bluuebunny/crossref_metadata_2025 huggingface dataset:
Saint Louis University GWEP Pivots to Virtual Service Delivery: Lessons Learned
Authors: Berg-Weger Marla , Zubatsky Max , Morley John
Published: December 2021

In response to the COVID-19 pandemic, Saint Louis University GWEP quickly pivoted service initiatives to online formats. Despite challenges of technology literacy and access, GWEP faculty, staff, and students creatively adapted in-person programming to online delivery and developed new virtually-delivered services. These service delivery adaptations provided opportunities for educating students, residents, faculty, community partners, and older adults and their caregivers to gain new knowledge and skills while continuing to participate in programming. This presentation will highlight innovations in the area of services to persons with dementia through Cognitive Stimulation Therapy, caregivers through education and support programs, older adults experiencing loneliness and social isolation through Circle of Friends, and older adults and caregivers through a virtual geriatric assessment clinic. We share highlights here of our efforts to pivot programming, access new funding streams, and, in some cases, create online delivery, including valuable lessons learned.
Marital and Romantic Satisfaction Among Older African Americans
Authors: Skipper Antonius , Taylor Robert
Published: December 2021

There remains a lack of knowledge on marital satisfaction of African Americans generally, but particularly older African Americans. In addition, only a handful of studies investigate satisfaction among couples who are unmarried. With data from the National Survey of American Life, this study examined the correlates of romantic and marital satisfaction among older African Americans. Findings reveal that married older African Americans were slightly more satisfied with their relationship than individuals who were either remarried or unmarried but in a romantic relationship. Among older African American married adults, older age was associated with higher marital satisfaction, and men had higher levels of marital satisfaction than women. Also, married older African Americans with lower family incomes reported higher marital satisfaction. Given the limited research on older African Americans couples, either married or unmarried, this study offers valuable implications for individuals and professionals engaging these couples in practical settings.
Contextual Correlates of Cognitive Aging in Black Older Adults: Examining the Neighborhood
Authors: Sol Ketlyne , Hill-Jarrrett Tanisha
Published: December 2021

Black older adults have a unique history that includes enslavement and legalized segregation. This history shapes the present-day experiences of older Blacks, in part, through the neighborhoods in which they live. The neighborhood is a reflection of both the physical and social contexts, and reflects the most natural and intimate context through which a person experiences life. Combined, the unique history and neighborhoods of Black older adults may contribute to their disproportionately experiencing impairments in cognitive function in older age. There is growing interest in how lived experiences across the life course affect cognitive trajectory and, ultimately, cognitive outcomes of older Black adults. In this presentation, we will review recent literature on psychosocial and physical contextual factors and their influence on cognitive aging in older blacks through the lens of the neighborhood.
Cultural Adaptations to Recruitment Strategies and Community-Based Interventions for Dementia Caregivers
Authors: Parker Lauren , Marx Katherine , Aranda Maria
Published: December 2021

Nearly 30 years after the 1993 National Institute of Health Revitalization Act, minority groups’ low participation in research remains (which required the inclusion of women and racial/ethnic minority groups into government-funded clinical trials). This is particularly the case for participation in research on Alzheimer’s Disease and related dementias (ADRD). Deeply rooted historical race-based mistreatment in research and in the health care system at large persist as barriers to low-participation of minorities (i.e. Black/African American, Hispanic/Latino) and immigrants in research studies, who remain at disparate risk for adverse ADRD health outcomes and expedited mortality. The use of culturally adapted approaches in recruitment strategies and community-based interventions might be helpful to encourage the participation of underrepresented groups into research. As such, this presentation highlights three studies that seek to use cultural adaptation to inform recruitment strategies and community-based interventions. First, Dr. Parker will present how tenets from Critical Race Theory can be used to inform culturally-adapted recruitment strategies of Black/African American caregivers into community-based research by drawing upon two ongoing studies: a randomized trial providing caregiver support through Adult Day Services (ADS) and the evaluation of impact of ADS on stress levels of Black/African American using biomarker measures. Next, Ms. Johnson will present results on cultural adaptions to the ADS-Plus Program for Spanish-speaking populations. Finally, Dr. Nkimbeng will present on the process of culturally-tailoring dementia education for African immigrants in Minnesota. Findings from this presentation identify opportunities for researchers to use cultural adaptations to encourage participation of underrepresented populations into ADRD research.
The Use of Critical Race Theory to Inform Culturally Adapted Recruitment Strategies for Community-Based Research
Authors: Parker Lauren , Gaugler Joseph , Gitlin Laura
Published: December 2021

