bluuebunny/crossref_metadata_2025 huggingface dataset:
LATENT VARIABLE MODELING FOR BIOLOGICALLY INFORMED PROGNOSIS IN STUDIES OF PHYSICAL RESILIENCE
Authors: Bandeen-Roche Karen , Xue Qianli , Varadhan Ravi
Published: December 2023

Physical resilience – rebound in relevant functioning and biomarkers following a health stressor – is hypothesized to be rooted in the level of fitness of stress-response physiology defining one’s “physiological resilience capacity” (PRC). This physiology forms a dynamical system comprising specific modules (the individual stress response systems and their underlying components) and their dynamic interactions with each other via feedback and other protocols. Such a system can be modeled using differential equations whose parameters may then define the PRC. We do not yet know how to measure these parameters directly, however. Rather, they are conceptually defined “constructs” which must be inferred using indirect measures—ideally, stimulus response data probing multiple aspects of the relevant physiology. Latent variable models are ideally suited to this setting. Two challenges for their application in studies of resilience are presented: (1) Integrating specific scientific knowledge on the dynamical systems in modeling the co-distribution of the indirect measures. (2) Synergizing such models’ advantages for construct measurement with advantages of machine learning approaches to optimize accuracy for predicting resilient outcomes by inferred PRC. Challenges and their proposed solutions are illustrated using multifaceted stimulus response data being collected in an ongoing investigation on the physiological basis of resilience to clinical stressors in older adults, the Study of Physical Resilience in agING. The work aims to produce physiologically rooted measures providing effective risk predictors for older adults facing impending stressors as well as intervention candidates by which to promote PRC in the longer term.
INTERACTIVE ROLE OF SLEEP AND AROUSAL ON COGNITION AND BRAIN STRUCTURE IN CHRONIC PAIN PATIENTS
Authors: Curtis Ashley , Nair Neetu , Craggs Jason , McGovney Kevin , McCrae Christina
Published: December 2023

Chronic widespread pain (CWP) patients experience heightened arousal, insomnia complaints, poor cognition, and diffuse brain structure alterations, but interactive relationships among symptoms remain unexplored. We assessed whether physiological arousal [assessed via heart rate variability (HRV)] moderated associations between sleep and cognition/brain structure. Adults (N=42, Mage=46.2±13.7) with CWP and insomnia (difficulty falling/staying asleep) completed 14 daily sleep diaries, 5-minute Holter monitoring [HRV root mean square of successive normal heartbeats (RMSSD), low frequency/high frequency (lf/hf) computed], cognitive tasks [Stroop (processing speed/attention/inhibition), Sternberg (working memory)], and magnetic resonance imaging. Moderation analyses examined interactive associations between sleep [total sleep time (TST), wake after sleep onset, sleep onset latency (SOL)] and HRV with cognition/gray matter volume of frontal/temporal regions. SOL and lf/hf interacted in associations with working memory and attention/processing speed. Longer SOL was associated with worse Sternberg/Stroop at lowest sympathetic predominance levels. Conversely, longer SOL was associated with better Stroop at highest lf/hf. SOL and RMSSD interacted in associations with anterior cingulate, showing longer SOL associated with lower volumes at lowest arousal levels. TST and RMSSD interacted in associations with right hippocampus, with shorter TST associated with lower volume at highest/average arousal levels. Shared dynamic physiological arousal and sleep onset hyperarousal mechanisms impact cognition and neural structure in CWP. Longer SOL may only negatively impact cognition/anterior cingulate structure up to a certain arousal threshold, with shared mechanisms potentially benefitting cognition at highest arousal levels. At higher arousal, longer TST may protect against hippocampal volume reduction. Future prospective studies are needed to inform temporal characteristics.
REMOTE ASSESSMENTS OF EMOTIONAL FUNCTIONING FOR INDIVIDUALS WITH DEMENTIA AND THEIR CAREGIVERS
Authors: Brown Casey , Chen Kuan-Hua , Scheffer Julian , Paul Deepak , Levenson Robert
Published: December 2023

Emotional impairments are a common symptom of neurodegenerative disorders that can be devastating for persons with the dementia (PWDs) and family members who provide care (i.e., caregivers). Emotional functioning can be well characterized and quantified using laboratory assessments of behavioral, physiological, and self-reported responses to emotional stimuli. However, continuous declines in functioning make it especially difficult for PWDs and caregivers to visit a research laboratory repeatedly over time. In order to understand changes in emotional functioning across time and their impact on PWDs and caregivers longitudinally, there is a need for technology to support remote assessments of emotional functioning. We developed a portable version of laboratory assessments—Laboratory in a Suitcase Assessment (LISA)—to collect data from PWDs and their caregivers remotely in their homes. In a shippable suitcase, LISA provides the necessary equipment for: (a) presenting emotional stimuli via laptop screen and headphones; (b) obtaining audio and video recordings of participants’ behavior; (c) obtaining continuous ratings of emotional experience via a rating dial; (d) measuring cardiovascular, electrodermal, and somatic responses from PWDs and caregivers via wearable devices; (e) synchronizing behavior and physiology; and (f) maintaining two-way communication with participants via Zoom. We present high quality physiological, behavioral, and self-report data collected using LISA with 17 PWD-caregiver dyads. Data collected with LISA are comparable to data collected in the laboratory, indicating that LISA could enable researchers to continue data collection further into the course of disease when travel to in-person laboratory sessions would no longer be feasible.
ASSESSMENT OF OLDER ADULTS’ BEHAVIORAL SYMPTOMS AND THEIR SOCIAL BEHAVIORS USING SURVEYS AND A TECHNOLOGY PLATFORM
Authors: Au-Yeung Wan-Tai , Miller Lyndsey , Lindauer Allison , Rodrigues Nathaniel , Guerrero Cierra Leon , Gothard Sarah , Beattie Zach , Kaye Jeffrey
Published: December 2023

