bluuebunny/crossref_metadata_2025 huggingface dataset:
HUSBAND’S EMOTIONAL SUPPORT PROVISION TO ADULT CHILDREN AND WIFE’S MARITAL SATISFACTION IN LATER LIFE
Authors: Choi Heejeong , Yoo Jaeeon
Published: November 2019

The current study examined the association between intergenerational support exchange and marital satisfaction among older Korean couples. Prior work has not paid due attention to the fact that older parents and adult children often exchange various types of support in the context of marital relationships, and that provision or receipt of support could influence their marital relationships (see Lee, Zarit, Rovine, Biritt, & Fingerman, 2010; Polenick, Birditt, & Zarit, 2018, for exceptions). Using the 2008 Actual Living Condition of the Elderly and Welfare Need Survey (ALCEWNS), a nationally representative survey of community-dwelling adults 60 years and older, we evaluated the links between marital satisfaction and each spouse’s reports of emotional and instrumental support provided to or received from adult children. For analyses, a series of actor-partner interdependence models were estimated. Findings revealed that wives’ marital satisfaction was associated with their husband’s exchange of emotional support with adult children. By contrast, husbands’ marital satisfaction was unaffected by their wife’s emotional support exchange with adult children. More specifically, wives were more satisfied with their marriage when their husband reported providing greater emotional support to adult children than receiving it from adult children. In addition, wives indicated higher marital satisfaction when the couple provided similar levels of emotional support to their children. Provision or receipt of instrumental support had no bearings on marital satisfaction of either spouse. Taken together, our findings highlight how older couples may evaluate their relationship quality in the Korean cultural context.
THE INTERSECTION OF RELIGION AND SES IN MANAGING CHRONIC CONDITIONS AMONG OLDER PERSONS IN NIGERIA
Authors: Mahmoud Kafayat O
Published: November 2019

Increased life expectancy in Nigeria has corresponded with higher rates of chronic diseases among older persons. Consequently, this is a new experience that older persons progressively have to deal with. In this study, I explored how religion and social support helped older persons cope with their chronic disease conditions, in light of the prevailing socio-cultural and economic circumstances in Nigeria. The research was conducted in two state-owned medical institutions, in a city in the North-Central part of Nigeria. In-depth, qualitative interviews were conducted among 19 purposively selected chronically ill persons aged between 50 years and over, during clinic days. The study revealed that religion is central to peoples’ management of feelings of despair, and acceptance of chronic disease conditions, as well as their adherence to prescriptions. This is explained by the theme “God as the Bestower and Reliever.” Also, some respondents perceived their coreligionists to be financially supportive. Although, some participants expressed that they depended on their families for their upkeep and emotional well-being, dire socio-economic conditions and lack of governmental support in chronic care meant that financial support was limited. This is explained by the theme “Times are Hard.” Subsequently, most respondents bore a dual burden of coping with chronic conditions even as they were financially responsible for themselves and their families. This was particularly stressful because it meant that most respondents were constantly worried about being able to meet basic daily needs, as well as manage the financial costs of their treatments, which proved expensive to manage.
PRESCRIPTION DRUG USE FOR PAIN AND FOR SLEEP AND INCIDENT FRAILTY IN OLDER ADULTS
Authors: Cil Gulcan , Park Juyoung , Bergen Andrew W
Published: November 2019

There is emerging evidence for association of polypharmacy with incident frailty. We performed a longitudinal study within the Health and Retirement Study (HRS) to address whether self-reported prescription drug use for pain and/or sleep (co-use or single use for pain or for sleep) influences incident frailty. We utilized data from the 2006–2014 waves of core and family member exit files in HRS to assign self-reported prescription drug use and sociodemographic and other drug use behavior variables as covariates and construct a Burden Model of frailty (≥ 0.2 ratio of positive/total indicators). We performed unadjusted and adjusted competing risk hazard model analysis with death as a competing risk. In a sample of 7,201 unique non-frail (at baseline) individuals (mean[SD] age 72[6.5] years, 54% female, 85% White, 12% African American, 7.3% Hispanic), prevalences of co-use and single-drug use for pain or for sleep were 2.2%, 14.9%, and 5.6%, respectively. Of 7,201 respondents, 2,723 (37.8%) became frail over the follow-up period and 713 (9.9%) died in non-frail state. The adjusted competing risk hazard model suggest that co-use and single use for pain or for sleep were associated with an increase in the risk of frailty by 92%, 58%, and 31%, respectively (p < .001), with statistically significant differences between all risk strata. Adjustment for baseline frailty score and selected chronic disease resulted in modest reductions in effect size with retention of significance. Validation of these initial findings should be undertaken with provider and pharmacy data to identify drug-, dosage-, and duration-specific risks.
HYPERGLYCEMIA AND INCIDENCE OF FRAILTY IN OLDER MEXICAN ADULTS LIVING IN RURAL AREAS
Authors: Espinoza Betty Manrique , Almaraz Ana Rivera , Rodriguez Aaron Salinas
Published: November 2019

