bluuebunny/crossref_metadata_2025 huggingface dataset:
IMPROVING GERIATRIC CARE OF INTERPROFESSIONAL PRACTICING PROVIDERS
Authors: Powers Becky , Ross Jeanette
Published: November 2019

Practicing providers often struggle with the care of older adults due to knowledge, skill, and attitude barriers. In an attempt to improve employee engagement in the care of older adults, the Geri-EMPOWER (Empowering Medical Providers and Older adults With strategies to Escape Readmission) program was initiated. In this program, case managers and visiting VA rural geriatric scholars participated in a two days of intensive educational sessions including lectures, shadowing inpatient teams and clinic providers, a dementia simulation learning exercise, and an Observed Structured Clinical Exam (OSCE) with standardized patient encounters. The 15 initial participating trainees came from a variety of medical backgrounds including physicians, nurse practitioners, nurses, social workers, and psychologists. A 10 item knowledge based pretest and posttest was constructed using the learning objectives of the course. Skills of attendees were directly observed during 4 OSCE stations. Attitudes towards older adults were measured before and after the intervention using the Caroline Opinions on Care of Older Adults (COCOA) scale. Geriatric and palliative care knowledge improved with average knowledge test scores improving from 63% to 86% before and after the course. Participants obtained all minimum competencies during their OSCE exam, and rated this session very highly in their course feedback. Attitudes towards older adults were also found to improve with an average COCOA score increase of 9 points before and after the educational sessions. This innovative course based in adult-learning theory demonstrates that employed interprofessional providers can quickly improve knowledge, skills, and attitudes towards older adults.
HOUSING AFFORDABILITY AND INTER-REGIONAL MOVES AMONG OLDER ADULTS
Authors: Mawhorter Sarah , Ailshire Jennifer A
Published: November 2019

Housing prices have risen in urban areas across the US since 2000, with only a brief interruption after the housing crisis of 2008. At the same time, prosperous urban areas have pulled away from declining urban and rural areas. Older adults are more likely to be affected by both increases and divergence of housing prices: owners may not be able to afford rising property taxes (though they benefit from increasing home equity), and renters are especially vulnerable. Housing affordability constraints may also affect the places where older adults can afford to move. In this paper, we compare the residential mobility patterns of adults aged 50+ living in high-cost, mid-cost, and low-cost areas from 2000-2014, using data from the Health and Retirement Study with county-level US Census and American Community Survey contextual data, as well as the Zillow Home Value Index. We find that both homeowners and renters living in high-cost areas remain in place at higher rates compared with those living in mid-cost and low-cost areas. Among those who move, older adults living in high-cost regions move towards mid-cost and low-cost regions more often than the reverse. The differences are particularly pronounced for renters. The overall outcome is a net movement of older adults away from high-cost areas towards mid-cost and low-cost areas. These shifts have consequences for the well-being of older adults facing budget constraints that may limit the areas where they can afford to live or move, and broader implications for the future of urban areas.
THE PHYSICAL AND SOCIAL ENVIRONMENTS, SOCIAL ACTIVITIES, AND SUBJECTIVE WELL-BEING: FINDINGS FROM THE K2 STUDY
Authors: Takayama Midori , Ishioka Yoshiko , Sugawara Ikuko
Published: November 2019

It has been pointed that the environments effect subjective well-being(SWB). However, it is still not clear what aspects of environments effect SWB among older adults and if degree on physical condition of older adults cause the difference on relations between and environments and SWB. In this study, firstly, we examined the relationship between the physical and social environments, social activities, and SWB in a sample of older Japanese. Secondly, we examined the differences on the effects of environments on SWB between older adults with lower physical functions and those with higher physical functions. We used data from locally representative longitudinal study of older adults 75±1, 80±1, and 85±1 years of age (at baseline) , which was conducted in Japan (The Keio-Kawasaki Aging Study(K2 study) ; N = 1388). Concerning the environments, we assessed the physical environments (public spaces and buildings, and accessibility) and the social environments (culture and recreation programs, and inclusive social environment). Results from covariance structure analyses showed that the accessible physical environment and the social environments were significant predictors of SWB, and showed that accessibility and the social environments influenced SWB via participation of social activities, too. Moreover, results from multiple group structural equation modeling showed that accessibility was a stronger predictor of SWB among older adults with lower physical functions, while accessibility was not a predictor among older adults with higher physical functions. The potential benefits of this approach provide a basic developing compensation model of SWB for this population of older adults.
DEVELOPING A QUALITY-OF-RELATIONSHIP INTERVENTION FOR STROKE-SURVIVOR FAMILY CAREGIVER DYADS
Authors: McCarthy Michael J , Lyons Karen , Dunn Dorothy , Garcia Yolanda , Bakas Tamilyn
Published: November 2019