Black/African American participation in non-pharmacological randomized trials and community-based research on Alzheimer’s Disease and related dementias (ADRD) remains low. This presentation introduces Critical Race Theory (CRT), its tenets and how it can be used in tandem with national strategies to encourage participation of Black/African Americans in ADRD research. CRT is a transdisciplinary methodology that draws on anti-racist tenets to study and transform the relationships among race, racism, and power. We describe how CRT constructs (e.g., race consciousness, counter-storytelling) can be used to inform recruitment strategies to enroll Black/African American ADRD caregivers into community-based research by drawing upon two ongoing studies: a randomized trial providing caregiver support through Adult Day Services (ADS) and the evaluation of impact of ADS on stress levels of Black/African American using biomarker measures. In the spirit of CRT this presentation is a call for action and transformation of dementia care research to actively include Black/African Americans.
Effects of Simulation-Based Learning on Nursing Students’ Learning Outcomes of a Gerontology Course
Authors: Kao Hsueh-Fen , Ye Minzhi , Chen Lin
Published: December 2021

Simulation-Based Learning (SBL) is beneficial to nursing education. Nevertheless, recent studies have shown a side effect of being overwhelmed by repeated exposures to simulation. Thus, how many times simulation scenarios should be provided to students remains a question. The objectives of this study were to (1) explore the changes in nursing students’ perceived competence, self-efficacy, and learning satisfaction after repeated exposures to simulations, and (2) determine the acceptable frequency of SBL in the ‘Care of Older Adults’ course. A one-group repeated measurement experimental design with self-administered questionnaires in a convenient sample of 84 senior nursing undergraduate students was used at a university in southern Taiwan, and 79 students completed all measurements. After taking the baseline measurements (T0), students were exposed to 75-mininute simulation scenarios from Time 1 (T1) to Time 3 (T3) three weeks apart throughout the semester. Students’ perceived nursing competence, self-efficacy, and learning satisfaction were measured immediately after each exposure. There were statistically significant improvements from T0 to T3 (p < .001) in all three areas; however, no significant difference when comparing scores from T1 to T2 and from T2 to T3. To conclude, SBL is effective in improving nursing students’ perceived competence, self-efficacy, and learning satisfaction. While the primary changes occur at the first simulation effort, it is the accumulated multiple exposures collectively improve students’ learning outcomes. Multiple instructional strategies are recommended to maintain students’ learning interests to achieve optimal learning outcomes of the course across a semester.
Enhancing Behavioral Health Competencies: Interprofessional Collaboration Between Social Work and Medicine
Authors: Keefe Bronwyn
Published: December 2021

This presentation will describe the creation and findings from an interprofessional curriculum in behavioral health developed by social work faculty for medical students. Training in behavioral health is needed more than ever during a time of increased isolation and fear during the COVID pandemic. Older adults with untreated behavioral health concerns are a vulnerable population, which can result in negative effects, including emotional distress, reduced physical health, increased mortality, and suicide (IOM, 2012). Healthcare is increasingly complex with a need to focus on the physical, social, and behavioral aspects of daily living, and providers are realizing the importance of interprofessional collaboration. Towards that aim, I created a module for 4th year medical students in mental health and older adults, which is now part of their medical education curriculum. I will present outcomes in: (1) satisfaction; (2) acquired knowledge and skills (post-test); (3) application of knowledge and skills (pre-post competency assessment and comfort around asking about depression); and (4) patient outcomes (frequency of depression screening and number of referrals to social worker). Feedback from the 143 medical students is positive with 95% strongly agreeing or agreeing that this expanded their knowledge and understanding in mental health issues among older adults. At baseline, 17% of medical students were moderately to very comfortable in asking questions on the GDS compared to 42% at post-assessment. After completing the course, almost 25% of medical students made a referral to social work during their rotation. This collaboration resulted in curriculum that is both rigorous and impactful.
Geriatric Workforce Enhancement Programs' Participation in the Nursing Home COVID Action Network
Authors: Waters Leland , Tumosa Nina
Published: December 2021

In late September, 2020, the Geriatric Workforce Enhancement Program’s (GWEP) Program Officer, at the Health Resources Services Administration (HRSA), alerted the 48 GWEPs about a nationwide initiative focusing specifically on the pandemic’s effect in nursing facilities. The ECHO Institute at the University of New Mexico negotiated a national contract with the Agency for Healthcare Research and Quality (AHRQ) to provide a nationwide educational intervention via the CARES Act Provider Relief Fund. The ECHO Institute recruited over 100 Training Centers as educational coordinators for the Project ECHO Nursing Home National COVID Action Network. Our Project Officer suggested that individual GWEPs participate in this effort and take the lead or provide geriatric educators for these Training Centers. Project ECHO (Extension for Community Healthcare Outcomes) is an innovative telementoring program that creates virtual learning communities, bringing together healthcare providers and subject matter experts using videoconference technology for brief presentations, and case-based learning, fostering an “all learn, all teach” approach. This symposium will describe the journeys that five GWEPs experienced becoming Training Centers, rapidly deploying a nursing home ECHO project, to support nursing home staff on best practices for protecting patients, staff, and visitors from coronavirus infection and spread. GWEPs from The University of Louisville, the University of North Carolina, the University of North Texas, the University of Rochester and The Virginia Geriatric Education Center’s two ECHO Hubs, joined the National COVID Action Network. This presentation will provide an overview of why GWEPs are well positioned to address emergent needs with short notice.
The Association Between the Use of Digital Health Management Tools and Subjective Well-Being Among Older Adults
Authors: Wang Haowei , Yang Mai See , Choi Yong Kyung
Published: December 2021

