bluuebunny/crossref_metadata_2025 huggingface dataset:
Project ECHO-Age Friendly Community Care: Applying the ECHO® Model with Area Agency on Aging Staff
Authors: Bennett Katherine , O'Leary Mary Pat , Phelan Elizabeth
Published: December 2021

The Extension for Community Healthcare Outcomes (ECHO®) model originated at the University of New Mexico to improve access to specialty care in underserved communities via telehealth and has spread worldwide. It has been utilized to improve geriatrics care with interprofessional participants but not specifically to train community case managers in Age-Friendly care and community initiatives. This is a program evaluation of an ECHO developed exclusively for Area Agency on Aging (AAA) case managers via a community-campus partnership. Twenty-eight AAA staff (including 15 case managers) participated in a 6-session series (March through April 2021) focused on the 4Ms of Age-Friendly care (What Matters, Medication, Mentation, and Mobility). Each one-hour session included a mini-didactic and at least one case presented by participants utilizing a novel age-friendly case form. Participants completed pre and post surveys to assess self-efficacy in applying Age-Friendly principles on 5-point scales. Surveys were anonymous and analyzed comparing pre-post using Mann-Whitney U tests. Of the 28 participants, 86% completed pre and 65% post-surveys. Self-efficacy for providing Age-Friendly care improved from 2.58 pre to 4.5 post (p<0.001) and for providing recommendations to colleagues on Age-Friendly care from 3.4 pre- to 4.5 post (p<0.001). Participants showed significantly increased self-efficacy (p<0.05) pre vs. post on 14/15 Age-Friendly care items. One hundred percent would recommend this ECHO program to a colleague. This pilot utilizing Project ECHO with AAA staff increased their self-efficacy for providing Age-Friendly care and suggests this may be an effective tool to bridge the Age-Friendly Health Systems and Age-Friendly Community initiatives.
Stereotypes of Older Adults, Older Men, and Male Leaders Predict Expectations, Stance, and Voting Intentions
Authors: Monahan Caitlin , Lytle Ashley , Inman Elizabeth , Apriceno Marybeth , Macdonald Jamie , Levy Sheri
Published: December 2021

The 2020 U.S. Presidential Election offered a unique opportunity to examine how stereotypes of older adults, older men, and male leaders impact expectations of candidate job performance and intentions to vote for Biden or Trump. This online study involved 500 college students from two universities from September 30th until November 3 (Election Day). A Biden and Trump model were tested for the relationships among (a) stereotypes from public discourse with (b) expectations of candidates/ presidential performance with (c) voting stance (pro- and anti-Biden vs pro- and anti-Trump) and (d) intentions to vote for Biden/Trump. As expected, for the Biden model, endorsement of older adult (lesser endorsement of senile, unhealthy), male leadership (greater endorsement of assertive and collaborative, lesser endorsement of uncaring), and older male stereotypes (greater endorsement of elder statesman and family-focused) predicted greater expectations of Biden’s performance, which predicted pro-Biden and anti-Trump stances and ultimately voting intentions for Biden. As expected, for the Trump model, endorsement of older adult (lesser endorsement of senile), male leadership (greater endorsement of assertive, collaborative, lesser endorsement of immoral and uncaring), and older male stereotypes (greater endorsement of elder statesman) predicted greater expectations of Trump’s performance, which predicted pro-Trump and anti-Biden stances and ultimately voting intentions for Trump. Taken together, these results suggest examining relevant categories of stereotypes associated with candidates and voting stances provides a fuller picture of voting behavior toward multiple candidates vying for office in addition to political ideology and voting intentions.
Acceptability of a Newly Developed Financial Program for Caregivers of Individuals Living with a Chronic Illness
Authors: Grant Claire , Fazio Sam , Moreno Monica , Kallmyer Beth , Lanigan Kerry , Judge Katherine
Published: December 2021

Over 40 million informal caregivers provide care to adults aged 50 or older with a chronic illness. In addition to the negative health and well-being impact, caregivers experience financial difficulties including lost income, retirement benefits, future earnings, and unanticipated out-of-pocket costs. Few evidence-informed programs exist to assist caregivers in understanding and managing these financial tasks. This poster presents preliminary acceptability data from 71 caregivers who completed the newly developed Managing Money: A Caregiver’s Guide to Finances program. The 60-minute program was delivered online by trained community educators and addressed caregiving costs/impacts; future planning; initiating conversations; avoiding financial abuse/fraud; and identifying needs. Participants (Mage = 59.45, SD = 11.31) were 87.32% female with 77.46% self-identified as White, 9.86%, as Black, and 8.45% as Hispanic/Latino. Using a Likert scale (1=strongly disagree to 5=strongly agree), participants indicated the program: 1) identified financial challenges (M= 4.11 ; SD = 0.73); 2) provided information for managing money (M = 3.99; SD = 0.64); 3) content was easy to read/understand (M = 4.49; SD = 0.61); 4) program length was appropriate (M = 4.18; SD= 0.68); and 5) activities were helpful (M = 4.13; SD = 0.69). Participants rated the program as very important (M = 4.54; SD = 0.82) and would highly recommend (M = 4.52; SD = 0.53). Results indicated the program was well-received by participants and highly acceptable. Discussion will highlight key program features designed to promote acceptability along with the importance of measuring acceptability for large-scale implementation along with next research steps.
Association Between Length of Residence in the U.S. and Insurance Coverage Within U.S. Chinese Older Adults
Authors: Tuseth Natalie , Dong XinQi , Bergren Stephanie , Eng Michael
Published: December 2021

