bluuebunny/crossref_metadata_2025 huggingface dataset:
DEVELOPMENT OF THE MEDICARE BENEFICIARY CARE SETTING TRAJECTORY DATABASE
Authors: Jarrín Olga , Zafar Anum , Kim Hyosin , Lin Haiqun
Published: December 2023

Despite national efforts to shift from fragmented to value-based/coordinated care, there is a lack of understanding of older adults’ longitudinal aging experience across diverse healthcare settings in their last years. To improve patient care and gain insights into areas for improvement in care coordination and management, it is crucial to have evidence about older adults’ longitudinal care experience and healthcare transitions. This study outlines the development of the Care Setting Trajectory File, which combines information on service dates and discharge destinations from various Medicare administrative, assessment, and claims data. The data sources include MedPAR, Hospice, Minimum Data Set (MDS), MDS-Swing Bed (SB), Outcome and Assessment Information Set (OASIS), and the Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI). The Care Setting Trajectory File contains a day-level summary of care settings, including inpatient hospice, inpatient-short stay, inpatient-long stay, inpatient-SNF, inpatient-VA, inpatient, rehab facility, nursing home, home health, hospice home, and home. This day-level file can then be utilized at various levels of granularity, i.e., monthly, quarterly, or yearly periods, for further analysis. For illustration, the file construction method is detailed for a cohort of Medicare decedents who died in 2019. Examples of how this analytic file can be used to generate important insights for policymakers and healthcare providers on improving care coordination, continuity, and quality of life for older adults with serious illnesses will be discussed.
HARMONIZATION OF SELF-REPORTED RACE/ETHNICITY TO ENHANCE HEALTH EQUITY RESEARCH USING MEDICARE DATA
Authors: Zafar Anum , Jarrín Olga , Kim Hyosin , Setoguchi Soko , Harvey Marie , Wu Bei , Lopez Maria , Lin Haiqun
Published: December 2023

Collection of valid race and ethnicity data is critical to understanding and promoting health equity. However, current administrative data often misclassifies members of the racial/ethnic minority groups. To address this issue, the Research Triangle Institute (RTI) developed an imputed race variable, which improves on administrative race data for Hispanic and Asian beneficiaries, but still has limitations. This study compares the RTI race with our new, harmonized, self-reported race/ethnicity data collected during Medicaid enrollment and post-acute and long-term care assessments. Out of 2,322,071 Medicare beneficiaries aged 18 and older who died in 2019 in the U.S., self-reported race/ethnicity was available for 75.1% (1,745,327) who formed the study population. Compared to the RTI race variable, our new race variable categorized more Medicare beneficiaries as non-Hispanic white (79.5% vs. 77.9%) and Asian American/Pacific Islander (2.5% vs. 2.3%), a similar percentage as American Indians/Alaska Native (0.5% vs. 0.5%), and slightly fewer as Black (11.1% vs. 10.9%) and Hispanic (7.2% vs. 6.5%). Using our new race variable as the gold-standard, RTI race had good validity (k=0.81), however sensitivity was highest for non-Hispanic white (96.5) and Black (95.8) beneficiaries, and lower for Hispanic (87.2), Asian American/Pacific Islander (76.2), and American Indian/Alaska Native (58.7) beneficiaries. These findings are consistent with prior work, comparing RTI race with self-reported race from a single data source. Our study provides empirical evidence to support the U.S. Office of the Inspector General’s recommendations to the Centers for Medicare and Medicaid Services to incorporate self-reported race/ethnicity data available to reduce error and bias.
HARMONIZATION OF CHRONIC CONDITIONS WAREHOUSE DATA FOR OUTCOMES RESEARCH ON GERIATRIC SYNDROMES
Authors: Ahmad Suzan , Kim Hyosin , Setoguchi Soko , Kobylarz Fred , Zafar Anum , Lopez Maria , Lin Haiqun , Jarrín Olga
Published: December 2023

Geriatric syndromes such as cognitive impairment, falls, depression, urinary incontinence, pressure ulcers, and polypharmacy are common conditions and syndromes that affect older adults. Studying geriatric syndromes in Medicare beneficiaries may provide important insights for improving health outcomes and quality of life. As a result of the Improving Medicare Post-Acute Care Transformation Act of 2014, it is now easier to compare standardized geriatric assessment data (including information about geriatric syndromes) collected in post-acute and long-term care settings with corresponding data from claims, encounter, Part D, and durable medical equipment files. However, to our knowledge, methods to link and harmonize post-acute and long-term care assessment data (available for 75% of decedents) are yet to be utilized in the health services research community. The goal of this project is to develop harmonized datasets that can be used to identify geriatric syndromes and study their prevalence, cost, health outcomes, and service delivery factors over time. This work will allow our team and other researchers to fully leverage these data for use in predictive algorithms and artificial intelligence and machine learning (AI/ML) research. The project uses the five most recent years of data available from the Centers for Medicare and Medicaid Services (CMS) Chronic Conditions Data Warehouse. Data sources include Medicare and Medicaid claims, encounter, MedPAR, Hospice claims, Minimum Data Set (MDS), MDS-Swing Bed (SB), Outcome and Assessment Information Set (OASIS), Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI), Pharmacy (Part D), and Durable Medical Equipment (DME).
INTERPROFESSIONAL HEALTH CARE: INTEGRATING AUDIOLOGY AND GERIATRICS IN INTERNATIONAL SETTINGS
Authors: Arnold Michelle , Deal Jennifer , Pichora-Fuller Kathleen
Published: December 2023

