bluuebunny/crossref_metadata_2025 huggingface dataset:
RACIAL DISCRIMINATION IN HEALTHCARE SETTINGS OF OLDER ADULTS: SUBJECTIVE REASONS AND CONTRIBUTORS
Authors: Yi Eun-Hye , Hong Michin , Bolton Cherish
Published: December 2022

Racism is prevalent in the United States; however, literature exploring racial discrimination experienced by older adults is still limited. The current study examined subjective reasons for discrimination and compared race/ethnic groups. Then, we examined the contributors to racial discrimination in healthcare settings. An older adult sample aged 55 or higher was drawn from California Health and Interview Survey 2017 for analysis (N=12,261). African Americans were the highest (13.06%) among five racial-ethnic groups who reported racial discrimination experienced in a lifetime in getting medical care, while Whites were the lowest (1.57%). Perceived reasons for discrimination were significantly different by racial/ethnic group. Only 3.5% of Whites perceived they were discriminated against due to their race, whereas racial/ethnic minorities perceived the main reason for discrimination was their race/skin color (African American: 55.43%, Others: 24.06%, Asian Americans: 20.26%, Hispanics: 18.22%). The weighted logistic regression analyses revealed that being a racial/ethnic minority, economic status, mental health status, citizenship, the length of living in the United States, and age were significantly associated with the experience of racial discrimination of older people. Analyses by race/ethnic groups found different contributors. For example, poverty was the most prominent factor in racial discrimination for Whites, while education was for African Americans. This study identified an apparent gap in lifetime discrimination toward racial/ethnic minority older people. Also, we found racial discrimination experience combined with systematic barriers. The findings of this study support the need for interventions for race/ethnicity-based trauma of older people and anti-racism framework education for healthcare professionals and researchers.
IMPROVING THE PERFORMANCE OF COMMUNITY HEALTH WORKERS IN A BEHAVIORAL LIFESTYLE INTERVENTION FOR OLDER ADULTS
Authors: Liu Xinran , Lin Yuxin , Baumann Sara , Albert Steven
Published: December 2022

Community health workers (CHWs) play essential roles in implementing community-based behavioral lifestyle interventions. This qualitative analysis aimed to explore what program factors and CHW characteristics would help improve CHW performance in the Mobility and Vitality Lifestyle Program (MOVE UP), a community-based behavioral weight-management intervention for improving mobility among overweight or obese older adults. The MOVE UP program was implemented from January 2015 to June 2019 at 23 community-based sites in Pittsburgh, Pennsylvania. Trained and supported CHWs delivered 32 group sessions over 13 months. We collected data from semi-structured interviews with 21 CHWs and 14 community key informants (community site directors or coordinators); seven focus group discussions with participants from 9 sites, and 124 pieces of graduation advice provided by MOVE UP graduates for future participants; onsite CHW performance observation at 18 sites, and 124 meeting memos of support phone calls with CHWs. Interviews and focus groups were audio-recorded and transcribed verbatim. All data were thematically analyzed in a deductive approach, using the CHW generic logic model. Emerging themes were: Trained CHWs still require onsite support by experienced CHWs or training staff to deliver the first session; Participants need a Q&A session by specialists to address their questions beyond CHWs’ knowledge; Desirable CHW characteristics could increase CHWs’ relation and accessibility to participants, such as the same age group, similar weight loss experience, and living or working in the same community. These findings provide important insight as to recruiting and supporting CHWs in a community-based behavioral lifestyle intervention for older adults.
IMPACT OF AN ONLINE EMOTION-FOCUSED COMMUNICATION TRAINING ON STAFF KNOWLEDGE AND SELF-EFFICACY
Authors: Abbott Katherine , Heid Allison , Kelley Megan , Heppner Alexandra , Van Haitsma Kimberly
Published: December 2022

The way we respond emotionally to others can impact how we provide care. Emotional intelligence is vital for care team members whose entire day involves interacting with other people. We have developed an interactive, online, self-paced course for people providing care to others with the specific goal of increasing awareness of emotions and helping to identify emotions in others. The training is supported by research indicating that individuals who can better manage their own emotions are better positioned to manage behaviors and emotions in others. The central concept of the training is to build relationships that enhance person-centered care through increasing care providers’ emotional intelligence. These skills allow care providers to better manage their own behavior and emotions, which results in improved quality of their care work. The purpose of this study was to assess the knowledge, self-efficacy, acceptability, and appropriateness of the online training. The data for this study came from n = 130 individuals (19% direct care worker, 16% activities, 13% health care provider, and 12% case manager) who completed assessments pre-and post-training. Knowledge of emotion-focused communication strategies and self-efficacy in using emotion-focused communication strategies both increased significantly with training (t(129) = -5.40 p < .001 and t(124) = -6.42 p < .001). In addition, high levels of acceptability, appropriateness, and satisfaction were reported. Findings indicate the benefits of online training for emotion-focused communication for caregivers. The discussion will focus on recommendations for practice, policy, and research.
COLORECTAL CANCER SCREENING (CRC) DISPARITIES: A ZIP CODE–LEVEL ANALYSIS
Authors: Singh Roshni , Parraga Carla , Lin Rachel , Tamariz Leonardo , Palacio Ana
Published: December 2022