Barriers to affordable insurance may worsen disparities among underserved populations. Immigrants with <5 years of residence are not eligible for Medicare and Medicaid and are potentially without affordable alternatives. This study aims to look at the relationship between length of residence in the U.S. and insurance coverage within U.S. Chinese older adults ages 65+.This study used data from a representative sample of 2,365 community-dwelling U.S. Chinese older adults age 65+. The association between length in the U.S. (<5, 6-10, 10+) and insurance status was analyzed using chi squared test and logistic regressions. Within this sample, 58 (2.78%) participants had coverage outside Medicare and Medicaid, with 279 participants reporting no coverage. The vast majority of participants living in the U.S. <5 years had no insurance (81.48%). In a fully adjusted model, participants who were older and female were positively associated with having insurance coverage (OR:1.11 [1.07,1.15] and OR:1.29 [0.88,1.90]). Conversely, both living in the U.S. <5 years (OR:0.009 [0.006, 0.014]),and between 5-10 years (OR:1.20 [0.13,0.30]) were negatively associated with insurance coverage. When including coverage outside of Medicaid and Medicare, residence <5 years and 5-10 years were still negatively associated with insurance coverage ((OR:0.13 [0.009,0.02]), and (OR:0.19 [0.13,0.30])). Vulnerable populations such as older immigrants may not have access to insurance outside of public options, making a 5-year waiting period an additional barrier to quality health care.
Poll Findings on Social Connection and Technology Use During the COVID-19 Pandemic
Authors: Solway Erica
Published: December 2021

The National Poll on Healthy Aging conducted an online survey of a nationally representative sample of adults age 50-80 (n=2,074) in June 2020 about experiences related to loneliness, their physical environments, and telehealth and technology use. 41% felt a lack of companionship, and 46% reported infrequent social contact. Feelings of loneliness were more likely among those who lived alone or who did not have access to features in their neighborhood and community which may offer opportunities for safe interactions. The poll also found that 26% of adults age 50-80 had a telehealth visit March through June 2020 and 64% overall reported being comfortable with video conferencing technology, with notable differences by demographic subgroup. These results highlight the need for new opportunities for older adults, especially those with the greatest social and economic need, to feel connected and to be confident using technology, both during and after the pandemic.
Caregiving for Persons Living With Dementia in the New Normal: Family Caregiver’s Perspective.
Authors: Shrestha Priyanka , Fick Donna , Boltz Marie , Loeb Susan , High Andrew
Published: December 2021

Persons living with dementia (PLWD) are at increased risk for COVID-19 and associated poor outcomes, including: incident delirium, hospitalization, severe symptoms, intensive care admission, and even death. PLWD are likely to rely on family caregivers to maintain their health and well-being in the community. Under normal circumstances, caregiving can be stressful and complex, and the COVID-19 pandemic has the potential to change and exacerbate the stresses of family caregiving. As a part of a larger study using descriptive qualitative methodology to explore the family caregiver understanding and experiences related to delirium in caring for a person with dementia, 14 participants (age x̄ =67, SD= 13.8) were asked about the impact of COVID-19 on their caregiving for PLWD. Thematic analysis of the transcribed interviews using Dedoose generated four overarching themes associated with the family caregiver’s perspective of changes in caregiving during the COVID-19 pandemic: 1) Cautious of COVID-19 exposure, 2) We can’t go in, 3) Feeling of isolation for both the PLWD and caregiver, and 4) Six-feet distance. The current study highlights the importance of understanding the needs of PLWD during a pandemic based upon the perspective of their family caregivers and will inform the development of ways to safely incorporate family caregivers in the interdisciplinary care team. Caregivers are integral to the care of PLWD across settings of care and should be partners even during a pandemic. Solutions for care include integrating technology for individualized approaches. Finally, future areas for research will be discussed.
Cohort Differences in Daily Life: Older Adults Have Higher Affect Variability Than 18 Years Ago
Authors: Drewelies Johanna , Koffer Rachel
Published: December 2021

Lifespan psychological and life course sociological perspectives have long acknowledged that individual functioning is shaped by historical and socio-cultural contexts. Secular increases favoring later-born cohorts are widely documented for general well-being (among older adults). However, little is known about secular trends in short-term fluctuations in daily affective well-being and whether historical changes have occurred in young, middle-aged, and older adults alike. To examine these questions, we compared data from two independent national samples of the NSDE survey obtained 18 years apart (1995/96 vs. 2013/14) and identified case-matched cohorts (per cohort, n = 782, aged = 23–75 years) based on age and gender. We additionally examine the role of economic and health resources for cohort differences in affective variability. Results revealed that later-born cohorts report higher variability in daily negative affect than did those 18 years ago. In contrast, no cohort differences emerged in variability in daily positive affect. We conclude from our national US sample that secular trends in affect variability do not generalize unanimously to different timescales across adulthood. We discuss possible underlying mechanisms and practical implications.
Do Caregiver Interventions Improve Outcomes in Relatives With Dementia? A Meta-analysis
Authors: Cheng Sheung-Tak
Published: December 2021