This study aims to examine the association between the use of digital health management tools and subjective well-being in later life. Research is limited about technology use (e.g., participation in online wellness program, finding medical information, using devices to monitor health) among community dwelling older adults. This study used data from the Health and Retirement study 2012 Module “Technology Use: Barriers and Benefits” (N = 1,416). We used multiple regression methods to test the association between technology use and subjective well-being (i.e., self-rated health, life satisfaction, and depressive symptoms). Over half of the participants reported using technology (58%). The mean age for this group was 68.7 (SD 9.6). Majority of the respondents were female (55%). About 18% were non-Hispanic Blacks, 2% were non-Hispanic other, 11% were Hispanic, and 68% were non-Hispanic Whites. For this sample of technology users, the usage of digital health management included online exercise programs (16%), online wellness programs or health monitoring programs (7%), searching for medical and health information online (43%), digital devices to monitor health (31%), and physical activity-based video game such as Wii Fit (7%). Over 88% of the sample have used at least one of these formats to monitor their health. Results from regression models suggested that the use of any digital health management tools was related to fewer depressive symptoms and better self-reported health. Findings from this study provide insight into how digital health management can protect older adults from poor subjective well-being in later life.
Asian Older Adults, Trauma, Resilience, and Health: Recent Findings From the Rutgers Asian RCMAR
Authors: Dong XinQi , Simon Melissa , Wu Bei
Published: December 2021

U.S. Asians are the fastest growing group of older adults in the nation. However, there remains a dearth of disaggregated research for this population assessing health outcomes such as cognition, suicidality, mortality, and the influence of nutrition on chronic conditions. Drawing on the research of Rutgers Asian RCMAR Scientists, this symposium will examine these areas to provide a better understanding of the health of diverse groups of U.S. Asian older adults. Session 1 will assess the association between living in an ethnic enclave and better cognition among Chinese older immigrants and examine the influence of moderating factors. Session 2 will explore the prevalence of traumatic experience and discuss the association among trauma experience, lifetime mental disorder, and risk of endorsed suicide ideation among aging Asians. Session 3 will assess the relationship between family types and 6-year mortality among U.S. Chinese older adults in Chicago. Session 4 will examine the association between ultra-processed foods and cardiometabolic health (obesity, hypertension, high cholesterol, and diabetes) among U.S. adults 50 or older reporting a single ethnicity. In summation, this symposium describes key research areas such as cognition, suicidal ideation, mortality, and nutrition on the overall health of U.S. older adults. The symposium addresses both risk and protective factors that influence these health outcomes and aims to inform interventions to improve the health of U.S. Asian older adults in the areas of trauma, resilience, and health.
Long-Term Effects of Social Insurance on Adult Mortality: Evidence From Three Social Programs in Mexico
Authors: Aguila Emma , Dow William , Parker Susan
Published: December 2021

Research on the mortality effects of social insurance programs for older adults has generated conflicting results. Some studies suggest important health benefits, others find no effects, and still others find unintended adverse effects potentially linked to pathways such as increased obesity. Evidence has focused predominantly on short-run effects rather than net long-run mortality effects and their effects on the health of older adults has been particularly understudied. Mexico offers a unique opportunity for studying the long-run effects of social programs on adult mortality. Within a ten-year period, Mexico introduced the following influential social insurance programs: Progresa conditional cash transfer (CCT) program in 1997, 70 y más unconditional cash transfer (UCT) program for older persons in 2007, and Seguro Popular, a public health insurance program (PHI) for the uninsured, in 2004. In this paper we analyze effects on mortality for middle-age and older adults, by gender, 10-20 years after program implementation.
Long-Term Care Insurance Policy Intensity and the Policy Matching Degree of Pilot Cities in China
Authors: Peng Rong , Wu Bei
Published: December 2021

Since China launched long-term care insurance (LTCI) pilot in 15 cities in 2016, the LTCI policy schemes have been developed gradually. Based on the 61 LTCI policy documents, this study evaluated the LTCI policies intensity in each pilot area by building a PMC index model with 10 primary variables and 44 two-level variables. Using the coupled coordination model, the coordination development indexes were calculated to evaluate the level of matching between LTCI policies and economy development and population structure. The results showed that the PMC index valued between 0.646 and 0.922. The three cities having the highest level of policy strength (PMC>0.8) were as follows: Qingdao, Nantong, and Jingmen. The three cities having the lowest level (PMC<0.7) were Ningbo, Qiqihar and Chongqing. The indexes of the coordination degree varied from 0.263 to 0.594. Shanghai, Qingdao and Guangzhou had the highest level of coordination degree, while Anqing, Chende and Qiqihaer are the lowest .The difference of financing mechanism of pilot cities was one of the main determinants of policy intensity. The matching degree was relatively low. Qingdao was a unique city having both high policy intensity and matching degree. It was suggested that the intensity and matching degree of LTCI policies should be improved to develop a national LTCI system in China.
Trauma Exposure, Mental Disorder, and Risk of Suicide Ideation Among Aging U.S. Asians
Authors: Ma Ping , Li Ruike , Shigemoto Yuki , Chen Lei-Shih
Published: December 2021