CRC is the third leading cause of cancer-related deaths among older adults in the US. CRC screening can prevent disease by early identification, yet there are disparities in CRC screening. This study aimed to determine the impact of race, social determinants, and geographic location at zip-codes level on CRC screening.We conducted a retrospective cross-sectional study of CRC screening among different races, evaluating the relationship with the social deprivation index (SDI) and annual income as health determinant factors using the public available data of 2016-2019 CDC 500 cities project and PLACES project 2020 database combined with 2019 American Community Survey for zip code-based analysis. We conducted a multivariate analysis and a confirmatory factor analysis among race, income, lack of health insurance, access to check-up visits and SDI.Increasing SDI tertile increased the likelihood of being Black and Hispanic and having lower median household income (p< 0.01). Lack of health insurance and lower regular checkup visits were less common in the third tertile of SDI (p< 0.01). The multivariate analysis showed that being black, Hispanic, having a lower income, not having health insurance, not having regular check-ups and SDI were related to decreased screening. In the confirmatory factor analysis, the variables most associated with decreased screening are SDI and access to health insurance.Race, SDI, insurance status, socioeconomic status, all impact CRC screenings, but the two most important factors are SDI and access to healthcare. These data may help implement interventions that specifically target these barriers to promote CRC screenings within disadvantaged communities.
PERSON-CENTERED CARE: WHY TAKING INDIVIDUALS' CARE PREFERENCES INTO ACCOUNT MATTERS
Authors: Hawes Frances , Tavares Jane , Cohen Marc , Hwang Ann
Published: December 2022

Person-centered care has been recognized as an integral part of a high-quality health care system. Utilizing the 2014 to 2018 waves of the Health and Retirement Study, we explore trends in person-centered care among those 50 and older by examining the extent to which they feel their care preferences are being taken into account, that is, that they are being heard by providers. We analyze the impact of not receiving person-centered care on health care utilization, health outcomes, and preventative care utilization. One-third of respondents reported that their care preferences were “sometimes” or “never” considered. Findings show that wealth and racial disparities in person-centered care are worsening over time. From 2014 to 2018, the percentage of non-Hispanic White respondents who reported that their care preferences were never taken into account decreased while the percentage for Hispanic and non-Hispanic Black individuals increased. Similar trends were seen for low-income individuals. Having a usual source of care was associated with a greater likelihood of having care preferences considered as well as significantly better control of chronic condition and greater use of preventive care. When care preferences are not being taken into account, there is less utilization of health care services, less preventive care usage, poorer control of chronic conditions, and increased risk for higher health care costs. These findings highlight the importance of assuring that people feel listened to by health care providers and emphasize a need for strategies to advance person-centered care for people of color and low-income populations.
ADJUSTING FOR COUNTRY-LEVEL VARIATION IN DEMENTIA PREVALENCE WITH CLASSIFICATION ALGORITHMS IN SHARE
Authors: Klee Matthias , Langa Kenneth , Leist Anja
Published: December 2022

Background. Population-level dementia prevalence depends on societal factors and individual-level risk and protective factors. To improve our understanding of how these factors interact, we can use cross-national surveys such as the Survey of Health, Ageing and Retirement in Europe (SHARE). However, in absence of validated cognitive assessments, adjusting for underdiagnosis of dementia is needed. The present study sought to explore the usefulness of the Langa-Weir and alternative algorithms to detect probable dementia while accounting for country-level variation in estimated prevalence and underdiagnosis of dementia.Method. Data from 57,880 respondents aged 60 years and older to wave 7 of SHARE (2017) with non-missing data on variables related to sociodemographics and cognition were used. Adaptations of the Langa-Weir classification algorithm were compared to a weighted logistic regression model and an XGBoost classifier applying the synthetic minority oversampling technique. Different specifications of algorithms were tested globally and for individual countries and compared with the World Alzheimer’s Report (2015)’s country-level projections of dementia prevalence for 2018. Results. All algorithms accurately classified self-reported diagnosis of dementia (accuracy = 0.90-0.96), with the Langa-Weir classification based on recall and a cutoff reflecting country-specific prevalence outperforming other algorithms regarding compensation of underdiagnosis. Algorithmically detected probable dementia is associated with newly self-reported dementia diagnosis, drop-out and death two years later. Discussion. Identifying probable dementia through classification algorithms can increase statistical power and improve validity in cross-national investigations. Further research is needed to replicate the findings in validated cognitive assessments and to identify causes of cross-national variation in dementia underdiagnosis.
BA FOR DEPRESSION AND DIABETES MANAGEMENT: EXAMINED VIA SINGLE-CASE DESIGN
Authors: Robertson Anna , Feliciano Leilani
Published: December 2022

