bluuebunny/crossref_metadata_2025 huggingface dataset:
THE ROLE OF ENGAGEMENT IN SUPPORTING AND LEVERAGING GERONTOLOGY AND GERIATRIC PROGRAMS
Authors: Fruhauf Christine
Published: November 2019

For nearly 20 years, gerontology and geriatric administrators and faculty have been challenged by managing “tough times” related to low enrollment and reduced or limited funding for their programs. At the same time, the aging population continues to increase and the need for highly trained individuals to work with and on behalf of older adults are needed in all sectors of the workforce. In this paper, I will build on previous empirical and theoretical work from AGHE and GSA Fellows as I integrate personal experience from my fifteen years at a land-grant university, whereby I serve as the coordinator of our undergraduate gerontology minor. In particular, in an effort to uplift the 2019 conference theme, I will organize my thoughts from the lens of university-community engagement, as I describe how to best harness networks to support and leverage gerontology and geriatrics programs.
TARGETING TRYPTOPHAN-KYNURENINE METABOLISM TO EXTEND LIFESPAN AND TREAT AGE-ASSOCIATED DISEASE
Authors: Sutphin George L , Sutphin George L
Published: November 2019

The kynurenine pathway, the major route for tryptophan catabolism, becomes dysregulated with age and in many age-associated pathologies in humans. Interventions targeting kynurenine metabolism are being pursued for neurodegeneration, cardiovascular disease, and chronic kidney disease. By manipulating kynurenine pathway enzymes and metabolites, we have extended lifespan up to 40% in Caenorhabditis elegans. Our most promising single target is the metabolite 3-hydroxyanthranilic acid dioxygenase (3HAA). Elevating physiological 3HAA by directly supplementing 3HAA or inhibiting the enzyme 3HAA dioxygenase (HAAO) extends worm lifespan by ~30% while reducing oxidative stress by directly degrading hydrogen peroxide. In rodents, anti-inflammatory activity of 3HAA improves outcomes in models of cardiovascular disease, asthma, and autoimmune encephalomyelitis. We are now beginning to validate our C. elegans work in mice and investigating a mechanistic model in which 3HAA acts to extend healthy lifespan by slowing age-associated accumulation of oxidative damage and repressing chronic inflammation.
AFRICAN AMERICAN FAITH LEADERS IN FLINT, MICHIGAN, FACILITATING ACCESS TO SEXUAL HEALTH INFORMATION
Authors: Senteio Charles R
Published: November 2019

In 2006, to respond to the HIV pandemic, the Flint-based YOUR Center collaborated with the National Coalition of Pastors’ Spouses to create an HIV Awareness and Prevention manual for African American faith communities. In 2006 this manual was transformed into Your Blessed Health (YBH), a community-level education and prevention intervention that provides HIV/STI health information to medically underserved communities throughout Michigan. Since then, YBH has trained over 200 faith leaders across 9 denominations in over 80 FBOs across Michigan to help disseminate information concerning the community-level impact of HIV. The YBH impact on congregants and community members has been detailed in peer-reviewed articles and presentations; however, the involvement of the faith leaders themselves has not been described. To address this gap in the literature, we conducted semi-structured interviews with African American faith leaders representing 20+ congregations in Flint who participated in YBH and welcomed the intervention into their congregations. Preliminary results show that faith leaders, whose median age is 65, embraced their role as conduits to health information in the interest of ministering to the “whole person”. They remain committed to educating themselves, and their congregants, to providing health information for various health and wellness issues. Detailing this impact is critical because community-health education and promotion literature suggests that older adult faith leaders can facilitate access to sexual health information through faith-based organizations, and may possess untapped potential as sources of health information across various health conditions. Older adult faith leaders are vital sources of information for medically underserved communities.
REFRAMING INTERGENERATIONAL FAMILIAL RELATIONSHIPS THROUGH THE STUDY OF GRANDPARENT-GRANDCHILD CONNECTIONS
Authors: Mendoza Nancy , Mendoza A Nancy , Fruhauf Christine A
Published: November 2019

Intergenerational relationships include non-familial and familial connections. Common familial bonds exist between grandparents and grandchildren. Although grandparent-grandchild connections have over 40 years of research, measurement and design gaps remain. With this paper, we will address new approaches to examining grandparent and grandchild relationships in an effort to understand how this connection impacts our attitudes on aging. Specifically, we will discuss the opportunities of approaching such relationships from a longitudinal perspective. The grandparent-grandchild relationship can span close to 30 years, and yet knowledge of relationship stability and change between individuals in these family roles is limited. We will highlight the conference theme by presenting how social network analysis (SNA) applied to empirical data of grandparents raising grandchildren can reframe aging’s network ties. Further, future research using SNA with grandchildren will be addressed as a way to build on previous work, extending our knowledge of intergenerational relationships from the family perspective.
CORRELATES OF LONELINESS AMONG OLDER ASIAN IMMIGRANTS: A SYSTEMATIC REVIEW
Authors: Wang Yihan , Woo Bongki , Jiang Nan
Published: November 2019