A strong interpersonal relationship after stroke is important for the well-being of survivors and family caregivers. At present, few interventions are specifically designed to strengthen the relationship between members of the care dyad. The aim of this study is to develop, validate, and pilot test a quality of relationship intervention for stroke dyads. This poster presents findings from the content validity phase of the study and includes “tips” that dyads offered for maintaining a strong relationship. Semi-structured interviews were conducted with N=19 dyads to solicit information about relationship problems and tips. These data were used to develop a 17-item relationship assessment questionnaire with 17 “tip sheets” corresponding to each item. A Delphi process was used to obtain feedback from a 10-member expert panel about the degree to which the questionnaire and each tip sheet was (1) relevant; (2) clear; (3) accurate, and; (4) useful. Expert agreement ranged for 80% to 100%. The final materials included tips for dealing with issues that arise when one or both partners experience communication, mobility, cognitive, or emotional issues; reaching agreement about different aspects of recovery; working together to meet each partners’ needs; adjusting to new roles after stroke; dealing with relationship problems that predated stroke, and; getting support from other family members, friends, peers, and professionals. Findings highlight areas to consider in promoting strong relationships in care dyads. Future research is needed to examine whether these materials can help to reduce stressful interactions for care dyads, promote dyadic coping, and improve overall relationship quality.
AN INTERGENERATIONAL DYADIC APPROACH TO UNDERSTANDING GRANDPARENT DEATH WITHIN A FAMILY SYSTEM
Authors: Manoogian Margaret M , Igarashi Heidi , Leinenweber Maggie
Published: November 2019

Due to increased longevity and generational location, grandparent death creates new contexts for identity, family culture, and intergenerational relationships. To explore this loss from two perspectives, we conducted intensive interviews with young adults and their mothers (N = 16) who experienced a recent grandparent (parent) death. Guided by the life course perspective, we were interested to learn how grandparent death may shape identity, meaning, and behaviors among family members, and influence their shared parent-child relationship. Findings suggest that the relationship with the grandparent, the diverse expressions of grief, the navigation of family transitions during and after death, and the curation of grandparent memories influenced individual and family outcomes. Implications suggest the need for varied supports that are sensitive to how individual family members approach grief in distinct ways reflective of their developmental positions, past experiences, and relational expectations.
SCAFFOLDING PARENTS TO ACCEPT ADULT CHILDREN’S INTERVENTION
Authors: Toyokawa Noriko , Darling Nancy , Toyokawa Teru
Published: November 2019

Guided by social-cognitive domain specific theory (Smetana, 1997), this study explored the issue of role reversal in the aging parent-adult child relation when parents are experiencing age-related functional limitations. Data was collected from adult children (N=16, Mage=53.06, SD=6.08) with a living parent of 70 years old or older who participated in a focus group and were analyzed by a directed analysis (Potter & Levine-Donnerstein, 1999). Participants legitimated their intervention into parents’ autonomy when they perceived a potential risk of parents’ health and safety and involvement of those and of others. Eight types of intervention emerged: (1) monitoring and talking with potential risk with parent (2) convincing parents under the name of super power or an authority figure (3) scaffolding parent’s task by teaching skills, (4) scaffolding by sharing role, (5) scaffolding by optimizing environment, (5) overriding parents’ autonomy behind parents, (6) forcefully overriding, (7) giving up parents’ behavioral modification by accepting parents’ lifestyle, and (8) giving up because of discomfort of talking about the issue (i.e., potential risks of parent’s sexual intercourse, parents’ death preparation). Thus, adult children changed their strategies of intervention from monitoring their parents’ behaviors to overriding parents’ autonomy, depending on their appraisal of potential harms of parents’ prudential and moral domains of life and of their own work/family conditions from monitoring to overriding. Adult children’s possible ways of scaffolding in helping their parents accept their children’s interventions as letting parents maintain their psychological autonomy, including communication skills to discuss uncomfortable topics is discussed.
ADVERSE CHILDHOOD EXPERIENCES REPORTED BY CUSTODIAL GRANDMOTHERS AND THEIR ADOLESCENT GRANDCHILDREN
Authors: Smith Gregory C , Infurna Frank J , Webster Britney A , Dolbin-MacNab Megan L , Crowley Max , Musil Carol M
Published: November 2019

The Risky Family Model postulates that adverse childhood experiences (ACE) are likely to be encountered across generations within custodial grandfamilies which, in turn, may adversely impact their overall well-being. The present study is a pioneering attempt to examine the patterns of ACEs self-reported by custodial grandmothers (CGM) and adolescent grandchildren (AGC) from the same families, and how their total ACE scores correlate with key physical and mental health outcomes. A total of 129 CGM-ACG dyads recruited for a nationwide RCT study completed separately at baseline the 10-item ACE-CDC and 4 items from the ACE-IQ, as well as various standardized measures of physical and emotional well-being. The most frequent ACEs reported by AGC were loss of a parent (60.5%), verbal abuse (58.1%), bullying by peers (46.5%), and living with someone jailed (45.0%). The predominant ACEs for CGM were bullying by peers (48.8%), verbal abuse (48.1%), living with a mentally ill person (34.1%), being touched sexually (29.5%), and loss of parent (29.5%). Only 10.1% of ACG and 15.5% of CGM reported 0 ACEs, whereas 65.1 % of ACG and 59% of CGM reported > 3 ACEs. For ACG, total ACE scores correlated significantly with externalizing (r=.32) and internalizing (r=.30) difficulties, self-esteem (r= -.28), loneliness (r=.27), school problems (r=.24), and physical health (r= -.26). For CGMs, anxiety (r=.23) and depression (r=.19) only were correlated significantly with total ACEs. We conclude that although both CGM and ACG reported alarmingly high levels of ACEs, different patterns and correlates exist between the generations. [Funded by R01AG054571]
SPOUSE OR CAREGIVER? EXAMINING CORRELATES AND CONSEQUENCES OF SPOUSES BEING IDENTIFIED AS CANCER CAREGIVERS
Authors: Litzelman Kristin
Published: November 2019