Behavioral symptoms are highly prevalent during the course of cognitive decline associated with dementia. Studies have shown that the social environment may affect these symptoms. Data sources examining the effect of environment come from two ongoing studies: 1) MOnitoring DEmentia-Related Agitation Using Technology Evaluations (MODERATE), focusing on agitation in individuals with later-stage dementia, and 2) Monitoring Apathy, Depression and Anxiety Using Technology Evaluations (ADA), focusing on apathy, depression and anxiety in older adults with or without cognitive decline. To date, a total of 9 dyads have enrolled in MODERATE while a total of 9 participants have enrolled in ADA. Caregivers (MODERATE) and participants with cognitive impairment (ADA) report symptoms via weekly online surveys. MODERATE integrates a modified Cohen-Mansfield Agitation Inventory-Short Form series of questions regarding weekly agitation-related levels/events. The ADA weekly online survey consists of Withdrawal-Apathy-Vigor, a subscale from Geriatric Depression Scale-30, a 4-item depression subscale from Patient-Reported Outcomes Measurement Information System-29 (PROMIS-29), and a 4-item anxiety subscale from PROMIS-29. A multi-sensor array (bed pressure mats, motion sensors, and wearables) is deployed in homes to objectively measure participants’ behaviors. With this array, duration of time-out of home, duration of simultaneous activities detected in more than one room, and the total number of occupants and pets within the home are extracted. Additionally, weekly online surveys inquire as to whether participants have been out of town or have overnight visitors. Associations between social activity and behavioral symptoms are obtained combining digital behavioral-activity biomarkers with frequently reported online behavioral data.
A THREE-TIER EXAMINATION OF RACIAL DISPARITIES IN PAIN AT THE END OF LIFE
Authors: Suntai Zainab , Beltran Susanny , McMullen Elyse
Published: December 2023

Over the past few decades, research focused on improving end-of-life outcomes has burgeoned within the field of gerontology. Pain is one of the most common symptoms assessed at the end of life and research has shown that Black and Hispanic older adults are significantly more likely to experience pain compared to White older adults. However, few studies have sought to describe racial/ethnic differences in help-seeking behavior for pain and satisfaction with pain management among older adults. This study employed a three-tier approach by investigating 1) differences in the experience of pain at the end of life, 2) differences in help-seeking behavior for pain at the end of life, and 3) differences in satisfaction with pain management at the end of life. Data were derived from the combined 2012 to 2020 last-month-of-life interviews as part of the National Health and Aging Trends Study. Using a multivariate logistic regression model, results showed that Black and Hispanic older adults were more likely to experience pain at the end of life, less likely to have received help for their pain, and less likely to report that they were satisfied with the level of help received. These results point to a disparity in not only the level of pain experienced at the end of life, but the treatment and quality of pain management. Implications for aging research, policy, and practice are discussed.
GENDER INEQUALITIES IN THE DISRUPTION OF LONG-TERM LIFE SATISFACTION TRAJECTORIES DURING COVID-19
Authors: Moreno-Agostino Dario , Das-Munshi Jayati , Ploubidis George
Published: December 2023

Evidence suggests that women’s mental health has been disproportionately impacted by the COVID-19 pandemic. Time-use differences have been hypothesised as an explanatory factor, as women generally spent more time than men on psychologically taxing activities. We used data on life satisfaction spanning 25 years (1996-2021, age 26-51) from a birth cohort representing adults born in Britain in 1970 (n=6,766). We used piecewise latent growth curve models to study gender differences in the long-term trajectories of life satisfaction and in the impact of the pandemic onset on these trajectories, and whether time-use differences partly explained that differential impact. Women had consistently higher life satisfaction levels prior to the pandemic (Δintercept,unadjusted=0.204 [95% CI: 0.073, 0.336], p=.002), and then experienced a more accelerated decline with its onset (Δquad2,unadjusted=-0.019 [-0.026, -0.011], p<.001). This gap remained stable after accounting for time use differences (Δquad2,adjusted=-0.019 [-0.028, -0.011], p<.001). Nevertheless, time spent working was positively related to life satisfaction in women but negatively in men (Δworking1-8h=0.499 [-0.168, 0.829], p= .003; Δworking>8h=0.543 [0.185, 0.902], p=.003), whereas time spent doing housework was negatively related to life satisfaction in women but positively in men (Δhousework1h=-0.723 [-0.749, -0.045], p=.027). Results were robust to adjustment for the concurrent financial situation. Our study shows gender inequalities in the impact of the pandemic on the long-term life satisfaction trajectories of adults in their 50s and suggests that time-use differences do not explain these inequalities. Further research on the mechanisms underlying the differential impact of the pandemic across genders in positive mental health is needed.
BLENDED GAMING COVID-19 TRAINING SYSTEM (BGCTS) FOR RESIDENTIAL CARE HOMES: A CLUSTER RANDOMIZED CONTROLLED TRIAL
Authors: Leung Angela Y M , Lau Terence , Leung Doris Y P
Published: December 2023