Hearing is fundamental to communication and important for quality of life and overall health of older adults. Despite a potentially large role in how patients engage in healthcare, its importance is underrecognized in healthcare settings. Decreased patient-provider communication and poor treatment understanding may drive decreased satisfaction with healthcare services and avoidance of routine medical care, resulting in poorer health outcomes for older adults with hearing loss. Additionally, despite a high prevalence of hearing loss, less than 20% of those who could potentially benefit from hearing healthcare use hearing aids, potentially exacerbating sequalae of hearing loss in healthcare settings. Amidst growing recognition of the need for inter-professional healthcare collaboration, this session will focus on how audiologists and hearing specialists may partner with other healthcare providers (pharmacists, nurses, physicians) to address hearing needs in primary care, specialty care and hospital settings. We will include perspectives from the United Kingdom, the United States and Canada. We will describe factors that facilitate and impede communication between pharmacists and patients with hearing loss in the community pharmacy. We will also present results of a mixed-methods study from an interdisciplinary team (gerontology, public health, audiology, and otolaryngology/ear nose throat (ENT)) to inform primary care/ENT physicians about preferences for hearing treatment among Black women in the United States. Within a hospital setting, we will present how audiologist-nurse partnerships impact delirium. We will conclude with a discussion of how policy for hearing aid coverage impacts primary care providers recommendations for hearing healthcare in the United States.
INTERDISCIPLINARY MANAGEMENT OF OLDER ADULTS WITH HEARING LOSS: POLICY MATTERS
Authors: Arnold Michelle
Published: December 2023

Hearing aids are an efficacious approach for treating hearing loss yet are underutilized in the US due to high out-of-pocket costs. Lack of hearing aid insurance coverage is one source of the breakdown in the interdisciplinary management of older adults with hearing loss, causing hesitation among primary care providers to refer patients to audiology for treatment. Recently, access and affordability of hearing aids for adults has gained traction, with several states mandating private insurance coverage of hearing aids. The purpose of this study was to understand state-level variability in private insurance hearing aid mandates and to quantify yearly averages of the share of privately insured adults aged <65. We conducted a longitudinal policy surveillance of state statutes for mandates through January 2023. Policy data were then combined with individual-level age, insurance, state, and year variables from American Community Survey and Medical Expenditure Panel Survey Insurance Component to estimate the share of privately-insured adults covered by a mandate from 2008-2022. We identified 25 states and 1 territory with effective private insurance hearing aid mandates. There was substantial variability in these mandates, including in exceptions, maximum age eligibility, allowable frequency of benefit use, and total coverage reimbursement amount. Between 2008-2022, we estimated that <10% of privately-insured adults lived in a state with coverage. We conclude that hearing aid mandates are covering a small but growing share of Americans. A federal mandate would be the fastest way to ensure access, but states can improve access by adopting exception-free mandates with limited utilization management.
AN INTERDISCIPLINARY APPROACH TO ADDRESSING HEARING LOSS IN THE INPATIENT SETTING TO IMPROVE COMMUNICATION
Authors: Reed Nicholas
Published: December 2023

Nearly half of all adults over 60 years of age have hearing loss which is associated with decreased satisfaction with care, higher risk of readmission, and longer length of stay. These associations may be mediated by the barriers hearing loss places on patient-provider communication. There is a paucity of sustainable programs focused on addressing hearing loss among older adults in the inpatient. An interdisciplinary collaborative team comprising audiologists, geriatricians, and nurses developed and implemented a quality initiative to address hearing loss in the inpatient setting in two medical inpatient units at Johns Hopkins Bayview Medical Center that started with offering 16 training session slots to raise awareness of hearing loss and teach technologic, environmental, and communication considerations for adults with hearing loss. Over a 3-month period, 543 of 644 admitted patients were screened for hearing loss using a sustainable model built into the admission process. Those without hearing loss (52.6%) received no intervention, those with mild loss (31.3%) received signage in the room reminding providers of training, and those with moderate or greater loss (16.1%) received signage and an amplifier. At discharge, 79% and 81.6% of those with mild and moderate hearing loss indicated improved communication during their current stay relative to previous stays. Notably, a larger proportion of those without hearing loss (52.9%) also indicated improved communication. A post study survey among 18 nurses suggested themes of moderate (33%) desiring more training and overwhelming perceptions (94.4%) the program didn’t interfere with other duties and made communication with patients easier.
EXAMINING A PERSON-CENTERED MODEL OF COMMUNITY SUPERVISION FOR OLDER ADULTS
Authors: Helmly Victoria
Published: December 2023