Loneliness is a prevalent social concern among older adults, which calls for attention as a condition itself and its influence on mental and physical conditions. However, limited efforts have been made to understand loneliness, particularly among immigrant older adults. Guided by the ecological perspective, the present study contributes to the literature by providing a systematic review of the prevalence and individual-, household-, and community-level correlates of loneliness among Asian older immigrants, one of the fast-growing immigrant population. Following the PRISMA guideline, we systematically searched eight electronic databases to identify relevant empirical research articles. Of the 828 articles identified, ten articles met the inclusion criteria. Majority of these articles focused on older Chinese and Korean immigrants. On the individual level, migration grief, longer length of residence, and weaker ethnic attachment were linked to higher level of loneliness, indicating that immigration can be a challenging experience for later life well-being of Asian older adults. Other identified correlates include mental and functional impairment and worsening health changes. On the household level, while living alone was a commonly identified correlate of loneliness, those who live with family also reported loneliness when they have fewer interactions with their family members. On the community-level, smaller social network and lack of social support and interactions were correlates of loneliness. The findings of the present study are helpful for identifying older Asian immigrants who may be at risk of loneliness and implicates that the efforts to mitigate the loneliness need to be made at various ecological levels.
RECIPROCAL RELATIONSHIP BETWEEN COGNITIVE STATUS AND HIERARCHY FUNCTIONAL LOSS AMONG FRAIL OLDER ADULTS IN CHINA
Authors: Sun Qian , Jiang Nan , Lu Nan , Lou Vivian W
Published: November 2019

The present study aimed to determine the reciprocal relationship between cognitive status and the loss hierarchy of specific functional activities among frail older adults in China. Data were derived from a sample of 469 older adults who participated in both the 2010 and 2013 waves of the Longitudinal Study on Family Caregivers for Frail Older Adults Aged 75 or Above in Shanghai, China. A two-wave cross-lag analysis was used to examine the proposed model. In general, the results showed that cognitive status in 2010 was a significant predictor of dependence in activities of daily living (ADLs) in 2013. Specifically, cognitive status at baseline has significant effects on feeding [β (SD) = -0.198 (0.043), p < .001], continence [β (SD) = -0.172 (0.045), p < .001], bladder [β (SD) = -0.159 (0.045), p < .001], toileting [β (SD) = -0.119 (0.043), p < .001], hygiene [β (SD) = -0.108 (0.044), p < .05], stairclimbing [β (SD) = -0.101 (0.044), p < .05], and dressing in 2013 [β (SD) = -0.100 (0.045), p < .05]). Furthermore, toileting and bathing in 2010 were significant risk factors of cognitive status in 2013 [toileting: β (SD) = -0.146 (0.066), p < .05; bathing: β (SD) = -0.113 (0.047), p < .05]. The findings not only expanded our understandings of the relationship between cognition and the hierarchy of functional loss, but also provided evidences for clinicians and service planners for anticipating the subsequent care and service needs of the elderly and their families.
SUSTAINING STAR-VA: EVALUATING SYSTEMIC OUTCOMES AND TEAM STRATEGIES FOR MANAGING BEHAVIOR SYMPTOMS OF DEMENTIA
Authors: Curyto Kim , Van Haitsma Kimberly
Published: November 2019

The Veterans Health Administration (VHA) has invested in the implementation and evaluation of STAR-VA, a Veteran-centered, interprofessional intervention for managing behavioral symptoms of dementia (BSD), with 86 Community Living Center (CLC nursing home) teams between 2013 and 2018. Results of a VHA Quality Enhancement Research Initiative (QUERI) partnered evaluation project are presented, including a multi-site interprofessional network created to collaborate on evaluation of the longitudinal impact of STAR-VA on CLC Veteran- and site-level outcomes, and to determine factors associated with sustained implementation and positive outcomes. The development and validation of a Minimum Data Set quality indicator of behavior symptoms of dementia (BSD) is presented. Characteristics of STAR-VA trained and untrained CLCs are presented, along with facilitators and barriers to sustained program implementation. Findings support the effectiveness of implementation of STAR-VA on decreased use of psychotropic medication. Qualitative outcomes demonstrate importance of having the appropriate staff, positive team relationships, supportive usual routines, and culture as critical for STAR-VA sustainability efforts. Results emphasize the importance of using a valid, routine measure of BSD to provide feedback to CLC teams, and to develop a sustainability intervention focused on addressing reported barriers to program sustainability through interprofessional networks. Both qualitative and quantitative outcomes will inform development and recommendations for an implementation and evaluation strategy for an outcome-driven, tailored intervention to support CLC teams in sustaining STAR-VA and to improve poor-performer and maintain high-performer outcomes. The potential benefit of our findings for other interprofessional behavioral nursing home interventions will be discussed.
CANCER, COGNITION, AND COMMUNICATION: A 2-DAY INTERPROFESSIONAL GERIATRIC PSYCHO-ONCOLOGY SYMPOSIUM
Authors: Gangai Natalie , Manna Ruth , Banerjee Smita , Muniz Rosario Costas , Nelson Christian , Korc-Grodzicki Beatriz
Published: November 2019