Despite plenty of reviews on the benefits of nonpharmacological interventions for dementia informal caregivers, large-scale review on the effects of these interventions on the care-recipients (CRs) is lacking. We searched PsycINFO, CINAHL with Full Text, MEDLINE, and PubMed from inception to end of 2020 and found 144 articles that reported randomized controlled trials of caregiver interventions using CR outcomes. Interventions were found to reduce neuropsychiatric symptoms and mood disturbance, enhance cognition and quality of life, and delay institutionalization and mortality, with care coordination/case management, educational intervention with psychotherapeutic components, and direct training of the care-recipient (with caregiver involvement) being the more potent interventions. However, the effects were generally small to very small. Together with existing findings on caregiver outcomes, a tripartite scaffolding model of caregiver support is proposed. Future directions in terms of developing consensual guidelines, a registry of intervention manuals, and family-centered programs are discussed.
Effects of Obesity Reduction on Physical Function, Inflammation and Osteoarthritis in Older Adults
Authors: Borack Michael , Holt Abigail , Starr Kathryn Porter , Rincker Jamie , Coppock James , Bales Connie , DeFrate Lou , McNulty Amy
Published: December 2021

Age-related increases in chronic inflammation lead to reduced physical function via damage to muscle and joints and contribute to osteoarthritis (OA) risk. Obesity in older adults with OA further exacerbates inflammatory damage. Whether obesity reduction can lessen inflammation and improve OA is unknown; however, novel biomarkers may provide an answer. We completed a 6-mo. weight loss intervention (-500 kcal/day), studying blood biomarkers of inflammation and cartilage damage along with physical function in obese older adults with (OA+; n=39) and without an OA diagnosis (OA-; n=20). Participants were aged > 60 yrs (mean = 70.2±6.0) and obese (BMI =34.6±4.7 kg/m2). At endpoint, weight loss was -6.3±4.0% and -5.8±4.1% in OA+ and OA-, respectively, with no group difference. Change scores for function for OA+ and OA- were: Short Physical Performance Battery score (+1.7±1.3 and +2.1±1.5), 8 ft up and go (-0.7±1.0 and -0.9±1.12 sec) and 6 min walk (+31.4±105.1 and +39.5±57.4 meters). All improved from baseline (p<0.05), with no group difference. Concerning blood biomarkers, there was a decrease (p<0.05) in cartilage oligomeric matrix protein (COMP: OA biomarker), indicating a potential benefit for OA. Change in COMP also differed between groups; OA- had a greater (p<0.05) reduction than OA+. Pooled results showed improved adiponectin (p<0.05), with no group difference. There were no changes for CRP, CTX-1, IL-6 and TNF-α. Our novel findings link early intervention with better reduction of OA risk and inflammation in obese older adults and also show important benefits for improved physical function regardless of OA status.
Navigating Black Aging: The Impact of Stress and the Power of Resilience in Promoting Health
Authors: Forrester Sarah , Whitfield Keith , Kiefe Catarina , Thorpe Roland
Published: December 2021

The health profile of African Americans clearly shows that stress works to worsen chronic conditions. To improve the health of aging African Americans, interventions need to address how effects of stress are reduced by individual resilience factors and exacerbated by anxiety or other traits. We will characterize the effects of stress by measuring rate of biological aging (RBA) over thirty years in a Black cohort (aged 18-30 at baseline) of approximately 2,000 individuals from the longitudinal CARDIA study. Biological aging (BA) captures premature physiological aging beyond that predicted by an individual’s chronological age. RBA will be characterized by within person change in BA over 30 years. We will measure the association between RBA and anxiety and will further measure the extent to which various forms of individual resilience factors mitigate the effects of anxiety on BA. We will also explore how intersectionality is evinced in sex differences in RBA.
Impact of Recreational Physical Activity And Body Composition On Insulin Resistance In Older Adult Population
Authors: Tsai Pao-Feng , Wang Chih-Hsuan , Hunt Caralise , Watts Sarah , Ware Katilya
Published: December 2021

