bluuebunny/crossref_metadata_2025 huggingface dataset:
Greater Adolescent Cognitive Ability Linked to Lower Risk of Earlier Mortality
Authors: Gruenewald Tara , Grossman Molli , Zavala Catalina , Arpawong Thalida , Fisher Gwen , Shultz Kenneth , Gatz Margaret , Prescott Carol
Published: December 2021

There have been few investigations of the role that adolescent cognitive ability might play in predicting physical resilience across the life course, including decreased risk of early mortality. Our limited knowledge of how multiple cognitive ability domains shape trajectories of longevity is due, in part, to a lack of aging cohorts with early life cognitive assessments, and family data that allow for examination of shared family and genetic characteristics that may play a role in cognitive ability-health links. We capitalized on data from the 1960 Project Talent high school cohort (n>360,000, born 1942-1946) and mortality data (n=22,584; 5,497 deceased) collected as part of two recent follow-ups, the Project Talent Twin & Sibling Study and the Project Talent Aging Study, to examine these potential associations. In 1960, ability was assessed in multiple cognitive domains (e.g., general aptitude, quantitative, reasoning). Mortality status was ascertained through 2016. Binary logistic generalized estimating equations with race, age, sex, and adolescent family SES covariates, indicated that each 1 standard deviation higher ability in multiple cognitive domains in adolescence predicted lower odds of earlier mortality (ORs of 0.79 - 0.87). Co-sibling control models indicated a similar pattern, suggesting that benefits associated with higher cognitive performance do not simply reflect shared environmental and genetic background, but may represent a direct protective effect. These findings indicate that better performance in multiple cognitive domains in adolescence, above and beyond the influence of genetic and family environmental factors, may be or point to modifiable protective factors against risk of early mortality.
COVID-19 Nursing Home Deaths in Cook County: Predictors and Modifiable Risks
Authors: DeMott Andrew , Hughes Susan , Gelder Michael , Kim Sage
Published: December 2021

Investigators at the University of Illinois Chicago, the Illinois Department on Aging (IDOA), the Illinois Department of Public Health, and the Health and Medicine Policy Research Group are collaborating to examine comparative rates of Covid-19-related deaths among older adults who reside in nursing homes vs. the community in Illinois. As a first step, we have examined data from the Cook County Medical Examiner’s office to compare nursing home resident fatalities to those who died in the community. Deaths with Covid-19 listed as primary or secondary cause of death that occurred between January 1, 2020 to September 30, 2020 among older adults ages 60 and over were identified from the Cook County Medical Examiner’s Office case archive file. Location at death and race/ethnicity were obtained from the same source. Location at death was matched with data in the Center for Medicare and Medicaid Services (CMS) Covid-19 Nursing Home Data to identify persons who died in skilled nursing facilities (SNFs) as well as facility and staff characteristics. We found that the 3,937 deaths among persons over the age of 60 comprised 75% of total deaths in Cook County. Of the total older adult deaths, 2,090 (53%) died in the community and 1,837 (47%) died in SNFs. Regression analyses that controlled for CMS quality ratings found that larger, for-profit nursing homes, with high levels of staff infected with Covid-19 were associated with higher mortality. The policy implications of these findings will be discussed.
Integrating Psychological Services Into Community-Based Clinics
Authors: Jacobs Lindsey
Published: December 2021

In Alabama, where mental health stigma is a critical barrier to care, integrated behavioral health services are vital to address the mental health needs that underlie substance use disorder (SUD) and opioid use disorder (OUD). Since October 2019, our team has developed partnerships with one rural and two peri-urban primary care clinics to offer behavioral health services with an emphasis on SUD/OUD prevention, screening, and treatment. The patient populations receiving services at these three facilities are under-resourced with multiple disadvantages placing them at risk for morbidity, mortality, SUD/OUD, and poor behavioral and mental health outcomes. Behavioral health services have been delivered primarily via telehealth due to the COVID-19 pandemic. This presentation will describe the process, current status, and future goals for implementing integrated behavioral health care, with a focus on identifying the barriers and facilitators during the COVID-19 pandemic era.
Caregiving Appraisals and Emotional Valence: Buffering Effect of Activity Participation
Authors: Lee Jeongeun , Cone Nicholas
Published: December 2021

Caregiving activities often lead to positive and negative appraisal for caregivers. Caregivers may limit social participation due to caregiving activities. Changes in level of activity participation could have profound consequences for caregiver’s valence. However, little is known about how activity participation could moderate the association between these caregiving appraisals and emotional valence. Data came from the National Study of Caregiving (Round 1 and 2), a nationally representative study of caregivers. Referencing Lawton’s two-factor model (1990), we examined both the level and changes in activity restriction interacting with positive and negative caregiving appraisals to predict both valence across two waves. Consistent with two factor models, findings revealed level and changes in activity restriction moderated the relationship between caregiving appraisal and outcomes for both valences. These findings highlight the role of activity restriction as a target to reduce negative valence and improve positive valence for caregivers.
Environment Still Matters: Examining Person-Place-Relationships in the Old and the New Normal Across Settings
Authors: Oswald Frank , Chaudhury Habib , Grenier Amanda
Published: December 2021