Background: Most cancer deaths are in patients older than 65 years. Healthcare professionals (HCPs) caring for older adults with cancer must be equipped with skills to manage cognitive related changes and the nuances of communication with patients and caregivers. Methods: A two-day interprofessional symposium was developed to increase knowledge regarding 1) chemotherapy-related cognitive changes; 2) distress, delirium, dementia and depression in older cancer patients; 3) communication with patients with cognitive deficits and their caregivers; 4) decision making capacity. Presenters include geriatric medicine, geriatric psychiatry, occupational therapy and legal, ethics and communication experts. Day one centered on didactics with a complex case interprofessional discussion. Day two comprised of a communication skills training consisting of three modules: Geriatrics 101, Communication and Cognitive Deficits and Shared Decision Making. Participants role-played with simulated older adult patients and caregivers. Knowledge, self-efficacy and satisfaction were assessed. Results: A total of 75 people attended day one and 33 people attended day two. Most attendees were white (74.4%) and female (85.4%). Nurses (36.6%), social workers (29.3%), physicians (14.6%), others (19.5%) were represented. Mean knowledge increased (t=-3.23, df (13), p<0.05) from pre (M=0.83) to post (M=0.96). Mean self-efficacy in communication skills increased significantly across the three modules from 3.33 to 4.51 on a 5-point Likert scale (t=-6.40, df=23, p<0.001). Discussion: This two-day symposium shows an increase of knowledge and self-efficacy among HCPs caring for older adults. Skills related to cognitive changes and communication are essential to providing patient-centered care and making shared decisions with older adults and their caregivers.
AGE MODERATES THE ASSOCIATION BETWEEN ENGAGEMENT IN MINDFULNESS AND PSYCHOLOGICAL DISTRESS AMONG CANCER SURVIVORS
Authors: Zhang Anao , Hu Rita X , Li Lydia , Wang Kaipeng
Published: November 2019

Geriatric cancer survivors constitute up to 65% of the U.S. survivorship population, and their psychosocial wellbeing are increasingly recognized. Facing high risk of psychological distress, many cancer survivors engage in mindfulness to reduce psychological distress. However, the acceptance of mindfulness across age groups was rarely examined. Based on the Motivational Theory of Life Span Development, mindfulness practice actives survivors’ secondary control strategies to better cope with the loss of primary control caused by cancer. In other words, older survivors may respond differently than their young counterparts when facing psychological distress. Therefore, it is important to examine to what extent engagement in mindfulness is different across age groups. Using the cross-sectional 2017 National Health Interview Survey (N=3,068), this study evaluated the association between engagement in mindfulness and psychological distress among cancer survivors and examined whether age moderates such relationship. Age significantly moderated the association between psychological distress and engagement in mindfulness, OR=0.97, p<0.05. The correlation coefficient between engagement in mindfulness and psychological distress were significantly greater among younger cancer survivors (<65 years old) than their older counter parts (65+), z=2.24, p<0.05. Consistent with previous literature and the Motivational Theory, this study found age moderates the relationship between psychological distress and mindfulness engagement, and this relationship was much stronger among younger cancer survivors comparing to their older counter parts. Therefore, geriatric cancer survivors’ unique psychosocial challenges should be addressed in ways that are appropriate to their developmental characteristics.
PAYROLL-BASED STAFFING MEASURES FOR NURSING HOMES
Authors: Williams Christianna , Zheng Qing , White Alan
Published: November 2019

The Centers for Medicare & Medicaid Services (CMS) developed the Payroll-Based Journal (PBJ) system for nursing homes to electronically submit direct care staffing information based on payroll and other auditable data. In spring 2018, CMS started reporting PBJ-based staffing measures on Nursing Home Compare. The objective of this research is to examine nursing home staffing patterns using PBJ data. We created measures of staffing hours per resident day, using PBJ staffing information and resident census calculated from MDS assessments. We examined how PBJ staffing levels varied for different types of nursing homes and the relationship between staffing and performance on other parts of CMS’s Five-Star Quality Rating System. We also examined weekday/weekend variation in staffing levels. We tracked about 15,650 nursing homes from 2017 to 2018. The average staffing level was 3.85 hours per resident day, of which 0.66 hours were for RNs. Average staffing levels were higher for smaller, non-profit, and hospital-based facilities. They were also higher for facilities with higher health inspection and quality measure ratings. Staffing levels were about 17% lower on weekends than on weekdays, and RN staffing was 38% lower on weekends. About 20% of facilities had one or more weekend day without any RN staffing in the quarter, while only 8% of facilities had any weekday without RN staffing. The use of payroll-based staffing measures improves the accuracy of the staffing information reported on Nursing Home Compare, providing consumers with additional quality-related information that can help guide their nursing home placement decisions.
SAFETY CLIMATE IN NURSING HOMES: ARE SENIOR MANAGERS IN AGREEMENT WITH DIRECT CARE STAFF?
Authors: Quach Emma , Kazis Lewis , Zhao Shibei , McDannold Sarah , Hartmann Christine W
Published: November 2019