Purpose: The study was to identify the impact of physical activity (PA) and body composition on insulin resistance in older adults and investigate racial/ethnic difference in these relationships. Method: This secondary data analysis project used 717 participants who were 55 years and older without diabetes from the 2017-2018 National Health and Nutrition Examination Survey. Major variables included homeostatic model assessment of insulin resistance (HOMA-IR), body mass index (BMI), waist circumference (WC), and recreational PA. The covariates included were demographics, nutrition intake, and lifestyle (smoking and alcohol usage). Hierarchical multiple regressions were conducted to analyze the data. Results: Body composition and recreational PA had interaction and main effects on HOMA-IR in the overall sample. Level of HOMA-IR decreased with increasing levels of recreational PA in individuals with lower levels of BMI, but in individuals with higher levels of BMI, HOMA-IR increased. Level of HOMA-IR increased with increasing levels of recreational PA across the range of WCs, but the rate of increase was slightly more pronounced at higher level of WCs. These results varied across racial/ethnic groups. Conclusion: Overall, both recreational PA and body composition are important factors that affect level of HOMA-IR, but body composition seems to be the dominant factor. PA is only beneficial for older adults with low BMI. Interventions for reducing insulin resistance should be tailored to specific racial/ethnic groups.
Older Adults and Family Perspective on Interaction with Nurses in Hospital: the Role of Mutual Understanding
Authors: Tonkikh Orly , Gur-Yaish Nurit , Shulyaev Ksenya , Rogozinski Amos , Siegel Elena
Published: December 2021

Optimal nurse-patient-family interaction is required to provide effective family-centered care for hospitalized older adults and their families. This qualitative descriptive study explored nurses’ interactions with older adult patients and their family members during acute hospitalization. We used semi-structured interviews to collect data from a convenience sample of nine dyads of older adults (aged 62-85) and family members (7 children and 2 spouses) who accompanied them during an acute hospitalization in medical or surgical units. Interviews were performed via Zoom beginning in December 2020 until August 2021, 1-12 months after the hospitalization. Thematic analysis was used to inductively capture key patterns in data. Both patients and family members revealed three factors contributing to the way nurses interact with patients and families: (1) nurses’ recognition and understanding of patients’ needs for family members’ presence and participation in care; (2) nurses recognition that family members expect dedication of attention, beyond nurses’ focus on patient’s care (3) patient and family members’ recognition of the extreme workload of nursing staff. Participants described a range of informal approaches used by both nurses and families to address each other’s needs. Both patients and families emphasize the benefits and costs of nurses engaging in “exceptional” interactions with patients and families considering structural characteristics such as establishing a personal relationship or accepting family visits beyond the rules. The findings provide direction for further exploration of hospitalization structures and processes needed to support optimal nurses’ interactions with families accompanying older adults and family-centered approach training in acute care context.
Perceptions on Own Aging: Comparisons between Young Adults with and without Caregiving Experience
Authors: Clark Phoebe , Cuppari Vanessa , Picchiello Matthew , Iwasaki Michiko , Futterman Andrew
Published: December 2021

Although informal caregiving for older adults (OAs) can increase knowledge and awareness about one’s own aging (Pope, 2013), it can also negatively impact caregivers’ physical health and emotional wellbeing (AARP & NAC, 2020) and have spillover effects on school, work, and marriage (Dellmann-Jenkins & Blankemeyer, 2009). Despite the recent trend of family caregiving for OAs by young adults (YAs), research about these young caregivers is scarce. The present study focused on YAs’ perceptions on aging. We hypothesized that YAs who provided at least three months of caregiving tasks for OAs would hold more awareness and negative perceptions on their own aging, as measured by a modified version of the Brief Aging Perceptions Questionnaire (Sexton et al., 2014), compared to those who did not. We recruited 234 YAs between the ages of 18 - 40 (Mage = 29.78, SD, age = 4.83; 59% White; 65.4% male) and had them complete a survey via Amazon Mechanical Turks. About one third (32.1%) had caregiving experience. Results of independent t-tests revealed that caregivers scored higher on awareness of aging [t(229) = 6.950., p < .001, d = .865] and negative consequences/control [t(231) = 6.528., p < .001, d = .927]. Scores of positive consequences/control did not differ between the two groups. Our findings indicate the need for psychological interventions designed to help young caregivers integrate their caregiving experiences with less negative aging perceptions. Future research should examine the direct effects of caregiving experience on perceptions of aging between young and middle-aged adults.
Strategies to Maintain Skilled Nursing Facility Staffing during COVID: Administrator Perspectives
Authors: Meehan Amy , Shield Renee , Brazier Joan , Gadbois Emily , Madrigal Caroline
Published: December 2021

As COVID-19 has resulted in a skilled nursing facility (SNF) staffing crisis, administrators attempt to maintain adequate staffing and stem decreasing patient census levels. We conducted four repeated interviews to date (n=130) at 3-month intervals with administrators from 40 SNFs in eight diverse healthcare markets across the United States. We used thematic analysis to examine their perspectives over time, including the perceived impact on staffing. Results include: 1) the impact of COVID-19 on staffing levels, and 2) strategies used in response to this crisis. Staffing levels have decreased throughout the pandemic, and struggles to maintain adequate staffing levels and patient census numbers have continued as the pipeline of potential new staff constricts. Facilities turned to agencies, many for the first time. Since agencies offer higher salaries, staff are drawn away from employment by SNFs, leading to a cycle of wage wars, and agencies are also challenged to provide staff. SNF administrators describe their responses to this crisis, such as flexible schedules, increased paid time off, sharing of non-direct-patient-care tasks, financial incentives (referral, sign-on, “no-call out”, and other general bonuses); wage analyses, and enhanced employee benefit packages. Some hire recruitment specialists, collaborate with nearby administrators, use creative advertising, or work with local schools. The vaccine mandate worries administrators; as one stated: “I can't afford to lose one person, let alone 20 because of this mandate...”. Given the dwindling pool of potential employees, we present NH administrators’ strategies to attract and retain staff.
The Buffering Effect of Resilience on the Social Consequences of COVID in Older Women
Authors: Goldberg Nacia , Carr Dawn , Taylor Miles , Sachs-Ericsson Natalie
Published: December 2021