Type 2 Diabetes Mellitus (T2DM) is a pervasive, chronic disease whose prevalence increases with age. The most common treatment options for T2DM include medication, dietary changes, and engagement in physical activity, which require considerable lifestyle changes. Further, individuals with T2DM are highly likely to develop physical and mental health comorbidities that can complicate effective T2DM management. In fact, individuals with T2DM and other comorbidities are frequently excluded from behavioral and other interventions in randomized controlled trials due to their comorbidities. Individualized treatment is necessary to address these comorbid diseases and to effectively navigate lifestyle changes. As part of a larger study evaluating an at-home diabetes management program with patients at a Federally Qualified Health Care Facility, the current study utilized a single-case experimental design approach using changing criterion design to evaluate behavioral activation to treat depression and diabetes in a 68 year-old Hispanic woman with cognitive impairment. Across her intake, five treatment sessions, and two follow-up appointments, we collaborated with her to set and achieve behavioral goals while effectively managing her diabetes. By end of treatment, she reported significant improvements in depression and overall well-being, increased engagement in exercises, increased blood glucose tracking, and rated improvement in her overall efficacy in life that maintained through follow-up. Results revealed the effectiveness of behavioral activation in treating comorbidities in a low-income, diverse individual. Attendees will learn about a promising treatment avenue for older individuals with complex medical and psychiatric conditions and the utility of single case design.
UNDERSTANDING THE EXPERIENCE OF EUSTRESS AMONG OLDER ADULTS WITH CHRONIC CONDITIONS
Authors: An Jaesung , Payne Laura , Liechty Toni , Iwasaki Yoshitaka
Published: December 2022

In their longitudinal study of stress and health among adults, McGonigal and colleagues (2013; 2016) suggested that how person perceives stress is a key factor affecting their actual physiological health. This is related to the concept of eustress (i.e., positive response to a given stressor) which has received very little attention in the literature. Besides, older adults with chronic conditions deal with symptoms that are difficult to manage and can contribute to chronic stress, which can then affect their health status and quality of life. Thus, helping older adults to shift their perceptions and interpretations of stressors from distress to eustress, rather than trying to avoid stress seems to be a reasonable approach to help them experience healthy aging. The purpose of this study was to explore the experience of eustress among older adults with chronic conditions in the context of leisure. Sixteen participants were recruited from three settings in a Midwestern city: a retirement community, an assisted living center, and a community senior program. Findings showed that participants’ health conditions were one of their greatest stressors, however, they modified their leisure engagement based on their conditions to enable their engagement in valued leisure activities. In the context of leisure, five themes emerged as facilitators that helped older adults to experience eustress: leisure satisfaction, sense of control, high levels of perseverance, positive attitude, and spiritual belief. Direct quotes and further discussion on how the themes are represented in the stress, leisure, and gerontology literature will be presented.
MARITAL DISSOLUTION AND DEPRESSIVE SYMPTOMS IN MIDDLE AND LATE LIFE: AN ANALYSIS OF THE HEALTH AND RETIREMENT STUDY
Authors: Tucker Julia , Han Sae Hwang
Published: December 2022

Literature to date has long indicated that marital relationships serve as one of the most important sources of health and well-being across adulthood. Despite the well-documented link between marital status and health, however, studies that have examined strict within-person linkages between martial transitions and subsequent health are limited . Drawing from the strength and vulnerability integration theory and the life course perspective, we investigated within-person mental health consequences of two forms of marital dissolution (i.e., divorce and widowhood), and whether the mental health consequences vary depending on the timing of marital dissolution (i.e., midlife vs late adulthood). Data for this study came from 11 waves of longitudinal data from the Health and Retirement Study (1998-2018). Study sample included 22,911 individuals 50 and older (11,429 women, 11,482 men) who were selected at the first wave at which they were identified as married during the observation period and subsequently followed up for up to 14 years (person-wave observations N=127,081). Approximately 4% and 17% of the study sample experienced a divorce and widowhood, respectively, during the observation. Mental health was assessed with an 8-item version of the Center for Epidemiologic Studies Depression scale. Study findings based on multilevel models indicated a robust within-person association between transition to widowhood and higher levels of depressive symptoms, but such association was not found regarding divorce. For women only, the mental health consequences of widowhood experienced during midlife were more detrimental compared to late-life widowhood. The findings are discussed in the context of intervention strategies.
DIFFERENT LEVELS OF LEISURE-TIME PHYSICAL ACTIVITY AND MENTAL HEALTH FOR OLDER ADULTS WITH DIABETES IN THE PANDEMIC
Authors: Lee Jungjoo , Kim Junhyoung , Han Sua
Published: December 2022