Nursing home safety climate in nursing homes reflects norms and attitudes about the safety of residents and is a key driver of safety. We investigated views of direct care staff and senior managers in 56 Department of Veterans Affairs nursing homes, because prior hospital studies reveal incongruent views of these two groups, which compromises quality of care. Each domain of the previously validated CLC Employee Survey of Attitudes about Resident Safety (CESARS) served as a dependent variable, with occupation as the major independent variable distinguishing senior managers (the reference group) from licensed nurses, nursing assistants, and clinicians/specialists. Mixed random effect models controlled for job tenure, work shift, ≤ 40 weekly work hours or more, as well as clustering effects (by VA hospitals, VA service networks, and geographic regions). We analyzed responses of 1316 direct care staff and senior managers, a 26% response rate. Senior managers were more favorable about their co-worker interactions regarding safety and their nursing home globally than each direct care staff group (small to moderate effects or ⅓ to ½ of a standard deviation) (p < 0.05). Direct care staff had comparable ratings on these two safety climate domains. We found incongruence between senior managers and direct care staff in their perceptions of their facility’s safety. Results imply that regular and open conversations between direct care staff and senior managers around safety may keep senior managers informed about frontline safety issues and direct care staff about high-level quality improvement initiatives, bringing them closer to a mutual understanding.
EFFECT OF STIGMA ON OUTCOMES OF A MEMORY TRAINING INTERVENTION
Authors: McDougall Graham J , McDonough Ian M , Kraemer Kyle
Published: November 2019

Cultural stereotypes equated with aging that emphasize decreasing competence and increasing forgetfulness can be threatening to older adults. Even brief exposure via entertainment media or the patronizing behavior of others may induce stigma in elders and thereby impair memory and executive functions. The sample was recruited for an RCT known as Senior WISE and conducted in Central Texas. The average age was 75 years and average of 14 years of education. Sex and minority status were consistent across groups. Data were analyzed using SPSS, v21. First, Pearson Rs were calculated between stigma (MIA Anxiety subscale) and memory outcomes at baseline. Stigma related significantly to Rivermead (RBMT), HVLT, and Memory Self-Efficacy (MSQ). Then, after controlling for the effects of trait anxiety, stigma explained a significant portion of the variance within scores on the RBMT (β = -.139, R2 MIA Change = .016, p = .037), HVLT (β = -.145 R2 Change = .017, p =.032), and MSQ-35 (β = -.253, R2 Change = .053, p < .001). Change in stigma was significantly associated with change in HVLT scores among those in the memory training group, r(105) = -.228, p = .018. Reductions in stigma were related to increases in HVLT score, β = -.14, F(1, 201) = 3.021, p = .084, R2 Change = .015; however, the overall regression model was not a good predictor of HVLT change, F(4, 201) = 1.793, p = .132, R2 = .034. Stigma is a high priority area of scientific inquiry and a self-fulfilling prophecy.
EFFECTS OF COGNITIVE TRAINING ON WHITE MATTER MICROSTRUCTURE AND COGNITION IN OLDER ADULTS: A SYSTEMATIC REVIEW
Authors: McPhee Grace M , Downey Luke A , Stough Con
Published: November 2019

Adults who remain cognitively active may be protected from age-associated changes in white matter (WM) and cognitive decline. To determine if cognitive activity is a precursor for WM plasticity, the available literature was systematically searched for Region of Interest (ROI) and whole-brain studies assessing the efficacy of cognitive training (CT) on WM microstructure using Diffusion Tensor Imaging (DTI) in healthy adults (> 40 years). Seven studies were identified and included in this review. Results suggest there are beneficial effects to WM microstructure after CT in frontal and medial brain regions, with some studies showing improved performance in cognitive outcomes. Benefits of CT were shown to be protective against age-related WM microstructure decline by either maintaining or improving WM after training. These results have implications for determining the capacity for training-dependent WM plasticity in older adults and whether CT can be utilised to prevent age-associated cognitive decline. Additional studies with standardised training and imaging protocols are needed to confirm these outcomes.
LINKS BETWEEN NEIGHBORHOOD CONTEXT AND ACCESS TO SOCIAL CAPITAL IN LATER LIFE
Authors: Webster Noah J , Ajrouch Kristine J , Antonucci Toni C
Published: November 2019

Social capital is essential for healthy living in later life, and evidence indicates the importance of neighborhood context in facilitating access to this resource. However, additional research is needed to compare how objective and subjective indicators of context shape this association. We examine links between objective (census tract-level population density and composition) and subjective (perceived safety and quiet) indicators of neighborhoods and social capital (contact frequency, network size, trust others in neighborhood). Data include participants age 65+ (N=259) from Wave 3 (2015) of the longitudinal Social Relations Study based in Detroit, Michigan. Multivariate analyses indicate respondents living in more densely populated neighborhoods reported more frequent contact with network members. Those perceiving their neighborhood as safe reported larger networks, more trust in and greater support exchanged among neighbors. Findings suggest both objective and subjective indicators of neighborhood context shape access to social capital, but perceptions play a larger role.
HOW POLITICO-ECONOMIC SYSTEMS CAN SHAPE THE ATTITUDE TOWARD ELDERLY CARE: LESSONS FROM THE GERMAN REUNIFICATION
Authors: Diederich Freya , König Hans-Helmut , Brettschneider Christian
Published: November 2019