Though research in aging and the criminal legal system is growing, there is still limited data on how the carceral system impacts this population. In this presentation, I will discuss my dissertation research on older adults on parole and probation (community supervision). This qualitative research study examines both the experiences of older adults under community supervision and the experiences of the officers who supervise this population. This data is collected through semi-structured interviews with community supervision officers and older adults under supervision. In addition to learning about the unique experiences of older adults impacted by the criminal legal system, this research aims to better understand a “person-centered model of community supervision” in the Southeastern United States. The interviews inquire about how this model is implemented, perceived, and understood by the participants. This research aims to inform policy and practice of community supervision and stimulate additional research in this area. In this presentation, I will discuss the study’s relevance to Gerontology, the research methodology, and the findings from the participant interviews. I will also discuss how this research can inform practice and future studies.
CROSS-TISSUE COMPARISON OF AGING BIOLOGY MEASURES AS NOVEL BIOMARKERS FOR HEALTHY AGING
Authors: Waziry Reem
Published: December 2023

We compared the role of aging biology biomarkers measured in saliva (N=5,808) and blood (N=9,934) as novel biomarkers for prevention of stroke and heart disease in a sample of older adults (aged 50 and older) from the Health and Retirement Study (HRS). Individuals who consented for blood and saliva draw in the HRS 2016 Venous blood and 2008 Telomere length studies were included. Measures in saliva included telomere length. Measures in blood included DNA methylation and physiology biomarkers. The main outcomes included stroke, heart disease and disease-free aging. Cases and disease-free adults were matched on age and sex using a probit link and propensity scores. No association was observed between saliva-based telomere length with stroke or heart disease. In contrast, blood-based biomarkers of aging biology showed strong associations with stroke and heart disease. Biologically older individuals had 3- and 2.5-times higher odds of stroke based on DNA methylation Grim Age (aOR=3.00, 1.87, 4.82, P< 0.001) and Physiology-based Phenotypic Age (aOR=2.50, 1.57, 3.98, P<0.001). Individuals who were biologically older had 3.6- and 2.3-times higher odds of heart disease according to physiology-based Phenotypic Age (aOR=3.64, 95% CI 2.68, 4.94, p < 0.001) and DNA methylation Grim Age (aOR=2.36, 95% CI 1.73, 3.23, P<0.001). Findings of the present study suggest that saliva-based telomere length and blood-based DNA methylation and physiology biomarkers likely capture different aspects of individual aging and vary in their precision and sensitivity as novel biomarkers for prevention of stroke and heart disease in older adults.
BUILDING A STRATEGIC PARTNERSHIP: TURNING CHALLENGES INTO OPPORTUNITIES
Authors: Elfenbein Pamela
Published: December 2023

The University of North Georgia’s Institute for Healthy Aging (IHA) and the Georgia Department of Human Services, Division of Aging Services (DAS), have partnered to address critical workforce needs in the program areas of Elder Abuse, Neglect and Exploitation and Public Guardianship. Working together they have aligned requirements a new University System of Georgia degree, the Nexus degree, with the educational and experiential requirements of employment in these DAS program areas. The University System of Georgia’s Nexus Degree, a new academic credential and the first new degree program in the United States since the 1890s when the associate’s degree was added, was designed to help more Georgians access careers in high demand areas. Creation of this degree is in direct response to talent demand analysis with employers in high demand career areas. The Division of Aging Services faces many challenges that hamper finding and retaining the right workers for the difficult but rewarding roles in Adult Protective Services and Public Guardianship. This presentation will outline the DAS needs and UNG academic program, and how working together to meet the needs of at-risk elders, a direct pipeline to employment has been developed. This paper will discuss and provide insight into this unique collaboration and newly created training approach.
DEVELOPMENT AND EVALUATION OF AN INTERPROFESSIONAL LEADERSHIP IN HEALTH CARE CERTIFICATE
Authors: Keefe Bronwyn , Slater Craig , Jacobs Karen
Published: December 2023

Leaders of healthcare teams have a critical role in coordinating services to deliver high-quality care to the patients and communities they serve. Leading teams can be challenging in the context of complex healthcare systems, increasing costs, resource limitations, and workforce issues. We created the Interprofessional Leadership in Healthcare Certificate for health professionals who lead, or aspire to lead, interprofessional teams. Learners complete courses relating to interprofessional collaboration, effective communication, mentoring and supervision, business acumen, and contemporary leadership models. The live classroom sessions use Project ECHO® to facilitate technology-enabled, collaborative learning. Participants completed an evaluation survey that included questions about course learning objectives, engagement in learning activities, application of content to professional practice, and interprofessional learning. The survey included open-ended questions about the most helpful aspects of each course and suggestions for changes. Evaluation data for each of the courses were collated across four cohorts. Participants represented over 10 healthcare professions. There was over 90% agreement that content met all of the learning objectives for each course. There was over 90% agreement that participants learned from other professions and engaged in interprofessional collaboration. The qualitative data indicated that learners found that the content helped them to be more intentional with their collaborative and leadership practices in their workplaces. The certificate program had a positive impact on participants’ knowledge, skills, and workplace practices relating to interprofessional collaboration and leadership. This may be attributable to intentional interprofessional collaboration in both program development and learning experiences and the use of the project ECHO model.
PLANNING FOR OLD AGE BY GRADUATES OF A MASTER’S GERONTOLOGY PROGRAM IN ISRAEL
Authors: Cohn-Schwartz Ella , Sagi Doron , Meiry Lian
Published: December 2023