In environmental gerontology, the home and the neighborhood have always been of particular interest for empirical research. Issues such as orientation and safety, place attachment and biographical bonding, have proven to be important for community dwellings older adults and for those living in care homes. However, with Covid-19, the seemingly stable person-place-relationships have been challenged. This symposium provides a set of applied research contributions that demonstrate the persistent salience of the environment by examining person-place-relationships in the old and the new normal in private homes and care homes. Contributions draw from ideas of “precarious ageing” (Grenier & Phillipson) and “pandemic precarity”, for instance to understand housing insecurity, while concepts from environmental gerontology are used to explain processes of environmental agency and belonging. The first contribution by Mahmood and colleagues introduces an environmental audit tool for people at risk of homelessness to assess built environmental features of housing and neighborhood that support housing stability in the face of insecurity. Second, Wanka provides data from people framed as ‘risk-groups’ through the Covid-19 pandemic and how they dealt with contact restrictions, showing the role of intergenerational neighborhood relations to mediate risks of pandemic precariousness. Third, Elkes examined mobility and wayfinding challenges for residents in a long-term care home and subsequent environmental interventions to improve orientation. Forth, Leontowitsch and colleagues present findings from long-term care home residents during the pandemic to gain understanding of their experiences of social isolation and a biographical sense of resilience. Finally, Amanda Grenier will serve as the session’s discussant.
The Role of Intergenerational Neighborhood Relations for Precarious Aging During the COVID-19 Pandemic in Germany
Authors: Wanka Anna
Published: December 2021

Throughout the Covid-19 pandemic, the immediate living environment has significantly gained importance - particularly for people framed as ‘risk-groups’, such as older adults. Effects of contact restrictions to contain the spread of the virus have affected inequalities, uncertainties and loneliness in later life differently depending on the intergenerational relations, informal infrastructures of provisioning and networks of solidarity given in a certain neighborhood. The paper presents findings from a recent mixed-methods study in Frankfurt, Germany, combining a quantitative survey (n=1.000) with a longitudinal qualitative study (n=60). Results show how intergenerational neighborhood relations can play a crucial role in mediating risks of pandemic precariousness in later life, but also how older adults themselves significantly contributing to neighborhood networks of provisioning. Strengthening such very local relations is key to protecting all age groups from the effects of crises beyond the pandemic, and, in conclusion, ways to do so are being discussed.
Factors of Caregiving Resilience by Race-Ethnicity in a National Sample of Caregivers
Authors: Cho Jinmyoung , Peterson Natasha
Published: December 2021

Despite heavy burdens and responsibilities, some caregivers are more likely to cope better with their care responsibilities than others, and this could vary by cultural beliefs and norms on caregiving. This study examined contributing factors of resilience with three racial-ethnic groups (White, Blacks, Hispanic). A total of 2,652 caregivers were included from Round 7 of the National Study of Caregiving. Caregiving resilience was defined by higher levels of care demands and higher levels of psychological well-being. Five domains of contributing factors were included: socio-demographic characteristics, context of care, caregivers’ psychological attributes, informal and formal support. Multiple logistic regressions showed that caregivers with higher psychological attribute levels were more likely to be resilient in all three groups. However, unique predictors have also been observed by race-ethnic groups (e.g., Blacks using formal support were more resilient). These findings suggest the need for culturally specific programs to facilitate resilience among caregivers.
Family Caregiver Training During Medicare Home Health Care: Clinician Perspectives
Authors: Burgdorf Julia , Arbaje Alicia
Published: December 2021

During Medicare home health care, providers often rely on family caregivers to help meet patients’ care needs. Beginning in 2018, CMS requires home health agencies to provide training to family caregivers. This qualitative study is the first research to examine current patterns of family caregiver training, and related facilitators and barriers, during Medicare-funded home health care. We conducted semi-structured key informant interviews with home health nurses and physical therapists (n=19) from 4 diverse agencies, then performed thematic analysis of interview transcripts using a hybrid inductive and deductive coding approach. Clinicians described family caregiver education as a dynamic and cyclical process: simultaneously providing patient care, training family caregivers, and gathering additional information about patient needs and caregiver capabilities, then adjusting the care plan accordingly. We present a model of this cyclic process and describe its four major stages: Initial Assessment, Education, Reassessment, and Adjustment. Additionally, clinicians identified a range of structural, individual, and interpersonal factors which impact their ability to successfully train family caregivers. We define each factor and, using illustrative quotes from our interviews, elucidate its role as a facilitator and/or barrier to clinicians’ educational efforts. Findings provide the first model of caregiver training during home health care and highlight policy and practice changes to better support clinicians in these efforts; including greater visit flexibility, access to more experienced clinical mentors, and standardized caregiver assessment tools designed for this unique care setting.
A Culturally Adapted Timed-Activity RCT for Latinos With ADRD and Caregivers: Feasibility, Acceptability, and Effects
Authors: Perez G Adriana , Huang Liming
Published: December 2021