Prior to the pandemic, public health experts argued that loneliness was among the most significant threats facing women’s health and wellbeing. As the COVID-19 pandemic brought our social lives to an abrupt pause in March, 2020, older adults were encouraged to remain isolated from friends and family. Social distancing guidelines led many older people to decrease social interactions with others. Using a community-based longitudinal study of women age 60+, we examined how changes in feelings of social connections with others influenced loneliness in October 2020 relative to prior to the pandemic (in September 2018). Our previous research has shown that psychological resilience decreases the negative consequences of major life stressors in later life. We hypothesized that women with high social consequences of the pandemic would experience increased loneliness, but resilience would buffer these effects. In line with our hypotheses, results showed that those who reported significant declines in social connectedness with others during the pandemic (i.e., high social consequences) experienced significant increases in loneliness (beta=0.125; p<0.001). Resilience, alternatively, was significantly associated with decreased loneliness (beta=-0.05; p<0.05), and buffered the social consequences of the pandemic. That is, as resilience increased, the social consequences of COVID-19 significantly declined (p<0.01), and resilience attenuated the negative consequences of high levels of social consequences of COVID-19 on loneliness, while those with high social consequences and low resilience experienced significant increases in loneliness in association with the pandemic. Based on our findings, we discuss potential clinical implications for resilience-based interventions for older adults.
The Myth of Care Coordination: Whether Professional Care Coordination Improved Older Adults’ Health Outcomes?
Authors: Ding Kedong
Published: December 2021

Background: Current evidence on the effects of Care Coordination (CC) on older adults’ well-being and health service utilization is inconsistent. Previous studies are mostly limited to regional data and focus mostly on nurse-led CC instead of layperson Care Coordinators like family caregivers. This study explores the effects of having CC in a national sample of U.S. older adults and whether the coordinators’ professionalism impacts the effect of having CC on multidimensional health outcomes (Health outcomes were conceptualized as physical health, healthcare utilization, and care encounters). Methods: Data were from the 2016 and 2018 waves of the Health and Retirement Study (HRS) (n=1,372). Multivariate regression models were used to examine the effects of CC on multidimensional health outcomes in 2016 and the longitudinal effects of having CC. We also tested the effect of Care Coordinators’ professionalism on the multidimensional health outcomes. All models controlled for sociodemographic characteristics and health status. Results: Findings suggest that having CC doesn’t have a positive effect on older adults’ health outcomes. Having CC was associated with an increased number of acute diseases (β = 0.16, p < .001) and nonacute diseases (β = 0.21, p < .01) in longterm. The results regarding cross-sectional effects show that receiving care from a Coordinator was related to increased health service utilization. Participants with professional Care Coordinators were more likely to report receiving person-centered care (OR=1.60, p<.05). Conclusion: This study demonstrates the limited effects of CCs on older adults’ physical health outcomes, and emphasized the importance of care coordinators’ qualifications.
Interviewing an Elder: Students’ Perceptions of Change in an Introduction to Gerontology Classroom
Authors: Hahn Sarah
Published: December 2021

Within the gerontological classroom, high-impact practices and creative assignments have consistently shown to help engage students, optimize learning, and increase positive attitudes toward older adults and aging (e.g., Chonody, 2015; Yamashita, et al., 2018). One such creative assignment, interviewing an older adult, has been cited as both an influential and valuable experience to gerontology students (e.g., O’Hanlon & Brookover, 2002). Although this assignment has been popular in and out of gerontology courses, more data regarding this and student’s understanding is needed. As such, this presentation aims to 1) introduce and establish the value of using the written assignment, "Interview an Elder" in the gerontology classroom and 2) present preliminary qualitative data on how students’ perceptions of older adults changed after the assignment. Using thematic analysis, results suggest that students are not only surprised by what they learned, but have increased positive perceptions of older adults overall.
Health of Aging Families: Comparing Compound and Noncompound Caregivers
Authors: Wang Fei , Marsack-Topolewski Christina , DiZazzo-Miller Rosanne , Samuel Preethy
Published: December 2021

Providing care to a family member with disabilities takes a toll on the caregiver and the whole family's health. Among aging caregivers, compound caregiving (i.e., caring for additional family members) has become an increasingly common scenario. However, few research studies have focused on compound caregivers. Extant literature describes individual-level outcomes, with sparse knowledge on family-level outcomes. The present study examines the differences in the individual and family health of aging compound and noncompound caregivers, using the family quality of life framework. Web-based cross-sectional data collected from 112 aging caregivers (i.e., over 50 years) was analyzed using chi-square and independent sample t-tests to examine differences between caregivers. Compound caregivers had worse perceptions of personal health (t = -2.96, p = .004, d = -.61) than noncompound caregivers. In terms of family health, although all caregivers shared similar perceptions on the importance, opportunities, initiative, and stability, compound caregivers had lower attainment (t = -2.64, p = .009, d = -.44) and satisfaction (t = -3.90, p < .001, d = -.73) than noncompound caregivers. Findings have practice implications for identifying caregivers' multiple responsibilities. It is necessary to develop individual and family level programs focused on health promotion and caregiving training.
State Medicaid Policy and LTC: A Multi-State Qualitative Study of Policy Influence on Caregiver Experiences
Authors: Sadler Tonie , Yan Kevin , Brauner Daniel , Pollack Harold , Konetzka R Tamara
Published: December 2021