Hyperglycemia is the main characteristic of diabetes and is the result of an absolute or partial deficit in the production or action of insulin. Recent evidence suggests that hyperglycemia increases the risk of frailty. This issue is of great importance for the Mexican population given the high prevalence of diabetes, particularly in older adults. Our objective was to analyze the association between hyperglycemia and the incidence of frailty in a cohort of rural older adults in Mexico. Prospective cohort study with 600 rural older adults, with measurements made in 2009, 2013 and 2018. Fragility was defined using the proposal of Fried and colleagues. The determination of glycosylated hemoglobin was performed through the A1CNow® device, with capillary blood; hyperglycemia was defined considering the recommendation of the American Diabetes Association; where values greater than 6.5% (140 mg / dL) of glycosylated hemoglobin were considered hyperglycemia. We used an ordinal logistic regression model to analyze the relationship between hyperglycemia and incidence of frailty. In the baseline measurement (2009), 8.6% of older adults presented frailty. The incidence of frailty was 6.9%. After adjusting for health and sociodemographic characteristics, hyperglycemia was significantly associated with the incidence of frailty (RR = 2.24 P = 0.018). These findings allow us to determine that hyperglycemia is a prognostic factor of the incidence of frailty. Because frailty is preventable, future interventions for the prevention of frailty should consider the presence of hyperglycemia.
EUROPEAN OLDER ADULTS FRAIL: FINDINGS FROM THE SURVEY OF HEALTH, AGEING AND RETIREMENT IN EUROPE (SHARE)
Authors: Manfredi Giulia , Midão Luís , Paúl Constança , Cena Clara , Duarte Mafalda , Costa Elísio
Published: November 2019

Frailty is a geriatric multidimensional syndrome whose signs and symptoms are predictors of increased vulnerability to minor stress events and risk of adverse outcomes such as falls, fractures, hospitalisation, disability and death. In this work, we aimed to update the data of frailty status in European community dwelling population, based on the latest data released (wave 6) of SHARE database, and to study the impact of each criterion on frailty assessment. Frailty status was assessed applying a version of the Fried Phenotype operationalised for SHARE. We included all participants who answered all the questions used in a frailty assessment and who disclosed their gender and, further, whose age was 50 or more. Our final sample was 60816 individuals. Of these, the mean age was 67.45 ± 9.71 years; 38497 (56.4%) were female. The overall prevalence of pre-frailty was 42.9% (ranging from 34.0% in Austria to 52.8% in Estonia) and frailty was 7.7% (ranging from 3.0% in Switzerland to 15.6% in Portugal). Pre-frailty and frailty prevalence increased along age and were more frequent among women. Regarding the five criteria considered on frailty assessment, exhaustion seems to be the criterion that contributes most to frailty status, followed by low activity, weakness, loss of appetite and slowness. With this work, we demonstrated that more than 50% of the 50+ European population are pre-frail/frail, which must be considered when designing interventions to reduce/postpone/mitigate the progression of this condition, reducing the burden associated with it.
ASSOCIATION BETWEEN FRAILTY AND DEVELOPMENT OF COGNITIVE IMPAIRMENT: EVIDENCE FROM THE HEALTH AND RETIREMENT STUDY
Authors: Resciniti Nicholas V , McNiel Jaleel , Lohman Matthew
Published: November 2019

Research has shown there is currently an increasing prevalence of cognitive impairment and dementia in older adults. To date, there remains a paucity of research to explain this increase and research on early markers and risk factors are warranted. This study aims to assess the association of cognitively normal older adults who are frail and the development of cognitive impairment four years later. Data from the Health and Retirement Study – a nationally representative sample of older US adults – was used from 2004-2008 for individuals 65 and older (n=8,377). Frailty was categorized by using Fried’s phenotype model: individuals were grouped into frail, pre-frail, and robust. Cognitive impairment – a composite score that assessed memory recall and global mental status – was classified as scoring eight or less on a 35-point scale. After restricting to cognitively healthy individuals, logistic regression with weights was used to assess the association between frailty status and the development of cognitive impairment four years later. The model was adjusted for baseline age, gender, race, education years, smoking status, and chronic health issues (high blood pressure, diabetes, cancer, lung disease, heart disease, stroke, psychiatric problems, and arthritis). Frail individuals, compared to those who were robust, had increased odds of cognitive impairment (OR=1.74; 95% CI: 1.48-2.16), after fully adjusting. Evidence from this study suggest that frail individuals are more likely to become cognitively impaired over time. This provides a potential pathway of intervention to help delay or prevent the development of cognitive impairment in older US adults.
AN INNOVATIVE PLATFORM BASED ON WEARABLE SENSOR TO QUANTIFY FRAILTY PHENOTYPES
Authors: Zhou He , Najafi Bijan
Published: November 2019