Latinos are twice as likely to develop Alzheimer’s disease (AD) compared to non-Latino whites, yet, account for <2% of clinical trial participants in AD research. This randomized controlled trial examined the feasibility, acceptability and effects of a culturally-adapted timed-activity intervention designed to promote quality of life (QOL) and reduce behavioral symptoms in older Latinos with AD and their caregivers. Healthy Patterns [Pautas Saludables] was implemented among 40 Spanish-speaking dyads. Measures assessed at baseline and 4 weeks post-intervention, indicate improvements in sleep efficiency (p=.06) and QOL (p=.01) among intervention participants. Pautas Saludables was found to be feasible and acceptable. Intervention attendance rate was >90% with low attrition (n=0); no adverse events. Most (74%) rated timed-activity sessions as helpful and appropriate; 58% recommended refreshers. Results provide evidence that Latinos with AD will participate in clinical trials and can improve on key health outcomes, when interventions are adapted to meet their cultural needs.
Implementation in Nursing Homes: Describing Early and Late Adopters of an Evidence-Based Dementia Care Program
Authors: Lekovitch Cara , Toto Pamela , Chew Felicia , Bieber Dawn , Leland Natalie
Published: December 2021

Despite national efforts to improve nursing home (NH) quality, care remains variable. Health system efforts to drive improvement often begin with a sub-group of NHs before scaling up across the organization. Yet, there is limited evidence on who to target for the first group. This study addressed this gap by examining facility characteristics of early and late adopters within a multi-site pragmatic clinical trial. Data were obtained from the Organizational Readiness to Change Assessment (ORCA), which was completed by expert trainers, and Nursing Home Compare. Early and late adoption was operationalized according to Roger’s Diffusion of Innovations. Sixty-percent of NHs (n=12) were late adopters and 40% (n=8) were early adopters. Between group differences (p<.01) were found in number of health inspection citations and context domain within the ORCA. These findings equip health systems with evidence on how to strategically target partners for initial quality improvement efforts prior to system-wide implementation.
Intergenerational Ambivalence, Loneliness, and Well-Being Among Older Adults in the United States
Authors: Zhang Xiaoyan , Silverstein Merril
Published: December 2021

Intergenerational relationships are important sources of informal social support for older people to maintain their emotional well-being. Previous research has extensively investigated the relationship between intergenerational support and older adult’s psychological well-being. However, the existing research has not adequately examined intergenerational ambivalence – mixed or contradictory feelings toward a family member in another generation or explored the mechanism that links intergenerational ambivalence and psychological well-being. Further, most studies are cross-sectional, which prevents us from establishing causality. This study utilized data from 2006, 2008, 2010, 2012, 2014, and 2016 waves of Health and Retirement Study (HRS), a national representative sample of U.S. adults aged 50 and more (N= 8,017). Structural equation models were used to examine the longitudinal relationship between intergenerational ambivalence, loneliness, depression, and life satisfaction. The final model indicated very good fit (χ2 = 113.31, p < .0001, CFI = 0.97, RMSEA = .05). The results revealed that ambivalence in older parent-adult child relationships predicted higher subsequent loneliness (β = 0.21, p < .0001), which in turn predicted depressive symptoms (β = 0.25, p <.0001) and life satisfaction (β = -0.30, p < .0001). The results demonstrated that loneliness mediated the relationship between intergenerational ambivalence and depression, and life satisfaction. Multiple group analysis was performed to test whether the study relationships varied by gender. Gender differences were found. Findings have implications for prevention and intervention initiatives targeting improving relationships between parents and children, thereby protecting against mental problems.
Public Health Messaging and Measures During COVID-19: The Experiences of Family Caregivers
Authors: McGhan Gwen , McCaughey Deirdre , Flemons Kristin , Hindmarch Whitney
Published: December 2021

To mitigate the effects of COVID-19, Health Ministries across Canada have enacted numerous public health measures. Our mixed methods study examined the effect of COVID-19 related public health messaging and measures for family caregivers (FCGs) of people living with dementia (PLWD). Of the 230 FCGs completing the survey, most frequently used information sources were television, family/friends, and websites. FCGs over 60 more often used television, newspaper and radio versus websites and social media. FCGs rated public health messaging as good-excellent (64%) especially messaging around the disease spread, symptoms, and finding information. 46% believe the restrictions in long-term care facilities went beyond necessary with 97% reporting restrictions have negatively impacted them. 84% were willing to undertake personal protective equipment and infection control training to ensure continued access to PLWD. Focus groups highlighted concerns about continued access to PLWD, quality of care provision, and increased social isolation’s impact on dementia progression.
Aims of the Adherence Promotion With Person-Centered Technology (APPT) Project
Authors: Charness Neil , Boot Walter , Carr Dawn , Chakraborty Shayok , He Zhe , Lustria Mia , Terracciano Antonio
Published: December 2021