This study focuses on long-term care (LTC) state Medicaid policy and its impact on caregiver decisions and experiences. It examines respondents’ general knowledge of LTC state policies and services, challenges with navigating LTC policies and services, and decision-making pathways based on these factors. Using purposive sampling, 63 family caregivers across eight states participated in open-ended qualitative interviews (2019-2020) until thematic saturation was reached. Questions broadly examined caregivers’ experiences and decisions, focusing on decisions made around type of care setting and experiences with LTC state policy. States were selected to represent variation in Home and Community Based Service (HCBS) expenditures as a percentage of total Medicaid long-term services and support expenditures. While LTC policies and services vary significantly by state, we identified many parallels in caregiver experiences and perceptions across states, as respondents often lacked specific knowledge about LTC policies and services and how to access them. Overarching themes include LTC policy navigation challenges, distrust in state-funded LTC services and supports, and moral expectations of caregiving. To manage these challenges, caregivers employed coping strategies such utilizing informal support networks, hiring care coordination assistance, and “stretching things thin” to fill the policy and service gaps. Study findings highlight potential strategies to improve LTC services across states. There is a need to improve community trust with state services by employing transparent regulatory and evaluation procedures for LTC. Wider access to case management may improve communication and knowledge of available services to maximize benefit from HCBS expansions.
Basic Resources and Psychological Strengths as Predictors of Depressive Symptoms
Authors: Lampraki Charikleia , Jopp Daniela
Published: December 2021

Loss of personal resources is expected to have a negative effect on well-being in all ages, however, in very old age, this effect may be exacerbated. Centenarians, who are confronted with accumulated age-related losses, may be at higher risk of experiencing depressive symptoms. This study investigated the link between basic resources (i.e., health, social network) and depressive symptoms and whether it was mediated by psychological strengths (i.e., meaning, optimism) in 119 centenarians and near-centenarians (Mage = 99.7 years). Results indicated that meaning in life fully mediated the link between health and depressive symptoms, and the link between social network size and depressive symptoms. Similarly, optimism mediated the link between network and depression, but no mediation effect was found when considering health as basic resource. In sum, basic resources are only indirectly associated to depressive feelings, with psychological strengths playing an important intervening role in very old age.
Aging With Pride: Cultural Relevance of Motivational Interviewing for LGBTQ Adults With Dementia
Authors: Petros Ryan , Goldsen Karen Fredriksen , Teri Linda
Published: December 2021

LGBTQ adults disproportionately experience dementia and are more likely to rely on informal social support to meet care needs in the community compared to cisgender, heterosexual peers. Culturally responsive interventions will accommodate the unique strengths and independence of this population and support self-determination as they navigate reduced capacity for self-care, increased need for support, and changes to autonomous, independent decision-making. Motivational Interviewing (MI) is a culturally responsive approach to treatment, amenable to integration with other evidence-based practices (EBP), and is especially relevant for the LGBTQ community for its compatibility with self-determination theory. This paper describes the unique contributions of MI that resulted in culturally relevant adaptations to a leading EBP for dementia and culminated in an efficacious intervention (Aging with Pride: IDEA) that is compatible with self-determination theory, designed for individuals and care providers in the LGBTQ community affected by dementia, and adapted for online delivery during the COVID pandemic.
Sleeping It Off: Sleep Quality Moderates the Association Between Family Bereavement and Heart Rate Variability
Authors: Chai Hye Won , Jester Dylan , Lee Soomi , Joo Susanna , Umberson Debra , Almeida David
Published: December 2021

While previous studies evince a strong link between family bereavement and worse cardiovascular functioning, factors that may influence the association remain unexplored. This study examined the relation between experiencing the death of an immediate family member and heart rate variability (HRV) and whether the associations differed by sleep quality. The sample included respondents from the Midlife in the United States (MIDUS) Biomarker Project who reported losing an immediate family member – parents, spouse, siblings, or children – within a year before project (n = 94) and those who did not experience any deaths (n = 872). Results showed that the death of a family member was associated with worse HRV only among those who reported having a poor sleep quality and not for those with good sleep quality. These findings suggest that poor sleep quality may indicate psychophysiological vulnerability for those who experienced the death of an immediate family member.
Daily Stress and Sleep Associations Vary by Work Schedule: A Between- and Within-Person Analysis in Nurses
Authors: Slavish Danica , Dietch Jessica , Kane Heidi , Wiley Joshua , Yap Yang , Kelly Kimberly , Ruggero Camilo , Taylor Daniel
Published: December 2021