This study is an initial investigation of the association of different levels of LTPA engagement with mental health (e.g., loneliness, happiness, and positive and negative affect) among older adults with diabetes during the COVID-19 pandemic. The COVID-19 has led public health researchers to improve mental health among older adults with diabetes. Leisure-time physical activity (LTPA) has been emerged to cope with mental health difficulties in the pandemic. Total 301 respondents were extracted from the Health and Retirement Study (HRS) based on the following two criteria: over 50 years old and the onset of diabetes. Multiple questionnaire items were used to assess mental health (i.e., loneliness, happiness, and positive and negative affect) for older adults with diabetes. Multivariate Analysis of Variance was utilized to investigate the relationships between the fixed variable (i.e., LTPA) and outcome variables (i.e., mental health). We categorized LTPA participation into three groups (i.e., low, mid, high) and examined mental health following a different level of LTPA participation. LTPA participation showed a significant group mean differences for loneliness, happiness, and positive affect, but not for negative affect. High-LTPA respondents presented lower loneliness) and higher happiness than Low-LTPA respondents. High-LTPA and Mid-LTPA respondents indicated higher positive affect than Low-LTPA respondents. This study provides evidence of the benefits of LTPA on mental health for older adults with diabetes. Our study supports the evidence that high-LPTA involvement can be effective in promoting mental health among older adults with diabetes in the COVID-19 era.
HEALTHCARE DISPARITY IN THE ASSESSMENT OF DEMENTIA IN THE PRIMARY CARE SETTING
Authors: Gibson Regina , Kodali Maneetha , Priyambada Priya , Mendiratta Priya , Hasan Danish , Harris Melodee , Wei Jeanne , Azhar Gohar
Published: December 2022

Literature suggests racial implicit bias can significantly affect quality of care. Data demonstrates that older adult Blacks are twice as likely to have dementia as their White counterpart. Inappropriate cognitive screening by providers or diagnosing dementia just based on clinical impression could easily result in an over or under-estimation of the dementia. We reviewed the rate and method of cognitive screening in randomly selected patient records (n=75) at a primary care university clinic. Our results indicated that the cognitive screening rate for Black patients was lower compared to their White counterpart (43.4% Blacks vs 68.5% Whites, p < 0.05). We designed a quality improvement project to identify any contributory causes and challenges involved in screening for dementia with the goal to reduce racial disparity in dementia diagnosis. We identified knowledge deficits in providers in their approach towards patients with dementia and a lack of experience in their use of appropriate instruments for cognitive screening. A multipronged educational program, with videos, case conferences, presentations and one-to-one training by dementia experts and a neuropsychologist was employed to reduce the bias and train the providers in appropriate screening methods. Post-educational intervention, screening rates greatly improved in n=75 randomly selected patients from both races. In Whites, the screening rate increased by 20.9% to 89.4% and in Blacks by 38.9% to 82.3% (p < 0.05). Overall, the quality improvement driven educational intervention improved the self-efficacy of providers and improved the standardized dementia screening rates in Black patients to levels comparable to those of White patients.
BLACK GREEK LETTER ORGANIZATIONS: FACILITATING HEALTH PROMOTION FOR AFRICAN AMERICANS ACROSS THE LIFECOURSE
Authors: Mingo Chivon
Published: December 2022

African Americans remain underrepresented in accessing and utilizing evidenced-based health promotion interventions (EBIs). Challenges with dissemination and implementation of EBIs further corroborate existing racial/ethnic health/healthcare disparities. Therefore, there is a need to identify effective ways to increase the widespread adoption of health promotion behaviors among African Americans across the life course. It is plausible that engaging in non-traditional partnerships (i.e., community groups or organizations valued in the community with the capacity and infrastructure) could result in greater adoption and improved utilization of EBIs among African Americans. Although frequently overlooked as a study variable in empirically sound public health research, Black Greek Letter Organizations (BGLO) could be an innovative and practical approach to advancing health in the African American community. It is necessary to gain preliminary evidence of feasibility (e.g., motivation, target population reach, acceptability, ). Therefore, the purpose of this study was to conduct a content analysis to identify the intentions and communication trends of BGLOs as it pertains to public health and the African American community and assess population reach and perceptions by evaluating responses to communication specific to health promotion.We assessed health promotion patterns of four BGLOs in a ten-county metropolitan area. Coded content included communication via the organization’s webpage, Facebook, Twitter, YouTube, Instagram, and LinkedIn from a five-year time period. Findings confirm that BLGOs are invested in the health and well-being of the community, place emphasis on mitigating health inequities, and are uniquely positioned to serve as stakeholders for the translation of EBIs to end-users.
TOWARD EQUITABLE AND DESTIGMATIZING DEMENTIA: ALASKA NATIVE POPULATIONS AND CULTURALLY BASED INTERVENTIONS
Authors: Crouch Maria , Rosich Rosellen
Published: December 2022