This study evaluated an innovative wearable sensor based platform (instrumented trail-making task, iTMT) to quickly quantify frailty phenotypes, without the need of walking test. 61 older adults (age=72.8 ± 9.9years, BMI=27.4±4.9kg/m2) were recruited and assessed by Fried Frailty Criteria to determine frailty phenotypes. All subjects participated the iTMT test by standing in front of a computer, wearing a wearable sensor on the front lower shin. The sensor tracked the subject’s ankle movement and projected it on a computer-screen as a moving cursor at real-time. The subject rotated the ankle joint to navigate the cursor to reach 5 indexed circles (including numbers 1-to-3 and letters A&B placed in random orders) in the alternative order of numbers and letters. The iTMT required coordination of brain and body movement, testing subject’s cognitive-motor function. The sensor quantified ankle-rotation biomechanics during the test. All subjects completed the iTMT with average time less than 3 minutes. The ankle-rotation velocity generated during the test distinguished between the presence and absence of Slowness phenotype (Cohen’s effect size d=1.40, p<0.001). The decline of ankle-rotation velocity determined the presence of Exhaustion phenotype (d=0.98, p=0.003). The ankle-rotation power generated during the test determined the presence of Weakness phenotype (d=1.38, p<0.001). The ankle-velocity variability determined the presence of Inactivity phenotype (d=0.90, p<0.001). This study demonstrated the feasibility and validity of the iTMT to quantify frailty phenotypes. This new platform is time-efficient and doesn’t require walking test. It’s more practical for routine assessment in small and busy clinics among patients with mobility limitation.
MULTIDIMENSIONAL FRAILTY SCORE IS SUPERIOR TO PREDICT COMPLICATIONS AFTER SURGERY THAN CONVENTIONAL RISK FACTORS
Authors: Choi Jung-Yeon , Kim Kwang-il , Jung Hee-won , Kim Cheol-Ho , Kang Sung-Bum , Han Ho-Seong , Kim HyungHo
Published: November 2019

Frail older adults are at increased risk for postoperative morbidity compared with their robust counterparts. We compared predictive utility of multidimensional frailty score (MFS) with physical performance parameters or conventional risk stratification indicators to identify postoperative complication in older surgical patients. From January 2016 to June 2017, 648 older surgical patients (age≥ 65) were included for analysis. The MFS was calculated through comprehensive geriatric assessment (CGA). Grip strength and gait speed were measured preoperatively. The primary outcome was postoperative complication (eg, pneumonia, urinary tract infection, delirium, acute pulmonary thromboembolism, and unplanned ICU admission). Secondary outcome was 6-months all-cause mortality. Sixty-six (10.2%) patients experienced postoperative complications and 6-months mortality was 3.9% (n=25). Grip strength, gait speed, MFS and ASA classification could predict postoperative complication but only MFS (Hazard Ratio = 1.564, 95% CI, 1.283-1.905, p < 0.001) could predict 6-months mortality after full adjustment. MFS (C index = 0.747) had superior prognostic utility than age (0.638, p value = 0.008), grip strength (0.566, p value < 0.001) and ASA classification (0.649, p value = 0.004). MFS only had additive predictive value on both age (C-index of 0.638 (age) vs 0.754 (age +MFS), p = 0.001) and ASA classification (C index of 0.649 (ASA) to 0.762 (ASA + MFS), p < 0.001) for postoperative complication, but gait speed or grip strength had no statistical additive prognostic value on both age and ASA classification.
PATTERNS AND DETERMINANTS OF POLYSUBSTANCE USE AMONG RETIRED POPULATION IN A U.S. NATIONALLY REPRESENTATIVE SAMPLE
Authors: Ou Tzung-Shiang , Hu Yi-Han , Lin Hsien-Chang , Wong Su-Wei
Published: November 2019

Polysubstance use in the U.S. has been a public health concern. The prevalence of substance use among middle-aged and older adults is predicted to increase by 50% by 2020. Previous studies revealed retirement could serve as a risk factor for substance use as this population was known to be more susceptible to mental health issues. However, patterns and determinants of polysubstance use among retired population remained understudied. The purpose of this study was to investigate the patterns and determinants of polysubstance use among retired adults aged 50 and older. This study extracted 3,019 retired participants from the 2017 National Survey on Drug Use and Health study. Polysubstance use was defined as the use of two or more substances, including alcohol, tobacco, marijuana, and painkiller misuse, in the past month. Weighted multinomial logistic regression model was conducted to examine the associations between utilization of mental health treatment and poly-use of substances. The findings suggested 52.0% of retired adults used at least one substance in the past month, where 17.0% used substances concurrently; 15% co-used alcohol, tobacco, and marijuana; 8.6% co-used tobacco and marijuana. Females were less likely to poly-use substances (RRR=0.37, p<.001) than males. Those who had received mental health treatment in the past year were more likely to co-use more than two substances in relative to substance non-users in the past month (RRR=1.71, p<.05). Retirement plan incorporating behavioral intervention and early detection of mental health issues are warranted to reduce polysubstance use among the retired population in the U.S.
AGING ACROSS THE LIFE COURSE: RESEARCH COLLECTIONS AVAILABLE FROM THE NATIONAL ARCHIVE OF COMPUTERIZED DATA ON AGING
Authors: McNally James , Lavender Kathryn
Published: November 2019