Migration flows have been rising over the past decades and are not expected to mitigate in the future. Migrants brings along values and preferences that were shaped by their origin countries, among those, their perceptions of how societies should care for the elderly. In this study, we examine how the attitude towards informal care is shaped by the politico-economic system an individual grew up in and if this attitude adjusts over time once an individual lives in a different system. After the fall of the Berlin Wall, Eastern Germans were exposed to the market-oriented western economy, a natural experiment that allows us to address these issues. By analyzing data from the German Family Panel (2009/10-2015/16), we assess differences in attitudes towards informal care among four birth cohorts that were born during the German separation (N=11,966) using random-effects models. We control for socio-demographic factors as well as the institutional and economic environment an individual lives in. The results reveal that, on average, older generations that grew up in East Germany exhibit up to a 6.7% (95% CI, 0.03-0.1) higher willingness to provide informal care to their parents than older generations that grew up in West Germany. There is no significant difference in younger birth cohorts. Attitudes do not significantly converge over the observed time horizon. The results provide evidence that individuals’ attitude towards informal care is deeply shaped by the system they grew up in such that migration flows can influence the supply of informal care in the future.
ALWAYS TRY TO DO MY BEST: A THEMATIC ANALYSIS OF CHINESE AMERICAN DEMENTIA CAREGIVERS
Authors: Liu Jinyu , Wu Bei , Mui Ada , Lou Yifan , Wei Wenxing , Jiang Jiyun
Published: November 2019

Objectives: Given the increasing prevalence of Alzheimer’s disease and related dementia (ADRD) in the United States and the rapid growth of the older Chinese American population, many older Chinese Americans are expected to need intensive care because of cognitive impairment. Prior studies on Chinese ADRD caregivers lack comprehensive examinations from a life course perspective that emphasizes the importance of time, context, process and meaning on human development. Using the life course perspective, this study aims to identify challenges and strength of caregiving experience for this population. Methods: We conducted semi-structured face-to-face interviews with 28 Chinese family caregivers of persons with ADRD in New York City. Thematic analysis method was used to assess the interview data. Results: Seven life-course themes emerged from the data. In the domain of challenges, four themes were identified: (1) physical and emotional exhaustion, (2) limited understanding on cognitive health, (3) difficulty in accessing effective and culturally-sensitive health care services for care recipients, and (4) caregivers’ inability to do self-care. Other three themes were found in the domain of strengths: (1) commitment to care due to cultural and religious values, (2) emotional closeness as resource to sustain caregiving, and (3) family support and cohesion. Conclusion: This study indicates that the life course perspective is an important lens to understand challenges and strengths of Chinese American caregivers. This study also suggests that health professionals could incorporate the life course perspective into assessment and intervention development when working with minority and immigrant ADRD family caregivers.
THE ASSOCIATION OF SUBCLINICAL HYPERTHYROIDISM WITH FRAILTY
Authors: Bhalla Nalini S , Vinales Karyne , Fawcett Janet , Li Ming , Bhattarai Richa , Harman Sherman M
Published: November 2019

The relevance of subclinical hyperthyroidism in the elderly has not been clearly defined. We studied whether the reported association of low TSH with frailty is an indicator of subclinical hyperthyroidism as assessed by free T3 levels. In a retrospective chart review of patients seen between January 2017 and December 2018 at the Phoenix VA Medical Center, we identified 100 patients aged ≥60 years with at least 2 low TSH measurements (<0.5 µIU/ml) and a free T3 measurement within 6 months of the measured TSH and 50 sex- and age-matched controls (TSH 0.5-5.0 µIU/ml). Patients with exogenous or clinical hyperthyroidism were excluded. We used a deficit accumulation approach evaluating 31 factors, to create a frailty index between 0 and 1 for each patient. The higher the FI, the more likely (p<0.001) it was that patients had expired in the interim. Patients with low (0.31±0.11 µIU/mL) vs. normal (1.84±0.84 µIU/mL) TSH had higher mean FI compared to controls (0.25±0.12 vs. 0.15±0.07, p<0.001). TSH significantly predicted frailty score (p<0.0001) independent of age. However, lower TSH was not associated with higher free T3 or free T4 levels. There was a nonsignificant inverse association of free T3 levels with FI (P = 0.09), which disappeared when adjusted for age. Similar to prior studies, low TSH predicted frailty. However, neither free T3 nor free T4 predicted low TSH or frailty index, suggesting that the association of low TSH with frailty is not due to subclinical hyperthyroidism, but perhaps to effects of comorbidities on TSH secretion.
A FRAMEWORK FOR CARE TRANSITIONS FOR OLDER ADULTS WITH COMPLEX HEALTH CONDITIONS
Authors: Stolee Paul , Elliott Jacobi B , Byrne Kerry , Sims-Gould Joanie , Tong Catherine , Chesworth Bert , Egan Mary , Forbes Dorothy
Published: November 2019