The master’s programs in gerontology in Israel were founded in 1999 in response to the challenges brought by extended life courses and the accompanying accelerated growth of welfare and health services for the aged. Since its beginning, thousands of students graduated from the programs and occupy central positions in the gerontological field. However, no empirical data exists on the extent of the involvement by graduates in employment in the field of aging. The current study aims to provide a first-time assessment of the experiences of graduates in Israel following their studies, as well as examine the level of preparedness to old age among graduates, since their work and study of older adults might make their own future old age more salient. We collected data using online surveys from 197 graduates of the gerontology programs. Participants were asked about their work experience in the gerontology field and about the extent to which they prepare for old age. The findings showed that most graduates (80%) currently work in the field of aging, and are overall pleased with the jobs. However, most of the graduated (68%) also reported difficulties in finding employment. Logistic regressions showed that those who currently work in aging and who graduated before less years were also less likely to make preparations for needing nursing care in old age and talking with relatives about their death. Thus, working and studying about aging could be related to being less likely to make preparations for old age.
EVALUATION OF AMINO ACIDS LEVELS OF HOSPITALIZED PATIENTS WITH DELIRIUM
Authors: Azhar Gohar , Sharma Shakshi , Gibson Regina , Pangle Amanda , Wolfe Robert , Wei Jeanne
Published: December 2023

Delirium is an acute and often fluctuating change in cognitive status characterized by disorientation, disorganized thought processes and changes in perceptual and psychomotor function. The common precipitating etiologies of delirium include any acute illnesses, infections, hospitalizations, fluid or electrolyte imbalance, or medications. Neurotransmitters are synthesized from amino acids. We hypothesized that regardless of the clinical reason for delirium, a sudden imbalance of plasma amino acids might alter the level of neurotransmitters and contribute to delirium. We measured amino acids in hospitalized patients 60 or older, both genders, with delirium secondary to any infection (n=13) for a period of 3 days and compared them with healthy control, non-delirious group (n=13). Delirium was evaluated twice daily using the Confusion Assessment Method (CAM) test. Plasma amino acids were analyzed using LC-MS. Our results showed that level of isoleucine was significantly higher in delirious patients on day 1 (64.26 %) as compared to healthy control (43.25%, p < 0.01). The level of tryptophan was slightly lower on day 1 as compared to control (31.13 % vs 36.80%, p=NS). However, the tryptophan/isoleucine ratio on day 1 was significantly lower in delirious compared to healthy controls (49.96% vs 85.54 %, p < 0.01). The tryptophan/isoleucine rose on day 2 of delirium but was still significantly lower compared to the healthy control (59.0% vs 85.54%, p < 0.01). Our results suggest that significant alterations in the levels and ratios of amino acids, in particular, tryptophan and isoleucine might disrupt the synthesis of neurotransmitters and hence contribute to delirium.
RACE AND SEX DIFFERENCES IN RELATIONS OF DIABETES BIOMARKERS WITH PHYSICAL FUNCTIONING BEFORE DIABETES ONSET
Authors: Khambaty Tasneem , Splain Ashley , Katzel Leslie I , Evans Michele K , Zonderman Alan B , Waldestein Shari R
Published: December 2023

It remains unclear if declines in physical functioning linked to Type 2 diabetes (T2DM) occur even before T2DM onset. We examined the longitudinal associations of T2DM biomarkers with upper and lower extremity strength among adults without T2DM at baseline. Participants were 1,572 African American (AA) and White adults (M(SD) age at baseline = 47.3 (9.7) years, 55% female, 53% AA) from the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study, assessed on up to 3 time points between 2004-2017. Participants provided blood samples for measurement of fasting glucose and glycosylated hemoglobin (HbA1c), and completed dominant and nondominant handgrip strength assessment, and a chair stands task to assess upper and lower extremity strength, respectively. Linear mixed effects regression models estimating relations of HbA1c on age-related change and adjusting for race, sex, literacy, and poverty status revealed significant four-way interactions of HbA1c, race, sex, and age (B = -.2.59, t(2853) = -2.0 p = 0.04), and to a lesser extent of fasting glucose, race, sex, and age (B = -.07, t(2863) = -1.84 p = 0.06) on change in the chair stands task, but not on handgrip strength (ps > 0.29). Among younger AA and White men, and younger White women, increasing HbA1c was related to worse lower extremity strength. However, among AA women, and older White women, increasing HBA1c was related to better lower extremity strength. Our findings suggest differential relations of worse glucose regulation on physical functioning amongst African American and White men and women.
OLDER ADULTS’ USE OF HOME AND COMMUNITY-BASED SERVICES: INDIVIDUAL ATTRIBUTES AND LOCATION DISPARITIES
Authors: Roberto Karen , Savla Tina
Published: December 2023