The APPT project supports the early detection and treatment of age-related cognitive decline and dementia by 1) enhancing adherence to cognitive intervention and assessment protocols, 2) improving understanding of barriers to long-term adherence, and 3) developing algorithms for predicting and preventing adherence failures. Two randomized controlled trials will test an adaptive technology support system predicted to boost adherence to cognitive protocols over a period of six months within samples of older adults with and without cognitive impairment. These studies will provide insight into the benefits of adherence support, and individual difference factors that should shape the adherence protocol, informing the process of identifying individuals who would benefit from additional support and predicting and preventing extended adherence failures before they happen. These studies should improve early detection and treatment of cognitive decline, extend functional independence, and improve lives of those with cognitive impairment as well as the lives of their families.
Positive Effect of a Successfully Implemented Model of Care on Unplanned Transfers to Hospital
Authors: Zuniga Franziska , Guerbaai Raphaëlle , Simon Michael
Published: December 2021

Models of care have shown effectiveness in reducing unplanned transfers in nursing homes (NHs) from 11.7% to 6.1%. These include coordination of care and access to skilled medical providers such as geriatricians, specialist nurses or registered nurses with additional training. A hybrid type-2 effectiveness-implementation project (INTERCARE) was developed to improve intervention uptake and to understand the mechanisms behind results. INTERCARE consisted of six core elements and was rolled-out to 11 Swiss NHs with a stepped-wedge design allowing all NHs to receive the intervention. 942 residents were recruited (June 2018 -January 2020). INTERCARE showed a significant reduction of unplanned transfers during the intervention period compared with baseline. The successful implementation of INTERCARE relied on the use of implementation science, building on stakeholder input and careful theory-driven contextual adaptations. INTERCARE’s success was driven by registered nurses with expanded roles, on-site coaching, and the use of tools for clinical decision making.
Learning to Work With Chronic Health Conditions: How Time Since Diagnosis Affects Older Workers' Vitality and Worries
Authors: Vanajan Anushiya , Bültmann Ute , Henkens Kène
Published: December 2021

Background. Chronic health conditions (CHCs) pose stark detrimental effects on the health and abilities of older workers. The extent of these effects depend on the CHC, the time since its diagnosis and the type of health measure: a rarely explored combination of heterogeneities. Objective. This study examined how four existing and newly diagnosed CHCs influences older workers’ vitality and worries about enduring physically and mentally until retirement age. Method. Data from two waves of the NIDI Pension Panel survey conducted in the Netherlands in 2015 and 2018 were used. We analyzed a sample of 1,894 older workers between the ages of 60-62 years at wave 1 using conditional change ordinal least square regression models. Results. Having a CHC at wave 1 was associated with lower levels of vitality and higher levels of worries at wave 2. These effects of CHCs on vitality and worries were much larger for older workers who were newly diagnosed with CHCs compared to those who experienced CHCs for longer. Intriguingly, the new diagnosis of physically disabling conditions increased worries about physical endurance at wave 2, while the new diagnosis of mentally disabling conditions increased worries about mental endurance at wave 2. Conclusion. By distinguishing the effects of four existing and newly diagnosed CHCs on vitality and worries, this study allows the identification of vulnerable groups of older workers. The findings may inform work accommodations and interventions which could improve both the quality and sustainability of work lives, while promoting healthy ageing of older workers.
(Re)Introducing the Gerontology and Geriatrics Curricular Standards and Guidelines in Higher Education
Authors: Shovali Tamar , Gugliucci Marilyn , Silverstein Nina
Published: December 2021

The Academy for Gerontology in Higher Education (AGHE), the education member group of GSA, is the only national institutional membership organization devoted primarily to gerontology and geriatrics education. Its mission provides for development and sponsorship of initiatives to advance the field of aging through its focus on education in gerontology/geriatrics. AGHE first published the Gerontology and Geriatrics Curricular Standards over three decades ago – a document that has been an integral resource for implementing/revising programs in liberal arts, the sciences, and more recently, health professions. To meet the needs in the field for increased breadth and depth of content, the new 7th edition of the educational guidelines fully embraces competency-based education for gerontology, as the health professions programs have for years. Our first presenter will provide an overview of the new edition. The second presenter will focus on associate degree programs in gerontology and their unique contribution to higher education. The third will present on undergraduate programs in gerontology explaining how these programs give students an edge in today’s job market. The fourth presenter will address graduate programs in gerontology, describing master’s degree programs and doctoral degree programs in gerontology and aging studies. The fifth presenter will discuss health professions programs including geriatrics curricula for osteopathic medical education, gerontology/geriatrics curricula for health-related programs and the doctor of pharmacy degree programs. Presentations will provide expert recommendations for program development through mapping AGHE’s Gerontology Competencies for Undergraduate and Graduate Education to programs in higher education. Nina Silverstein will serve as discussant.
Assessing Age-Friendly Community Progress: What Have We Learned?
Authors: Black Kathy , Oh Patricia
Published: December 2021