Spouses provide critical support to cancer survivors, but are not always identified as caregivers. This study sought to understand the differences between such spouses. Using the Medical Expenditures Panel Survey 2016 Experiences with Cancer Supplement, spousal dyads in which one spouse had cancer were identified (n=670). Cancer survivors reported which family members or friends, if any, provided care during or after their cancer treatment. Survivor and spouse sociodemographic characteristics and spouse psychosocial characteristics including depression (Patient Health Questionnaire-2), distress (Kessler-6), and self-rated health were self-reported in the survey. The proportion of spouses identified as caregivers was calculated and compared with those not identified as caregivers on dyadic characteristics. Multivariable logistic regressions compared spouses’ depression, distress, and self-rated health by identification as a caregiver. All analyses employed survey weighting. Most married cancer survivors reported that their spouse was a caregiver (32%) or that they did not have a caregiver (65%); very few did not list their spouse as a caregiver (3%). Survivors who were white (non-Hispanic) or off treatment were less likely to report that their spouse was a caregiver (30% vs. 46%, p0.10; 9.6% vs 11.1%, p>0.10; and 46% vs 50%, p>0.10, respectively). The findings suggest that spouses’ experiences may be similar regardless of whether they are considered a caregiver, with implications for research and service delivery.
FACTORS ASSOCIATED WITH CAREGIVER REACTIONS TO PROBLEM BEHAVIORS OF PERSONS WITH ALZHEIMER’S DISEASE
Authors: Shi Junrong , Scott Cathy
Published: November 2019

Problem behaviors among persons with Alzheimer’s Disease (AD) can have a major impact on caregivers. However, caregiver’s subjective reactions to the problem behaviors have a stronger impact on caregivers than the objective frequency of problem behaviors (Robinson et al., 2001). This study aims to examine the factors associated with caregiver’s subjective reactions to problem behaviors. Data were collected from a sample recruited from community agencies served AD caregivers in the southeastern region of the country (N=109). The caregivers’ reactions to problem behaviors were measured by the Revised Memory and Behavior Problem Checklist (Teri et al., 1992). Three subscale scores were used to measure the reactions to the behaviors related to memory loss, depression and disruption. Multivariate regression models were conducted including gender, race, employment, living arrangement, knowledge about the disease, resilience for caregivers; and ADL and IADL functioning, and frequency of problem behaviors for care recipients. Race (B=-.162; p<.05) and frequency of care-recipient problem behaviors (B= 0.733; p<.001) were significantly associated with caregiver’s reaction to problem behaviors. Caregiver’s knowledge about the disease (p<.01) only influence their reactions to memory loss problems but not for disruption and depression problems. African American caregivers had fewer reactions to disruption (p<.01) and more reactions to depression problems (p=0.06) than white caregivers, but no difference between the two groups in their reactions to memory loss problems. Personal resilience was not associated with reactions to any problem behaviors. Intervention should be tailored to the needs of caregivers to deal with behaviors of a person with AD.
INFORMED CONSENT IN CLINICAL TRIALS FOR PERSONS WITH DEMENTIA
Authors: Carpenter Joan G
Published: November 2019

Informed consent is one of the most important processes during the implementation of a clinical trial; special attention must be given to meeting the needs of persons with dementia in nursing homes who have impaired decision making capacity. We overcame several challenges during enrollment and consent of potential participants in a pilot clinical trial including: (1) the consent document was designed for legally authorized representatives however some potential participants were capable of making their own decisions; (2) the written document was lengthy yet all seven pages were required by the IRB; (3) the required legal wording was difficult to understand and deterred potential participants; and (4) the primary mode of communication was via phone. We tailored assent and informed consent procedures to persons with dementia and their legally authorized representative/surrogate decision maker to avoid risking an incomplete trial and to improve generalizability of trial results to all persons with dementia.
FUTURE PLANNING AMONG OLDER CAREGIVERS OF FAMILY MEMBERS WITH INTELLECTUAL DISABILITY OR MENTAL ILLNESS
Authors: Wang Fei , Han Yangdi
Published: November 2019