Home and Community-Based Services (HCBS) are designed to support older adults with functional and cognitive limitations. Yet, use of services is low, gaps exist in service provision, and available services do not always meet the person’s need. This symposium focuses on idiosyncrasies surrounding HCBS use. Nah and colleagues identify individual (income, ADL limitations, informal support) and county-level (poverty and public spending on services) factors associated with HCBS use among persons living with dementia in rural Appalachia. Shippee and colleagues’ examination of services received/desired indicates that older adults who are Black/other race/ethnicity were more likely to receive ADS; individuals living with AD/ADRD consumed personal care services at the highest proportion. Cheng’s and Li’s assessment of generosity in supporting HCBS reveals that while overall state support for HCBS has increased, Medicaid and OAA programs expenditures for services varies substantially across states. Fortinsky and colleagues’ examination of risk factors for emergency department use among older adult Medicaid HCBS users shows use was associated with high school education, more severe depressive symptoms, and more chronic conditions; non-Hispanic Asian individuals had the lowest likelihood of use. Konetzka and Wang provide national evidence that use of Medicaid HCBS influences Medicare post-acute care utilization among the dually enrolled. Collectively, the symposium highlights the importance of taking into consideration individual variations in care needs, local and state support for HCBS, and disparities in healthcare and service use influencing older adults’ use of HCBS, and advances understanding of intersecting micro- and macro-level effects on service availability, use, and outcomes.
UNMET NEED AMONG A NATIONAL SAMPLE OF OLDER ADULT HCBS USERS
Authors: Shippee Tetyana , Bucy Taylor , Mulcahy John , Jutkowitz Eric
Published: December 2023

Long-term services and supports delivered in the home or community (home and community-based services) continue to be favored by consumers and policymakers alike. Given that HCBS is largely state-directed, there is considerable heterogeneity in program design and eligibility, and no standardized tool by which quality is measured. In the absence of the widespread use of standardized and uniform measures of HCBS quality, unmet need is poorly understood. We examined the relationship between services received and desired as a means of predicting unmet need among a national sample of older adult (65+) consumers of publicly funded HCBS (e.g., Medicaid, PACE, OAA) using data from the National Core Indicators - Aging and Disability survey. Our sample included 13,459 older community-dwelling adults, of which 60.0% were White, 23.2% were Black, and 17.0% of another race/ethnicity. Roughly 15% of older adults reported having AD/ADRD (54% White, 20% Black). Older adults with AD/ADRD were more likely to use personal care services (59.6%), followed by delivered meals (21.3%), and homemaker services (18.6%) compared to those without AD/ADRD. Adults with AD/ADRD desired more caregiver support services and transportation services vs what they were already receiving. Of 10% already receiving caregiver support services, approx. 9% desired additional support. Of 9.6% receiving transportation services, 7.3% desired additional support. We found variation in HCBS received and desired among older adults by both AD/ADRD status and race/ethnicity, suggesting gaps in unmet needs for these groups.
ESPO AND HEALTH SCIENCES SECTION SYMPOSIUM: BUILDING BRIDGES: LEVERAGING SOCIAL CONNECTIONS AND ENVIRONMENTS TO IMPROVE HEALTH IN LATER LIFE
Authors: Moored Kyle , Britt Katherine , Cudjoe Thomas
Published: December 2023

The COVID-19 pandemic has renewed focus on social connections as fundamental contributors to health across the lifespan. Social connections have been studied in numerous ways (e.g., social network size, daily social interactions, engagement in social activities) and may facilitate health via multiple, dynamic biopsychosocial mechanisms. In line with this year’s theme, we review novel insights from early-career scholars into how “building bridges” with others throughout life may promote mental and cognitive health in later life. Further, we emphasize how bridging disciplines (e.g., social and neurocognitive sciences) is vital to understanding how social environments may “get under the skin” to impact health. Presentations will span multiple social-ecological levels (community, institutional, interpersonal). Beginning at the community/institutional level, Dr. Moored will discuss how the quantity of neighborhood social destinations contributes to GPS measures of community mobility in older adults. Dr. Britt will then describe how religious participation, a specific social institutional activity, is associated with an inflammatory biomarker predictive of cognitive impairments. The remaining talks will then report on daily social experiences. Dr. Ng will highlight links between daily support exchanges and life satisfaction in older adults and how these relationships differ by marital status. Extending to the caregiving context, Dr. Puga will present on how role captivity and daily changes in social isolation contribute to mood symptoms in family caregivers of individuals living with dementia. Our Discussant, Dr. Cudjoe, will provide a critical review in the context of new directions for research on social connections and environments.
RESEARCH TO STRENGTHEN, INNOVATE, AND TRANSFORM AGE-FRIENDLY COMMUNITY PRACTICE
Authors: Black Kathy
Published: December 2023

