bluuebunny/crossref_metadata_2025 huggingface dataset:
Online Training That Changes Family Caregiver Behavior and Attitudes
Authors: de Klerk-Rubin Vicki
Published: December 2021

The Family Caregiver Course (FCC) is an 18-week Validation training to sensitize family carers to the psycho-social needs of their relatives, integrate new behaviors that build relationships and specific verbal and non-verbal techniques to increase communication. Validation Training Institute partnered with the Alzheimer’s Association of Colorado in 2019 and 2020 in delivering this course. Due to COVID-19 limitations, the 2020 iteration was completely digital, using principles of online learning. To replace the two-day in-person component of this course, we developed four, 4-hour Zoom sessions that allowed participants to: practice specific Validation techniques, exercise, process and apply what was learned, role play and receive coaching to anchor skills. Important online rules were maintained, such as, offer opportunities for participant engagement every 10 minutes and create a community of inquiry. Pre- and Post-Surveys of the 2019 and 2020 iterations of FCC showed that after taking this course, family carers: reported that they knew what to do when faced with challenging behaviors from their relative; understood that lying or pretending to agree with a disoriented person was not an effective strategy for communication; gained knowledge of the different forms of dementia and that the differences are significant; were clear about the differences between Validation and other methods.
Spillover Benefits and Achieving Sustainability of Age-Friendly Communities
Authors: Gleason Shayna , Coyle Caitlin , Mutchler Jan
Published: December 2021

As the age-friendly movement grows in its second decade, urgent questions of initiative sustainability have taken hold in the academic literature and among advocates implementing age-friendly changes. The creation of authentically age-inclusive environments requires not just the continuation of the initiative itself, but that its principles become embedded in formal and informal organizational processes, across sectors and beyond familiar networks focused on older populations. This paper argues that sustainability of age-friendly initiatives is enhanced by “spillover” effects, in which a behavioral or policy change in one environment spurs change in another environment. Evidence for such spillover and an understanding of how and when it occurs is currently limited in the context of age-friendly environments. This paper draws on the experiences of Age-Friendly Boston, which has been working towards age-friendly goals for more than five years. Based on Boston’s experience, we identify, describe, and exemplify three pathways to positive spillover across environments: 1) branding positively; 2) publicizing successes; and 3) embarking on new relationships, while strengthening existing ones, in pursuit of shared goals. We also draw conclusions about what positive spillover means for the sustainability of age-friendly environments.
The Role of Secondary Care Networks, Gender, and Race on Primary Caregiver Burden
Authors: Liang Jiaming , Aranda Maria
Published: December 2021

In addition to primary caregivers, many older adults receive care from secondary care networks (SCN), which include family members and friends. Literature rarely considers support that SCN provided to primary caregivers. This study examines: (a) the association between SCN support and primary caregiver burden, and (b) the intersectional effects of gender (male/female)-race (White/Black) identities of primary caregivers on the association. A cross-sectional study using data from 2015 National Health and Aging Trend Study (NHATS) and National Study of Caregiving (NSOC) was conducted. A total of 967 older adults, 967 primary caregivers, and 2253 secondary caregivers were selected. SCN support was measured by (a) care domain overlap, and (b) proportion of caregiving by SCN. Negative binomial regressions on overall and split samples estimated main effects of SCN support and the intersectional effects of gender and race. Both SCN-related variables were associated with primary caregiver burden, but significant three-way interaction was only found between gender, race, and proportion of caregiving by SCN. Black female caregivers reported heaviest burden and having SCN support was associated with lower risk of being burdened. Whereas Black male caregivers reported lightest burden and SCN support was not associated with their perceived burden. Our findings support the positive role of SCN in reducing stress of primary caregivers, and demonstrate that positive impacts of SCN support vary across gender-race groups. The results indicate a strong need for support programs aimed at promoting cooperation among family caregivers for burden reduction, especially families with female and Black primary caregivers.
Lessons Learned in Executing the Nursing Home COVID Action Network
Authors: Faul Anna , Cotton Samantha , Yankeelov Pamela , Gordon Barbara
Published: December 2021

The University of Louisville ECHO Hub for the Nursing Home COVID Action Network put together a hub of experts that could effectively address the diverse needs of the 240 nursing homes in the 7 cohorts launched. We included an infectious disease expert, a geriatrician, and a behavioral health specialist who adjusted the curriculum to be more in line with the needs of the nursing homes. Our nursing homes were diverse in terms of geography, size and location. We created space for our cohorts to feel comfortable with each other, despite their differences. To foster this sense of togetherness, our facilitators used anonymous opinion polls and incorporated the use of virtual breakout rooms to encourage small group discussions. These strategies assisted in developing a sense of community within the Project ECHO sessions, that will continue to evolve in the post COVID world.
Material Hardship Among Custodial Grandparents and Grandchildren's Physical and Mental Health in COVID-19
Authors: Xu Yanfeng , Zhao Qianwei , Schuler Brittany , Levkoff Sue
Published: December 2021