Objectives: This study aims to examine future planning among older caregivers for family members with intellectual disability or mental illness, focusing on preferences, predictors and barriers. Method: Data were drawn from 260 caregivers (aged 50 or older) to a family member with intellectual disability or mental illness in Shanghai, China. Caregivers rated six types of future care arrangement under three circumstances: (1) the ideal situation, (2) unable to provide care due to age-related illnesses, and (3) caregivers are deceased. Socio-demographic factors associated with future planning were examined using multinomial logistic regression. Caregivers also rated twelve barriers to future planning. Results: Government-subsidized care facility is the most preferable care arrangement across the three circumstances. While continuing family care was still preferred if caregivers were to become sick or deceased, it was a less preferred option in the ideal situation. Common barriers were the cost of institutional care and the inadequate skills of the staff. Regarding the predictors of future planning, the older the caregivers were, the less likely they had no future plans. Caregivers were more likely to prefer family care over institutional care if their family members had mild impairment. Caregivers of a family member with mental illness were more likely to have no future planning than caregivers of a family member with intellectual disability. Conclusion: This study identified the needs of older caregivers for future planning specific to different circumstances. It also identified demographic profiles of future planning and the caregiver population at risk of no future planning.
ACTIONS TAKEN BY STROKE FAMILY CAREGIVERS TO POTENTIALLY PREVENT SURVIVORS’ HOSPITAL READMISSIONS IN CHINA
Authors: Yu Hairui , Perion Jennifer , Steiner Victoria , Pierce Linda
Published: November 2019

Stroke is a leading cause of death in China; its level of burden on the Chinese population is greater than the global average. Family caregiving plays an essential role in prevention and management of stroke. The purpose of this qualitative descriptive study was to identify actions family caregivers of stroke survivors in China take to prevent hospital readmissions. Using purposive sampling, adult family caregivers (n=10) were enrolled from Huai’an city in Jiangsu province who provided care for a survivor in community settings for six months or longer. Caregivers were asked questions in a face-to-face, semi-structured interview with content validity established by experts in the field. Audiotaped interviews were transcribed/translated into English and the narrative data analyzed using Colaizzi’s approach to content analysis. Seven female and three male caregivers with an average age of 55 years indicated actions that comprised six themes. These themes are: 1) Encouraging care recipients to be physically active, 2) Balancing a healthy diet with pleasurable foods, 3) Monitoring the physical health of care recipients and preventing injuries, 4) Developing personal and intimate strategies to motivate care recipients, 5) Providing emotional support and maintaining optimism, and 6) Gaining knowledge through relationships with doctors but desiring communication with other caregivers. Recognizing these actions taken by stroke family caregivers may improve education programs aimed at preventing hospital readmissions and be applicable throughout the world. Findings may also guide healthcare professionals who can advocate with Chinese local, provincial, and central health commissions on stroke survivors and their family caregivers’ behalf.
FEASIBILITY OF CARRES MODULES TO REDUCE POTENTIALLY AVOIDABLE HOSPITALIZATIONS IN PERSONS WITH COGNITIVE DEFICITS
Authors: Steiner Victoria , Pierce Linda , Bryan Carol
Published: November 2019

Family caregiving is an essential, yet understudied, factor that can hasten, delay, or prevent hospital readmissions in individuals with cognitive deficits. This 3-month feasibility study examined 18 Internet-based educational CARREs (Communicate, Assist, Recognize & Report Events) Modules for family caregivers that address care recipients’ potentially avoidable hospitalization (PAH) conditions, e.g. UTI. This study determined: 1) caregivers’ perceptions about the use of the CARREs Modules, 2) caregivers’ self-reported value of the Modules, and 3) potential outcomes for caregivers and care recipients. Community-dwelling family caregivers were recruited from local support/education programs and assigned 6-8 Modules based on their care recipients’ needs. Links to online surveys were emailed at baseline, and 30 and 90 days post-enrollment. Descriptive statistics were performed on these data. Twenty potential subjects were screened but five were ineligible and three refused to participate. The remaining 12 subjects were primarily White females caring for a husband or parent. Subjects completed all the Modules they were assigned and did not experience any difficulties answering the survey questions. Subjects reported completing the Modules at least moderately increased their knowledge (67%), not being burdened by completing the Modules (67%), and very likely to participate again (58%). Many subjects stated the Modules taught them new things about preventing hospital readmissions in their care recipient (75%) and improved their well-being as a caregiver (83%). In collaboration with a home care agency, the investigators plan to implement and test a sustainable, “real-world” educational intervention incorporating the CARREs Modules that reaches a wide audience of family caregivers.
RESULTS FROM RESEARCH ON A HEALTH-COACHED WALKING PROGRAM IN FAMILY CAREGIVERS OF PERSONS WITH DEMENTIA
Authors: Flanagan Jane , Post Kathryn , Hill Rebecca
Published: November 2019