Objective

This study aims to assess the effect of the Blended Gaming COVID-19 Training System (BGCTS) on infection control practices, compliance rates and knowledge of standard precautions among all staff in residential care homes (RCHs). Design: A 2-arm single-blinded cluster randomized controlled trial. Setting: Thirty RCHs were recruited and randomized. Due to COVID-19 pandemic and there were infected cases in the homes, 17 RCHs refused or delayed the on-site observations. Participants: 212 staff (from 13 RCHs) were randomized to the intervention group (IG) or the control group (CG) according to their RCHs. Intervention: This is a blended mode of training with contents derived from WHO and local guidelines.

Results

After using the BGCTS , the use of gloves and personal protective equipment (PPE) was significantly improved in IG than that of CG (F=43.206, p< 0.001). The IG has significantly higher scores in self-reported infection control practices (SICP) than that of CG (β= 2.619, Wald χ2 95% CI [4.291, 9.426]).

Discussion

BGCTS improved RCH staff’s performance in infection control practices. BGCTS was shown to be an effective training and it is worth to consider for adopting it as routine training for all staff in residential care homes.
VISITATION SHELTERS FOR THE LONG-TERM CARE SETTING DURING THE PANDEMIC: AN EXPLORATORY STUDY
Authors: Porter Michelle , Mallory-Hill Shauna
Published: December 2023

In 2020, the province of Manitoba in Canada devised a plan to provide external visitation shelters for long-term care (LTC) facilities. The intent of the shelters was to alleviate the problems with visitor restrictions due to the COVID-19 pandemic. Dozens of visitation shelters, which were re-purposed shipping containers, were installed at facilities across the province. The purpose of this research was to: examine the experiences of the users through online surveys; make field measurements of the conditions (CO2 values, lighting, acoustics); and conduct an environmental scan of documents (government, media, etc.). Media and government documents provided insights into: design considerations; timing of installation/use; policies and procedures; how much they were utilized; as well as constraints. Survey findings from family/friends (n=20), LTC staff (n=9) and a resident (n=1) revealed that while many agreed that the shelters made a difference for their emotional well-being, many felt that the shelters did not support meaningful connections between residents and visitors. Furthermore, many respondents described the shelters as institutional/sterile and suggested that the décor should be improved to make them homier. Field measurements showed that the ventilation system ensured that CO2 values remained low, indicating that substantial fresh air exchange occurred. Acoustic values indicated that there could be challenges with residents hearing visitors. Lighting values demonstrated that color temperature was appropriate, but lux values were relatively low depending on the specific location in the shelter. Overall, this study was able to outline the advantages and disadvantages to using external visitation shelters in a pandemic situation.
HOW PATTERNS OF INTERGENERATIONAL SUPPORT RECEIVED PREDICT FUTURE PROVISION OF CARE? EVIDENCE FROM CHINA
Authors: Zhang Yinkai , Chen Yu-Chih
Published: December 2023

Intergenerational support refers to the exchange of financial, emotional, and physical support between generations. The types of support that older adults receive can influence their willingness to provide care in the future. However, there is limited knowledge about the different patterns of support that older adults receive. Examining these patterns can provide insight into how older adults contribute to future financial, emotional, and physical support. Using data from 5,388 older adults aged 60 and older from the China Health and Retirement Longitudinal Study, latent profile analysis was used to explore the patterns of received support. The associations between the patterns and provisions of financial, emotional, and physical support were examined using lagged OLS regression. Results showed that three patterns of received support were identified based on financial and physical aspects: financially and physically disadvantaged (low financial and physical support), engaged but financially disadvantaged (low financial but high physical support), engaged but physically moderate (high financial and medium physical support). Compared to the financially and physically disadvantaged group, those who were engaged but financially disadvantaged offer more financial and emotional support but less physical support, whereas engaged but physically moderate groups are more likely to provide emotional care. Findings suggest that policies and programs should consider the different patterns of support that older adults receive to promote more balanced support across different generations.
REDUCING FINANCIAL TOXICITY IN THE HEALTH CARE SYSTEM USING COST ESTIMATION TOOLS FOR OLDER ADULTS
Authors: Gelburd Robin
Published: December 2023