COVID-19 has increased economic hardship for many families, including custodial grandparent-headed families. We aim to examine latent classes of material hardship among custodial grandparent-headed families, to assess predictors associated with identified classes, and to investigate associations with grandchildren’s physical and mental health outcomes during COVID-19. Data was collected from a cross-sectional survey in June 2020. The sample comprised of 362 grandparents. Latent class analysis and logistic regression were conducted. Three latent classes of material hardship were identified: Class 1 (n = 232; 64.1%) low overall hardship with high medical hardship, class 2 (n = 52; 14.4%) moderate overall hardship with high utility hardship, and class 3 (n = 78; 21.5%) severe overall hardship. Factors, such as race, household income, labor force status, financial assistance status, and trigger events to raise grandchildren, were associated with class membership. Class 2 (OR = 0.19, p < 0.05) compared to Class 1 was significantly associated with grandchildren’s physical health. Our findings suggest that material hardship is heterogeneous among custodial grandparents during COVID-19, and children in households experiencing utility hardship have a higher risk for poorer physical health outcomes. Results highlight the needs to meet grandparents’ material needs and call for future research to examine the mechanism that explains the link between material hardship and grandchildren’s outcomes.
Resourcefulness Skills Use by Grandmothers Raising Grandchildren: A Longitudinal Case Study Approach
Authors: Jeanblanc Alexandra , Musil Carol , Tracy Elizabeth , Zauszniewski Jaclene
Published: December 2021

In the U.S., over 2.7 million grandparents are primary caregivers to grandchildren. It is critical to understand the experiences of grandparent caregivers to design tailored, supportive programs. Our aim was to analyze 4 weeks of daily online journals of 129 grandmothers with respect to their use of a set of Resourcefulness Skills© following web-based skills training. Using a thematic analysis approach, coding was completed by a three person team using NVIVO 12. Percent agreement among coders was over 90% (Kappa = .956). Twelve cases were randomly selected for case study development. Comparative case study analysis was used to look within and across cases for instances where skills were used and how skill use changed over time. The pattern of skill use showed that grandmother caregivers used resourcefulness skills to deal with the grandchild’s behavior and developmental issues as well as within the entire family system to manage conflicted relationships with the grandchild’s parents, balance relationships with their spouse/partner, and maintain relationships with other relatives. Case studies will be presented to show skill use over the four weeks of journaling in the context of the family system, as well as the strategies used by participants who improved skill use over time and those who faced barriers to skill use. Findings highlight the use of journals as a means to assess enactment fidelity of treatment interventions and the importance of the family network in skills training program implementation and ways to help grandmothers make use of skills training in the family setting.
Supporting One’s Own? Grandparents’ Help to Grandchildren Who Live With Other Unrelated Children
Authors: Cooney Teresa
Published: December 2021

The structures of young families today are becoming increasingly complex, which may impact grandparents’ involvement. I examine whether grandparents’ support to adult children’s households differs for those with biological grandchildren only, versus households with both biological and non-biological (step, unrelated) grandchildren. The resource dilution hypothesis and sociobiology theory suggest that grandparents will be less supportive of grandchildren when other unrelated children co-reside in their households. Grandparents (mean age 62.23) in the Add Health Parent Study (2015-2017) reported on instrumental and financial help given to each of their adult children's families in the past year. These data were merged with information from their adult children (mean age 36.76) who participated in Add Health Wave V (2016-2018). Adult children’s household structures—biological children only (n=400) or biological + other children (n=51)—were determined using their fertility histories and household rosters. No significant differences were found in the likelihood that grandparents offered any instrumental or financial support to these two household types (controlling for grandparent resources and adult child characteristics). Nor was the level of grandparents’ financial support significantly different for the two groups. However, grandparents gave significantly fewer hours of help to adult children heading households including both biological grandchildren and unrelated children. Grandparents appear less willing to devote time to assisting their grandchildren’s families when their investment is diluted by the presence of unrelated children. Perhaps time with grandchildren is less pleasing or comfortable when unrelated children are present. This same issue does not impact financial giving, which need not involve contact.
CATCH-ON Educational Interventions for Providers, Older Adults, and Caregivers
Authors: Emery-Tiburcio Erin , Newman Michelle , Golden Robyn
Published: December 2021

CATCH-ON, the collaborative GWEP led by Rush University Medical Center, is working to create Age-Friendly Communities by assuring that health systems, community-based organizations, and older adults and families are educated about the 4Ms. For providers, CATCH-ON offers a monthly Learning Community that focuses on one of the 4Ms each quarter. Each session provides practical recommendations for 4Ms implementation and opportunities to share experiences in small groups. CATCH-ON also partnered with Community Catalyst, older adults, and caregivers to develop a 4Ms educational brochure. The brochure is available electronically and by paper to educate older adults and caregivers about the 4Ms and discussing them with their healthcare team. Additionally, CATCH-ON created 4M online modules for older adults and families. This session will explore the success and lessons learned in developing educational interventions for diverse audiences and how this approach strengthens Age-Friendly Communities.
Is Living in an Ethnic Enclave Associated With Better Cognitive Health of Older Immigrants? Results From PINE
Authors: Guo Man , Wang Yi , Xu Hanzhang , Li Mengting , Wu Bei , Dong XinQi
Published: December 2021