Caregivers of persons with dementia demonstrate increased levels of stress, anxiety and depression, placing them at increased risk for poor health-related outcomes. Walking is widely supported as a cost-effective, accessible exercise and way to maintain physical fitness and mitigate stress levels. There is a critical gap in addressing health promotion strategies in caregivers. The specific aims of this health-coaching (HC) walking study using wireless pedometers in family caregivers of persons with dementia were to: 1) establish the feasibility of HC and wireless pedometer use, 2) examine outcomes of well-being, stress and activity level and 3) understand the experience of participation. This 2-group comparative study used a repeated measure design and mixed methods approach. We enrolled 27 females and 5 male caregivers (n=32), μ age 57 years: with both 16 in the control in the intervention arm. Pre-post measures of general health (body mass index [BMI], blood pressure, heart rate, cognition, well-being, stress and perceived activity level) were obtained from caregivers at baseline and again at 12 weeks. Results indicate that those who received HC had a statistically significant improvement in BMI (p = .01). There were no other statistically significant improvements in outcomes in either group. Qualitative findings suggest that participants reported many stresses that made self-care challenging. In summary, this was a feasible intervention that resulted in improved BMI in the HC group. Work is needed to understand the long-term impact of this outcome. Further exploration of other health-promoting interventions that may be beneficial for this population is essential.
QUALITY OF LIFE OF GRANDPARENTS RAISING GRANDCHILDREN IN NIGERIA
Authors: Aransiola Joshua O , Togonu-Bickersteth Funmi , Aliyu Kolawole , Afolabi Mojirayo , Akinyemi Akanni
Published: November 2019

This article examined the personal and household characteristics influencing the quality of life (QoL) of grandparents caring for grandchildren in Skipped Generation Households in Nigeria with a sample of 2, 144 grandparents in Imo, Lagos and Kano. Chi square and multinomial logistic regression were employed to understand the relationship between the dependent variable (QoL) and independent variables (personal and household characteristics). The level of the QoL of the grandparents almost spread evenly among low (34.3%), average (34.3%) and high (31.4%). Five domains of QoL were examined including level of independence (LI), psychological well-being (PW), social relation (SR), physical health (PH), environment (ENV) and engagement in income generating activities (IGA). Personal characteristics including; state of residence was significantly associated with all the domains except LI and PW, age was associated with IGA, LI and ENV, sex was associated with SR and ENV and level of education was associated with all the domains except IGA and ENV while religious affiliation was associated with IGA. Household characteristics including; sex of household head was significantly associated with PH, SR and ENV, age of household head was associated with IGA and LI and wealth index was associated with all the domains while the number of household members was significantly associated with ENV. The regression analysis shows that only state of residence and wealth index significantly influence the QoL of the grandparents (P≤0.05). The state of residence and wealth index are therefore important in any policy intervention for this category of elderly persons in Nigeria.
FEASIBILITY OF A LOW-DOSE FRAILTY PREVENTION INTERVENTION AMONG OLDER AFRICAN AMERICANS
Authors: Fritz Heather A , Tarraf Wassim , Patel Pragnesh
Published: November 2019

Older African Americans (OAA) are at high risk for becoming frail in later life. Interventions can reverse or delay frailty, yet OAA have largely been excluded from frailty intervention research. Many interventions are also time and resource intensive, making them inaccessible to socially disadvantaged OAA. We present results of a feasibility trial of a low dose frailty prevention intervention among 60 community-dwelling, pre-frail OAA aged 55+ recruited from a primary care clinic between June 1st and October 31st 2018. Using a 2-arm RCT, participants were assigned to the intervention, which was delivered by an occupational therapist (OT) and comprised of four sessions over four months (an OT evaluation, and sessions on healthy dietary practices, increasing physical activity, and maintaining a healthy lifestyle), or enhanced usual care (publicly available information about healthy lifestyle, home safety, and local elder services). Feasibility criteria were set a priori at 75% for participant retention (including attrition due to death/hospitalization), 80% for session engagement, 2 participants/week for mean participant accrual, and 90% for program satisfaction. Participants were 65% female with an average age of 76.58 years, 51.67% of which lived alone and 51.67% lived off of less than 15K per year. Feasibility metrics were met. The study recruited 2.5 participants per week and retained 75% of participants who attended 95% of scheduled sessions. Mean satisfaction scores were 93%. The intervention was feasible to deliver. Qualitative findings from exit interviews suggested changes to the program dose, structure, and content that could improve it for future use.
CULTURALLY ADAPTING A TIMED ACTIVITY INTERVENTION FOR OLDER LATINOS WITH DEMENTIA AND THEIR CAREGIVERS
Authors: Perez Adriana G
Published: November 2019

The number of Latinos living with Alzheimer’s Disease (AD) is expected to grow from 379,000 in 2012 to 3.5 million in 2060. The purpose of this study was to generate recommendations for meaningful approaches to culturally adapt a timed-activity intervention, Healthy Patterns, to promote quality of life in this population. Consistent with a descriptive qualitative approach, community-based focus groups were conducted among a purposive sample of older Latinos with AD and their caregivers. Seventeen dyads participated. Surface structure issues included: need for linguistically appropriate intervention sessions; partnerships with local, trusted community organizations. Deep structure themes, included: 1) embedding social support through group sessions; 2) culturally relevant activities; and 3) building individual and caregiver motivation for participation. This study gives “voice” to older Latinos and caregivers in adapting a timed-activity intervention. Results may inform the design and implementation of AD interventions, including recruitment and retention of older Latinos in clinical trials.
AM I FRAIL, LOVE? YES, I SUPPOSE I AM: WHAT 10 OLDER PEOPLE CAN TELL US ABOUT LIVING WITH FRAILTY
Authors: Todd Oliver M , Clegg Andrew , Godfrey Mary
Published: November 2019