Financial toxicity— the financial, emotional and mental burden patients experience with medical costs that can lead to diminished access to care and reduced quality of life—is a growing issue among older adults, family caregivers and care partners. Research suggests that financial health literacy tools may reduce financial toxicity. With support from The John A. Hartford Foundation, FAIR Health undertook an 18-month initiative to advance shared decision making (SDM) among older adults (aged 65 and older) with serious health conditions, and their family caregivers/care partners, through the development and dissemination of decision aids that combine clinical and cost information with resources and educational content; these tools are offered for free to consumers on fairhealthconsumer.org and to healthcare providers on fairhealthprovider.org. This presentation will discuss salient findings from the initiative, as detailed in the brief, Advancing Shared Decision Making among Older Adults with Serious Health Conditions: Lessons from FAIR Health’s Grant-Funded Initiative. Feedback from older patients, caregivers/care partners and providers revealed the demand and need for financial health literacy tools that provide cost information and underscored key insights that included: (1) Healthcare costs, billing and lack of transparency in the healthcare system are sources of frustration; (2) Barriers to SDM include low health literacy and poor access to devices; and (3) SDM is viewed by many as a vehicle for patient empowerment. The session will offer a unique insight into how these findings can be used to usher in a new paradigm of healthcare and retool clinical practice and medical education.
WHO, HOW, AND WHEN DOES PRIMARY CARE USE THE 4MS? CLINICIAN PERSPECTIVES OF THE AGE-FRIENDLY FRAMEWORK IN AN FQHC
Authors: Knecht-Fredo Jenny , Husser Erica , Fick Donna , Hogue Angela , Mulvihill Marie , Lorelli Lisa
Published: December 2023

Older adults are at higher risk of living with multiple chronic health conditions and confront health care systems ill-prepared to manage the underlying complexities of providing care to older people. The Geriatric Workforce Enhancement Program (GWEP) aims to transform primary care to improve the health of older adults. Our GWEP is a collaboration between the Penn State College of Nursing and Pennsylvania’s largest Federally Qualified Health Center (FQHC), the Primary Health Network (covering 16 counties [13 rural]). We aim to disseminate the 4Ms of an Age-Friendly Health System (What Matters, Medication, Mentation, and Mobility). Although AFHS is being disseminated across the nation, there is little research regarding clinicians’ perspectives of the 4Ms framework in primary care. After 3 years of program delivery, we administered a PHN system-wide survey to 614 employees with 307 returned (50% response rate) regarding 4Ms knowledge, clinicians’ responsibilities, timing of assessments, how results inform care, perceptions on the role of the electronic medical record (EMR), competence, barriers, and facilitators to providing Age-Friendly care. Analysis includes a subset of 40 registered nurses (n=21) and nurse practitioners/physician’s assistants/physicians (n=19). Results suggest the medical providers were perceived as most likely to assess What Matters and Medication and multiple team members assessed Mentation and Mobility. 65% either agree or strongly agree that the EMR should prompt them to review the 4Ms with their patients. Survey results provide understanding of the barriers, specific roles, workflows, and EMR alterations needed to implement AFHS care into the busy culture of primary care clinics.
IMPACT OF ENVIRONMENTAL CHARACTERISTICS ON SELF-RATED HEALTH AMONG THE VERY OLD IN GERMANY DURING THE COVID-19 PANDEMIC
Authors: Zimmermann Jaroslava
Published: December 2023

Current research demonstrates negative impact of COVID-19 pandemic on health. Nevertheless, there is evidence that older population might be more resilient against the effect of pandemic than younger adults. Since very old adults are often underrepresented or excluded from these studies, the aim of this paper was to examine the link between environmental characteristics and self-reported health in very old population in Germany during COVID-19 pandemic. Data from the representative survey “Old Age in Germany” of the population aged 80 and older were used. The study sample included 10,578 community-dwelling as well as institutionalized persons. Multilevel analysis was conducted to investigate the association of environment characteristics on individual, and community level with self-rated health. The results showed that higher perceived walkability of outdoor environment, better housing condition, being closer attached to home environment, higher neighborhood trust, and living in a house increased self-rated health (individual level). On community level, residency in one of the communities in western Germany (compared to eastern Germany) was associated with better self-rated health. 35% of the variance in self-rated health was explained at individual and 21% at community level. The findings revealed that very old adults who lived in better home environment experienced better health during the COVID-19 pandemic in Germany. These findings may indicate that the capacity of the very old to adapt to health losses depends on available environmental resources. Therefore, improvements of home environment inside and outside of houses and apartments (e.g., ensuring barrier-free accessibility) may strengthen the resilience in later life.
RECIPROCAL RELATIONSHIP BETWEEN FAMILY, FRIENDS, AND COGNITIVE HEALTH AMONG OLDER ADULTS IN CHINA
Authors: Yu Xinfang
Published: December 2023