Alaska Native (AN) people’s incidence and prevalence of Alzheimer’s Disease and Related Dementias (ADRD) are projected to disproportionately increase in contrast to the U.S. population. This is alarming given that AN peoples experience health disparities exacerbated by prejudice, stigma, and systemic and structural inequalities. Twelve semi-structured interviews with AN Elders assessed the culturally derived meanings of memory function, loss, decline, and disease. Qualitative analyses observed eight culturally grounded themes and five interrelated and nested subthemes elucidating both the resilience and the stigmas, racism, and barriers faced by AN peoples: (1) Historical Trauma; (2) Oppression; (3) Distrust of Western Medicine; (4) Social Justice; and (5) Walking in Two Worlds. En masse historical and contemporary oppression, particularly within Western medicine, both contextualizes the present and points to the ways in which the strengths, wisdoms, and balance inherent in AN culture are imperative to the holistic health and healing.
SEXUAL MOTIVES, SEXUAL FREQUENCY, AND SEXUAL SATISFACTION AMONG MIDDLE-AGED DIFFERENT-SEX AND SAME-SEX COUPLES
Authors: Chai Hye Won , Mernitz Sara , Umberson Debra
Published: December 2022

Reasons for having sex and frequency of sex are significant correlates of sexual satisfaction. However, the possible interplay between sexual motives and sexual frequency remains unexplored. Also, prior studies on sexual satisfaction largely focused on heterosexual couples and less is known about the experiences of same-sex couples. Using dyadic survey data collected from 838 middle-aged spouses in 419 gay, lesbian, and heterosexual marriages, this study examined whether the associations between sexual motives and sexual satisfaction differed by sexual frequency and whether these dynamics varied across gay, lesbian, and heterosexual couples. Results showed that intrinsic sexual motives (e.g., for enjoyment and pleasure) were associated with higher sexual satisfaction only in the context of more frequent sex, and this association did not differ for same- and different-sex couples. On the other hand, extrinsic sexual motives (e.g., to please spouse) were associated with lower levels of sexual satisfaction in the context of high-frequency sex only among men married to men and women married to men, wherein the association was stronger for heterosexual couples compared to same-sex couples. These associations were not significant with less frequent sex. Results suggest that while frequent engagement in sex with intrinsic sexual motives benefits middle-aged adults’ sexual satisfaction regardless of relationship type, the sexual satisfaction of individuals married to men is vulnerable to the negative consequences of engaging in sex due to external pressure. These findings highlight the importance of considering how sexual experiences of men and women in midlife same-sex marriages compare to those of different-sex marriages.
CHILDHOOD PHYSICAL ABUSE INCREASES THE RISK OF SUBJECTIVE MEMORY IMPAIRMENT
Authors: Roach Lauren , Bell Tyler , Pope Caitlin
Published: December 2022

Subjective memory impairment, defined as self-reported difficulties in recall and learning, doubles the risk of Alzheimer’s Disease and related dementia, despite being weakly related to objective memory decline. Because of its strong stability over time, it may be possible that subjective memory impairment reflects earlier life risk factors for dementia such as adverse childhood experiences. It is reported that over a fifth of older adults worldwide experienced physical abuse during childhood. Previous cross-sectional studies suggest physical abuse is associated with later cognitive impairment. Still unclear, are the longitudinal associations between childhood abuse and subjective memory impairment in later life. Using a sample of adults drawn from the Health and Retirement Study (n = 19,185, Mage = 67.05, SD = 11.33) we assessed associations between reported physical abuse by a parent before the age of 18 and subjective memory impairment (current memory problems and perceived memory decline) over periods of up to 18 years. Generalized linear mixed models examined longitudinal associations between childhood physical abuse and subjective memory impairment while controlling for depressive symptoms and other empirically relevant covariates. Experiencing childhood physical abuse was associated with increased likelihood of reporting more current memory problems (OR = 1.17, 95% CI 1.04, 1.33) and perceived memory decline in later life (OR = 1.27, 95% CI 1.13, 1.43). Findings suggest childhood physical abuse is associated with subjective memory impairment, a strong predictor of dementia. Understanding early life conditions, including adverse childhood experiences may help explain associations between subjective memory impairment and dementia risk.
PROGRESSIVELY LOWERED STRESS THRESHOLD FOR BEHAVIORAL SYMPTOMS OF DEMENTIA: A DYNAMIC STRUCTURAL EQUATION MODEL
Authors: Pickering Carolyn , Yefimova Maria , Wang Danny , Maxwell Christopher , Jablonski Rita
Published: December 2022

The progressively lowered stress threshold model suggests that due to impairments in coping, persons living with dementia have a reduced threshold for stress and respond with more behavioral symptoms of dementia as stress accumulates throughout the day. While the propositions of the model have not been evaluated, this model serves as the basis of non-pharmacological interventions for behavioral symptom management aimed at modifying the environment to reduce stressors. These interventions have mixed success, which may be due to traditional longitudinal measurement models that don’t account for the dynamic temporal nature of behavioral symptoms. This paper evaluates the progressively lowered stress threshold conceptual model as an explanation for behavioral symptoms of dementia and tests several of its hypothesized propositions using an intensive longitudinal design. A sample of N=165 family caregivers completed brief daily diary surveys for 21 days (n=2841) reporting on behavioral symptoms of their care recipients. Dynamic structural equation modeling was used as the analytic technique to examine the impact of caregiver and care recipient environmental stressors on the diversity of behavioral symptoms of dementia (number of different symptoms) to account for the nested data structure and autoregressive relationships. Results show direct relationships between environmental stressors and diversity of behavioral symptoms of dementia that same day and the following day. Findings provide support for the progressively lowered stress threshold model. Further, findings suggest an extension to the conceptual model is warranted given evidence of an exposure/recovery trajectory and the lagged effects of stress exposure on behavioral symptoms of dementia presentation.
MULTIMORBIDITY AND ITS ASSOCIATION OF WIDOWHOOD, RACE, AND ETHNICITY IN OLDER ADULTS
Authors: Karakida Maki , Song Qian , Stokes Jeffrey , Leveille Suzanne , Dugan Beth
Published: December 2022