We sought to explore what matters in later life with frailty from an older persons perspective. Between March and May 2018, we recruited ten people, purposively sampled from the CARE75+ ageing cohort study. Interviews took place at the participant’s own home in two sittings, each 45 minutes long. Interviews were semi-structured, used narrative techniques based on a topic guide developed with a patient representative. We used systematic analysis of the narrative experience to identify meaning in the context of an individual’s time, space and history. Participants had a mean age of 84 years (range 77 to 93), half were women, and three were interviewed with their care-givers. All had moderate or severe frailty: mean frailty index 0.36 (range 0.25 to 0.47); mean Fried score 4 (range 3 -5). Half knew hunger as children; most grew up in large families and left school early; two survived TB in early life; all lived through or were affected by war. The term frailty was: never voluntarily used; described negatively and in value laden terms; seen better in others than themselves. Decision making was best delegated to doctors who knew you and your family over time. Narratives focused on health events of a spouse; symptoms featured more than diagnoses. Survivorship, reciprocity and community were sustaining values. To engage elders in shared decision making we learnt to consider influences of cohort, of people closest to them; and to describe rather than declare someone to be frail, in terms that are real to them.
INTERPROFESSIONAL SOCIALIZATION AND VALUING SCALE FOR HEALTH PROFESSIONAL STUDENTS WORKING WITH OLDER ADULTS
Authors: Cicala David , Ang Nicholas , Mendez Jennifer , Brown Shanique , Schiller Martha
Published: November 2019

Interprofessional education allows students from two or more professions the opportunity to collaboratively practice patient centered care. Given the importance of interprofessional education in helping individuals become effective team members and understanding their value to a healthcare team, there is a need to evaluate the experiences. The Interprofessional Socialization and Valuing Scale (ISVS), aims to measure self-perceived experiences with interprofessional collaborative teamwork, including the ability, value, and comfort in working with others. The Wayne State University Interprofessional Team Visit (IPTV) program is an older adult home visit program that places pharmacy, social work, occupational therapy, nursing, and medical students in teams. Students form teams of 3 different disciplines and interview the older adult to assess various aspects of health and wellbeing. In order to evaluate the interprofessional educational experiences of the students, they are given a pre- and post- survey utilizing the ISVS tool. 18 questions pertaining to perceptions of what students have learned about working with professionals from other disciplines. Students respond to each statement using a 7-point scale with 1 = “Not at All” and 7 = “To a Very Great Extent.” Statistical analysis is conducted in order to compare pre- to post-surveys and also assess differences between groups. It is found that ISVS scores increase from pre- to post-survey, second year medical students and third year pharmacy students feel more comfortable working in teams, and teams consisting of these two have higher average scores.
INTERDISCIPLINARY CURRICULUM FOR THE CARE OF OLDER ADULTS: CREATING NETWORKS OF COLLABORATIVE LEARNERS
Authors: Yankeelov Pamela , Faul Anna , D'Ambrosio Joe , Cotton and Samantha G
Published: November 2019

Serving older adults with multiple chronic conditions and variable social, emotional, or physical support effectively within the primary care setting requires an interdisciplinary approach to care. Our GWEP program has developed an interprofessional education center that educates and prepares students and professionals from social work, medicine, nursing, dentistry, pharmacy, and community health partners, to function within a transformed integrated patient-centered geriatric primary care and community-based service delivery system. Learners from multiple disciplines attend a face-to-face Interdisciplinary Case Management Experience (ICME) session lasting 2.5 hours. Sessions include learners from each discipline and, if possible, at least one community practitioner in small groups of 6–8 learners at each table facilitated by 1 faculty member. Approximately 1,200 learners have received the curriculum. To evaluate the program, Kirkpatrick’s Training Evaluation Model was used to determine if learners were satisfied with the content, skilled, and confident in their abilities to utilize the curriculum. Learners completed a satisfaction survey after taking each module, along with an interdisciplinary geriatric care knowledge test and self-efficacy test before and after taking each module to measure learning outcomes. Analysis showed that learners, irrespective of discipline, were satisfied with the program. All disciplines showed a significant increase from pre- to posttest for all 5 online modules achieving a mean post-knowledge score of 85% across all 5 online training modules. All disciplines experienced significant differences in their self-efficacy with working on interdisciplinary teams from pre to post ICME. Implications for future interprofessional curriculum will be discussed.
FOSTERING INTERPROFESSIONAL COLLABORATION IN HISPANIC GERIATRIC PATIENT CARE: NEW GME PROGRAM AND PALLIATIVE TEAM
Authors: Martin Jessica G , Rivera-Burciaga Andrya , Gutierrez Cesar , Dentino Andrew , Bravo Vianis
Published: November 2019