Existing research links perceived social support from family and friends to cognitive health in later life. Yet we know less about how cognitive functioning may also shape social support and whether these reciprocal relationships vary between rural and urban areas, especially in China where rural-urban migration is common. This study investigates: (1) whether family support and friendship support help maintaining cognitive functioning, (2) whether cognitive functioning improves perceived family support and friendship support, and (3) whether and how these relationships differ between rural and urban areas. I estimate cross-lagged panel models with a sample including 9,553 adults aged 60 years and above, from two waves of the China Longitudinal Aging Social Survey (CLASS). Results show that cognitive functioning was positively associated with perceived friendship support, regardless of the area of residence. There was a reciprocal relationship between friendship support and cognitive functioning only for rural older adults, with friendship support predicting lower cognitive functioning for urban older adults. Findings suggest that rural and urban context matter – perceived social support, whether from friends or family, may have different implications for the cognitive health of older Chinese adults depending on where they live.
ANXIETY AND MEMORY COMPLAINTS IN MIDDLE-AGED AND OLDER ADULTS: THE MODERATING ROLE OF PHYSICAL ACTIVITY
Authors: Costa Amy , Curtis Ashley
Published: December 2023

The relationship between anxiety and memory complaints is well established. Additionally, physical activity has been shown to improve anxiety symptoms and cognition. Little research, however, has examined if physical activity impacts associations between anxiety and memory complaints in cognitively healthy middle-aged and older adults. Given memory complaints are often the first indicator of subsequent cognitive decline, it is important to understand factors that impact complaints. The present study tested whether physical activity moderated associations between anxiety and memory complaints. Adults aged 50+ (N=271, Mage=64.5, SD=7.8, 124 women) completed the International Physical Activity Questionnaire, Hospital Anxiety and Depression scale (HADS), and the Cognitive Failures questionnaire (CFQ). Multiple linear regressions and simple slope analyses were conducted to examine if physical activity moderated associations between anxiety and memory complaints (CFQ-memory), covarying for age, sex, income, difficulty walking, number of medical conditions, number of medications, body mass index, and depressive symptoms (HADS-depression). Results revealed total physical activity (R2-change=.01, p=.04), vigorous activity (R2-change=.02, p=.02), and walking activity (R2-change=.01, p=.03) moderated associations between anxiety and memory complaints. Specifically, higher anxiety was associated with more memory complaints at all levels of physical activity, with the magnitude of the effect largest at highest levels of physical activity. The present findings suggest higher amounts of physical activity may exacerbate the relationship between anxiety and memory complaints. It is possible aging adults with greater perceived memory disruption experience more anxiety and engage in health enhancing behaviors, such as physical activity. Future studies should explore temporal patterns of this relationship.
COGNITION TRAJECTORY AND DISABILITY AMONG OLDER AMERICAN COUPLES: THE MEDIATING ROLE OF DEPRESSIVE SYMPTOMS
Authors: Kong Dexia , Lu Peiyi , Jiang Da , Chan Helen
Published: December 2023

Background

Using a dyadic approach, this study examined the mediating effect of depressive symptoms on the longitudinal relationships between husbands’ and wives’ memory trajectories and their prospective disability status. Method: Longitudinal data from Health and Retirement Study 2004-2018 were used. Older (aged 50+) heterosexual couples married for 5+ years and had no limitations on activity of daily living at baseline (2004) were included (N=1,310). Latent class growth analysis grouped wives and husbands into distinct memory trajectories in 2004-2014. Structural Equation Model examined the actor and partner effects of memory trajectories on depressive symptoms in 2016 and disability status in 2018. The mediating effect of depressive symptoms was tested.

Results

Four distinct trajectories were found: persistently high (wives: 11.83%; husbands: 3.83%); high and slow decline (wives: 36.26%; husbands: 33.66%); moderate and slow decline (wives: 41.30%; husband: 47.97%); low and rapid decline (wives: 10.61%; husbands: 14.54%). Only the wife’s low and rapid decline memory trajectory predicted her own more depressive symptoms (β=0.588, 95% CI=0.209, 0.967) and her husband’s more depressive symptoms (β=0.326, 95% CI=0.004, 0.648). Meanwhile, depressive symptoms had strong and significant actor effects on disability (β=0.046, 95% CI=0.036, 0.057 in the wife’s outcome; β=0.060, 95% CI=0.046, 0.074 in the husband’s outcome).

Conclusions

Wife’s low and rapid decline trajectory was associated with her own and her husband’s more depressive symptoms, which in turn increased the disability risk of both partners. Detection and treatment of cognitive decline among wives have the potential to mitigate the couples’ depressive symptoms and ultimately disability risks.
SOCIOECONOMIC STATUS, CHANGES IN HEALTH BEHAVIORS, AND DEPRESSIVE SYMPTOMS AMONG OLDER ADULTS DURING THE PANDEMIC
Authors: Liu Yujun , Wang Heng , Hughes M Courtney
Published: December 2023