The Global Network of Age-friendly Cities and Communities has grown steadily over the past decade across the United States, however surprisingly little is known regarding their accomplishments to date. We utilized content analysis to assess the progress reported by American age-friendly communities (n = 30) that joined by end of year 2015 using the Age-Friendly Community Evidence-based Tool with expanded program evaluation measures including health equity as defined by the World Health Organization. We employed deductive analytic techniques to assess reported community performance in eleven thematic areas across the range of structures and processes that characterize age-friendly efforts. We found strong evidence in the areas of leadership and governance, harnessed resources, application of age-friendly framework, and in multisector collaboration as well as reported provisions. All of the communities reported health equity aims, particularly in promoting accessible physical environments and social inclusion efforts. Our analysis further revealed areas for continued improvement.
Age-Friendly Communities and Aging in Place: Findings From Latent Profile Analysis
Authors: Kim Seon , Kim Kyeongmo , kim junpyo
Published: December 2021

Older adults prefer to live in their current home or community and ‘Aging in place’ has been shown to reduce the cost of caring for older adults and help their successful aging. Although age-friendly communities (AFC) initiatives have been helpful to aging in place, little has been known about the relationship between the types of AFC and aging in place. Using the 2017 AARP Age-Friendly Community Survey, we included 1,079 adults aged 65 or older. We measured aging in place as ‘move to a different community’, ‘move into a different residence within your current community’, and ‘stay in your current residence’, and included eight AFC constructs. We identified the type of AFC using Latent Profile Analysis: low-friendly, mid-friendly, and high-friendly. We also ran multinomial logistic regression to examine whether the types of AFC were associated with aging in place. Of the total participants, 26.0% lived in the low-friendly community, 23.7% in the mid-friendly community, and 50.3% in the high-friendly community. Older adults living in the high-friendly community were more likely to stay in the current residence (64.7%) than those in the low-friendly (47.1%) (χ2=28.680, p<.001). Also, older adults living in the low-friendly community (OR=3.05, p<.001) and the mid-friendly community (OR=1.42, p<.10) were more likely to move to a different community compared to those living in the high-friendly community. This result suggests that it is important to build an AFC to promote aging in place. For the growing number of older adults' lives, policymakers should consider expanding the AFC initiatives.
An Evolving Role for the Long Non-Coding RNA H19 in Aging and Senescence
Authors: Potnis Manali , Sell Christian
Published: December 2021

The long non-coding RNA (lncRNA) H19 is a maternally imprinted gene transcript that, in conjunction with the neighboring Igf2 gene, is critical in controlling embryonic growth. Loss of H19 results in fetal overgrowth associated with Beckwith Weidemann syndrome, while elevated H19 occurs in human cancers. In the adult, H19 functions in cancer cells where it promotes migration and is correlated with poor prognosis, and in adult stem cells where it is a key regulator of cell fate decisions during differentiation. While the function of H19 in primary somatic cells has not been defined, a reduction in the abundance of H19 has been reported during senescence in endothelial cells. Given the critical importance of H19 in cell fate decisions, it is likely that understanding the precise function of H19 in somatic cells in general and why reduced levels occur with cellular senescence will provide novel insights into both somatic cell maintenance and the senescence program. Towards this end, we examined the role of H19 in somatic cell growth using cardiac interstitial fibroblasts. Our results indicate that H19 is not only vital for somatic cell proliferation and survival, but that depletion of H19 leads to cell cycle arrest and the formation of abnormal nuclei resulting in senescent cells. We are defining both the upstream regulators of H19 and the downstream mediators of senescence following H19 depletion. Overall, these results indicate an essential role for H19 in cell cycle progression, chromatin structure, and possibly proper mitotic division.
Associations Between Perceived Physical and Mental Fatigability and Life Space Mobility in Older Men: The MrOS Study
Authors: Moored Kyle , Rosso Andrea , Gmelin Theresa , Qiao Yujia (Susanna) , Carlson Michelle , Cawthon Peggy , Cauley Jane , Glynn Nancy W
Published: December 2021