This project aims to explore the prevalence of traumatic experience and examine the association among trauma experience, lifetime mental disorder, and risk of endorsed suicide ideation among aging Asians. Data were drawn from the National Latino and Asian American Survey and participants aged 55 and above were included in the study. Descriptive analyses and weighted logistic regressions were employed to analyze the association among outcomes of interest. Approximately 74% of 376 aging Asians experienced trauma exposures. Specifically, 17% of respondents with trauma exposure reported a lifetime mental disorder, and 8% had suicide ideation. After adjusting for demographic, social support, and family factors, aging Asians with traumatic experience had a significantly higher risk of experiencing discrimination and mental disorders (p-values<.05). Assaultive or interpersonal violence exposure was positively associated with increased odds of suicide ideation. Culturally tailored mental health intervention and suicide screening are warranted for aging Asians with previous trauma exposure.
I Wouldn’t Search That With My Mobile Phone: Credibility and Trust in OHIRs Among Lower-Income Black Older Adults
Authors: Harrington Christina , Woodward Amanda
Published: December 2021

Online health information resources (OHIRs) such as conversational assistants and smart devices that provide access to consumer health information in the home are promoted as viable options for older adults to independently manage health. However, there is question as to how well these devices are perceived to meet the needs of marginalized populations such as lower-income Black older adults who often experience lower digital literacy or technology proficiency. We examined the experiences of 34 lower-income Black older adults aged 65-83 from Chicago and Detroit with various OHIRs and explored whether conversational resources were perceived to better support health information seeking compared to traditional online web searching. In a three-phase study, participants tracked their experiences with various OHIRs and documented health-related questions in a health diary. Participants were then interviewed about their diaries in focus groups and semi-structured interviews, followed by a technology critique and co-design session to re-envision a more usable and engaging conversational device. We present preliminary results of the themes that emerged from our analysis: cultural variables in health information seeking practices, perceptions of credibility, likelihood of use, and system accessibility. Participants indicated that their trust of different resources depended on the type of information sought, and that conversational assistants would be a useful resource that require less technology proficiency, even among those with lower e-health literacy. Although our findings indicate that familiarity and trust were salient constructs associated with perceptions of OHIRs, these devices may address digital literacy and technology familiarity with certain design considerations.
Factors Impacting Treatment Decision Making in Older Adults With Indolent Non-Hodgkin Lymphoma
Authors: Trevino Kelly , Martin Peter , Leonard John
Published: December 2021

Indolent non-Hodgkin lymphomas (NHL) are among the most common lymphomas and up to two-thirds of diagnoses are made in older adults (age≥65 years). Initial treatment options include cancer-directed therapy or active monitoring by the oncologist for disease progression. Despite the disparate nature of these treatments, the factors impacting older adults’ treatment decisions are unknown. This study examines the reasons older adults chose their initial treatment, factors influencing this decision, shared decision-making preferences, and differences in these factors relative to younger adults (age<65 years). Adult patients (≥21 years) with a new diagnosis of indolent NHL in the past six months completed electronic self-report measures. The final sample consisted of 86 patients; 43.0% (n=37) were older adults. Over two-thirds of older adults (n=25, 67.6%) were being monitored by their oncologist with no age differences in current treatment (p=.55). Most older adults chose their treatment plan to “maximize my long-term health” (n=24, 64.9%) which did not differ from younger adults (p=.77). The primary factors impacting older adults’ treatment decisions were their doctor’s recommendation (M=3.92, SD=.28, Range=0-4) and their personal preference (M=2.88, SD=1.68, Range=0-4). Factors impacting treatment decisions did not differ by age (all p’s>.05). Most older adults (n=25, 69.4%) expressed a preference for shared decision-making with their oncologist which did not differ from younger adults (p=.17). Treatment planning for older adults should consider long-term health, consistent with older adults’ values. Older adults may view treatment decision-making similarly to younger adults; assumptions about patients’ values and decision-making preferences based on age are likely inappropriate.
Remote Monitoring Activity Trajectory-Associated Weight Loss and Functional Ability in Obese Older Adults
Authors: Batsis John , Petersen Curtis , Kahkoska Anna , Fortuna Karen
Published: December 2021

