those older than 60 suffered more from joint pain, while controlling for education and subjective assessment of the ability to cope economically (Able to make ends meet). A large percentage of those with pain were not taking medication to manage their pain, and there were significant demographic differences between those that did and did not take medication. Those that took medication were younger, male, had more education, were able to cope economically and had supplementary insurance. Our study showed that about half of the individuals with pain were not taking medication to manage their pain. Our results demonstrate that among individuals over 50 in Europe income is strongly associated with taking pain medication and that there is economic inequity in medication access.
Modifiable Factors of Health-Related Quality of Life Among LGBTQ Older Adults Living With Cognitive Impairment
Authors: Kim Hyun-Jun , Goldsen Karen Fredriksen
Published: December 2021

Cognitive impairment can lead to significant decline in health-related quality of life (HRQOL) in later life especially among those who are socially marginalized. While Lesbian, gay, bisexual, transgender, and queer (LGBTQ) older adults are documented to be at heightened risks of cognitive impairment, they may face unique challenges due to discrimination, social isolation, and other LGBTQ-related risks. This study examined factors associated with psychological and physical HRQOL among LGBTQ adults aged 50 and older analyzing a sub-set of longitudinal data (N = 646) from National Health, Aging, and Sexuality/Gender Study: Aging with Pride. Lifetime LGBTQ discrimination and victimization and insufficient food intake were negatively, and physical and leisure activities were positively associated with both HRQOL dimensions. Community engagement, social support, and social activities were positively associated with psychological HRQOL. Culturally responsive interventions addressing these modifiable factors are needed to improve HRQOL of this socially marginalized but resilient population.
Nursing Home Social Work With Residents With Severe Mental Illness, Thoughts of Suicide, or Dementia
Authors: Bern-Klug Mercedes , Roberts Amy Restorick
Published: December 2021

Many of the close to 3 million persons who receive care in a U.S. nursing home in any given year face mental-health-related challenges that range from minor to severe. One of the core professionals involved with care planning for the psychosocial needs of nursing home residents with mental health concerns is the social worker. Reporting data from a 2019 nationally representative survey of nursing home social services directors, this session provides information about the training needs of nursing home social workers in terms of their work with residents diagnosed with a severe mental illness such as schizophrenia or severe depression, residents who are suicidal, and residents with dementia.
Disability Trends Among Community-Dwelling Older Adults and Related Determinants of Disability
Authors: Li Qiwei , Szanton Sarah
Published: December 2021

The growing aging population with disabilities poses challenges to caregiving and health care services but there is little recent data on disability trends. Some studies have shown that disability is decreasing while others have shown it increasing. Understanding these trends among community-dwelling older adults is critical for communities to allocate resources and develop policies. This study updates disability trend data among community-dwelling older adults using nationally representative National Health & Aging Trends Study data. Results revealed that about 30% of Medicare beneficiaries had at least one limitation of the activity of daily living (ADL) from 2011 to 2019. Age 75-79 (IRR=1.55), 80-84 (IRR= to 4.60), 85-89 (IRR=2.99), 90+ (IRR=4.60), female, (IRR=1.18), not a house owner (IRR=1.51), financial strain (IRR=1.71), and receiving Medicaid (IRR=1.84) are associated with a higher likelihood of becoming ADL limited or having more ADL limitations. We will discuss potential policy, intervention, and research implications.
Sleep, Lifestyle, and Socioeconomic Markers of Mental Aging and Well-Being: Lessons From England, China, and Japan
Authors: Steptoe Andrew
Published: December 2021

Healthy ageing has become a popular topic worldwide. We investigated the role of sleep, leisure activities, and socioeconomic inequalities in relation to cognitive decline, wellbeing, and quality of life in data from the English Longitudinal Study of Ageing (ELSA), Chinese Health and Retirement Longitudinal Study (CHARLS), and Japanese Study of Aging and Retirement (JSTAR), national representative samples of England, China and Japan, respectively. We found an inverted U-shaped association between sleep quality and memory in English adults and a positive dose-response association in Chinese older adults (Brocklebank). In another examination, we found that younger English individuals playing games had lower quality-of-life than older participants who game, and this association is more pronounced for widowed individuals than others (Almeida-Meza). Cognitive impairment and dementia represent significant challenges worldwide. In a cross-country investigation, we found that the prevalence of MCI was twice as great in England compared with Japan, but that the two nations differ slightly across socioeconomic correlates (Gireesh). In another cross-country comparison between England and China, we found that the rate of memory change appeared socioeconomically patterned, primarily by education and area-based characteristics (urban vs. rural), with a more substantial impact on rural China inequalities compared to England (Cadar). Our results indicate more robust educational and geographical disparities in China and increased occupational impact among English and Japanese participants. Our findings highlight the imperative need for policy interventions and tailored strategies to protect those particularly disadvantaged in England and China.
Teaching Anti-Racism in Gerontology: An Interactive Program of Recognition, Self-Work, Pedagogy, and Action
Authors: Pestine-Stevens Althea , Newsham Tina K
Published: December 2021

Older adults with intersecting identities as persons of color experience disparities in health and well-being due to racism in individual and structural spheres, which have been amplified by health, economic, and social consequences of COVID-19. We can begin the work to reduce these inequities by training scholars and practitioners to disrupt the systems within which we work that relegate advantages and disadvantages throughout the life course and in later life by racial groups. This interactive symposium presents resources on anti-racist gerontological education and provides an opportunity to engage critically with peers in all stages of their careers and anti-racism journeys who are interested in integrating anti-racism into their teaching. The first presenter introduces conversations to begin anti-racist pedagogy and assumptions to dismantle. The second presenter describes cultural humility as an essential step towards self-awareness and critical self-reflection for educators and practitioners. The third presenter presents how anti-racist pedagogy, a teaching approach that combines racial content, pedagogy, and organizing, may be applied to gerontology education. Fourth, an example will be presented from an online course module developed to guide Master of Social Work students toward recognizing racial disparities in aging services systems and identifying concrete suggestions for improvement. Finally, strategies for curriculum design will be presented with examples from Public Health education. This symposium is designed to include ample time for group discussion on this critical and under-addressed area of teaching in gerontology across disciplines, such that participants can better connect with others to build awareness, competency, and resources.