For older adults with complex health conditions, transitions between care settings are common and a major risk to quality of care and patient safety. Care transition interventions have shown positive impacts on continuity of care and health service use, however, most require additional human resources (e.g., transition coach), focus on one transition or “handoff”, and provide support for individual patients without addressing underlying challenges of health system integration. We sought to develop a framework for system-level enhancements to care transitions for older adults. We report a secondary framework analysis of an ethnographic investigation (the “InfoRehab” project) of care transitions for older persons who had experienced a hip fracture. The ethnographic study involved interviews, observations, and document reviews for 23 patients, 19 family caregivers, and 92 health care providers. Data were collected at each transition point (1-4/patient) along the care continuum, at three Canadian sites (large urban, mid-size urban, rural). Our framework analysis followed the approach described by Gale et al. (2013), using as cases 12 peer-reviewed papers which had reported InfoRehab results. Two researchers coded findings from each paper, then developed an analytical framework of eight themes by consensus; these include: patient involvement and choice, family caregiver involvement, patient complexity, health care provider coordination, information sharing, documentation, system constraints, and relationships. NVivo 11 was used to index findings into these themes and to generate a matrix. We are working with system stakeholders, including patients and caregivers, to apply this framework in the development of improved systems for care transitions.
TRANSGENDERED OLDER ADULTS IN LONG-TERM CARE: PREPARING FOR THE RISING TIDE
Authors: Henry Jean , Patton Susan K
Published: November 2019

Gender non-conforming older adults are more likely to be without traditional support systems in place; many may need to turn to nursing homes for long-term care (LTC). Little information is available about the experiences of LGBT older adults in these settings. Research questions: What is known about the experiences of transgender (TG) older adults in LTC? What evidence-based recommendations exist to guide LTC administrators in providing quality care to TG residents? What are key future research areas? Method: Systematic review of extant literature, using databases: PubMed, Medline, Psych Info, CINAHL, Academic Search Complete, and ProQuestCentral. Key Results:RQ1) Published research in transgender healthcare consists primarily of case reports, and retrospective and cross-sectional studies; minimal literature specifically on TG individuals; combining LGBT carries risk of minimizing or equating the TG experience to that of gays and lesbians. RQ2) Recommendations: take proactive approach; focus on awareness of relevant laws and regulations; establish non-discriminatory and inclusive environments, policies, and procedures; regular staff training, monitoring, and evaluation. RQ3) Need exists for quantitative and qualitative research into all aspects of the TG experience in LTC. Key areas include: lived experience of the TG in LTC; beliefs, attitudes, values and practices of LTC staff; administrative challenges and responses. Conclusions: Transgender and gender non-conforming individuals frequently experience discrimination in healthcare. Lack of cultural and clinical competence, and discrimination and bias by providers, create barriers to quality healthcare. Healthcare professionals and systems must be proactive in preparing for the inevitable growth of this population in the LTC setting.
ADVERSE CHILDHOOD EXPERIENCES AND ALCOHOL-IMPAIRED DRIVING IN LATER LIFE
Authors: Sahoo Shalini , Sacco Paul
Published: November 2019

Adverse Childhood Experiences (ACEs) are associated with a range of negative behavioral health outcomes in adulthood. Those with ACEs may use alcohol as a component of long-term coping, increasing risk of alcohol-impaired driving. Associations between ACEs and alcohol-impaired driving are relatively understudied. Using the 2012/2013 data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), logistic regression models examined the relationship between five types of ACEs (e.g. child abuse and neglect) and lifetime alcohol-impaired driving among a representative sample of American adults aged between 18 to 90 years (N = 36,309). ACEs were positively associated with lifetime alcohol-impaired driving for adults under age 50 (witnessed intimate partner violence (OR = 1.624, p < 0.001), physical abuse (OR = 1.723, p < 0.001), sexual abuse (OR = 1.651, p < 0.001), physical neglect (OR = 1.571, p < 0.001), and emotional neglect, (P > 0.05). We found similar positive associations between ACEs and impaired driving among adults aged 50 and over (witnessed intimate partner violence (OR = 1.398, p < 0.05), physical abuse (OR = 1.751, p < 0.001), sexual abuse (OR = 1.690, p < 0.001), physical neglect (OR = 1.455, p < 0.001), and emotional neglect, p > 0.05). Among adults under age 50, ACEs were associated with past-year alcohol-impaired driving, but this relationship was not seen in adults aged 50 and over. Findings suggest that the effect of ACEs on alcohol-impaired driving is in younger adulthood when alcohol use and driving occur most.
SUICIDE TRENDS AND DISPARITIES AMONG OLDER ADULTS IN THE UNITED STATES, 2008-2017
Authors: Ibrahimi Sanae El , Xiao Yunyu , Smith Matthew L
Published: November 2019