There is much research being conducted to better understand and advance age-friendly community practice. This symposium presents research from leading age-friendly researchers and practitioners across the United States. Drs. Black and Oh provide an analysis of the nation’s sectoral efforts based on progress reported by the age-friendly communities. Drs. Hernandez and Coyle will describe the research and community engagement that led to the development of an aging equity conceptual framework and examples of how it is being operationalized in the City of Boston. Drs. Greenfield and doctoral student Pope will present on a scoping review of studies in the U.S. and Canada on the range of ways in which the public sector participates in age-friendly community efforts. Drs. Coyle and Oh and doctoral students Gleason and Somerville present on a study that explored factors inhibiting communities from officially joining the age-friendly network. Dr. Perry reports on efforts to elevate the voice of older adults on social justice issues pertaining to aging in place in the domain of housing. Individual abstracts provide further detail on each study’s methods and findings.
CAREGIVER WELL-BEING OUTCOMES IN A STROKE TRANSITIONS TRIAL: THE EFFECTS OF CAREGIVER BURDEN AND PREPARATION
Authors: Woodward Amanda
Published: December 2023

The Michigan Stroke Transitions Trial (MISTT) was an open, pragmatic randomized trial which tested the effectiveness of a 60-day in-home social work case management for patients and caregivers transitioning home after hospitalization for a stroke. This secondary analysis explores the effect of caregiver burden and preparation on caregiver outcomes. The analytic sample is the 169 caregivers who participated in MISTT. Dependent variables are the Bakas Caregiver Outcomes Scale (BCOS) and the Patient Health Questionnaire-9 (PHQ9) at 90 days after discharge home. Key predictors include the Preparedness for Caregiving Scale and the Oberst Caregiving Burden Scale which measures caregivers’ perception of burden in relation to the both the time and difficulty of caregiving tasks. Analyses that controlled for outcomes at 7 days post discharge as well as caregiver age, marital status, and education were conducted using Stata v.16. Results indicate that caregivers who perceived caregiving tasks as more difficult had worse outcomes as measured by the BCOS. In addition, there was a significant interaction between task difficulty and age such that the effect of task difficulty on BCOS declined with age. In addition, depression was associated with greater task difficulty and less preparation. This study contributes to a growing body of work related to the complexity of transitions of care and has implications for how we support caregivers as their care recipient moves from inpatient to outpatient care.
POLICY SERIES: INTERDISCIPLINARY PUBLIC POLICY DISCUSSION SESSION
Authors: Taffet George , Lindberg Brian
Published: December 2023

This interactive session is an interdisciplinary look at the impact of social isolation and loneliness policy issues as we age. This session, organized by the GSA Public Policy Committee, will provide both GSA section leadership and attendees an opportunity to have an open dialogue on important public policy issues of significance in the field of aging. The panelists represent the six sections of GSA: ESPO, BS, BSS, SRPP, HS, and AGHE.
STRENGTHENING CAREGIVING NETWORKS: PROMISING PRACTICES TO SUPPORT PAID AND FAMILY CARE TEAMS IN THE HOME
Authors: Franzosa Emily , Ornstein Katherine
Published: December 2023

Older adults and people with disabilities often rely on both family and paid caregivers to live independently in the community. But while paid and family caregivers work closely together in the home, these groups are often siloed in research and policy. Research describing the structure and work of caregiving teams is limited, as are efforts to better support them in providing person-centered care. In this symposium, we present innovative interdisciplinary research that highlights the vital relationship between paid and family caregivers and how this influences the care they provide. We begin with two studies focusing on the structure and function of older adults’ formal and informal care networks. First, Franzosa et al present results from a care mapping project which found care networks were often far more expansive than what is captured in medical records. Reckrey et al describe the need to provide family-centered home care that reflects the nuanced and individualized care that these teams provide, based on a study of interviews with families and paid aides. Next, we describe results of two promising interventions to support family and paid care in the home. Weidenbacher et al describe a community health worker-led navigation program connecting family caregivers of seriously ill veterans to supportive resources, and Scales and King describe a training for home care workers and family members to facilitate collaborative problem solving and person-centered care. Taken together, these studies broaden our understanding of care teams in the home and highlight promising opportunities to support team-based home care. This is a collaborative symposium between the Family Caregiving and Paid Caregiving Interest Groups.
VISUALIZING VETERANS’ CARE: UNDERSTANDING THE BREADTH OF OLDER VETERANS’ PAID AND FAMILY SUPPORT NETWORKS
Authors: Franzosa Emily , Ali Imran
Published: December 2023