This study addressed three questions: 1) Is living in Chinatown associated with better cognition among Chinese older immigrants? 2) Is the association moderated by education, acculturation level, and social engagement? 3) Does the association vary by preferred language (Mandarin, Cantonese, Taishanese), an important indicator of heterogeneity among Chinese immigrants? Data were derived from the Population Study of Chinese Elderly in Chicago (N = 3,055). Results showed that Chinese older immigrants who lived in Chinatown had significantly poorer cognition than those who didn’t, and such a difference was largely due to educational differences between the two groups. Higher education or acculturation buffered the influence of Chinatown residence on cognitive health, but only among those who speak Mandarin. The findings indicate that living in an ethnic enclave may have a negative impact on cognitive function of Chinese older immigrants. The findings also reveal the sources of heterogeneity within the population.
Family Caregivers of Persons With Mild Dementia Share Their Spiritual Struggles
Authors: McGee Jocelyn , Morgan Davie , Myers Dennis
Published: December 2021

The lives of family caregivers of persons with Alzheimer’s disease and related dementias (ADRD) may change dramatically with disease progression in their loved one. Many rely on spirituality as a resource for coping. There is evidence that persons experiencing transition/losses, as a consequence of disease/illness, can experience spiritual struggles or a crises in meaning. However, there is limited research related to spiritual struggles among family caregivers of persons with ADRD, particularly in the beginning stages of the disease process. In this study, three domains of spiritual struggle were identified after analyzing 27 caregiver interviews using the constant comparative method: 1) changes in relationship with their higher power (e.g., feelings of anger towards, feeling punished by, feeling disconnected from, and questioning); 2) changes in spiritual practices (e.g., decreased participation as a consequence of feeling unsupported, judged, or misunderstood by spiritual communities); and 3) dissonance between previously held core beliefs and current life circumstances (e.g., feelings of shame, doubt, and guilt as well as cessation of self-care activities due to the belief that they must sacrifice everything for their loved one). Notably, 74% experienced spiritual struggle in one domain; 33% in two domains, and 11% in three domains. The majority of participants had come to resolution of these spiritual struggles by the time they were interviewed. However, 40.7% were experiencing ongoing spiritual struggles, at the time of interview, suggesting the importance of identifying and addressing spiritual struggles in this population over time in order to enhance coping and adaptation.
Religiosity Among Young-Adult Baby Boomers: Associations With Psychological Well-Being Over 45 Years
Authors: Cheng Kent Jason , Brown Maria , Hwang Woosang , Silverstein Merril
Published: December 2021

Past studies on the influence of religiosity on psychological well-being tended to be cross-sectional in nature and neglected generational differences. In this study, we assess how religiosity in early adulthood (mean age = 19) affects baby-boomers’ psychological well-being over the life course. We used waves 1 to 9 or 45 years of survey data from the Longitudinal Study of Generations (LSOG) (N=798), a sample of Southern Californians. First, we used latent class analyses on five domains to identify three typologies of baby boomers’ religiosity in early adulthood. We call these typologies “strongly religious,” “weakly religious,” and “personally religious.” Then, we used latent growth curve modelling to ascertain the influence of these religiosity typologies on psychological wellbeing from waves 1 to 9, controlling for time-invariant (religious affiliation, age, sex, race, parental income) and varying (religious salience, education, marital status, and annual income) factors. We found that the strongly religious have a consistently upward psychological wellbeing trend throughout the study period whereas wellbeing started to decline for the weakly religious and personally religious at around wave 6, on when they were about mid-40s to almost 50. We provide evidence that religiosity in early adulthood – a period in life characterized by the exploration of various options for the future brought about by greater personal freedom – positively influences baby boomer’s psychological wellbeing over the life course.
Functional MRI to Assess Decision-Making Capacity of Older Adults With Dementia: A Proof of Concept Study
Authors: TANNOU Thomas
Published: December 2021