Functional decline in older adults can often be mitigated by physical activity. As older adults increasing adopt wearable technology, an understanding of how remotely monitored activity is associated with clinical outcomes is needed. Data was analyzed from two cohorts of older adults with obesity (□65 years, BMI (□30kg/m2)) who completed weekly dietary and exercise-based weight loss interventions (n=93). Follow-up time varied between cohorts (n=37: 12-weeks; n=56: 16 weeks). All participants were provided a Fitbit to monitor physical activity. Baseline and follow up weight, 6-minute walk distance, grip strength, and Late Life Function and Disability Instrument (LLFDI) were collected. We used k-means clustering for longitudinal data to identify physical activity trajectories from Fitbit steps at the daily level. Linear regression models tested for differences in each outcome between trajectories, adjusting for age and sex. Baseline characteristics did not vary across cohorts: mean age 72.7±4.5 years, 76.5% were female, and mean BMI was 36.4±5.1 kg/m2. Two physical activity trajectories were identified, termed high and low activity based on differences in mean daily steps (7,476±4,117 vs. 2,960±2,453, p <0.001). Participants in the high activity group experienced a 2.4% reduction in weight (p <0.001) and a 4.74% increase in LLFDI score (p=0.007) relative to the low activity cluster. Other outcomes were not significantly different between trajectories. These results demonstrate the potential for remote monitoring data to elucidate longitudinal trends in weight and functional ability. As such, older adults’ use of wearable technology may facilitate improvements in weight and functional ability in the community.
Age Differences in the Association Between Anxiety Symptoms and Suicide Risk
Authors: Owsiany Montgomery , Cui Ruifeng , Fiske Amy
Published: December 2021

Suicide rates increase over the life-span, necessitating concern in older adults. Recent studies suggest that anxiety disorders are associated with suicidal thoughts and behavior. The present study examined the association between anxiety symptoms (General Anxiety Disorder-7) and suicide risk (Suicide Behaviors Questionnaire-Revised), testing whether the association differs between younger and older adults. Depression symptoms (Patient Health Questionnaire-8) were controlled for in the analyses. In a sample of 944 participants (46% 60+ years), anxiety symptoms, depression symptoms, and suicide risk were lower among older adults (60+ years) than younger adults (all p < .01). Age moderated the significant association between anxiety symptoms and suicide risk (ΔR2 = .008, p < .01). Results indicate that an increase in anxiety is associated with a smaller increase in suicide risk for older adults than younger adults. The need for suicide risk screening among individuals with elevated anxiety symptoms is critical, especially for younger adults.
Retirement and Suicidal Behaviours: A Review of the International Literature
Authors: Owsiany Montgomery , Crnek-Georgeson Kylie , Wilson Leigh
Published: December 2021

This scoping review maps published literature on retirement patterns and the effect retirement has on individuals. Recommendations are provided for future research, including changes to retirement policies, to decrease the prevalence of suicidal behaviours for older adults. A literature search (2014 - 2020) was conducted in Medline, PubMed, Cinahl and Scopus, using the terms retirement, transition, redundancy, and pathways. A rapid review of global literature was undertaken, identifying 204 articles, with 27 papers chosen for full review. Search terms included retirement, transition, redundancy and pathways to retirement. Themes arising from the data were experience of retirement, planning, health (physical and psychological), and levels of social participation. This review provides information for policy makers, health workers and employers to assist individuals with retirement, emphasising the need to maintain competency in a complex set of skills to improve health literacy and decrease psychological stress/ suicidal behaviours in older adults.
Racial Disparities in Use of Memory Care and Prevalence of Duals in Assisted Living
Authors: Cornell Portia
Published: December 2021

Assisted living (AL) communities with memory care licenses are disproportionately located in affluent and predominantly White communities and Black older adults are underrepresented in AL. But little is known about characteristics of AL that care for Black residents. We estimated the association of facility-level characteristics as proxy measures for AL resources, such as memory care designations and percentage of dual-eligible residents, across low (0-5%), medium (5-10%) and high (>10%) percentages of Black residents. We found broad differences among communities in the three levels of Black-resident prevalence. High percentage of Black residents was associated with large differences in the percentage of Medicaid-enrolled residents (high 54% duals [s.d.=34], med 28% [31], low=13% [22], p<0.001). ALs with high Black populations were less likely to have a memory-care designation than ALs with medium and low percentages of Black residents (high 4.7% memory care, med 11%, low 17%).
Spillover Effects of Retirement on Physical and Mental Health of a Spouse or Partner: Do Gender and Sexuality Matter?
Authors: Liu Jingwen
Published: December 2021