Living with chronic disease is common in later life and over 60% of adults 65+ have two or more conditions. Spousal loss, also common in late adulthood, is linked to chronic diseases, like heart attacks, cardiovascular disease, and strokes. This study examines the associations between widowhood, race/ethnicity, and onset of multiple chronic conditions (i.e., cancer, diabetes, heart disease, stroke) among 4,187 Americans aged 60+. Using the RAND HRS Longitudinal File 2018, we analyzed how married/partnered adults without major chronic conditions in 2010 experienced widowhood and developed cancer, diabetes, and/or cardiovascular disease during the subsequent eight years. We used ordinal logistic regressions to examine the associations between marital status, race/ethnicity, and multimorbidity onset, controlling for age, gender, birthplace, living conditions, income, education, smoking habits, physical activities, self-reported BMI, and Medicaid enrollment. Among participants, 69.41% were non-Hispanic White, 13.04% were non-Hispanic Black, 14.19% were Hispanic (any race), and 3.37% were non-Hispanic other. The mean age was 70.33 years, more than half (54.79%) were female, and 83.85% were married or partnered in 2018. Older widowed group were more likely to be non-Hispanic White women without smoking habits nor multimorbidity. The onset of multimorbidity at follow-up was elevated among divorced or separated non-White/Hispanic participants (OR = 1.83, 95%, CI 0.896, 3.744) unlike widowed non-White individuals (OR = 0.71, 95%, CI 0.433, 1.152). Age, previous smoking behavior, BMI, and birth in the South were all significantly associated with increased multimorbidity risk (p<0.017). The association of widowhood and health outcomes may vary by race and ethnicity.
SOCIAL DETERMINANTS OF HEALTH UNDERLIE RACIAL/ETHNIC DISPARITIES IN PSYCHOLOGICAL HEALTH AND WELL-BEING
Authors: Jester Dylan , Kohn Jordan , Tibirica Lize , Thomas Michael , Brown Lauren , Murphy James , Jeste Dilip
Published: December 2022

This study sought to determine the impact of selected social determinants of health on psychological health and well-being (defined as depression, cognition, self-rated health) among Black and Hispanic/Latinx adults relative to White adults aged 51 to 89. We measured disparities in depression, cognition, and self-rated health among 2,306 Non-Hispanic/Latinx Black, 1,593 Hispanic/Latinx, and 7,244 Non-Hispanic/Latinx White adults from the Health and Retirement Study (n=11,143). Blinder-Oaxaca decomposition was used to examine whether differences in selected social determinants of health explained a larger share of the disparities than age, sex, measures of health, health behaviors, and healthcare utilization. Selected social determinants included education, parents’ education, number of years worked, marital status, veteran status, geographic residence, nativity status, income, and insurance coverage. Black and Hispanic/Latinx adults reported worse depression, cognition, and self-rated health compared to White adults. Selected social determinants of health explained a larger proportion of the Black-White disparities in depression (51%), cognition (39%), and self-rated health (37%) than did age, sex, measures of health, health behaviors, and healthcare utilization. Social determinants of health explained a larger proportion of the Hispanic/Latinx-White disparity in cognition (76%) and self-rated health (75%), but age and functional status primarily drove the disparity in depression (28%). Education, parents’ education, years worked, income, and insurance parity were social determinants associated with the disparities.In conclusion, differences in social determinants of health underlie racial/ethnic disparities in depression, cognition, and self-rated health among older adults. Education, income, number of years worked, and insurance parity are key social determinants of health.
SOCIOECONOMIC CHARACTERISTICS AND HEALTH OF OLDER ADULTS IN RURAL CAMBODIA: ROLES OF SOCIAL AND WELFARE SUPPORT
Authors: Kuy Kakada
Published: December 2022