Assessment of decision-making capacity is essential to respect older adult dignity, particularly concerning major decision such as ageing in place. To date, it is the clinician's assessment, based on a global analysis of his clinical evaluation and neuropsychological tasks, which enables decision-making assessment. Given the difficulty it represents, and the ethical and societal issues raised, the research question concerns the contribution of neuro-imaging technologies as an aid to the evaluation of decision-making capacity. We included in our proof-of-concept study 4 healthy older patients and 2 older patients with dementia (mild stage) followed in a memory clinic. Each of the participants completed neuropsychological tests with a focus on executive functions, anosognosia and judgemental skills. Next, they performed a decision-making task, the Balloon Assessment Risk Task (BART) in functional MRI, and, finally, they participated in a semi-structured interview completed with interview of their caregiver. For both patients, their referring geriatrician was questioned a priori on his assessment of their decision-making capacity. The results showed a common activation pattern in functional MRI between the patient considered competent in decision-making and the healthy subjects, unlike the patient who was not clinically competent. The qualitative analysis highlighted major anosognosia in both pathological situations, but decision-making in everyday life situations differed between the 2 patients. This study shows the feasibility, on a sensitive topic, to explore the potential contribution of functional neuroimaging and semi-directed interviews as tools. It also demonstrates the value of conducting mixed research, combining neurosciences and social science to explore complex clinical issues.
What Keeps Older People out of Nursing Homes? A Meta-Analysis
Authors: Gaugler Joseph , Zmora Rachel , Peterson Colleen , Mitchell Lauren , Birkeland Robyn , Jutkowitz Eric , Duval Sue
Published: December 2021

Perhaps one of the most examined, and costly, health transitions older people experience is nursing home admission. In addition to the financial costs nursing home admission poses to older people, their families, and other payers (e.g., the public), institutionalization is linked with a range of negative outcomes and represents a loss of independence and quality of life to many older persons. The current meta-analysis attempted to synthesize all available randomized controlled trials available to ascertain which intervention approaches appeared to prevent nursing home entry for older adults. The MEDLINE, PsycInfo, CINAHL, Cochrane, and EMBASE databases were searched to August, 2020. Abstracts were screened (N = 28,120) to identify randomized controlled trials of interventions to prevent or delay nursing home admission as well as systematic reviews. Identified studies were cross-referenced until the point of saturation, resulting in 1,786 studies for additional inclusion/exclusion screening. Following a consensus-based review among the authors that included risk of bias, 323 randomized controlled trials were included in the meta analysis. Although several intervention modalities appeared protective against nursing home admission and approached statistical significance, preliminary results suggest that comprehensive geriatrics assessment (pooled OR = .69, 95% CI: .50, .95) and specialized, inpatient geriatrics care (pooled OR: .77, 95% CI: .59, .99) were most consistent in helping to prevent institutionalization among older persons. The findings emphasize the importance of geriatrics when delivering optimal care to older persons. Integrating such approaches more effectively into a largely fee-for-service healthcare paradigm remain a critical challenge.
Caloric Restriction Mimetics Attenuate the Hallmarks of Aging
Authors: Kroemer Guido
Published: December 2021

Nutrient depletion, which is one of the physiological triggers of autophagy, results in the depletion of intracellular acetyl coenzyme A (AcCoA) coupled to the deacetylation of cellular proteins. We found that there are at least 4 possibilities to mimic these effects, namely (i) the depletion of cytosolic AcCoA by interfering with its biosynthesis, (ii) the stimulation cytosolic AcCoA consumption, (iii) the inhibition of protein acetyltransferases, or (iii) the stimulation of protein deacetylases. Thus, AcCoA depleting agents, AcCoA-consuming agents, acetyltransferase inhibitors or deacetylase activators are highly efficient inducers of autophagy and reduce aging-associated diseases including diabetes, obesity, cardiac failure and failing cancer immunosurveillance. Hence, we classify them as "caloric restriction mimetics" (CRM). We have initiated the systematic search for CRMs based on their cellular effects in vitro. We built screening assays amenable to high-throughput technology for the identification of CRMs. These results will be discussed.
From Awareness to Social Action: The Role of Dementia Friends in Sustaining Dementia Inclusiveness
Authors: Burman Bonnie , Williman Martha
Published: December 2021

According to the World Dementia Council, three components are important to effectively engage a community to become dementia inclusive, 1) raising awareness and consequently decreasing stigma, 2) enabling participation, and 3) providing support—including in health and care settings. Too many times these components are separate initiatives thus limiting their effectiveness and sustainability. By applying the collective impact model and utilizing the Dementia Friends program as the link between the three, all dementia inclusive efforts can be enhanced and sustained regardless of the range of activities and approaches a community chooses to adopt. This symposium provides both evidence and examples of how to personalize and employ the Dementia Friends program to optimize the process, outcome, and impact of dementia inclusive initiatives. By engaging the entire community, awareness is raised, the structure is in place to enable action, and cross-sector collaboration will ensure continuation and sustainability of these important efforts.
Mastery Goals for Black American Dementia Caregivers
Authors: Johnson Kalisha Bonds , Epps Fayron , Brewster Glenna , Clevenger Carolyn , Daniel Gaea , Pak Victoria , Paul Sudeshna , Hepburn Kenneth
Published: December 2021