Disparities in COVID-19 morbidity and mortality based on race and gender exist among older adults. Few studies have explored the complex relationships between the multiple components of COVID-19 vulnerabilities and the intersectionality across gender and race. This study aims to examine the impact of the COVID-19 pandemic on financial difficulty, health behavior, and depressive symptoms among older adults across the intersectionality of gender and race. Using Round 5 and Round 10 of the National Health and Aging Trends Study (NHATS) linked with the NHATS COVID-19 dataset, our sample included Medicare beneficiaries aged 65 or older in the U.S. (N =3,118). We modeled the interrelationships between financial difficulty, health behaviors, and depressive symptoms using a structural equation model. The results indicate that within the intersectionality framework, female participants reported less walking, more changes in eating habits, less sleeping, and less alcohol consumption during the pandemic than before compared to male counterparts. Compared to Non-Hispanic White, Non-Hispanic Black, Hispanic, and Other races, participants showed higher proportions of experiencing financial difficulty, less walking, less vigorous activity and changes in eating and sleep during than before the pandemic. Financial difficulty was significantly and positively associated with depressive symptoms and sedentary behavior. Active behavior was significantly and negatively associated with depressive symptoms, sedentary behavior was significantly and positively associated with level of depressive symptoms. Health professionals should consider the connection between various sociodemographic and health factors and the impact of COVID-19 on older adults when designing and delivering health and wellness programs post-pandemic.
CHALLENGES AND STRATEGIES TO IMPLEMENTING THE TRANSITIONAL CARE MODEL: LESSONS LEARNED FROM THE MIRROR-TCM TRIAL
Authors: Hirschman Karen , McHugh Molly , Osokpo Onome , Mccauley Kathleen , Shaid Elizabeth , Hanlon Alexandra , Pauly Mark , Naylor Mary
Published: December 2023

The Transitional Care Model (TCM) is an advanced practice registered nurse-led, team-based, care management strategy which has repeatedly been shown to improve outcomes for older adults transitioning from hospital to home. The MIRROR-TCM randomized controlled trial was implemented at three healthcare systems (7 hospitals) in four states. Older adults, hospitalized with heart failure, chronic obstructive pulmonary disease, or pneumonia, were enrolled between September 2020 and January 2023. A parallel evaluation study of “what it takes” to implement the TCM was launched to explore the challenges and strategies necessary to implement the Model’s 10 components, especially in the context of COVID-19. A qualitative descriptive analysis of 167 meetings (clinical, community, leadership) from June 2020 (Pre-Implementation) through January 2023 (implementation/evaluation) was conducted. Codes were developed inductively over the first year of the study. The most common challenges were patient and caregiver factors (e.g., engagement, preferences, medical complexity), staffing coverage (e.g., time off, absences), and collaboration with multidisciplinary teams (e.g., poor or reluctant collaboration/communication). Common strategies to address challenges included: clarifying and adapting TCM processes, establishing an appropriate plan of care, building and engaging networks and relationships across healthcare and community settings, and trialing alternative strategies (e.g., telehealth in place of in-person visits). While some challenges were more common across sites such as patients refusing visits or no weekend coverage, strategies to resolve them tended to be site-specific. Findings provide important insights into what it takes to successfully implement complex evidence-based interventions such as the TCM.
PARENTAL TRANSITION TO LONG-TERM CARE: IMPLICATIONS FOR PSYCHOLOGICAL WELL-BEING OF ADULT CHILDREN
Authors: Kalesnikava Viktoryia , Lane Annalise , Dang Linh , Sneed Rodlescia , Mezuk Briana
Published: December 2023

Approximately a quarter of US Baby Boomers provide informal caregiving for their parents. Though the psychological burden of caregiving is well-documented, the extent to which this burden relates to parental transition into long-term care is understudied. This study examined the longitudinal associations between parental transition to long-term care and life satisfaction and depressive symptoms among older adults of the ‘Baby Boom’ generation. Sample included respondents with at least one living parent from the Health and Retirement Study, 2010 - 2018 (n = 6,519, mean age = 56). Single-item life satisfaction was assessed on a 5-point Likert scale (range: not at all - completely satisfied). Depressive symptoms were indexed by the Composite International Diagnostic Interview (range: 0-8). Multivariate mixed effects poisson regressions of depressive symptoms and life satisfaction were fit, separately, adjusting for demographic characteristics, total wealth, and interview wave. Over the study period, 12% of respondents had a parent transitioning into long-term care. On average, respondents with parents transitioning into long-term care were older, wealthier, had higher depressive symptoms and lower life satisfaction. Longitudinally, parental transitions to long-term care was associated with mild increase in reported depressive symptoms, but there was no association with life satisfaction. Our findings are generally consistent with previous studies, reaffirming that while placement of parents in long-term care may alleviate caregiving burdens, it may not reduce distress in their adult children.
RECOGNIZING AND ENGAGING FAMILY CAREGIVERS ACROSS THE CARE CONTINUUM: FULFILLING NATIONAL STRATEGY ACTIONS
Authors: Fields Beth , Bangerter Lauren , Bangerter Lauren
Published: December 2023