Many older veterans rely on a complex network of paid and unpaid caregivers to age safely at home. Medical records often only capture a primary family caregiver, giving medical teams a limited picture of veterans’ supports at home as well as plans for contingency care. We tested a novel visual tool, care mapping, to better understand the scope of veterans’ formal and informal support. We created collaborative care maps with 10 dyads/triads of veterans age 65+ eligible for VA-paid home care and their primary paid and family caregivers. We compared the maps to veterans’ electronic medical records (EMRs) to explore care network structure, function and adequacy. Care maps identified substantially more care partners than EMRs, including functional, medical, socioemotional and spiritual supports such as family, paid aides, neighbors, Veterans’ groups, faith communities, local businesses (pharmacies, food delivery), and social media. Veterans, family and paid caregivers described working together closely, with aides serving as a “third arm” to fill care gaps. Care was often mutual, as veterans described financial and emotional support they provided to family members, aides and their families, and friends. Participants also described these networks as dynamic and fluid, changing based on care needs and care partners’ availability and skills. Identifying the range of support Veterans receive from family, paid aides, and their community may better help medical teams understand often overlooked community supports and relationships, identify care gaps and tailor home and community-based services where they are most effective and needed.
FEASIBILITY OF A COMMUNITY-BASED NAVIGATOR SUPPORT PROGRAM FOR CARE PARTNERS OF SERIOUSLY ILL VETERANS
Authors: Boucher Nathan , Weidenbacher Hollis , Eldridge Madeleine , Johnson Kimberly , Van Houtven Courtney , Steinhauser Karen , Allen Kelli
Published: December 2023

We examined the feasibility and satisfaction of a short-term Veterans Health Administration (VHA)-based care partner support intervention delivered by trained navigators during COVID-19 through a single-arm interventional cohort feasibility study of a telephone-based care partner navigation intervention. Navigators (n=9) received the standard state curriculum online from a local community health worker training program plus an additional eight weeks of online role-specific training by the study team. Subsequently, navigators contacted care partners (n=30) of seriously ill veterans weekly via telephone over a 12-week period to assess social and practical needs, and connect care partners to appropriate community-based or VHA resources. All navigators (9 female; 1 male) and 17% of care partners were African-American (83% were Caucasian or other). Care partners were 90% female and 10% male; age range 41 to 80. In this telephone-based support program delivered to care partners by standard-trained navigators across 12 counties, care partners were overall very satisfied (x̄=4.69 out of 5, sd =.77) with their navigator’s responsiveness and social support throughout the 12-week course of the study. Navigators’ confidence increased over time (x̄=8.2 out of 10 (sd=1.14) to x̄=8.78 (sd=.97)), while their self-assessed effectiveness ratings lowered over time as they encountered real-life scenarios (x̄=8.5 (sd=1.43) to x̄=7.89 (sd=.93)). Navigators documented successful connections to services in the VHA and in care partners’ communities. Using remote navigators with minimal but standard training is a feasible and acceptable model of care partner support.
PRELIMINARY FINDINGS OF THE SHARING CHOICES INTERVENTION ON PRIMARY OUTCOME MEASURES
Authors: Wolff Jennifer , Zhang Talan , Giovannetti Erin , Rebala Sri , Roth David
Published: December 2023

A cluster randomization approach was applied to 55 primary care practices across two health systems. A 1:2 randomization design resulted in 19 practices being randomized to the SHARING Choices intervention condition and 36 practices randomized to a usual care control condition. The primary outcome variables include documentation of an advance directive (AD) or medical orders for life-sustaining treatment in the electronic health record (EHR) within 12 months of exposure to the intervention for all patients and receipt of potentially burdensome care within 6 months of death for patients who die with a serious illness diagnosis. At the time of this abstract submission, preliminary data on AD documentation in the EHR have been analyzed for one of the two health systems. In that health system, among 8,350 patients in intervention practices, AD documentation in the EHR increased from 19.2% to 25.1% one year later, compared to increases from 15.7% to 17.9% among 19,179 patients in control practices. This markedly greater increase for patients in intervention practices was highly significant statistically in a multilevel logistic regression model that took patient clustering within practices into account (adjusted odds ratio = 2.25; 95% confidence interval = 2.01, 2.51; p < 0.001). The SHARING Choices intervention, therefore, more than doubled the odds of having an AD added to the EHR within one year. Preliminary findings on this outcome from the other health system and other outcomes from both health systems will be analyzed in the months ahead and presented at the GSA meeting in November.
UNDERSTANDING RESOURCE PROFILES OF OLDER LEARNERS TO PROMOTE RECURRING ENGAGEMENT IN LEARNING
Authors: Sung Pildoo , Maulod Ad , Chan Angelique , Malhotra Rahul
Published: December 2023

Understanding characteristics of recurring learners among older adults is important for designing targeted strategies to promote lifelong learning. Studies have shown that older adults with human, social, and psychological resources are more likely to engage in learning. However, less is known about the interplay of these resources in motivating older learners to remain engaged in learning. Using longitudinal data from 515 older learners, aged 50 years and above, collected in Singapore in 2017-2018, we examined distinct resource profiles among older learners and their impact on recurring engagement in learning. Latent profile analysis explored (1) clusters of individuals with distinct resource profiles at baseline, comprising varying levels of human (education), social (civic attitudes, civic behaviors, and loneliness), and psychological resources (motivation to learn and control/autonomy/self-realization/pleasure), and (2) whether the resource profiles were associated with recurring engagement in learning (defined as attending another course within six months from baseline). Empirical analyses identified four resource profiles: (1) educated, resourceful (42.2% of older learners), (2) less educated, less resourceful (24.5%), (3) less educated, resourceful (20.0%), and (4) educated, less resourceful (17.0%). ‘Educated, less resourceful’ learners had a lower likelihood of recurring engagement in learning than ‘educated, resourceful’ learners. In summary, older adult learners are likely to possess varying levels of human, social, and psychological resources, which predict their recurring engagement in learning. Interventions helping older learners enrich their civic and psychological resources may facilitate their continued engagement in learning.
UNDERSTANDING THE NEW NIH DATA SHARING REQUIREMENTS: WHY THEY IMPROVE THE QUALITY OF RESEARCH
Authors: McNally James
Published: December 2023