About 5.8 million older American adults live with Alzheimer’s disease and related dementias; Black American older adults’ prevalence is more than twice that of non-Hispanic white older adults. The Black American dementia caregiving experience can be pictured within the Black Family Social-Ecological Context Model, which provides a conceptual basis for examining social determinants of health at individual, family, community, and societal levels with careful consideration for how the intersecting identities of race, gender, and class of Black American caregivers influence the multiple dimensions of their caregiving experiences. Family dynamics, community setting, and healthcare systems have a potentially bidirectional influence on these caregivers, which is informed by the larger historical reality of systemic racism and general disenfranchisement. This paper outlines how Stress Process and Perceived Control frameworks offer ways for Black American dementia caregivers to achieve a sense of mastery within the complicated and fraught ecology within which their caregiving occurs. We propose a research and development agenda to create a program for enhancing a sense of mastery among Black American dementia caregivers. Two concepts in particular, “constraints” and “efficacy expectations,” provide ways to develop a systematic approach to developing successful coping strategies for the constraints perceived by individuals as they undertake and function in the caregiving role. The recognition of the complexity of the caregiving ecosystem and intersectionality of caregivers’ experience emphasize the importance of individualization: each caregiver’s experience of this ecosystem– and therefore each Black American caregiver’s way to mastery within it– will be uniquely shaped and experienced.
Childhood Socioeconomic Status and Cognitive Aging: An Intersectional Life Course Perspective
Authors: Reynolds Addam , Greenfield Emily , Moorman Sara , Reyes Laurent
Published: December 2021

Greater childhood socioeconomic status (cSES) is associated with better later life cognition. Largely absent from this literature is how structural racism potentially influences this relationship. Guided by intersectional life course theory, we examined if the influence of cSES and region of schooling on later life cognitive outcomes differs among non-Hispanic White (NHW) and Black older adults. We used data from the 2010-2016 waves of the Health and Retirement Study for participants ages 65 and older in 2010. Using growth mixture modeling, we estimated the associations between race, cSES (parental education, social, and financial capital), and region of schooling at age 10 (southern versus not) on cognitive performance. Consistent with prior research, there was a main effect of race on cognitive performance levels (but not with decline over time), with lower scores among older Black adults, on average. Among NHWs, higher cSES was protective for later life cognition, especially for NHW participants from the South. Although Black older adults who attended school outside of the South had higher levels of cognitive performance than their counterparts who attended school at age 10 in the South, Black older adults who attended school outside of the South--regardless of cSES--still had lower average scores on cognition at baseline than the most disadvantaged NHW participants. This paper implicates the effects of structural racism on cognitive performance among older Black adults, indicating the need for heightened attention to structural racism within interventions for optimizing brain health and promoting equitable cognitive aging across the life course.
Refining Care to Plan: Delivering Personalized Recommendations to Support Dementia Caregivers
Authors: Cha Jinhee , Peterson Colleen , Millenbah Ashley , Louwagie Katie , Baker Zachary , Jensen Christine , Gaugler Joseph
Published: December 2021

Caregivers of persons living with Alzheimer’s disease and Alzheimer’s disease-related dementias (PLWD; AD/ADRD) benefit from unique interventions to address their different needs. While information on which interventions best meet specific needs exists, less is known about how to match caregivers with those interventions. To address this research gap, we tested Care to Plan (CtP) within a large healthcare system. After care navigators guided caregivers through twenty CtP tailoring questions to identify caregivers’ greatest needs, the online tool provided the intervention type best suited to meet their needs, along with region-specific information on available programs. This mixed methods analysis evaluated the utility of the CtP tool with 20 family caregivers of PLWD after a 1 month follow-up. Most caregivers agreed that the CtP tool was helpful (85%) and would recommend the tool to other caregivers (90%). Caregivers also said they valued being able to discuss the CtP recommendations with the care navigator (95%). However, only 65% said they found services that met their needs or planned on using services recommended by CtP. Interview data indicate time constraints and restricted availability of resources due to COVID-19 precautions reduced caregivers’ abilities to pursue some recommendations. In addition, the stage of dementia experienced by their care recipient may explain why others found CtP less useful. However, these caregivers noted the potential utility of the resources for their future care planning needs. A larger evaluation of the CtP tool within the healthcare system is ongoing.
COVID-19 Death in High-Medicaid Nursing Homes: The Role of Employment Empowerment
Authors: Lord Justin , Davlyatov Ganisher , Ghiasi Akbar , Weech-Maldonado Robert
Published: December 2021