Nurses experience poor sleep and high stress due to demanding work environments. Night shift work may exacerbate stress-sleep associations. We examined bidirectional associations between daily stress and sleep, and moderation by shift worker status and daily work schedule. 392 nurses (92% female, mean age = 39.54) completed 14 days of sleep diaries and actigraphy, plus daily assessments of stress and work schedule upon awakening. Nurses were classified as recent night shift workers if they worked 1+ night during the past 14 days. Greater daily stress predicted shorter diary sleep duration and lower diary sleep efficiency. Shorter diary and actigraphy sleep duration and lower diary sleep efficiency predicted higher next-day stress. Compared to recent night workers, day workers had higher stress after nights with shorter sleep. Associations did not vary by daily work schedule. Sleep disturbances and stress may unfold in a toxic cycle and are prime intervention targets among nurses.
Pain Persistence Is Associated With Increased Odds of MCI in Late Midlife and Early Older Adulthood
Authors: Bell Tyler , Elman Jeremy , Franz Carol , Kremen William
Published: December 2021

Twenty percent of older adults will experience persistent pain, the sensation of bodily harm lasting three or more months. Persistent pain doubles the risk of dementia, but we know less about the impact on earlier stages, such as mild cognitive impairment (MCI). As a step for clarification, this study leveraged data from the Vietnam Era Twin Study of Aging (VETSA) to understand how pain persistence relates to MCI in late midlife to early older adulthood. Participants (n=1,465, 100% male) were recruited across three waves at average ages 56, 62, and 68. At each wave, participants completed the SF-36 and were asked to rate their pain intensity from none (1) to very severe (6). Clinical pain was coded as pain intensity rated more than mild (>3/6). As a time-varying predictor, pain persistence was then calculated as a running frequency of the total waves reporting clinical pain. MCI diagnosis was based on Jak-Bondi criteria. Age, depressive symptoms, comorbidities, and opioid use were included as time-varying covariates. Age and education were included as time-invariant covariates. General estimating equations showed that pain persistence over two waves, reported in 35% of the sample, increased MCI odds by 57% (OR=1.57, 95%CI: 1.28 to 1.94). Pain persistence over three waves, reported in 17% of the sample, increased MCI odds by 98% (OR=1.98, 95%CI: 1.44 to 2.70). The findings emphasize the role of pain in earlier stages of dementia and the potential importance of pain management in offsetting cognitive decline.
Impact of Caloric Restriction on Molecular and Functional Networks in Rhesus Monkeys
Authors: Anderson Rozalyn
Published: December 2021

Caloric restriction (CR) delays aging and the onset of age-related disease in diverse species. Several diseases of aging including diabetes, cancer, and neurodegeneration, have an established metabolic component. Although the mechanisms of CR remain unknown, numerous factors implicated in longevity regulation by CR converge on regulation of metabolism. The reprograming of metabolism with CR is tissue specific, but mitochondrial activation and changes in redox metabolism are among the shared features. Changes in non-coding miRNA and in processing of transcripts are contributing mechanisms in integrating metabolic and growth pathways. Our studies in simple cell culture shows that small changes in metabolic status can precipitate large-scale multi-modal functional changes across cellular processes. We propose that modest failures in metabolic integrity with age broadly impact homeostasis and adaptation, creating shared vulnerability to diseases and conditions despite differences in their etiology, and that CR harnesses this same axis to promote health and enhanced longevity.
Online Gaming and Well-Being in the English Longitudinal Study of Ageing
Authors: Almeida-Meza Pamela , Cadar Dorina , Steptoe Andrew , Ryan Carrie
Published: December 2021

Play is considered an important contributor to healthy ageing. Using data from 3,067 participants aged 50+ from the English Longitudinal Study of Ageing, we explored online gaming assessed at wave 6 (2012/13) and quality-of-life, loneliness, and depression at wave 9 (2018/19). Covariates were age, sex, marital status, education, work status, depression, self-rated health, physical activity, smoking and alcohol consumption. We found that 22% of respondents engaged in gaming. Interaction analyses indicated that for younger individuals (<65 years), gaming predicted lower scores in the self-realization sub-scale of the quality-of-life scale in comparison to older gamers. Furthermore, there was a significant association between gaming and lower quality-of-life for widowed individuals only, particularly in terms of autonomy, self-realization, and pleasure. There were non-significant associations between gaming and loneliness and depression. Online gaming might be independently associated with lower levels of quality of life, especially for younger and widowed adults.
Teaching Anti-Racism in an Aging Services Course: Lessons Developed and Lessons Learned
Authors: Pestine-Stevens Althea , Greenfield Emily
Published: December 2021

Despite high levels of racial disparities in health and well-being among older adults, curricula addressing how aging services systems contribute to or work to ameliorate these disparities are scarce. This paper introduces a module on inequalities and anti-racism in aging developed for an online course on aging services within a Master of Social Work program. First, materials that help students identify and understand racial inequalities in aging and in the programs that serve older adults are presented. Next, students are introduced to the applied context of how COVID-19 has exacerbated these inequalities. Finally, students critically engage in reflections and assessments of the available resources within aging services and advocacy organizations, providing recommendations for how these systems may better incorporate anti-racist practices. Challenges and opportunities will be discussed, including piloting this module in a virtual, asynchronous environment.
Considerations in Curriculum Design for Teaching About Race and Racism in Gerontology
Authors: Liu Darren , Burston Betty
Published: December 2021