Millions of family caregivers (relatives, partners, or other support persons) provide support to older adults across the care continuum, but feel unrecognized and disengaged in health care and social service systems. To address this gap, congress passed the Recognize, Assist, Include, Support, and Engage (RAISE) Family Caregiving Act in January 2018. The RAISE Act established a Council to deliver recommendations to the Secretary of Health and Human Services on how to increase recognition and engagement of family caregivers. This Council released the National Strategy to Support Family Caregivers in September 2022, detailing recommended actions for health care and social service systems. In response to the recommended actions, this symposium will present innovative approaches to increase recognition and engagement of family caregivers across the care continuum. This symposium will help bridge the policy and practice gap by offering health care and social service systems examples of how to involve family caregivers across the care continuum. Dr. Riffin will describe a checklist-based intervention to support family caregivers in primary care. Drs Perpezko and Toto will discuss the convergence of goal setting among older adults and their family caregivers in the home setting. Ms. Muntefering will report facilitators and barriers to involving family caregivers in hospital care. Dr. Wyman will identify effective clinician behaviors for including family caregivers in geriatric mental health VA services. Dr. Werner will share an online portal for supporting family caregivers in rural areas.
A CHECKLIST-BASED INTERVENTION TO SUPPORT FAMILY CAREGIVERS IN PRIMARY CARE
Authors: Riffin Catherine
Published: December 2023

Family caregivers commonly accompany older adults to their routine medical visits, but caregivers’ own needs and concerns are not systematically identified or addressed in clinical practice. Collaborative Healthcare Encounters with Caregivers (CHEC) is a checklist-based intervention that uses a prioritization approach to help caregivers efficiently identify and communicate their most salient concerns to primary care providers. This presentation will report findings from a pilot randomized controlled trial of N=37 patient-caregiver dyads who were randomized to CHEC (N=21) or usual care (n=16). The goals of the pilot trial were to evaluate CHEC’s impact on medical visit duration and communication (using time-stamped audio-recordings and a structured coding system) and caregivers’ perceptions of CHEC’s utility (using questionnaires and interviews). Total visit duration was comparable across treatment groups (CHEC: 29.3 minutes vs. UC: 32.8 minutes; p=0.55), but a greater proportion of the visit time was spent addressing caregivers’ concerns among CHEC group participants, as compared to usual care participants (25% vs. 6%; p<.001). In post-visit interviews, caregivers commented that CHEC was useful in helping them to prepare for the visit by thinking about their questions in advance and prompting providers to acknowledge their concerns. Findings from this study explicitly address the RAISE Act’s recommendation for integrating evidence-based caregiver assessment instruments into clinical care delivery (Outcome 2.2) and indicate CHEC’s potential as an efficient, clinically feasible intervention that can support greater inclusion of caregivers in primary care discussions.
AGING IN ENVIRONMENTALLY RISKY AREAS: FINDINGS FROM A NATIONALLY REPRESENTATIVE SURVEY
Authors: Merdjanoff Alexis , Lynch Katie
Published: December 2023

The Aging in Risky Environmental Areas (AREA) Study is a novel cross-sectional dataset of community-dwelling adults in the U.S. ages 50 and older. The sample of 1,504 participants was collected in November 2022 and is nationally representative. The survey examines several topics related to aging during the climate emergency including, recent climate-related disaster exposure; perspectives on climate adaptation and mitigation strategies; disaster resilience; and, various measures of healthy aging. There is a misconception that a majority of older adults do not believe in climate change or are unwilling to make behavioral changes to decrease their carbon footprint, despite their vulnerability to climate-related disasters. Results from the AREA Study demonstrate that a majority of older adults (50+) are willing to make “a lot” or “some” changes to the way they live or work in order to reduce the impact of climate change and that there are no statistically significant differences among age groups (50-64; 65-74; 75+). Instead, factors such as region, political affiliation, prior disaster exposure, and place attachment are significant predictors of willingness to engage in adaptation strategies. Findings suggest that an overwhelming majority of older adults (74%) believe that climate change is happening and are willing to be active participants in efforts to reduce negative impacts.
BREATHLESSNESS AND BIOSOCIALITY: AN ETHNOGRAPHY OF LIVING WITH RESPIRATORY DISEASE IN LATER LIFE
Authors: Nyman Fredrik
Published: December 2023

This paper is based on multi-sited ethnographic fieldwork conducted predominantly amongst support groups for older people with respiratory disease in the North of England, and sheds light on how communities are formed around chronic breathlessness. By utilising (and reconceptualising) the postmodern framework of biosociality, this paper explores how people living with respiratory disease negotiate and incorporate different kinds of health-related knowledge in their everyday lives—explicitly in support group settings outside of the clinic. People are living longer than ever before according to the World Health Organization, and chronic conditions are now the chief causes of death globally and have surfaced as major causes of disability and functional dependency. More specifically, in the United Kingdom 115,000 people die each year of chronic respiratory disease, which makes it one of the three biggest killer disease areas in the country. These mortality figures have remained stagnant for the past decades. What is more, in the era of neoliberalism respiratory care is individualised. Public health responses now emphasise the responsibility of individuals over collective or institutional responsibility, which is predominantly enforced through self-care and by training (or activating) patients in taking their medications and monitoring their pulmonary performance. By attending to public health responses in neoliberal times where respiratory healthcare regimens are habitually individualised, this paper contributes to understandings of biomedical subjectivities. Explicitly, it examines how support groups—as biosocial gatherings—can be understood as technologies for bridging dialogues between subjective and collective bodily experiences of health, illness, and wellbeing.
COMPARING SELF-REPORTED MEASURES OF SUBJECTIVE COGNITIVE DECLINE
Authors: Olivari Benjamin , Omura John , Shean John , McGuire Lisa
Published: December 2023