This study examines the association between COVID-19 death and employee empowerment in under-resourced nursing homes (70% or higher Medicaid census). Employee empowerment captures elements of participative decision making, autonomy, responsibility, open communication, decentralization, and decision-making flexibility within an organization. Survey data from 391 Directors of Nursing (response rate of 37%) from 2017-2018, were merged with secondary data from CMS Nursing Home COVID-19 Public File, LTCFocus, Area Health Resource File, and Nursing Home Compare. A Poisson regression was used to examine reported COVID-19 death and employee empowerment. The independent variable employee empowerment was the mean score of summated Likert scale questions. Control variables included organizational (size, location, ownership, chain affiliation, quality, payer mix, acuity, occupancy, and race/ethnicity, staffing mix), and county factors (Medicare Advantage penetration, per capita income, poverty, unemployment, education, 65+ population, and competition). Employee empowerment was associated with a lower number of COVID-19 cases (p < 0.05). Rural, not-for-profit, and payer-mix were also significantly associated with a lower number of COVID-19 deaths. Employee empowerment captures the decentralization of authority and an employee’s ability to make decisions without approval. In light of this crisis, empowerment may have helped under-resourced nursing homes be more agile and faster in their response. High-Medicaid nursing homes may need to consider different decision-making practices when faced with a crisis, such as, COVID-19.
Trajectories of Body Mass Index and Multimorbidity in Old Age: 12-Year Results From a Population-Based Study
Authors: Calderón-Larrañaga Amaia , Hu Xiaonan , Guo Jie , Ferrucci Luigi , Xu Weili , Vetrano Davide
Published: December 2021

We aimed to study the association of long-terms trajectories of body mass index (BMI) with contemporaneous changes in multimorbidity development in older adults. Twelve-year BMI trajectories (2001–2013) were identified in subjects aged 60+ years from the Swedish National Study on Aging and Care-Kungsholmen (SNAC-K) using growth mixture models (N=2,189). Information on chronic diseases and multimorbidity was ascertained based on clinical examinations, lab tests, medications, and inpatient and outpatient medical records. Linear mixed models were used to study the association between BMI trajectories and the speed of chronic diseases accumulation, in general and by groups of cardiovascular and neuropsychiatric diseases. Eighty percent of the study population was included in a stable BMI trajectory, 18% in a slow-decline trajectory with an accelerated BMI decline from age 78 onwards, and 2% in a fast-decline trajectory that reached underweight values before age 85. A significantly higher yearly rate of chronic disease accumulation was observed in the fast-decline versus stable trajectories (β=0.221, 95% CI 0.090-0.352) after adjusting for age, sex, education and time to death. Subjects in the slow-decline trajectory showed a significantly higher rate of cardiovascular diseases accumulation (β=0.016, 95% CI 0.000-0.031); those in the fast-decline trajectory showed a faster accumulation of both cardiovascular (β=0.020, 95% CI -0.025, 0.064) and neuropsychiatric diseases (β=0.102, 95% CI 0.064-0.139), even if the former association did not reach statistical significance. Carefully monitoring older adults with sustained weight loss seems relevant given their likelihood to develop a phenotype of rapidly accumulating chronic -especially neuropsychiatric- diseases.
Bringing Transdisciplinary Aging Research From Theory to Practice
Authors: Sargent Lana , Gendron Tracey , Mackiewicz Marissa , Diallo Ana , Zanjani Faika , Price Elvin , Parsons Pamela , Ford Gregory
Published: December 2021

There is a growing emphasis to use a transdisciplinary team approach to accelerate innovations in science to solve complex conditions associated with aging. However, the optimal organizational structure and process for how to accomplish transdisciplinary team science are unclear. In this study, we illustrate our team’s experience using transdisciplinary approaches to solve challenging and persistent problems for older adults living in urban communities. We describe our challenges and successes using the National Institutes of Health four-phase model of transdisciplinary team-based research. Using a de-identified survey, the team conducted an internal evaluation to identify features that created challenges including structural incongruities, interprofessional blind spots, group function, and group dynamics. The team then identified responses to address the features that created challenges and determined indicators for success. Indicators for success were identified by the team as a place for continued evaluation of the teams’ collaborative effectiveness, transdisciplinary integration, and impact on the university and aging community. This work resulted in the creation of the team’s Transdisciplinary Conceptual Model. This model became essential to understanding the complex interplay between societal factors, community partners, and academic partners. Conducting internal evaluations of transdisciplinary team processes is integral for teams to move beyond the multi- and interdisciplinary niche and to reach true transdisciplinary success. More research is needed to develop measures that assess team transdisciplinary integration. Once the process of transdisciplinary integration can be reliably assessed, the next step would be to determine the impact of transdisciplinary team science initiatives on aging communities.
Older Student Experiences: A Critical Examination of Aging on Campus
Authors: Barragan Cassandra , Walsh Sarah
Published: December 2021