The creation and maintenance of sustainable data archives can be challenging but it offers clear advantage. Properly curated data can be used by multiple researchers, testing a variety of hypotheses and increasing the return on investment to the expensive process of data collection. Having an internally managed archival system also provides greater control and autonomy in the equitable distribution of data resources, insuring all researchers have full use of the data for original research, teaching and new directions once the data leaves the control of the local investigator’s control. This poster reviews the advantages of having a local strategy geared toward the preservation and sharing of gerontological research data. Using the National Archive of Computerized Data on Aging (NACDA) as a working example, the poster offers an overview of collections at NACDA. Using our metadata tools and variable search database, NACDA can identify studies in its collections that examine aspects of aging and health among adults during their lifecourse. Many of the studies are longitudinal or repeat measure cross-sectional studies. We are also able to identify studies which focus on aging that are not maintained by NACDA but which are available to interested researchers. Using a strategy of archival preservation combined with a strong focus on productive research and outreach, NACDA has amassed data and metadata covering a wide array of studies worldwide that address the aging lifecourse. Because our collections are multinational, we share these data at no cost to interested users worldwide
PHYSICAL AND SOCIAL ACTIVITIES AND COGNITIVE CHANGES AMONG OLD-OLD ADULTS: RESULTS FROM 3-YEAR FOLLOW-UP PERIOD
Authors: Ishioka Yoshiko L , Takayama Midori , Sugawara Ikuko
Published: November 2019

The association between activity engagement and late-life cognitive function is considered to depend on the characteristics of the activity, the cognitive processes it involves, and the life stage of participants. A better understanding of this association is required to comprehend cognitive function in old age. The present study examined the association between baseline activity engagement and cognitive changes across a 3-year period among old-old adults. We extracted data for 873 Japanese community-dwelling participants from data of the Keio-Kawasaki Aging Study. We assessed cognitive performance thrice (at baseline, 1.5-year follow-up, and 3-year follow-up) using a short version of the Mini-Mental Status Examination. For the subsequent analyses, we used three measures of cognitive function: total score, orientation, and concentration, which showed diverse individual differences. We measured the frequency of physical activity and social group participation at baseline. Using conditional latent growth curve models, we examined which baseline activity was associated with the three measures of cognitive function over 3 years. Greater physical activity was significantly related to higher rate of orientation, after adjusting for age and education (β = −.261, p < .001). Social activity was significantly related to rates of higher total cognitive score (β = −.276, p < .001) and higher orientation (β = −.207, p < .001). These findings suggest that the association between activity engagement and late-life cognitive function among old-old adults varies by activity type and cognitive domain.
LEISURE, LONGITUDINALLY: PARTNER DISAGREEMENTS ABOUT LEISURE DECREASE OVER THE LIFE COURSE
Authors: Naar Jill Juris , Turner Shelbie
Published: November 2019

Leisure is a major context within which older couples interact, and researchers have recently called for more longitudinal data analysis exploring how leisure-related couple interactions change over the life course. Several waves of the Midlife in the United States (MIDUS) study include a single-item question asking respondents how much they disagree with their spouse or partner about leisure activities. Given the longitudinal nature of MIDUS, the variable offers great utility to explore shifts in leisure-related couple interactions over the life course. Utilizing longitudinal data from Wave 1 (1995-1997), 2 (2004-2006), and 3 (2013-2015) of the MIDUS study, we explored how leisure-related partner disagreement changed with increased age (age range = 20-93). We first ran an unconditional multilevel model, which revealed that 68% of the variation in leisure-related spousal disagreement was attributed to within-person differences over time, justifying our analysis of longitudinal within-person change. An age-based growth curve model then revealed that leisure-related partner disagreements decreased linearly over the life course (Estimate = -0.01, SE = 0.001, p<.0001). Men reported more leisure-related partner disagreements than women at age 20 (p = 0.002). But men’s reported disagreements decreased over the life course at a faster rate than did women’s reported disagreements (p = 0.03), so that from ages 70-93, men reported less disagreements than women. To our knowledge, this is the first longitudinal study to explore leisure-related couple disagreements over an extended period of time (20 years). The significance of our results sheds light on the value of longitudinal research on leisure.
RETROSPECTIVE LIFE HISTORY SURVEY REVEALED AUTOBIOGRAPHICAL MEMORY BUMP
Authors: Larkina Marina , Meister Lindsey , Smith Jacqui
Published: November 2019

The reminiscence bump is a well-documented autobiographical memory phenomenon characterized by middle-aged and older adults reporting a disproportionate number of memories from adolescence and early adulthood (Rubin, Wetzler, & Nebes, 1986). It is typically assessed through either cue word or important memory techniques. The Life History Mail Survey (LHMS) in the Health and Retirement Study affords unique data to investigate this phenomenon among a representative US sample of older adults. At the beginning of the LHMS, participants (N=3088, M age=70, range 50-107) completed a calendar noting the important things that happened to them in seven life decades, starting with ages 0-9 and ending by ages 70-79 (or their actual age). For each life period, we coded the number of events respondents reported. We observed significantly more memories reported for the age decade 20-29, compared with other life periods (80% vs 47-66%). Our results are consistent with previous findings in the autobiographical memory literature. Follow-up analyses evaluated existing theoretical accounts of the bump, such as cultural life script theory which suggests that life events occur in a specific order and are characterized by a prototypical life course. For example, we determined whether respondents’ sociodemographic characteristics, such as age cohort, gender, marital and educational histories (information available in LHMS) influenced the size and temporal location of the reminiscence bump. We also analyzed the content of reported important life events to investigate whether types of events included in each decade of life are consistent with the cultural life script account of the phenomenon.
CLINICIAN PERCEPTIONS OF SOCIAL WORKERS AND COMMUNITY HEALTH WORKERS IN PRACTICES CARING FOR FRAIL ELDERS
Authors: Berrett-Abebe Julie , Donelan Karen , Auerbach David I , Maramaldi Peter , Berkman Barbara
Published: November 2019