Hispanic minorities have a higher incidence of chronic disease which may result in increased hospitalizations and life-threatening illness. Our growing geriatric population led our community hospital to create a dedicated Palliative Care department, an interprofessional team of physicians, nursing, pharmacy, social work, counselors, and chaplains whose collaborative practice has improved outcomes thus strengthening healthcare delivery. When our new medical school established graduate programs, including Internal Medicine residency and Hospice/Palliative Medicine fellowship, our team embraced the opportunity to optimize our palliative service through enhanced interprofessional care. We created a geriatric rotation on July 1, 2018 in which 60% of residents worked with palliative care professionals as a consult team bringing together the inpatient resident service and palliative interdisciplinary team. This collaborative model allowed the palliative team to interface with our trainees and teach them to identify the range of needs of older adults early on in their care. Residents reported 100% satisfaction on evaluations, specifically on clinical training, goal fulfillment, and team support. Our learners valued the opportunity to learn with and from other healthcare professionals. Supervising providers also felt that working with residents was beneficial to their practice habits (i.e., providing evidence-based practices, application of guidelines), which offered them a more holistic approach in caring for patients and families. The interprofessional collaboration between a community hospital and medical school to educate and train clinicians who care for individuals with advanced illness has fostered confidence, trust, mutual respect, open communication and effective sharing of critical information for both clinicians and patients.
MOBILITY EDUCATION FOR THE DIVERSE AGING COMMUNITY, CAREGIVERS, AND THEIR HEALTH CARE PROVIDERS
Authors: Karnick Chrysanne , Manna Ruth , Gangai Natalie , Muniz Rosario Costas , Korc-Grodzicki Beatriz
Published: November 2019

Older adults can reduce fall risk in their homes and the community. Health care professionals (HCP) have a role in preventing falls. An interprofessional team of HCPs at a comprehensive cancer center created and delivered educational workshops to increase knowledge about falls prevention. Educational workshops were provided in community centers, libraries, places of worship and at local hospitals to medically underserved, diverse community members, caregivers and HCP. An Occupational (OT) and Physical Therapist (PT) taught three workshops together and the OT taught nine workshops. Workshops included fall prevention, home modifications, safe patient handling (SPH), and the role of OT/ PT in geriatric oncology care. Practical and culturally competent steps were emphasized, with translation of written materials and live interpretation provided as appropriate. Knowledge increase was assessed, and post-session qualitative data was collected. The mean age of community members was 68 years, of nurses was 42, and of caregivers 63. A majority of participants were female. 220 older adults completed surveys, 40 caregivers, and 11 registered nurses. The Falls Prevention workshops with unmatched (n=79) and matched data (n=140) showed significant improvements in knowledge [t(135)=-3.33, p<0.001; t(139)=-4.03, p<.001; respectively). Caregivers who participated in the SPH workshop improved their learning for the unmatched (n=12) and matched data (n=28) after participating in the workshops [t(22)=-3.50, p=.002; t(27)=-3.95, p<.001] respectively. For nurses, the change in scores from pre (M=.56) to post scores (M=.73) were significant (t=-2.76, df=10, p=.02). Caregivers and HCPs benefit from continued education to promote safer, holistic care for family members and patients.
EFFECTS OF A SHARED DECISION MAKING INTERVENTION FOR OLDER ADULTS WITH CHRONIC CONDITIONS: AN OBSERVATIONAL STUDY
Authors: Pel-Littel Ruth E , Buurman Bianca , Pol Marjolein van de , Tulner Linda , Minkman Mirella , Reimer Wilma Scholte op , Weert Julia van
Published: November 2019

Shared decision making (SDM) in older patients is more complex when multiple chronic conditions (MCC) have to be taken into account. The aim of this research is to explore the effect of the evidence based implementation intervention SDMMCC on (1) the preferred and perceived participation (2) decisional conflict and (3) actual SDM during consultations. 216 outpatients participated in a video observational study. The intervention existed of a SDM training for geriatricians and a preparatory tool for patients. Consultations were videotaped and coded with the OPTIONMCC. Pre- and post-consultation questionnaires were completed. Participation was measured by the Patients’ perceived Involvement in Care Scale (PICS). Decisional conflict was measured by the Decisional Conflict Scale (DCS). The patients mean age was 77 years, 56% was female. The preparatory tool was completed by 56 older adults (52%), of which 64% rated the tool as positive. The preparatory tool was used in 12% of the consultations. The mean overall OPTIONMCC score showed no significant changes on the level of SDM(39.3 vs 39.3 P0.98), however there were significant improvements on discussing goals and options on sub-items of the scale. There were no significant differences found in the match on preferred and perceived participation (86.5% vs 85.0% P 0.595) or in decisional conflict (22.7 vs 22.9 P0.630). The limited use of the preparatory tool could have biased the effect of the intervention. In future research more attention must be paid towards the implementation of preparatory tools, not only among patients but also among geriatricians.
THE DEVELOPMENT OF AN INTERVENTION TO IMPROVE SHARED DECISION MAKING IN GERIATRIC OUTPATIENTS
Authors: Pel-Littel Ruth E , Weert Julia van , Minkman Mirella , Reimer Wilma Scholte op , Pol Marjolein van de , Buurman Bianca
Published: November 2019