Background: Suicide ranks within the top fifteen causes of death among adults 55 and older in the United States and is a growing concern in the face of social isolation and other end-of-life issues. This study examined differences and trends in suicide rates and methods among older adults in the U.S. Methods: Suicide mortality rates from 2008-2017 were derived from the Multiple Cause of Death files in the CDC’s WONDER database. Suicide deaths were identified from the underlying causes of death using ICD-10 codes. Age-adjusted death rates (per 100,000) were calculated. Older adults were grouped into four age categories: 55-64, 65-74, 75-84, and 85+ years. Percent change in suicide rates between 2008-2017 were examined, which were then stratified by gender and top suicide methods. Results: Suicide rates increased by 16% among adults 55 years of age and older from 2008 to 2017 (15.4 vs 17.8 per 100,000 respectively). In 2017, the suicide rate among older adults was 27% higher than the general population (14.0 per 100,000). Suicide rates were significantly higher among men relative to women for those ages 85+ (14:1 ratio of males-to-females). However, females in the 65-74 age group experienced the highest increase of suicide rate (41%) compared to other females or males across age groups. The most common method of suicide was firearms, followed by poisoning and suffocation. Suffocation had the highest increase over time (37%). Conclusion: Rising suicide rates among older adults suggest the need for tailored intervention strategies that address upstream suicide-related risk factors.
CARING RELATIONSHIP DEVELOPMENT IN THE NURSING HOME IN SHANGHAI: A DYADIC QUALITATIVE STUDY
Authors: Chen Lin , Ye Minzhi , Zhu Qiang
Published: November 2019

Caring relationships between older residents and nurse aides are fundamental in terms of service delivery in nursing homes. However, little is known for the nuanced dynamics of this relationship in China. The purpose of this study is to explore how caring relationships develop between older residents and nurse aides in the nursing home setting in urban China. Informed by the dyadic perspective, this study illustrates the development process and relational nuances by simultaneously eliciting residents’ and nurse aides’ perceptions. This qualitative study purposively sampled 20 matched resident-nurse aide dyads (N= 40) in a government-sponsored nursing home in Shanghai. Participants participated in semi-structured, in-depth interviews from January to June 2017. Thematic analysis was performed. The findings reveal that the caring relationship began with nursing home assignment and primarily focused on instrumental assistance. Gradually, emotional involvement grew within dyads and reciprocity emerged. Based on different dyadic perceptions, this study conceptualized four types of caring relationships: (a) parent-child alike, (b) mutually respectful, (c) solo performance, and (d) reasonably detached. The findings suggest that residents and nurse aides could have different views on caring relationships, which further influenced the relationship development. The four types of caring relationships shared some similar traits while differentiating from some of the common types of interactions found in the existing nursing evidence across the world. Chinese filial tradition also influenced the relationship dynamics.
AGING, TASK DIFFICULTY, AND EFFORT: A META-ANALYSIS
Authors: Best Ryan , Freydefont Laure , Freund Alexandra M
Published: November 2019

Tasks of increasing difficulty require increasing levels of cognitive engagement from participants. The costs associated with cognitive engagement rise with age in response to normative cognitive decline. Additionally, previous studies have shown an interaction between age and task difficulty, with age differences in effort expenditure increasing along with task demands. Motivational accounts of effort allocation predict the opposite relationship, where increased task difficulty in the face of declining cognitive abilities result in disengagement among older adults, comparatively lowering their effort expenditure relative to younger adults that remain committed to the task. The current study quantitatively reviews the available literature on age and effort expenditure across tasks of increasing difficulty. An initial meta-analysis found no age differences in effort across task difficulty, but inspection of the significantly heterogeneous effect sizes indicated that measurement domain might account for some of the variance found between the effect sizes. A second, post-hoc meta-analysis was conducted, recoding effect sizes giving preference to subjective measures. Subsequent moderator variable analyses found that the combined effect of age and domain of effort measurement explained a sufficient portion of the variance across effect sizes. When using physiological measures, effort was not found to differ across task difficulty for either age group. Alternatively, when measured subjectively, effort was reported to greatly increase (>1 standard deviation) with difficulty, with a larger increase in younger adults. Results are discussed in terms of effort mobilization across adulthood and the importance of measurement domain in the interpretation of results.
DEVELOPMENT AND VALIDATION OF THE TESTAMENTARY CAPACITY MEASURE AMONG OLDER ADULTS AND PATIENTS WITH DEMENTIA
Authors: Nguyen Christopher M , Block Cady , Linck John , Denburg Natalie
Published: November 2019