The recognition of structural racism as a public health crisis has enlarged the breadth and depth of discussions of the unique “Isms” in higher education classrooms. A significant number of undergraduate or graduate level gerontology programs participate in the delivery of training through instruction on the topics of aging, gerontology, or long-term care administration to future labor market participants. Absent from these classroom conversations, however, has been an analysis of how syntax, the analytical vocabulary, and other framing of such conversations can impact learners. While these educational programs provide highly critical information on disease, illness and injury prevention, self-care, population health, and other topics, professors can also introduce perspectives on race, racism, and how they may be related to the delivering of care to the aging population. Specifically, this session will introduce an example of curricular design for the identification of structural racism in the operation of long-term care institutions.
Driver Speed Profiles Index Warning Signs of MCI
Authors: Merickel Jennifer , Wu Ruiqian , Rizzo Matthew , Zhang Ying
Published: December 2021

Goal: Use driver behavior profiles to screen and index early warnings of cognitive decline and Alzheimer’s disease (AD). Hypothesis: Real-world driver speed behavior profiles discriminate mild cognitive impairment (MCI). Methods: Sensors were installed in personal vehicles of 74 legally-licensed, active drivers (age: 65-90 years, μ = 75.85) who completed 2, 3-month real-world driving assessments, including demographic and cognitive assessments, 1 year apart (244,564 miles driven). MCI status was indexed using 8 neuropsychological tests (spanning executive function, visuospatial skills, processing speed, and memory), relevant to MCI and driving. Driving environment was indexed from state speed limit (SL; roadway type: residential, commercial, interstate) and sunrise-sunset databases (time of day: day vs. night). Models: Data were randomly split into training (66%) and validation (33%) sets. An optimal mixed effects logistic regression model was determined from validation data AUC values. Results: MCI drivers drove slower with optimal discrimination (estimated for every 5 mph decrease in speeding) in 1) residential roads (SL 25-35 mph; MCI odds increased by 6% [95% CI: 2-11%]), 2) interstate roads (SL >55 mph; MCI odds increased by 14% [95% CI: 8-20%]), and 3) night environments (MCI odds increased by 7% [95% CI: 2-12%]). Conclusion: Quantitative indices of real-world driver data provide “ground truth” for screening and indexing phenotypes of cognitive decline, in line with ongoing efforts to link driver behavior with age-related cognitive decline and AD biomarkers. Behavioral biomarkers for diagnosing early warnings of dementia could ultimately bolster our ability to detect and intervene in early AD.
Using Clinical Trials as Agents of Transformation in Populations Burdened by Disparities
Authors: Jimenez Daniel , Kim Giyeon
Published: December 2021

Older adults from racial/ethnic backgrounds as well as those from rural areas experience a disproportionate burden of physical and mental health risk factors. Given the prevalence of comorbid physical and mental health conditions in later life, the inadequacies of current treatment approaches for averting years living with disability, the disparities in access to the health care delivery system (including mental health care), and the workforce shortages to meet the mental and physical health needs of racial/ethnic and rural populations, development and testing of innovative strategies to address these disparities are of great public health significance and have the potential to change practice. This session will illustrate how four different interventions are being used to address mental and physical health needs in Latino and rural-dwelling older adults with the goal of reducing and ultimately eliminating disparities in these populations. Particular attention will be paid to the use of non-traditional interventions (e.g. social support, health promotion, technology). Results of clinical research studies will be presented alongside clinical case presentations. This integrated focus highlights the importance of adapting research interventions to real-world clinical settings.
Ageism and Perceptions of Vulnerability: Framing of Age During the COVID-19 Pandemic
Authors: McConatha Jasmin Tahmaseb , Broussard jordan , magnerelli Jacki
Published: December 2021

Media representations of the Covid-19 pandemic and its devastating consequences have shaped people’s fears, anxiety, and perceptions of vulnerability. Social scientists have examined the consequences of how information is “framed.” Framing theory asserts that issues can be portrayed differently by emphasizing or de-emphasizing aspects and information. According to Lakoff (2004) the impact of a message is not based on what is said but how it is said. Theories of framing focus on how the media frames issues, which then structure and shape attitudes and policies. A news article serves as a frame for an intended message. The purpose of this project is to analyze the ways that “age” has been framed during the Covid-19 pandemic. One of the most dominant frames in terms of COVID-19 coverage is how the pandemic has been analyzed through the lens of age and framed in terms of age discrimination. Method: A thematic analysis of New York Times and Washington Post news articles addressing older adults and illness vulnerability was conducted. The results of news articles appearing in these prominent newspapers indicated that the perceptions of older men and women tended to focus on the relationship between age and vulnerabilities to severe consequences from Covid-19. The frames in which these new articles were presented indicated ageist tones and messages that had the potential to either reinforce or lead to age stereotyping and discrimination.