There is overwhelming evidence that the number of older learners on college campuses has been steadily increasing since the 1970s. The needs of older learners differ from traditional students, and many services and resources available at higher education institutions are geared towards students aged 18-25 (Silverstein, Choi, & Bulot, 2001). Age Friendly University (AFU) principles highlight the need to consider older learners at a university and provide structure to evaluate programs and practices and to enhance inclusion and diversity based upon age. This study examined how an AFU designated university is working to better understand their older students. Methods: A web-based pilot survey of older learners (N=248) asked all students ages 40 and older a series of questions regarding motivation to attend school, barriers and supports, campus environment, and connection with AFU principles. Analysis: A regression analysis found that older learners who felt more welcomed by faculty (p=.001), administration (p=.002),and student organizations (p=.026) were more likely to feel connected to campus, and younger-older students (p=.031) and those who did not feel their job was a barrier to attending school (p=.037) were more likely to feel satisfied with their level of engagement on campus. Additionally, older learners felt the AFU principles were demonstrated by their university. Discussion: The experiences of older learners are important as we continue to see higher numbers of students over the age of 40. Our results demonstrate the need to engage older learners as part of diversity and inclusion efforts to facilitate connection to the campus community.
Toward Age-Friendly High Education: An Intergenerational Participatory Co-Design Approach
Authors: Vivian W Q Lou , Woo Esther , Pan Nicol , Cobb Peter J , Hu Xiao , Cheng Michael
Published: December 2021

Objective: When aging becomes a global challenging, we believe it is timely important to equip aging knowledge among university students regardless of their disciplinary study subjects. This study aims to describe principles and process of development an aging-related curriculum in high education entitled “Intergenerational Participatory Co-design Project (IPCP)” and evaluate its impacts. Methodology: Guided by a key principle of involving participants of any learning context as co-creators of both the learning process and learning outcomes, IPCP went through four stages of development including capacity building, co-creation on learning objectives, deliberated content learning, and learning outcome dissemination. Mixed methodology including qualitative in-depth interview and quantitative questionnaire were applied in evaluation. A total of 26 participants, from three generations recruited from one university, one secondary school, and a pool of senior champions under a geron-infusion initiative participated. Findings: after attaining capacity building workshops applying Optimal Quality Intergeneration Interaction Framework, three learning groups formulated. A common theme “preserving cultural heritage” emerged, while each group has identified a specified focus (e.g., food, Tai Ji, and historic sites guide). Quotes collected and survey data revealed positive impacts in reducing stereotype and enhancing learning experiences. Conclusion: IPCP demonstrated good practices in role models in multi-disciplinary collaboration in pedagogy innovation. It also paved solid way towards a learning community interwoven with continuous innovation: IPCP becomes a pioneer contributor of library’s digital data hub solution; common core office starts to develop a human lifespan cluster; two research team members started new collaboration on geron-infusion in Faculty of Education.
Building Caregiver Resilience: Pitfalls and Potential for Interventions
Authors: Lee Jeongeun , Peterson Natasha , Zarit Steven
Published: December 2021

Informal caregivers provide substantial practical and emotional support for individuals with chronic and acute conditions. Consequently, many experience caregiver burden and are at high-risk for psychological morbidity and associated breakdown in the provision of care for care recipients. Many psychosocial interventions have been designed to help caregivers. However, more work is needed to identify which, or what kind of, interventions are optimal for identifying suitable strategies and care management. The main objectives of this symposium are to (1) address psychosocial and demographic factors contributing to caregiver resilience, (2) understand the role of cognitive and behavioral factors that have implications for caregivers’ psychological well-being, and (3) specify different caregiving styles and adaptive outcomes. This symposium assembles a panel of experts and brings together empirical research on various challenges that need to be addressed and potential opportunities for creating effective psychosocial intervention targets for caregivers. The first session will discuss several psychosocial and demographic factors associated with resilience among caregivers. The second session will share how caregiving appraisals are closely related to positive and negative affect and whether the level and changes in caregivers’ activity participation moderate this linkage. The third session will identify caregiving styles and strategies utilizing k-modes machine learning analysis and share how caregivers adapt to care situations. The final session will present caregivers’ stress experiences related to dementia patients’ behavior and psychosocial symptoms in dementia during the day. The session will conclude with Dr. Zarit, who will integrate the four papers and offer insight on implications across studies.
Future Eldercare Planning Among Chinese Aging Families in Hong Kong
Authors: Bai Xue , Luk Joanne , He Ranran , Kwong Yanyee
Published: December 2021

Increasing attention has been paid to the potential role of care planning in buffering future eldercare challenges. However, little is known about the characteristics of care planning among Chinese ageing families. It is also of interest to reflect how recent events such as COVID-19 pandemic may affect their views of the future care planning. From a family systems perspective, this study explored the extent, processes, and contents of intergenerational care planning of Chinese ageing families in Hong Kong. Dyadic interviews were conducted with 60 adult child-older parent pairs, and individual interviews were conducted with another 33 adult children. Intergenerational discrepancies in extent and processes of care planning, intergenerational congruence of care expectations and struggles, facilitating role of family capital and hindering role of cultural capital in care planning were primary themes. Although both generations demonstrated strong awareness of future eldercare needs, they were found engaged in different levels and processes of care planning. Adult children’s level of engagement in planning activities may influence parents’ extent and contents of care planning. Intergenerational transmission of eldercare values contributed to intergenerational congruence of care expectations but also led to similar struggles and ambivalent attitudes toward future care. Moreover, family capital was found to facilitate family care planning while Chinese cultural values that emphasize family care may hinder both generations’ efforts in care planning. The findings will deepen our understanding on characteristics of intergenerational care planning in Asian Chinese communities and inform services to improve adult children and ageing parents’ preparation for future eldercare.
Patterns of Intergenerational Care Planning Among Chinese Aging Families in Hong Kong
Authors: Bai Xue , Liu Chang , Xu Tongling
Published: December 2021