As the growth of the population aged 65 and older is projected to be one of the most substantial demographic trends in history, geriatricians and other professionals working with older adults will be regularly consulted for opinion regarding an individual’s testamentary capacity (Brenkel et al., 2018). For individuals with severe cognitive and psychiatric impairment, the reduced capacity to make decision is evident. However, testamentary capacity among individuals with mild or moderate cognitive impairment has been mixed: some patients with mild cognitive impairment may be incapable of will making, while other patients with moderate cognitive impairment may have testamentary capacity (Spar & Garb, 1992). While several measures of testamentary capacity have been developed, these instruments are either not available for clinicians or lacks the sophistication of a comprehensive assessment (Marson, Huthwaite, & Herbert, 2004; Papageorgiou et al., 2018). With increasingly complex modern family structures (e.g., multiple marriages and stepchildren from these relationships), together with a projected largest transfer of wealth in human history about to occur in the next 30 years (Havens and Schervish, 2003), more standardized assessment procedures for testamentary capacity will be valuable for clinicians working with geriatric populations. In this study, healthy community-dwelling older adults and patients with Major Neurocognitive Disorder due to Alzheimer’s disease were recruited to participate in a validation study of a proposed testamentary capacity measure. Preliminary findings and implications are discussed.
COGNITIVE INTRAINDIVIDUAL VARIABILITY TO MEASURE INTERVENTION EFFECTIVENESS: BALTIMORE EXPERIENCE CORPS TRIAL
Authors: Bielak Allison A , Brydges Christopher R , Carlson Michelle C , Andrews Ryan M , Rebok George W
Published: November 2019

Studies investigating the effectiveness of intervention programs on cognitive ability in older adults are equivocal; however, these studies generally focus on traditional measures of cognition, and therefore may miss some improvements by not utilizing alternate measures. We evaluate the potential for intraindividual variability in cognitive speed (IIV), a demonstrated sensitive indicator of cognitive functioning, to be used as an index of cognitive plasticity from an intervention. The current study evaluated whether older adults in a school volunteering program showed a reduction in IIV, compared to a low-activity control group over two years of exposure. Non-demented aging older adults (n = 336) participated in the Baltimore Experience Corps Trial, an evaluation of a volunteering program conducted at elementary schools designed to increase older adults’ physical, cognitive, and social engagement. Participants completed a cognitive battery that included a computerized Stroop task at baseline and after 12 and 24 months. Participants who complied at the 80th percentile or above showed a significant reduction in IIV at 24 months, with an additional trend of improved IIV with increased compliance to the treatment protocol, both at 12 months, and at 24 months. Men specifically also showed significant dose-dependent improvements after 12 months. The Experience Corps program resulted in an improvement in cognitive performance as measured by IIV. Analyzing previously collected data with non-traditional measures of cognition, such as IIV, may be a potentially fruitful and cost-effective method for understanding how interventions impact cognition in aging populations.
DEVELOPING A PAIN IDENTIFICATION AND COMMUNICATION TOOLKIT FOR FAMILY CAREGIVERS OF PERSONS WITH DEMENTIA
Authors: Riffin Catherine , Pillemer Karl , Herr Keela , Petti Emily , Reid Cary
Published: November 2019

Best practice guidelines have emphasized the importance of routine pain assessment of older persons with dementia (PWD), yet pain remains severely underdetected and undermanaged in this population. Training family caregivers in observational pain assessment and subsequent communication of the assessment results to a healthcare provider has the potential to help improve pain management among PWD. The goal of this presentation is to describe the approach to developing, refining, and pilot testing the Pain Identification and Communication Toolkit (PICT), a novel intervention to help family caregivers recognize pain symptoms in PWD and communicate those symptoms to healthcare providers. Guided by self-efficacy theory and empirical research on dementia and pain communication, this presentation will detail the approach to developing the PICT intervention manual and delineate its major components, including modules that prepare caregivers to: a) recognize and differentiate pain from dementia symptoms, b) administer an observational pain assessment tool, c) communicate effectively about pain symptoms, and d) plan steps to take when pain is detected. The presentation will report results from the process by which preliminary versions of the PICT manual were refined, including iterative field-testing with a sample of racially and ethnically diverse caregivers of community-dwelling PWD and healthcare providers. Results suggest that the development of PICT represents a useful step in addressing the underdetection and undermanagement of pain in PWD, and can pave the way for future intervention research on caregivers’ initiation of pain-related communication with healthcare providers.
WHICH CAME FIRST, WELL-BEING OR PHYSICAL HEALTH? A LONGITUDINAL INVESTIGATION IN MID- TO LATE LIFE
Authors: Raldiris Tarah , Dzierzewski Joseph
Published: November 2019

As the United States population continues to age, focus has turned toward understanding and promoting positive aging processes. However, positive aging is not only about maintaining physical health, but also about maintaining and improving psychological health. Though previous research has found well-being to be predictive of physical health outcomes, research has yet to examine the temporal associations between these variables. The aim of the current study was to begin to disentangle these temporal associations by investigating how well-being and physical health relate over the course of nearly two decades in a nationwide sample of adults (N = 7,419, Mage = 46.38 at Time 1). The current study employed a cross-lagged panel SEM design across three time points to investigate if well-being, operationalized as purpose in life and personal growth, predicted future self-rated physical health. Data from the Midlife in the United States (MIDUS) study was analyzed from 1995, 2004, and 2014. Cross-lagged analyses revealed well-being was significantly predictive of future physical health, and physical health was also significantly predictive of future well-being. However, the magnitude of the path loadings indicated well-being was a stronger predictor of future physical health than physical health was of future well-being. Thus, these results suggest that personal growth and purpose in life may be particularly important for the promotion of physical health as individuals age. Future research should investigate if these predictive associations apply to all age-groups, as well as for individuals who self-identify as caregivers.