While the health implication of retirement on retirees has been widely discussed in social sciences, less is known about its spillover effects on one’s spouse or partner. Indeed, large quantities of studies have shown that retirement is a joint decision of couples that may influence the time use of spouses and the incidence of divorce, and so leaving the cross-spouse effects unexplored may underestimate the influence of retirement and social security policies. Using ten waves of Health and Retirement Survey (HRS 1996-2014, N = 85039 observations), this research adopts fixed effects models and instrumental variable methods to examine the causal effects of a retiree’s retirement on the physical and mental health outcomes of his/her spouse or partner, with particular attention paid to the gender and sexuality differentials. Regression results suggest that transitioning into retirement is associated with enhanced self-reported health and cognitive function and decreased depressive symptoms, physical limitation, and BMI among the retirees’ spouses or partners. However, the timing when retirement occurs also matters that retirement at the culturally expected retirement age leads to beneficial spillover effects, while late retirement brings about detrimental effects. Further comparison analysis indicates that retirement’s spillover effects are more prominent among females and heterosexual couples than among their male and gay and lesbian counterparts. These findings inform policymakers of the cross-couple spillover effects of postponing retirement ages and the increasing physical and psychological disparities of females and gay and lesbian couples within families in middle and later life.
Doing Time: Experiences of Care Home Residents in Germany During the Early Phase of the COVID-19 Pandemic
Authors: Leontowitsch Miranda , Oswald Frank , Schall Arthur , Pantel Johannes
Published: December 2021

Residents of care homes across the globe are affected by the spread of SARS-CoV-2 as they have been identified as a high-risk group and because they experienced strict social isolation regulations during the first wave of the pandemic. Social isolation of frail older people is strongly associated with negative health outcomes. The aim of this research project was to investigate how residents in care homes experienced social isolation during the first phases of contact ban in Germany. This paper draws on structured interview data collected from 22 residents in two care homes during early June 2020 in Frankfurt/Main. The findings show that their experiences were shaped by three factors: care home staffs’ approach to handling the contact ban; biographical sense of resilience; and a hierarchy of life issues. The findings highlight the importance of locally specific response mechanisms in care homes, and the need to contextualize residents’ experiences.
Transplant Centers That Measure Frailty as Part of Clinical Practice Have Better Outcomes
Authors: Chen Xiaomeng , Liu Yi , Chu Nadia , Walston Jeremy , Segev Dorry , McAdams-DeMarco Mara
Published: December 2021

Frailty predicts adverse outcomes for kidney transplant (KT) patients; yet the impact of clinical assessments of frailty on center-level outcomes remains unclear. We sought to test whether KT centers that measure frailty as part of clinical practice have better pre- and post-KT outcomes. We conducted a survey of US transplant centers (11/2017-4/2018), 132 KT centers (response rate=65.3%) reported frequencies of frailty assessment at candidacy evaluation and KT admission. Center characteristics and clinical outcomes were gleaned from the national registry (2017-2019). Poisson regression was used to estimate incidence rate ratios (IRRs) of waitlist mortality rate and transplantation rate in candidates and graft loss rates in recipients by frequency of frailty assessment. All models were adjusted for case mix and center characteristics. Given similar center characteristics, centers assessing frailty at evaluation had a lower waitlist mortality rate (always=3.5, sometimes=3.2, never=4.1 deaths per 100 person-years). After adjustment, centers assessing frailty at evaluation had a lower rates of waitlist mortality (always IRR=0.91, 95% CI:0.84-0.99; sometimes=0.89, 95% CI:0.83-0.96) and transplantation (always IRR=0.94, 95% CI:0.91-0.97; sometimes=0.88, 95% CI:0.85-0.90) than those never assessing frailty. Centers that always assessed frailty at KT admission had 0.71 (95% CI:0.54-0.92) times the rate of death-censored graft loss than their counterparts never assessing frailty. Assessing frailty at evaluation is associated with lower transplantation rate but better waitlist survival; centers always assessing frailty at admission are likely to have better graft survival. Research is needed to explore how routine assessment of frailty in other clinical practices benefits broader patient populations.
Home Health Agencies With More Socially Vulnerable Patients Have Lower Experience-of-Care Ratings
Authors: Wang Jinjiao , Ying Meiling , Li Yue
Published: December 2021

Little is known about the disparities in patient experience of home health (HH) care related to social vulnerability. This study examined the relationships of patient Medicare-Medicaid dual eligible status and race and ethnicity with patient experience of HH care. We analyzed national data from the Home Health Care Consumer Assessment of Healthcare Providers and Systems (HHCAHPS), Outcome and Assessment Information Set, Medicare claims and Area Health Resources File for 11,137 Medicare-certified HH agencies (HHA) that provided care for Medicare beneficiaries in 2017. Patient-reported experience of care star ratings (1-5) in HHCAHPS included 3 domains (professional care delivery, effective communication, and specific issues in direct patient care) with each dichotomized into high (4-5) and low (1-3) experience of care. The proportion of patients with dual eligibility and the proportion of racial/ethnic minorities were summarized at the HHA level. HHA with higher proportion of dual eligible patients were less likely to have high experience of care rating in professional care delivery (smallest Odds Ratio [OR]=0.514; 95% CI: 0.397, 0.665; p<0.001), effective communication (smallest OR=0.442, 95% CI: 0.336, 0.583; p<0.001), and specific direct care issues (smallest OR=0.697, 95% CI: 0.540, 0.899; p=0.006). HHA with higher proportion of racial/ethnic minorities were also less likely to have high patient experience of care rating across all three domains (smallest OR=0.265, 95% CI: 0.189, 0.370; p<0.001). Disparities in patient experience of HH care exist and they are associated with low income and racial/ethnic minority status, indicating substantial unmet needs among these socially vulnerable patients.
Support From the Top: Diverse Leadership Partners for Sustained STAR-VA Implementation
Authors: Karel Michele , Snow A Lynn , Hartmann Christine , Jedele Jenefer , Minor Lisa
Published: December 2021