Care planning before the onset of intensive care needs can increase families’ ability to manage caregiving crises and cope with care transitions. However, future care planning has not been substantially examined in a family context. Drawing on the model of Preparation for Future Care Needs and a family systems perspective, this study investigated patterns of intergenerational care planning across multiple planning domains (awareness, avoidance, information gathering, decision making, and concrete planning) among Chinese intergenerational pairs. Quantitative data of 213 pairs of aging parents and adult children were collected in Hong Kong. Latent Profile Analysis was conducted to examine typological structure underlying care planning patterns. Three patterns were discovered: filial-maximal, dyadic-moderate, and filial-minimal. Profile 1 contained approximately 9.9% of pairs, which demonstrated a relatively higher level of avoidance on considering the need of care preparation and engaged less in concrete planning activities. Profile 2 contained 68.5% of intergenerational pairs that had a moderate preparation level. Profile 3 contained 21.6% of intergenerational pairs that were comparatively active in care planning. The findings also indicated that although older adults across three groups demonstrated a similar level of awareness to prepare for future care, their engagement in the concrete planning activities may be driven by their children’s awareness and preparation toward future care. The findings will enhance professionals’ and service providers’ awareness of diverse care planning patterns among Asian aging families, and inform targeted policies and programmes to alleviate unpreparedness for eldercare through intergenerational care planning which can be more effective than unilateral preparation.
Temporal Patterns of Daily Behavioral and Psychological Symptoms of Dementia Throughout the Day
Authors: Connelly Caitlin , Kim Kyungmin , Liu Yin , Zarit Steven
Published: December 2021

Behavioral and psychological symptoms of dementia (BPSD) are taxing for both the person with dementia (PWD) and their family caregivers. Yet, little is known about how BPSD fluctuates throughout the day (i.e., morning, daytime, evening, and night; e.g., sundowning) and how caregivers perceive BPSD at different times of the day. Using 8-day daily diary data from 173 family caregivers whose relatives were using Adult Day Services (ADS), this study investigated temporal patterns of BPSD and caregivers’ stress responses to BPSD throughout the day. Overall, the number of BPSD was highest in the evening, and caregivers’ stress reactivity to BPSD increased throughout the phases of the day (i.e., most stressful at night). However, caregivers showed lower reactivity to BPSD in the mornings and at night on days when the PWD used ADS. Our findings about fluctuations of (caregiver reactions to) BPSD throughout the day suggest target windows for just-in-time adaptive intervention.
Disruptions and Adaptations in End-of-Life Care Delivery for Homebound Patients During COVID-19
Authors: Franzosa Emily , Kim Patricia , Zhang Meng , Reckrey Jennifer , Lubetsky Sara , Xu Emily , Ornstein Katherine
Published: December 2021

The initial COVID-19 pandemic surge in New York City caused widespread delays and disruption in end-of-life services. This study examined the impact of disruptions among homebound adults in an HBPC practice who died between March-June 2020. Through an in-depth mixed-methods chart review, we identified 113 patient deaths (mean age: 87, 73% female, 67% with dementia). Forty-nine (43%) of deaths occurred in April 2020. Through a content analysis of clinician notes, we identified key COVID-related themes, including a shift to intensive phone-based care and to a lesser degree, telehealth; delays in hospice referrals and admissions; and an increase in treatment for behavioral symptoms. Our analysis also demonstrated the central role of family and paid caregivers in coordinating care, and efforts by patients, caregivers and providers to avoid hospital admissions. These findings demonstrate the importance of care coordination across medical, home and community partners to support end-of-life care in emergencies and beyond.
Translating Science Into Practice and Making It Stick: System-Level Approaches
Authors: Wray Laura , Curyto Kim , Sullivan Jennifer
Published: December 2021

The delay between establishing evidence-based practice and implementing this evidence base is well documented. This presentation will focus on the application of implementation science principles to real-world clinical programs. A VA priority is to implement evidence-based practice for management of DBD in CLCs. Key implementation science concepts will be introduced, along with a description of how these conceptual models facilitate application of roll-out and sustainment of complex evidence-based interventions. Conceptual frameworks that contributed to intervention selection and facilitation of STAR-VA implementation, including the Consolidated Framework for Implementation Research (CFIR) and Knowledge Reservoirs (KR) framework, and their application in health care practice, will be discussed. The CFIR Expert Recommendation for Implementing Change (ERIC) Mapping Tool will be introduced as useful to identify strategies that address barriers to sustaining implementation. Attendees will be provided with resources to support implementation and sustainment efforts.