Shared decision making (SDM) contributes to personalised decisions that fit the personal preferences of patients. However, older adults frequently face multiple chronic conditions (MCC). Therefore, implementing SDM requires special features. The aim of this paper is to describe the development of an intervention to improve SDM in older adults with MCC. Following the Medical Research Council framework for developing complex interventions, the SDMMCC intervention was developed step-wise. Based on a literature review and empirical research we developed in a co-creation process with the end-users a training for geriatricians and a preparatory tool for older patients with MCC and informal caregivers. After assessing feasibility the intervention was implemented at two outpatient geriatric clinics in a pilot study (N=108). Key elements of the training for geriatricians include: developing skills how to involve older adults with MCC and informal caregivers in SDM and learning how to explore personal goals related to quality of life. Key elements of the preparatory tool for patients include: an explicit invitation to participate in SDM, nomination that the patient’s own knowledge is valuable, invitation to form a partnership with the geriatrician, encouragement to share information about daily and social functioning and exploration of possible goals. Furthermore, invitation of informal caregivers to share their concerns. Through a process of co-creation both a training for geriatricians and a preparatory tool for older adults and their informal caregivers were developed, tailored to the needs of the end-users and based on the ‘Dynamic model of SDM with frail older adults’.
BELIEFS REGARDING GERIATRICS PRIMARY CARE TOPICS AMONG MEDICAL STUDENTS AND INTERNAL MEDICINE RESIDENTS
Authors: Jester Dylan J , Hyer Kathryn , Andel Ross
Published: November 2019

Our study evaluated and contrasted responses to 25 content areas essential to the primary care of older adults by medical students and residents, and identified attitudes toward aging amongst students and residents. One hundred and thirty-six medical students and 61 Internal Medicine residents completed a survey including the 25-item Geriatrics Clinician-Educator Survey and 18-item Images of Aging Scale. Students and residents rated importance and knowledge for content areas from 1 (low) to 10 (high). Gap scores reflecting the difference in ratings between importance and knowledge were calculated. The Images of Aging scale ranges between 0 (furthest from what you think) and 6 (closest to what you think). Results indicated that students and residents reflected similar beliefs about the importance of content areas, but students provided lower ratings in knowledge. Students revealed larger gap scores in areas that reflected general primary care (e.g., assess chronic conditions, medications), whereas residents revealed larger gap scores in areas that reflected specialists’ expertise (e.g., driving risk, cognition, psychiatric symptoms). Attitudes toward older adults did not differ appreciably between students and residents. In sum, primary care topics applicable for any age demographic were rated as most important by first-year medical students and Internal Medicine residents. Topics relevant to older populations – particularly those requiring specialists’ knowledge of or requiring sensitive discussion with older adults – were rated as less important and were less well mastered.
COST-BENEFIT ANALYSIS OF COMMUNITY-BASED SERVICES AS A MEANS OF PROMOTING ACTIVE AGING IN GALILEE
Authors: Hantman Shira
Published: November 2019

Increase in life expectancy has benefits, but also costs from increased expenses related to morbidity and prevention. These costs may be reduced by adopting a healthier lifestyle. The goal of the study was to quantify the economic value of a variety of activities in which older adults partake: e.g. cultural, intellectual, physical and nutritional activities. Research questions: Are the monetary benefits of improved health different when measured on a subjective willingness-to-pay (WTP) approach or on an objective Cost-of-Illness (COI) approach? Is the monetary benefit of active aging larger than the cost associated in doing that? 300 older adults participating in various activities of the local senior center and a control group not participating filled out a life style survey. A choice modelling (CM) approach estimated a subjective monetary welfare and compared it to an objective measure of benefit associated with the occurrence of different health symptoms associated with more active aging. An association was found between the various activities explored and the objective and subjective perspective of health. Moreover, all older adult activities passed the cost benefit test albite the order was different between objective and subjective estimations. Nutrition related activities were found to be the most beneficial. Cultural activity ranked second objectively and subjectively. Intellectual activity ranked last objectively and physical activity ranked last subjectively. Participants will understand the need to provide optimal policy and efficient resource distribution between the various activities offered to older adults. This will result in better health lowering public health expenditures.
ASSESSING THE EFFECTS OF LONG-TERM CARE INSURANCE ON EQUITY AND EFFICIENCY: A CASE STUDY OF QINGDAO CITY IN CHINA
Authors: Yang Wei , Chang Shuang
Published: November 2019

The demand for equitable and efficient long-term care (LTC) has risen rapidly, and finding a suitable mechanism to finance LTC has become a pressing policy concern for many countries. A number of high income countries have chosen to use a social LTC insurance to fund the LTC system, but empirical assessments on such an insurance in low-and middle-income countries are limited. Using China as an example, this paper empirically assesses the performance of newly-piloted LTCNI by evaluating its impact on equity and efficiency in financing. We draw data from 47 in-depth interviews conducted with local government, care providers and family members of the LTCNI participants in Qingdao in 2016. We found that there remain sizable disparities in financial burden among LTCNI participants, despite of its emphasis on ensuring access to care based on people’s needs; care providers are incentivised to provide care at the least cost even this care is deemed as insufficient or inadequate due to fixed payment for their services. Our paper offers critical insights into the potential and challenges in applying LTC insurance model to a LMIC, where critical lessons can be drawn for public LTC insurance in other LMICs.