The STAR-VA program was an initiative out of what is now called the VA Office of Mental Health and Suicide Prevention, partnering with the national Offices of Geriatrics and Extended Care and Nursing Services. Ongoing collaboration with these national, as well as regional and medical-center-level leaders, has been critical for informing program implementation and dissemination strategies. We will discuss several key partnered strategies, including (1) linking STAR-VA to national CLC systematic quality improvement efforts; (2) engaging national inter-office program leaders in decisions about outreach to and inclusion of facilities in STAR-VA training and implementation; (3) training local STAR-VA champions on strategies for engaging local leadership support; (4) briefing leaders across the system with program updates; and (5) using national VA data to inform STAR-VA sustained implementation. Discussion will address challenges and opportunities for engaging leadership stakeholders in facilitating sustained implementation of evidence-based programs.
Preferable Use of Information and Communication Technologies in Long-term Care Settings: A Vignette Survey of Japan
Authors: Wakui Tomoko , Ikeuchi Tomoko , Itoh Sakiko , Miwa Hiroyasu , Watanabe Kentaro
Published: December 2021

The remarkable development of information and communication technologies (ICT), considering the rapidly aging global population, could eliminate the physical and mental burdens involved in caregiving and enhance the perceived dignity and autonomy of older adults. However, the introduction of ICT in long-term care (LTC) in Japan has not yielded good results yet, and the social acceptance of ICT remains understudied. This study aimed to understand and examine people’s views on ICT use in LTC settings. An online vignette survey was conducted in August 2020, among community-dwelling persons between the ages of 40–89 years, throughout Japan. A set of four vignettes of different physical and cognitive functional situations, at either a home or nursing home, with or without ICT use, was presented to select a preferred care setting. Multinomial regression analyses were used to examine the relationships between participants’ choices and individual characteristics. A total of 4,457 participants (52.8% of whom were women) were analyzed (mean age = 60.8 years). Participants were more likely to choose nursing homes in cognitively dependent situations. Participants who were women, relatively younger, and had higher education were more likely to choose care settings employing ICT for physically and cognitively dependent situations. Those who experienced either informal or formal caregiving were more likely to choose care settings that used ICT. This study revealed that individuals preferred different levels of ICT use based on physical and cognitive situations. Barriers to introducing ICT in LTC settings will be discussed.
Implementing Behavioral Health Social Workers' Increased Mental Health Care Among Older Adults
Authors: Pfoh Elizabeth , Hohman Jessica , Alcorn Kathleen , Vakharia Nirav , Rothberg Michael
Published: December 2021

Depression is underdiagnosed and undertreated among older adults. Health systems can screen patients to identify depression, but systemic linkages to treatment are required to ensure care. We used a retrospective stepped-wedge study to identify the impact of implementing behavioral health social workers (BHSWs) on receipt of treatment after a new depression diagnosis. We included adults over 65 years of age with a primary care visit between 2016 and 2019 at a large integrated health system. We excluded patients who were diagnosed with or treated for depression in 2015. Patients were categorized into control (diagnosed before implementation) and intervention (diagnosed after implementation) groups. From our electronic health record, we collected prescriptions for pharmacotherapy and behavioral health visits. Patients were considered treated if they received pharmacotherapy or had a behavioral health visit within 30 days of diagnosis. We used multilevel logistic regression models to identify the association between implementation period (pre versus post) and treatment, adjusted for demographic variables and clustering within site. Our population included 4,475 people. The percent of patients that received treatment increased from 47% to 54% after implementation and the percent of patients with ≥1 behavioral health visit within 30 days increased from 3% to 8% (p<0.01, respectively). The adjusted odds ratio of receiving treatment (AOR: 4.13, 95%CI: 2.84-6.01) and having a behavioral health visit (AOR: 3.12, 95%CI: 2.31-4.24) was significantly higher in the post-implementation period. In conclusion, implementation of BHSWs was associated with increased treatment for older patients with depression.
The Impact of State Dementia Training Requirements for Nursing Homes on Resident Outcomes
Authors: Shier Victoria , Bae-Shaaw Yuna , Lekovitch Cara , Chew Felicia , Leland Natalie , Sood Neeraj
Published: December 2021