In 2021, NIH began a long period of planning, drafting, and requesting public comment to create a new data-sharing policy, beginning with a Request For Information (RFI). The new policy, beginning January 25, 2023, will apply broadly to all scientific data produced with NIH funding. NACDA and (ICPSR), drawing upon our expertise and understanding of best practices for data sharing, have been working actively to develop tools and resources to assist NIH grant recipients in complying with federal data-sharing expectations with minimal disruptions to their research. This presentation will provide a detailed overview of the new data-sharing requirements and how to incorporate them into the required data-sharing plan. We will offer examples of successful data-sharing plans, identifying an appropriate repository, budgeting for the data preparation process, and creating informed consent documents consistent with the spirit of the NIH Data Sharing requirements. In addition to explaining the new data-sharing policy, the presentation will discuss the rationale behind the requirements and how they contribute to data equity using the FAIR principles. By increasing access to federally funded data, we contribute to a multidisciplinary approach that enhances cross-disciplinary communication and a broad understanding of different ways of knowing when working collaboratively with other researchers. Team Science has facilitated substantive discourse between qualitative and quantitative specialists. Multidisciplinary research increasingly represents a critical aspect of overall knowledge creation. Finally, the presentation will illustrate how data-sharing increases the impact of studies and enhances the credentials of researchers who engage in data-sharing.
HOW’S YOUR MEMORY? CONVERGENCE OF AMBULATORY COGNITIVE PERFORMANCE AND RETROSPECTIVE PERFORMANCE REPORTS
Authors: Zheng Anqing , Vo Tina , Muñoz Elizabeth , Wadsworth Sally , Sliwinski Martin , Reynolds Chandra
Published: December 2023

Calibration accuracy, the agreement between individuals’ perceived performance and actual performance, plays a critical role in self-regulated learning, knowledge monitoring, and goal maintenance. However, it is unclear how calibration accuracy operates at the micro-level timescales, especially among individuals approaching midlife. We investigated the convergence between perceived cognitive performance and the trajectory of momentary assessments collected repeatedly over 14 days. We analyzed the data of 440 participants (Mage = 35.78, %Female = 57.7%) from the Colorado Adoption/Twin Study of Lifespan Behavioral Development and Cognitive Aging (CATSLife1), who completed spatial working memory tasks administered via smartphones up to three times a day. On average, participants’ working memory improved across the 14-day period (β=-.014, SE=.001, p<.001), with lower scores indicating more accurate placement and better performance. Moreover, we observed less day-to-day variability in working memory performance (β=-.010, SE=.001, p<.001). The trajectory of working memory performance was consistent with participants’ evaluations of cognitive performance after completing the study: those perceiving improvement in their performance tended to perform better overtime (r = .25, SE = .046) and showed less variability in momentary assessments (r = -.28, SE = .046). Participants’ self-reported performance was also positively correlated with their working memory intercept at the start of the study (r = .34, SE=.045). Exploratory analyses then examined the associations between momentary calibration accuracy and other personality characteristics (e.g., openness). Our findings suggest that understanding the dynamic interplay between calibration accuracy and cognitive performance could shed light on individual differences during periods of cognitive maintenance versus decline.
UTILIZATION OF ELDER CARE AMONG PEOPLE LIVING WITH DEMENTIA IN SWEDEN: A REGISTER-BASED STUDY
Authors: sm-Rahman Atiqur , Meinow Bettina , Hydén Lars-Christer , Kelfve Susanne
Published: December 2023

The growing number of people living with dementia (PlwD) implies an increase in the demand for eldercare at different stages of the disease. This study aims to investigate the utilization of eldercare among people with and without dementia in Sweden during the last five years of life and what social-background factors influence the use of eldercare. Data were derived from four linked Swedish national registers comprising all decedents aged 70+ in Sweden as of November 2019 (n=6294). The primary outcome variable was the utilization of eldercare (no care, homecare, residential care). Following the study sample retrospective from death, data analysis was performed using multinomial and linear logistic regression models. Results showed that (1) nearly a quarter of all PlwD did not use any eldercare, primarily people who were newly diagnosed with dementia and living with partners; (2) three out of four PlwD used residential care in the last years of life; and (3) age, gender, and cohabitation status were important social-background factors determining utilization of eldercare for PlwD. This study provides unique insight that many Swedes with a dementia diagnosis do not receive any eldercare and that the utilization of eldercare increases with time since dementia diagnosis. We suggest more research to investigate why a substantial part of PlwD does not have any eldercare at all and what the policy implications of this might be.