Social workers (SW) and community health workers (CHW) have emerged as key workforce personnel in efforts to care for elders in the U.S. However, little is known about the presence and roles of these professionals in outpatient practices. This paper presents findings from a nationally representative survey of geriatrics and primary care practices. Key findings include: reported challenges in meeting the social service needs of elders, underutilization of SW, and fuller utilization of social work competencies in practices in which both SW and CHW were present. These findings offer a unique perspective of SW on interprofessional teams and have implications for the future of the profession.
EARLY-LIFE ADVERSITY AND ADULT MENTAL AND BEHAVIORAL HEALTH OUTCOMES: AN INTERSECTIONAL APPROACH
Authors: Lee Chioun , Harari Lexi , Coons Jennifer
Published: November 2019

There is much research confirming the link between experiencing early life adversities (ELAs) and adverse health outcomes in adulthood. Further, experiencing co-occurring ELAs rather than one ELA appears to be the rule rather than the exception, and leads to poorer health outcomes. However, information on how ELAs cluster and differentially harm the health of different intersectional groups is lacking. The stress process model suggests that intersectional configurations of race and gender are differentially exposed to ELAs and as a result, some groups suffer worse outcomes than others. We examine the risks of experiencing different clusters of ELAs—low childhood socioeconomic status (SES), family instability, and child abuse—among four intersectional groups (white men, white women, Black men, Black women). We also investigate whether experiencing these ELAs is responsible for the association between having a particular racial and gender configuration and adverse mental and behavioral health outcomes. Data come from a subsample of the Midlife in the U.S. Study (n = 2,076). Black men and women have the highest risk of experiencing all three ELA configurations. Men, regardless of race, have a higher risk of experiencing low SES while women are more vulnerable to low SES/family instability and all three ELAs. Black men and women appear to suffer the worst mental health outcomes, while Black and white men experience more drug/alcohol abuse than their female counterparts. ELAs, especially the co-occurrence of all three ELAs, partially mediate most of these associations, but more so for women than men.
WAR COHORT DIFFERENCES IN MILITARY SERVICE APPRAISALS AND HOMECOMING EXPERIENCES
Authors: Lee Dylan , Choun Soyoung , Kurth Maria , Lee Hyunyup , Aldwin Carolyn M
Published: November 2019

Nearly all the research on appraisals of military service and homecoming experiences have been done on World War II veterans. However, Spiro et al. (2016) hypothesized that there were war cohort differences in military experiences that could affect life-long adaptation. For example, Boscarino et al. (2018) found that Vietnam veterans reported less welcoming homecoming experiences than OEF/OIF/OND veterans. We examined war cohort differences among OEF/OIF/OND, Persian Gulf, and Vietnam combat veterans in military service appraisals and homecoming experiences. We used pilot data from Veterans Aging: Longitudinal studies in Oregon (VALOR) from an online survey. The sample included male and female combat veterans (Mage = 58.1, SD = 12.0, range = 35-83, 30.5% female): 39 from the OEF/OIF/OND, 68 from the Persian Gulf War, and 60 from the Vietnam War cohorts. Comparable to earlier studies (e.g., Aldwin et al., 1994), combat veterans were surprisingly much more likely to endorse desirable appraisals than the undesirable ones, with each of the 14 desirable appraisals endorsed by over 90% of the veterans. Fewer endorsed the undesirable experience items; the most common was separation from loved ones and loss of friends. Most also reported positive homecoming experiences. Contrary to expectations, ANOVAs revealed that there were no significant differences in appraisals of desirable and undesirable military service experiences, nor in homecoming experiences among the war cohorts. In this small sample, military experiences were perceived similarly among combat veterans despite differences in wartime experiences. Most felt that positive experiences resulted from their desirable military service.
COHORT DIFFERENCES IN CHANGES IN LIFE SATISFACTION AMONG OLDER JAPANESE
Authors: Nakagawa Takeshi , Kobayashi Erika
Published: November 2019