Physical performance and fatigue can limit mobility within the larger environment (life-space mobility). It is unknown whether perceived fatigability, fatigue anchored to activity intensity and duration, is independently associated with life-space. We assessed this cross-sectionally in the Osteoporotic Fractures in Men Study (MrOS; N=1,681, Meanage=85±4.1). The Pittsburgh Fatigability Scale (PFS, range: 0-50) measured physical (Mean=16.2±9.5) and mental fatigability (Mean=7.5±8.0). Life Space Assessment scores (range: 0-120, higher=greater life-space) incorporated level, frequency, and assistance used for life-space mobility (Mean=84.3±22.0). Compared to the lowest fatigability strata (Physical: PFS 0-4; Mental: PFS 0-3, modeled separately), men in the two highest physical strata (PFS 20-24: B=-4.10±1.67; PFS≥25: B=-6.23±1.72; p’s≤.05) and men in the three highest mental strata reported significantly lower life-space mobility (PFS 13-15: B=-3.42±1.74; PFS 16-19: B=-5.38±1.83; PFS≥20: B=-7.96±1.66, p’s≤.05), adjusted for physical performance and health covariates. Our results provide evidence linking fatigability and real-world mobility, independent of physical health, in older men.
The Association Between Older Adult Technology Use and Mental Health During the COVID-19 Pandemic
Authors: Drazich Brittany , Li Qiwei , Perrin Nancy , Samuel Laura , Hladek Melissa diCardi , Szanton Sarah , Cudjoe Thomas , Taylor Janiece
Published: December 2021

Physical distancing during the COVID-19 pandemic may impact the mental health of older adults, but technology use may buffer this impact. This study aimed to 1) examine changes in older adult technology use during the COVID-19 pandemic and 2) determine if technology use moderates the relationships between decreased in-person communication/activity and the mental health of older adults during the pandemic. Data were taken from the NHATS COVID-19 Round 10 (n= 3,188). Older adults engaged in more technology-based activity (b= .237, p<0.001), technology-based healthcare communication (b=.112, p<0.001), and technology-based food acquisition (b= .214, p<0.001) during the COVID-19 pandemic, compared to before. Technology use did not moderate the relationship between decreased in person personal communication (b= .021, p= 0.662)/activity (b= .045, p= 0.749) and mental health during the pandemic. Although older adults are utilizing technology more during the pandemic, it might not be protective against negative mental health outcomes from physical distancing.
Integrating Life-Review and Drama Therapy for Community-Dwelling Older Adults: An Evidence-Based Model
Authors: Keisari Shoshi
Published: December 2021

Drama therapy is a widely acknowledged way to explore life-stories in late life. This presentation will describe a new model for creative interventions, based on the results of four studies that provide multiple perspectives on the integration of life-review and drama therapy for community dwelling older adults. The results of two quantitative studies (n=55, aged 62-93; n=78, aged 63-96) suggest that the drama therapy interventions have robust therapeutic potential to enhance mental health while aging. The findings of two qualitative studies with therapists (n=8), participants (n=27; aged 63-96) and staff (n=13) provide a better understanding of the process, and support the mechanisms that lead to positive effects on mental health. Combining the results yielded a multidimensional model which points to three potential transformative routes: the evolution of the life-story, the evolution of improvised dramatic expression, and the expansion of social engagement.
Online Dignity Therapy and Photo Collages: The Narratives of Israeli and Italian Older Adults in the COVID-19 Era
Authors: Keisari Shoshi , Elkarif Talia , Mola Giada , Testoni Ines , Piol Silvia
Published: December 2021

The social isolation imposed by the Covid-19 pandemic has significantly affected older adults, and has impacted both their physical and mental health. The pandemic has led to an increase in ageism associated with poorer mental health and a lower sense of dignity, self-esteem and contribution to society. This cross-cultural study involved 24 participants from Italy and Israel aged 79 to 92. The aim was to develop a brief art-based online intervention to enhance the participants’ sense of dignity and sense of meaning in life during this time of crisis. The process focused on the creation of digital photo-collages that captured the participants’ values through three perspectives: their past experiences, legacy, and future perspectives. It employed an arts-based research methodology to explore the participants’ experiences by analysing their relationship with the artistic expression, the photo collage, and its creative process.
Brief Video-Delivered Interventions to Reduce Anxiety in Older Veterans: A Pilot RCT
Authors: Gould Christine , Carlson Chalise , Anker Lauren , O'Hara Ruth , Wetherell Julie , Goldstein Mary , Beaudreau Sherry
Published: December 2021

Older Veterans with anxiety disorders encounter barriers to receiving mental health services that may be overcome by using brief technology-delivered interventions. To address this, we conducted a pilot randomized controlled trial (RCT) comparing the effects of a guided self-management intervention called BREATHE, a 4-week video-delivered (DVD/internet) intervention and a psychoeducation control (Healthy Living; HL) on anxiety symptom severity. Older Veterans with anxiety disorders (N = 48; 87.5% men; Mean age = 71.77 ± 6.2 years) were randomized to BREATHE or HL. Regarding intervention delivery modality, 67% used DVDs, 23% used the internet, 4% used both to access their assigned intervention. Both groups experienced significant declines in affective anxiety from baseline to 8 weeks followed by an increase in symptoms (i.e., quadratic pattern). HL had significant declines in somatic anxiety, whereas BREATHE did not experience such declines. The longitudinal effects and Veteran satisfaction will be further described in the presentation.
Ushering in the Silver Age of Telehealth: Addressing Telehealth Disparities for Older Adults With Disabilities
Authors: Touchett Hilary
Published: December 2021