Considering differences in support systems and socioeconomic characteristics, findings from studies of high-income nations could be biased if generalized to population of low- and middle-income countries. Insights into roles of social support in socioeconomic characteristics and health relationships are valuable for health interventions targeting older adults in low-resource communities, such as rural Cambodia, but such knowledge remains unexplored. This study examined mediating roles of social and welfare support in associations between socioeconomic characteristics and health among older Cambodians. Data came from a 2019 survey of older Cambodians age 60 and older (N=220) living in three rural provinces. Dependent variables included health complaints and psychological well-being index. Independent variables were wealth index derived from household items and living conditions, and subjective socioeconomic characteristic derived from three self-perceived economic circumstances. Social support and welfare support were operationalized using Social Support and Social Network scale and status of welfare assistance, respectively. Mediation analysis using Structural Equation Modeling substantiated a full mediation effect of social support on the relationship between subjective socioeconomic characteristic and psychological health. A partial mediation of social support was also found in the subjective characteristic and physical health relationship. However, no mediation was found in relationships between wealth index and health. Welfare support did not mediate any relationship between socioeconomic characteristics and both health outcomes. Healthy aging interventions in low-resource settings could benefit from improving existing support system of family and friends, which may buffer the impact of economically negative self-image on one’s health and well-being in the community.
SOCIAL DETERMINANTS OF COGNITIVE HEALTH
Authors: Rusch Amber , Camp Janella , Patrick Julie Hicks
Published: December 2022

Social determinants of health (SDOH), such as age, race, sex/gender, socioeconomic status, and access to healthcare, influence wellbeing, and shape day-to-day life. To what degree SDOH influence cognitive decline is less well understood. Thus, we applied frameworks of SDOH to understand cognitive health better. We used data from the CDC's 2020 Behavioral Risk Factor Surveillance System, in which 61,770 adults (mean age = 64.7, SD = 10.4, range 24-80+ yrs.) supplied demographic information and answered questions about cognitive decline. We conducted a logistic regression and interpreted the Odds Ratios (ORs). A significant equation emerged, X2 (DF = 8) = 438.214, p < 0.001. Each indicator of age, sex, race, and education uniquely contributed to the equation. Older adults, those with less education, and those identified as American Indian (OR = 1.25) were more likely to express cognitive decline. Using this equation, we correctly classified 0%, so we added a second step that included SDOH beyond demographic predictors: number of health conditions, access to health care, urban/rural status, and depression. The model retained its significance (X2 (DF=12) = 3400, p < .001. The OR showed adults with depression were 3.8 times more likely to report cognitive decline. Thus, examining a range of SDOH beyond demographics increases our understanding of the context in which cognitive decline occurs.
EFFECTS OF CHANGES IN THE FREQUENCY OF SOCIAL OUTINGS ON DEPRESSION AND WELL-BEING DURING THE COVID-19 PANDEMIC
Authors: Abe Koji
Published: December 2022

In Japan, in order to reduce the risk of infection with COVID-19, a state of emergency was declared in areas the infection had spread to, and priority measures were issued in equivalent areas. As a result, many senior citizens who were not good at using the Internet lost the opportunity to communicate with others through interpersonal interaction. Previous studies have shown that reduced interpersonal interaction negatively affects the mental health of senior citizens. However, little research has been done on the effects of socially created restrictions on interpersonal interaction. The purpose of this study was to focus on the changes in the frequency of going out among senior citizens and to examine the effect on mental health. An internet survey of a nationwide sample of individuals was conducted in October 2021. In total, there were 1600 respondents (males, 47.8%; females, 52.2%; mean age, 70.39(SD=4.67) years). During the pandemic, 47.1% participants had decreased the frequency of going out, and 52.9% had either no change or a slight increase in the frequency of going out compared to the period before the pandemic. Multiple regression analysis showed that social capital and decreasing frequency of going out had a significant effect on depression. However, a decrease in the frequency of going out had no effect on subjective well-being, and only social capital had a significant effect. The results showed that a decrease in frequency of going out increased the depressive mood, but social capital had an even greater impact on depression and subjective well-being.
“A GLARING OMISSION”: BARRIERS TO INCLUDING LONG-TERM CARE RESIDENTS’ VOICES IN THE NEWS MEDIA
Authors: Allen Laura , Bradley Dana , Ayalon Liat
Published: December 2022

News media stories on residential long-term care (LTC) are mostly negative in tone, and the increase in news coverage of residential LTC during the COVID-19 pandemic intensified the pessimistic tone with panicked and accusatory reporting. Although there has been an increase in the amount of news coverage on residential LTC over the last two years, the perspectives of the residents themselves have been largely overlooked and excluded. The aim of this study is to identify and understand the barriers and embedded institutional logics in the news reporting process of LTC that prevent residents from being included and interviewed. Using a purposive sampling strategy, the researchers conducted 26 semi-structured interviews with LTC administrators (n=7), journalists on the topics of aging and LTC (n=7), and older residents living in LTC settings (n=12) in the United States. Thematic analysis is applied to the data to qualitatively extract the guiding logics frameworks of each stakeholder group. Findings are grouped into the following four themes: (1) residents are not considered "experts" by reporters and are therefore not a prioritized source of information; (2) facility administrators fear for the facility's public image & reputation and do not enthusiastically cooperate with inquiring reporters; (3) facilities were in physical lockdown for several months during the COVID-19 pandemic, and (4) residents feel forgotten and unheard. Implications of this study point to the social exclusion of older residents living in LTC and reductive reporting that fails to capture their nuanced and dynamic lived experiences.
COGNITIVE COPING AND PERSPECTIVE-TAKING AMONG OLDER ADULTS DURING THE COVID-19 PANDEMIC: AN ECOLOGICAL INVESTIGATION
Authors: Heideman Kristin , Griffith Eric , O'Connor Daniel , Orlovsky Irina , Alwan Elizabeth , Martins-Klein Bruna
Published: December 2022