Life span research has been interested in how sociocultural contexts shape individual development and aging processes. Empirical studies have reported that later cohorts show higher levels of well-being. However, more recent studies indicate that cohort differences are not sustained in very late life. The present study examined whether cohort differences in well-being, as measured by life satisfaction, are observed in the young-old and old-old, and further explored potential determinants of cohort differences. Using longitudinal data from a nationally representative study of older Japanese, conducted from 1987—2002, we compared earlier- and later-born cohorts in the young-old (N = 874; age 60—65; year of birth: 1922—1927 and 1931—1936) and old-old (N = 1,022; age 70—80; year of birth: 1907—1917 and 1919—1929), respectively. To control for covariates, we used case-matched groups based on age and gender. Results revealed that later cohorts exhibited higher levels of life satisfaction in both age groups. In the young-old, life satisfaction declined across cohorts. In the old-old, life satisfaction remained stable among earlier cohorts but declined among later cohorts. Socioeconomic, social, and health factors at the individual level and methodological factors (i.e., number of observations) did not fully explain the cohort differences in both age groups. Our results suggest that historical increases in levels of well-being are observed in late life, but that these improvements do not hold in very late life. Future studies should consider potential societal factors behind observed cohort differences in well-being.
THE NATURE OF PEER WORKPLACE INCIVILITY AND BULLYING AMONG RESIDENTIAL CARE AIDES IN LONG-TERM CARE
Authors: Cooke Heather A , Murray Kaitlin , Baumbusch Jennifer , Kelly Lisa
Published: November 2019

Residential care aides (RCAs; unregulated workers also known as certified nursing assistants or personal care assistants) provide much of the hands-on care in long-term residential care (LTRC). While many RCAs report being exposed to violent or aggressive acts from residents, we know little about their exposure to incivility and bullying from their colleagues. This is a significant knowledge gap as increased workplace incivility and bullying is associated with specific gender-dominated fields, hierarchical and stressful work environments, and low job autonomy, all of which characterize LTRC. Drawing on data from a critical ethnography examining workplace incivility and bullying among RCAs in a rural, not-for-profit care home, this presentation explores the types of incivility and bullying encountered by RCAs, and the contextual factors impacting their experiences with such behaviors. To date, more than 50 hours of participant observation, and 20 in-depth interviews with RCAs, licensed practical nurses, support staff, and management have been conducted. Findings illustrate the pervasiveness of incivility; while bullying acts (repeated, hostile behaviors intended to undermine, humiliate or injure) were rare, incivility (low-intensity acts with an ambiguous intent to harm) was an almost daily occurrence. Commonly-occurring behaviors included ignoring and refusing co-worker’s requests for help, social exclusion, acting impatient with, blaming and criticizing co-workers, and insisting on getting one’s own way. Chronic staffing shortages, staffing arrangements, and workload issues exacerbated RCAs’ experiences. Findings provide an important first step in understanding the nature of workplace incivility and bullying in LTRC.
PROFESSIONAL STAFFING AND ROLES IN CARE TEAMS SERVING FRAIL ELDERS LIVING IN THE COMMUNITY: 22 SITE VISITS
Authors: Roberge Barbara , Michael Carie , Auerbach David I , Maramaldi Peter , Donelan Karen
Published: November 2019

In 2017, as part of a study to understand the evolving roles of nurses, physicians and social workers in leading and working in teams, our interprofessional team explored 22 sites of care for frail elderly adults in five US regions (Chicago IL, Denver CO, Tampa/Orlando FL, San Diego CA, New England).. The purpose of these site visits was to understand the current range of models of care for frail elders living in community, the roles of health professionals within those care models, and to inform national measure development. We selected regions based on elder population density, scope of NP practice, and screened over 100 sites to identify physician, nurse and social work led teams. We included general primary care, PACE, academic geriatrics, home based primary care, assisted living, FQCHC, palliative care, mobile health. We interviewed 108 key informants. We found considerable variation in staffing/elders within each site type.
THE RELATIONSHIP BETWEEN ORGANIZATIONAL CULTURE AND FINANCIAL PERFORMANCE AMONG HIGH-MEDICAID NURSING HOMES
Authors: Weech-Maldonado Robert , Ghiasi Akbar , Davlyatov Ganisher K , Lord Justin C , Banaszak-Holl Jane
Published: November 2019

This study examines the relationship between organizational culture and financial performance of high Medicaid census (70% or higher) nursing homes (NHs). Based on the Competing Values Framework, there are four types of organizational culture: clan culture (friendly working environment); adhocracy culture (dynamic/creative working environment); market culture (results-based organization); and hierarchy culture (formalized/structured work environment). This study used facility survey data from approximately 324 nursing home administrators (30% response rate) from 2017- 2018, merged with secondary data from LTCFocus, Area Health Resource File, and Medicare Cost Reports. The dependent variable consisted of the operating margin, while the independent variable comprised type of organizational culture. Control variables were organizational (ownership, chain affiliation, size, occupancy rate, and payer mix), and county-level factors (Medicare Advantage penetration, income, education, unemployment rate, poverty, and competition). Multivariable regression was used to model the relationship between organizational culture type and financial performance. Regression results show that compared to a market culture, a hierarchy culture was associated with an 11.8 % lower operating margin, a clan culture with a 10.6% lower operating margin, and a non-dominant culture with 11.4% lower operating margin. Organizational culture is associated with financial performance among high Medicaid facilities, with market cultures outperforming other organizational cultures. Given increasing competition in the nursing home market and declining resources for high Medicaid nursing homes, facilities with a more external orientation and focus on results may be able to perform better financially. Future research should examine the effect of organizational culture on quality of care.
SUPPORTING NURSING HOME STAFF THROUGH PERSON-CENTERED CARE PRACTICES
Authors: White Diana , Dys Sarah , Winfree Jaclyn , Hasworth Serena , Tunalilar Ozcan
Published: November 2019