One silver lining of COVID-19 has been the ushering in of ‘the golden age of telehealth’. However, this unplanned rapid conversion to telehealth left many providers and clinics unprepared to address systemic barriers that adversely affect older adults, particularly those with disabilities. Data from the VA Corporate Data Warehouse suggest that the rapid adoption of telehealth in mental health clinics during COVID-19 widened telehealth utilization disparities for older Veterans (65+) with disabilities. With 4.5 million Veterans 55+ who have at least one disability more attention to addressing this widening gap is needed. For those with hearing, vision, and complex mobility impairments, there are unique challenges to initiating telehealth services. Dr. Touchett will present preliminary findings while discussing ethical and contextual considerations when using telehealth with older Veterans who have disabilities, while discussing ways to facilitate robust clinical encounters for this population.
Profit Status and Employee Turnover in Iowa Nursing Homes
Authors: Sharma Hari , Xu Lili
Published: December 2021

Employee turnover is a huge concern for nursing homes that care for millions of older individuals whose physical and cognitive impairments make them vulnerable, especially in the middle of a pandemic like COVID-19. Existing research has shown that high turnover of employees can lead to poorer quality of care. Low pay is often cited as one of the key reasons for high turnover of employees in nursing homes. For-profit nursing homes may try to maximize profits by limiting wages paid to their employees. In this study, we examine whether profit-status of a facility is associated with high turnover of its employees. We obtain data on 415 nursing homes operating in Iowa between 2013-2017. We descriptively examine the turnover trends in nurse employees and all employees over time by profit status. We evaluate whether profit status is associated with high turnover using pooled linear regressions controlling for nursing home and resident characteristics. Descriptive results show that for-profit facilities had higher turnover of nurse employees (61.1% vs. 49.6%) and all employees (56.6% vs. 45.4%). Results from multivariate regressions show that, compared to non-profit facilities, for-profit facilities had 6.93 percentage points higher (p<0.01) turnover of all employees, and 7.76 percentage points higher (p<0.01) turnover of nurse employees after controlling for facility and resident characteristics. Given existing evidence on the adverse impact of high employee turnover on nursing home quality, we need policies aimed at lowering employee turnover, targeting for-profit nursing homes.
Family Conflict and Older Chinese Americans’ Self-Efficacy in End-of-Life Care Planning: The Role of Acculturation
Authors: Wang Kaipeng , Sun Fei , Liu Yanqin , De Fries Carson
Published: December 2021

Family involvement in end-of-life (EOL) care is critical to ensure older adults’ health and quality of life. Older adults’ self-efficacy in discussing EOL care plans with family members can facilitate family involvement in EOL care planning. Research shows that family relationships are associated with self-efficacy in discussing EOL care with family members among older Chinese Americans. However, the roles of family conflict and acculturation remain unknown. This study examines the association between family conflict and self-efficacy in discussing EOL care with family members and whether such an association differs by acculturation levels among older Chinese Americans. Data were collected from 207 Chinese Americans aged 65-102 in two metropolitan areas in 2017. Ordinary least squares regression was conducted to examine the association between family conflict, acculturation, and self-efficacy in discussing EOL care with family. Family conflict was negatively associated with older adults’ self-efficacy in discussing EOL care with family. More specifically, the negative association between family conflict and self-efficacy in discussing EOL care with family members was more pronounced for those with higher levels of acculturation. Findings highlighted differential effects of family conflict on self-efficacy of EOL care plan discussion for older adults with different acculturation levels. Those with higher acculturation may be more independent in their EOL care planning and aware of the possible negative effects of family conflict in their EOL care planning discussions. Acculturation needs to be considered by geriatric health providers to develop family-centered interventions in improving end-of-life care planning for this population.
The Effects of Religiosity on Depression Trajectories Before and After Widowhood
Authors: Hawes Frances , Tavares Jane , Ronneberg Corina , Miller Edward
Published: December 2021

Widowhood is associated with decreased emotional well-being, particularly increased depression. Religiosity may help improve mental health among widowed individuals. However, longitudinal studies exploring the role of religiosity on emotional well-being among widowed older adults is lacking, as are studies which examine this relationship using different dimensions of religiosity. This study analyzed data from the 2006-2016 waves of the nationally representative Health and Retirement Study (HRS). Trajectories of depression among older adults >50 years (N=5,486) were examined to explore patterns of depression among those entering widowhood and the potential impact of religiosity on depressive symptoms during widowhood. Ordinary least squares (OLS) regression analysis was used to examine the association between widowhood and depression as well as the role of religiosity as a moderator of this association. Older adults experienced an increase in depressive symptomology after the onset of widowhood, and although the levels of depressive symptomology decrease post-widowhood, they do not return to their pre-widowhood levels. Additionally, high religious service attendance and higher intrinsic religiosity were both associated with lower depressive symptomology. High religious service attendance moderated the relationship between widowhood and depression. The relationship between high religious service attendance and depression was stronger among widowed older adults living alone. This study highlights the long-term effects of widowhood on depressive symptomology among older adults. The findings also suggest that higher religious service attendance can lessen the effects of widowhood on depressive symptoms, especially for those living alone. These findings may inform intervention development around increased screening and treatment for depression.
Social Isolation and Sleep Quality of Older Adults in China: Do Family and Friendship Isolation Differ?
Authors: Zhang Dan , Lin Zhiyong , Chen Feinian , Li Shuzhuo
Published: December 2021