Symptoms of subjective cognitive decline (SCD) can be early indicators of possible future dementia. Estimates of self-reported SCD prevalence are available from various data sources including the Behavioral Risk Factor Surveillance System’s (BRFSS) current Cognitive Decline Optional Module. Recent revisions to the Module were proposed based on input from subject matter experts, including reducing introductory phrasing and refining question and response options. It is unknown how these changes may impact estimates of SCD prevalence. To assess whether prevalence of SCD differs based on Module phrasing and conceptualizations of SCD-related questions, this analysis used data (n=3526) from the 2022 FallStyles survey. Respondents were randomly assigned to one of two groups receiving different sets of Module questions: group A received questions mirroring the former language and group B received the revised phrasing. Estimates were weighted to match the 2021 US Current Population Survey. SCD prevalence among respondents aged ≥18 years was 8.9% in group A versus 16.9% in group B. Among adults aged ≥45 years, SCD prevalence in group A (9.3%) was similar to the 2019-2020 BRFSS estimate (9.8%), while it was nearly double (17.6%) in group B. Within both groups, SCD prevalence was higher among those earning less than $25,000, with lower educational attainment, and who identified as female than their counterparts. Simplified prompts and refined questions may provide higher estimates of SCD prevalence. Given the subjective interpretation of respondents’ own memory changes involved in measuring SCD, understanding the impact of question phrasing and language is critical when interpreting resulting data.
PROVIDING DEMENTIA CARE ACROSS LOW-RESOURCE COMMUNITIES
Authors: Holmes Sarah , Corazzini Kirsten
Published: December 2023

The growing number of persons living with dementia (PLWD) require ongoing care and supportive services, but dementia care access and quality are more limited in communities with fewer health resources and these limitations are exacerbated by current dementia care workforce shortages. Across low-resource communities—including poorer urban and rural settings—health resources tend to be limited and PLWD are predominantly socioeconomically disadvantaged and have few personal financial resources to contribute to care provision. Although there is growing evidence about the consequences of care inequities for PLWD, less is known about key issues and opportunities for improving dementia care in low-resource communities. This symposium features presentations that highlight unique social and economic challenges and opportunities for providing dementia care in low-resource communities. The first presenter reports results from a community-based, participatory research study in four long-term care settings in federally designated medically underserved areas (two rural, two urban) that highlights strategies used by long-term care providers to recruit and retain dementia care staff and describes their perspectives on quality dementia care. The second presenter shares findings from an innovative pilot program of case management services to address challenges of PLWD who are living alone in the community through collaboration with local paramedicine services. The third presenter provides an overview of the Person-Centered Options Counseling Certification program with a discussion on strategies for implementing person-centered dementia care initiatives in low-resource communities. This symposium reveals complexities in providing care for PLWD in diverse low-resource communities and generates directions for addressing dementia care inequities.
A FRAMEWORK OF SUPPORT: THE NURSING HOME PERSON-CENTERED OPTIONS COUNSELING CERTIFICATION PROGRAM
Authors: Crary Kate , Mandrell Melissa , Davie Laura
Published: December 2023

Person-centered initiatives and approaches are the cornerstone of best practices when it comes to supporting older adults and persons living with dementia. Lack of person-centered care has been associated with higher medical costs and negative health outcomes, particularly in low-resource communities. Implementing person-centered care may help to address disparities and improve care outcomes in these communities, although it is often unclear which approaches are most appropriate. The Person-Centered Options Counseling Certification program attempts to address this gap via a mentoring program and competency framework. Developed and piloted in rural New Hampshire, this framework helps professionals and organizations evaluate the approaches that works best for them, while creating fidelity for ongoing support through a rigorous mentorship program. The framework shows promise of being cost effective, an important consideration for many low-resource communities. Professionals can attain knowledge, skills, and abilities without incurring higher education costs and agencies can utilize pre-developed instructional materials. Pilot data was collected to evaluate the program and demonstrated that professionals found the educational training delivered within the framework was relevant to their community and increased their knowledge about person-centered care, although some expressed hesitancy when applying the skills learned with individuals. Professionals who completed both the training and participated in the mentorship program reported a high level of competency, satisfaction, and confidence in delivering person-centered care. The use of this framework may support staff retention in low-resource communities and approaches can be tailored across different environments to facilitate the delivery of person-centered care.