Policies and practices have increasingly focused on person-centered care (PCC) to improve quality of life for long-term care residents and staff. Adequate staffing has been a consistent barrier to implementing and sustaining PCC practices. The purpose of this paper is to explore the association between job satisfaction and PCC practices. This research was conducted in a stratified random sample of 33 Oregon nursing homes which were representative in terms of quality, profit/nonprofit ownership, and urban/rural location. Data were collected from 415 staff who completed the staff assessment of person-directed care, direct care worker job satisfaction scale, turnover intention, and organizational belongingness. Consistent with other research, job satisfaction is significantly and negatively correlated with turnover intention (r=-.66) and positively associated with belongingness (r=.66). It is also significantly correlated with scales related to five PCC practices: personhood, autonomy, knowing the person, individualized care, and relationships. Regression analyses examined how these five aspects of PCC practices were associated with 1) job satisfaction and 2) number of deficiencies. Perceptions of practices to support autonomy, personhood, and relationships were associated with higher ratings of job satisfaction among staff. In general, those reporting these practices were in place at least half of the time or with at least half of the residents, showed significantly greater positive associations with job satisfaction (p<.05). Only lower staff reports of autonomy practices were associated with higher deficiencies (p<.05). Findings from this research suggest that supporting PCC practices benefit staff through increased job satisfaction and potentially reduced turnover.
THE IMPORTANCE OF CREATING SHARED EXPECTATIONS FOLLOWING NURSING HOME DISCHARGE
Authors: Mills Whitney L , Kerr Nathan , Simons Kelsey
Published: November 2019

Nursing home stays often represent a time of change for residents and their social networks (e.g., family, friends, and other social supports). Nursing home residents may be experiencing exacerbations of medical conditions, changes in physical functioning, and/or cognitive impairment. These changes often preclude the resident from returning to their pre-admission level of functioning, resulting in the need for adjustments for both residents and their social network. However, nursing home staff and residents/caregivers frequently have different expectations for post-discharge functioning. This may be the result of inadequate or unclear communication on the part of nursing home staff and/or residents and caregivers being unable or unwilling to internalize the information. The lack of shared expectations can leave residents and caregivers unprepared, creating unanticipated caregiving burdens for the social network and unwanted outcomes for the resident. We conducted interviews with 14 resident/caregiver dyads who experienced care transitions from VA nursing homes to examine expected and actual functioning and activities post-discharge. Using a qualitative content analysis approach, we identified several themes including marital strain related to mismatched expectations, impact of physical changes on Veterans’ social functioning, and differences between planned and actual post-discharge activities. We will discuss the importance of clear communication about expectations throughout the nursing home stay. We will also provide suggestions for improving discharge care planning to ensure creation of shared expectations and timely communication to allow residents and their social networks to adequately prepare for nursing home discharge.
THE INFLUENCE OF STAFF RETENTION ON NURSING HOME QUALITY
Authors: Castle Nicholas , Hyer Kathryn , Harris John A
Published: November 2019

The association of retention of Nurse Aides (NAs) with nursing home quality of care is examined. Retention is defined as staff continuously employed in the same facility for a defined period of time. Deficiency citations were used as quality indicators. Data used came from a survey of nursing home administrators, the Certification and Survey Provider Enhanced Reporting (CASPER) data, and the Area Resource File. All of the data was from 2015, and included 3,550 facilities. Analyses included negative binomial regression and multivariate logistic regression models (using GEE). The analytic modeling included staffing variables (turnover, agency use, staffing levels), facility factors (size, ownership, occupancy rate), and market characteristics (competition, Medicaid rates). The average number of deficiency citations was significantly lower (p<.01) in facilities with the higher levels of NAs consistently employed for one year or more. The same was found for facilities with the higher levels of NAs consistently employed for two years or more. While the average number of deficiency citations, the quality of care grouping of deficiency citations, and J, K, L deficiency citations were all significantly lower (p<.01) in facilities with the higher levels of NAs consistently employed for three years or more. Staff retention has been promoted as potentially influential based on little empirical evidence. The findings provide some justification for the importance of NA retention.
STAFF PERCEPTIONS OF INVOLUNTARY NURSING HOME CLOSURE AND RELOCATION PROCESSES
Authors: Weaver Raven H , Roberto Karen A , Brossoie Nancy , Teaster Pamela B
Published: November 2019