This study provides one of the first population-based studies investigating associations between social isolation, especially its two sub-dimensions (family isolation and friendship isolation), and sleep quality among older adults in China. We address three major research questions: 1) Does the risk of poor sleep quality vary by social isolation status? 2) Are the associations between social isolation and sleep quality mediated by mental disorders (depressive symptoms and loneliness) and physical impairments (pain and comorbidity)? and 3) Does the isolation from family members and friends differ in explaining sleep quality? We analyzed data from the 2014 wave of the China Longitudinal Aging Social Survey (CLASS), in which 7,597 respondents (aged 60-98) had complete information on measures of sleep quality (self-rated sleep difficulty), social isolation (using the Lubben Social Network Scale), and other analytical variables. Logistic regression models were estimated to predict the risk of sleep difficulty and Karlson-Holm-Breen (KHB) decomposition method was employed to test potential mediating effects. Results showed that social isolation, both family and friendship isolation, was significantly associated with higher risks of having sleep difficulty. The adverse effect of family isolation was found to be stronger than that of friendship isolation. Although both mental disorders and physical impairments mediated significant shares of associations between social isolation and sleep quality, physical impairments explained a lesser extent of them than mental disorders. These findings will be helpful for health policymakers and practitioners to design effective intervention strategies to help older adults with sleep problems.
A Nurse-Led Conceptual Model to Inform Patient-Centered Type 2 Diabetes Management in Public Clinical Settings
Authors: Bosun-Arije Stella , Nwakasi Candidus
Published: December 2021

Globally, there is an increased need to provide patient-centered care for people diagnosed with Type 2 diabetes mellitus (T2DM). In Nigeria, a poorly financed health system worsens the difficulties associated with managing T2DM in clinical settings, resulting in a detrimental effect on patient-centered care. We aimed to develop a conceptual model to promote patient-centered T2DM care in clinical settings. We explored nurses' contextual perceptions of clinical practices and operations that are relevant to T2DM management across public hospitals in Lagos, Nigeria. Identifying a nurse-led intervention is critical to care optimization for people diagnosed with T2DM. Using a qualitative research, we used semi-structured questions and the Constant Comparison Method to interview 17 practice (registered) nurses with over 1-year experience working in public hospitals across Lagos, Nigeria. The Framework Method was used for data analysis. The nurses provided insight into four areas of patient-centered T2DM management in clinical settings. They are: empowering collaboration, empowering flexibility, empowering approach, and empowering practice. The nurses discussed an empowering pathway through which health settings could provide patient-centered care to individuals diagnosed with T2DM. The pathway includes the integration of macro, meso, and micro levels for patient management. Their views informed the development of a conceptual model for the optimization of patient care. The model developed from this research sits within the Patient-Centered Care model of healthcare delivery. The model has the potential to inform patient-centered care in countries with poorly financed healthcare systems, and developed countries with comparatively better healthcare.
Medication Management and the Role of the Geriatric Pharmacist in Interdisciplinary Care Teams
Authors: Jensen Christine , Burnette Lauren , Zanjani Faika
Published: December 2021

Among adults 65 and older, 30% are taking at least five medications to treat acute and chronic health conditions (Gavin, 2020). As the number of medications increases, the more complex the regimen tends to be, which increases risks with proper management and unwanted side effects. Our interdisciplinary geriatric assessment team has been conducting medication reviews for individuals living with dementia, where geriatric pharmacists meet with these individuals and their family caregiver. These sessions build a trusting relationship, where older adults are able to receive education about their prescription and over-the-counter medications, address any concerns and reach shared goals. Pharmacists routinely recommend deprescribing, and all recommendations are sent to the older adults’ primary care provider. After the initial appointment, a follow-up takes place six months later to re-examine adherence to recommendations and assess outcomes. Since April 2019, our pharmacists have served over 300 individuals, where nearly 90% would recommend this review to others. Pharmacists have recommended over 250 medication changes, averaging 2.53 per person. A statistically significant decrease in prescription medications (from 12.48 to 12.16) has been identified, in addition to a trending decline for over-the-counter medications (3.91 to 3.79). Medication reviews have successfully reduced the overall number of medications, as 36% of recommendations have been accepted by the patient and their healthcare provider. Comprehensive medication review programs, where pharmacists are integrated into an interdisciplinary care team, offer high quality, best practice healthcare, where safety and quality of life is improved for older adults.