Stakeholders, including policymakers, have prioritized the need to educate nursing home (NH) staff about Alzheimer’s disease and dementia. Despite this prioritization and the relationship between staff training and outcomes, dementia-specific knowledge is variable. This study examined state-level training policies between 2011-2016. During this time 12 states (regulators and payers) implemented NH dementia training requirements, creating an opportunity for a natural experiment between states with and without new requirements. We estimated difference-in-differences models to determine the effect of state requirements on outcomes. Data from Nursing Home Compare and LTCFocus.org were linked to data on state policies. Training requirements were associated with 0.39 and 0.17 percentage point reductions in antipsychotics use and restraint use, respectively, and no impact on falls or need for help with daily activities. State requirements for dementia training in NHs are associated with a small, but significant reduction in the use of antipsychotic medication and physical restraints.
The M. Powell Lawton Award Lecture: The Person-Environment Fit Framework, Older Adults and Technology Interactions
Authors: Czaja Sara
Published: December 2021

M. Powell Lawton made significant contributions throughout his illustrious career to improve the quality of life of older adults. His landmark theory of person-environment fit (P-E Fit) recognized the importance of understanding the dynamic interactions between older adults and their physical and social environments and the subsequent impact of these interactions on independent living. In today’s living environments, technology is ubiquitous and can serve as both a barrier and facilitator to the ability of older people to live independently. This presentation will discuss how the P-F Fit Model can be used to clarify potential mismatches between technology systems and the characteristics, abilities, and preferences of older adult and how it can be used to guide design and training interventions to maximize the ability of aging adults to interact successfully with technology systems. Examples will be drawn from the Center for Research and Education on Aging and Technology Enhancement (CREATE) in the domains of social engagement, work, and health from technology design and intervention perspectives. The CREATE conceptual framework, consistent with the P-E Fit Model posits that users have varying needs, abilities, and attitudes; technology systems and tasks vary in demands; social, physical, and policy environments influence a person’s access to and support for technology transactions; and human-technology interactions are dynamic. A focus of the presentation will be on how a user-centered design approach is compatible with the P-E Fit model and can optimize the fit between older adults and technology systems.
COVID-19 in Assisted Living: Evidence on Policies, Provider Experiences, and Resident Mortality
Authors: Thomas Kali , Schwartz Lindsay
Published: December 2021

The devastating effects of Coronavirus disease 2019 (COVID-19) among older adults residing in long-term care settings has been well documented. Assisted living settings in the U.S. have 811,000 residents; most are 80 years or older, and many have one or more chronic illnesses, making them highly susceptible to poor outcomes if exposed to COVID-19. This symposium highlights five studies that focus on various levels of COVID-19 response in assisted living: national organizations, states, assisted living operators and healthcare providers, and residents. The first study compares the sometimes conflicting guidance provided by national long-term care industry-related organizations and recommends assisted living-specific actions for the future. The second study describes the state regulatory response to COVID-19 in assisted living, identifying the themes and implications for the function of the care networks of assisted living residents. The third study presents findings from interviews with key stakeholders, including policymakers and industry leaders, that reflect on the challenges responding to changing recommendations and policies. The fourth study reports results from a survey with administrators and medical and mental health care providers who treat their residents that illustrates the care practices that were implemented in response to COVID-19 in assisted living. The fifth presentation documents the national excess assisted living resident mortality that was attributable to COVID-19. This symposium culminates with a leading assisted living industry expert reflecting on providers’ experiences and posing areas to consider when preparing for and responding to future pandemic events in assisted living settings.
COVID-19 and Psychosocial Changes: Results From the National Health and Aging Trends Study (NHATS)
Authors: Samuel Laura , Ong Anthony
Published: December 2021

The COVID-19 pandemic likely altered many aspects of daily life for older adults, including social connectedness, technology use, financial resources and hopefulness. This symposium examines these exposures and changes during the COVID-19 pandemic and tests their associations with health and related factors. Analyses are all conducted among a nationally representative sample of U.S. adults aged ≥65 years who participated in the NHATS COVID-19 supplement, which was a mail-in survey with participant and proxy respondents conducted between June and October of 2020. Additional NHATS participant data collected between 2011 and 2019 was used to account for individual characteristics before COVID-19, including demographic, socioeconomic and relevant health characteristics. Sampling weights were applied to analyses to account for study design and non-response so that inferences can be drawn to the US population of adults aged ≥65 years. This symposium will present results from five COVID-19 pandemic focused studies that examine the associations between 1) financial changes and health, 2) loneliness and behavioral changes, 3) hopefulness with function, sleep and loneliness, 4) technology use and mental health, and 5) predictors of technology use. These results offer insights into the mechanisms that influence health during the COVID-19 pandemic. Results have clinical, policy and public health implications because they can inform the development of interventions, programs and policies with potential to improve health and health care and advance health equity for older adults.