In response to the COVID-19 pandemic, older adults report engaging in coping to manage sources of pandemic stress (e.g., loneliness, reduced healthcare access, ageism). Variability in cognitive coping strategies, however, has not been explored through an ecological model lens. In this study, we interviewed older adults online in the northeastern US (N=33, age 63-92) regarding stress and coping strategies during the pandemic, using the taxonomy of cognitive strategies from the Cognitive Emotion Regulation Questionnaire. Consistent with Bronfenbrenner’s ecological model, stress and cognitive coping were qualitatively coded using NVivo in reference to individual, immediate environment (microsystem), connections between environments (mesosystem), and societal (macrosystem) factors. Microsystem-level stressors were prevalent and endorsed in all interviews, but stress was reported at multiple ecological levels. Common microsystem stressors included changes to work/personal life, travel restrictions, and loss of face-to-face socialization. Many participants reported engaging in adaptive cognitive coping (87%), with perspective-taking being one of the most common strategies (78%). Perspective-taking was endorsed across all levels of the ecological model (e.g., comparing the pandemic to other personal experiences, considering family-level resilience, and reflecting on impact to community). The multi-level structure of pandemic stress and coping highlights that older adults subjectively experience stress simultaneously at multiple ecological levels. In turn, they confront stressors using individualized patterns of cognitive coping that extend beyond intrapersonal experience/insight to help fully contextualize the COVID-19 experience. Future studies should explore the use of perspective-taking at intra- and interpersonal levels as integrated coping approaches for managing naturalistic stressors in daily life.
FUTURE TIME PERSPECTIVE MODULATES AFFECTIVE REACTIVITY TO SOCIAL PROBLEMS DURING THE PANDEMIC
Authors: Garza Elizabeth Zambrano , Choi Yoonseok , Pauly Theresa , Gerstorf Denis , Hoppmann Christiane
Published: December 2022

Socioemotional Selectivity Theory posits that individuals with a limited future time perspective (FTP), prioritize emotionally meaningful, positive social interactions. Due to the high value placed on positive social interactions, individuals with a limited FTP might be particularly vulnerable to experiencing elevated negative affect when problems that involve other people do occur as compared to an experience of non-social problems. This project examined the role of FTP in modulating social problem–negative affect links during the pandemic, a time when people were particularly aware of their mortality, and thus their remaining time in life. This study used data from 150 Canadian adults (Mage =43 years, SD= 19, range 18-83, 78% women) who participated in two measurement bursts (one in 2020 and one in 2021). Participants provided FTP information at baseline and then repeatedly reported their negative affect and everyday problem characteristics in 10 consecutive daily diaries across both bursts. Results from multi-level models reveal a differentiated picture. The within-person association between social problem occurrence and elevated negative affect was significant among individuals with a more limited FTP. In contrast, at the between-person level, experiencing more social problems was associated with higher overall negative affect among those with a more extended FTP. To better understand these differential associations, follow-up analyses will explore if type of person involved in the problem and how the problem was handled matter for how they respond to social problems. Findings will be discussed in the context of the Strength and Vulnerability Integration model.
ASSOCIATION BETWEEN EDUCATION LEVEL AND DEPRESSIVE SYMPTOMS AMONG COMMUNITY-DWELLING OLDER ADULTS IN ICELAND
Authors: Gudjonsson Milan Chang , Nishizuka Chiharu , Sigurdardottir Sigurveig
Published: December 2022

Objectives. Previous research studies have suggested that a higher education level has a positive impact on one's health throughout life. The aim of this study was to examine the association between education level and depressive symptoms among community-dwelling older adults aged 65 years and older in Iceland. Method. This is a cross-sectional study using data from the Age, Gene/Environment Susceptibility–Reykjavik Study (AGES–RS) cohort (n = 3,989, mean age = 76.2, 56.3% women). Education was classified into four levels: primary (n = 895), secondary (n = 1,980), college (n = 630), and university (n = 484). For the analysis, education was categorized into two groups: primary education versus higher than primary education (secondary, college, and university). Depressive symptoms were assessed by using the 15-item Geriatric Depression Scale. High depressive symptoms (HDEPS) were defined if the GDS score was 6 or higher. Results. Education was highly significantly associated with the 15-GDS score (p < .001). Compared to people with primary education, those with higher than primary education level were significantly less likely to have HDEPS after adjusting for confounders including age, gender, body mass index, physical activity, coronary diseases, and smoking status. Discussion. Older adults with higher than primary education were less likely to have HDEPS compared to those with primary education in the current cross-sectional analysis. The findings indicate that level of education is highly associated with depressive symptoms of community-dwelling older adults in Iceland.