Involuntary nursing home closures happens infrequently, but when they do occur, they impact residents, their family, and facility staff. During the transition, residents’ care needs are of primary concern, yet few studies have examined the centrality of the actions of staff to residents’ relocation adjustment. This paper examined staff perceptions of the involuntary relocation process for 132 residents after a facility lost its Medicaid certification because of low quality performance. Interviews were conducted with 34 staff (e.g., administrators, nurses, social workers) from 21 receiving facilities. Using content analysis, we identified challenges that hindered relocation and affected resident/family experiences. Receiving facility staff perceived undue distress and hardship on residents and family members because of inadequate notification about the situation. Limited, untimely, and poor communication led to residents being uninformed or unprepared for moving. The efficiency and effectiveness of the resident discharge process was also viewed as unacceptable. Minimal documentation in residents’ charts hampered the coordination of resident moves. Receiving facility staff offered recommendations for decertified facilities and receiving facilities to improve the relocation experience including the need for open communication, thoughtful and early engagement in the process, and transparent and timely interactions. Findings suggest that staff are well-positioned for active involvement in the relocation process and should facilitate deliberate and strategic planning, decision-making, and communication with residents and their relatives. Resident-centered policies are needed to improve the involuntary relocation process and give voice to remaining/receiving staff, both of whom are integral to residents’ support system.
DIRECT CARE WORKERS EMPLOYED BY PRIVATE HOUSEHOLDS: A DISTINCT LABOR FORCE
Authors: Kelly Christopher M , Deichert Jerome , Holley Lyn
Published: November 2019

Purpose: This study tracks the growing number of direct care workers (DCWs) employed by private households and describes the differences between this often ignored labor force and DCWs employed by agencies. Design and Methods: Data were from the 1% Public Use Microdata Sample (PUMS) of the 2000 and 2017 American Community Survey (ACS). Logistic regression was used to compare demographic and employment characteristics of DCWs employed by private households and DCWs employed by agencies, which include outpatient care centers, home health care services, and individual and family services. Results: Between 2000 and 2017, the number of DCWs employed by private households in the U.S. increased 32% and the majority of this growth was since 2007. Compared to DCWs employed by agencies, DCWs employed by private households were more likely to be over age 65, white, unmarried, have higher educational attainment, be more likely to be in poverty, receive health insurance from Medicare or direct-pay. DCWs employed by private households were less likely to be under age 25, nonwhite, Hispanic, speak a language other than English, work year-round and full-time, receive health insurance from an employer or through Medicaid, and have a disability. Implications: DCWs employed by private households represent a small, but growing proportion of the long-term care (LTC) workforce in the U.S. Further, these workers are distinct within the LTC workforce. This has important implications both for DCWs and for families, particularly those with limited LTC options due to location, financial resources, family support, or other factors.
STAFFING AND CARE QUALITY OF NURSING HOMES IN KOREA
Authors: Lee Hee Seung
Published: November 2019

Staffing has been regarded as the most important factor for the quality of care service in nursing homes. Korea introduced Long-Term Care Insurance (LTCI) in 2008. The payment system of LTCI has incentivized LTC facilities based on the staffing level of LTC facilities. This study aims to investigate whether staffing is associated with quality of care. The effect of staffing on care quality was assessed using ordered logit analysis. Staffing data in 2015 were retrieved from claim data in the National Health Insurance Service. The publicly reported care service quality grade in 2015 was used as a proxy for care quality. Staffing of registered nurses (RN) and social workers were strongly associated with the care quality. As the number of RNs per residents additionally increased, the LTC facilities were more likely to receive better grades (OR=16851.54, p<0.000). The effect of social workers’ staffing was significant for the care service quality, even though the effect size of smaller than that of RNs (OR=345.87, p<0.000). However, staffing in other professions such as nurse assistants (NA) and personal care workers (PCW) was insignificantly associated with care quality. The effect of staffing on service quality might not be profession-neutral. RN staffing affects most in care quality in Korea. Still, the possibility remains that PCWs or NAs could serve for indirect care services such as cooking or cleaning because of short staffing in indirect care services. This finding could be considered when designing financial incentives for nursing homes in Korea as well as other countries.
ORGANIZATIONAL AND POLICY FACTORS INFLUENCING FEEDING IN RESIDENTS WITH DEMENTIA: NURSING ASSISTANTS’ EXPERIENCES
Authors: Douglas Joy W , Jung Seung Eun , Noh Hyunjin , Ellis Amy , Ferguson Christine
Published: November 2019

In the United States, Certified Nursing Assistants (CNAs) are critical in providing direct care to nursing home residents with dementia, which includes the challenging task of feeding residents. Guided by the Social Ecological Model (SEM), this qualitative study aimed to gain an in-depth understanding of organizational and policy constructs that CNAs encounter when feeding residents with dementia. Using purposive sampling, nine semi-structured focus groups were conducted with 53 CNAs. Each participant had at least one year of experience working as a CNA with older adults. Focus groups were audio recorded and transcribed verbatim. Data were analyzed using the directed content analysis. Factors that emerged were organized into organizational and policy categories within the SEM levels. CNAs identified organizational barriers such as exclusion from the interdisciplinary team, inability to meet resident needs and wants due to budgetary constraints, and inadequate staffing to function efficiently. Organizational facilitators included teamwork, interdisciplinary assistance, and varying dining styles and meal times to accommodate resident needs. Policy-related barriers included funding concerns, staffing ratios, and frustration with unrealistic regulations and state inspections. These results suggest that organizational and policy factors have a large influence on the ease of feeding nursing home residents with dementia. Involving CNAs in interdisciplinary collaboration, resident-centered accommodations, and subtler state inspection behaviors could improve the mealtime experience for both residents and CNAs. Careful attention to these factors may enhance facilitators and minimize barriers to improve the feeding experience of CNAs and residents with dementia.