bluuebunny/crossref_metadata_2025 huggingface dataset:
Findings From Implementation of the EIT-4-BPSD Trial
Authors: Resnick Barbara , Boltz Marie , Kolanowski Ann
Published: December 2021

Behavioral and psychological symptoms of dementia (BPSD) include aggression, agitation, depression, anxiety, apathy and hallucinations and are exhibited by up to 90% of nursing home (NH) residents with dementia. BPSD result in negative health outcomes, functional decline, high care costs, increased risk for inappropriate use of antipsychotic medications and social isolation. Behavioral approaches are endorsed as the first line of treatment for BPSD. Despite regulatory requirements, less than 2% of nursing homes consistently implement these approaches. The EIT-4-BPSD Trial was done to test a novel implementation approach to assure that staff in nursing homes use non-pharmacologic, behavioral approaches for the management of BPSD. EIT-4-BPSD is a theoretically-based four-step approach that includes: 1. Assessment of the environment and policies; 2. Education of staff; 3. Establishing person-centered care plans; and 4. Mentoring and motivating staff. Implementation of the four-step approach was guided by the Evidence Integration Triangle (EIT). The EIT brings together evidence and key stakeholders from the NH and uses a participatory implementation processes, practical evidence-based interventions, and pragmatic measures of progress toward goals. A total of 55 nursing homes from two states and 553 residents were included in this study. Nursing homes were randomized to EIT-4-BPSD or education only. This symposium will describe the utility of the EIT as an implementation framework based on the Reach, Effectiveness, Adoption, Implementation, and Maintenance model, report detailed effectiveness outcomes of EIT-4-BPSD at the setting and resident levels, and address recruitment and measurement challenges and future solutions to these challenges.
Breathing Uneasy: Fit-Tested N95 Respirator Access in Washington State Long-Term Care Facilities
Authors: Ham Carolyn , Nakamura Mikkie
Published: December 2021

Long-term care facilities (LTCF) have been disproportionately impacted by illness and death from COVID-19. Shortages of respirators for staff, especially Particulate Filtering Facepiece Respirators (N95), have limited LTCFs ability to follow public health recommendations for preventing COVID-19 transmission. Use of N95 respirators was infrequent in Washington State (WA) LTCFs prior to May 2020. N95 respirators must be individually fit tested to provide intended protection; a fit test is a procedure that tests the seal between the N95 respirator and the wearer’s face. The WA Department of Health (WA DOH), collaborated with stakeholders to survey LTCFs in November 2020 regarding needs for fit tested respirators and analyzed responses (n=384). Responses by facility type: 8.3% nursing homes, 17.7% assisted living, 62.8% adult family home, 11.2% other. In WA, adult family homes (AFH) are licensed for six or fewer residents. 23.70% of LTCFs indicated they did not have any N95 respirators in stock at their facility; 96.7% of these were AFH. In August 2020 WA DOH surveyed AFH owners and received 110 responses; 9.76% reported having at least one staff member fit tested for respirators. Smaller facilities may experience increased burden in accessing N95 respirators and fit testing due to lack of established relationships with suppliers and small volumes being purchased. WA DOH used federal COVID funding to contract with mobile fit testing providers and prioritized AFHs for this service. Between December 1, 2020-February 28, 2021, staff at 290 LTCFs were fit tested. The project will continue throughout 2021.
Measuring What Matters in Long-Term Care: Common Data Elements in Brazil, China, and the United States
Authors: Lepore Michael , Corazzini Kirsten , Zimmerman Sheryl
Published: December 2021

Internationally sharable common data elements on residential long-term care (LTC) settings, such as nursing homes and assisted living facilities, can facilitate comparisons across diverse LTC settings for valuable insights on LTC regulation and oversight, practice and operations, infrastructure development, human resources issues, and quality and safety. However, such insights are predicated on the premise that data elements capture information that matters to the full LTC community, including residents, relatives and staff, and are able to be collected across diverse care settings, including low-resource contexts. A critique of much current LTC measurement is its focus on deficits and loss, rather than thriving, person-centered care, and healthy aging, which have been established as important to LTC communities internationally. Further, measurement burden, cultural differences in perceptions of data sharing, and data infrastructure differences are key issues for international data. An international collaborative of LTC researchers—Worldwide Elements to Harmonize Research in Long-Term Care Living Environments (WE-THRIVE)—has developed a set of common data elements that are recommended for parsimoniously assessing key outcomes, workforce and staffing, person-centered care, and the contexts within which LTC settings operate. The studies in this symposium provide insights into the validation and implementation of WE-THRIVE recommended measures in diverse, low-resource LTC contexts, including LTC settings in Brazil, China, and rural Midwest US. Study findings validate WE-THRIVE measures, and provide new knowledge to inform capacity-building for the measurement of person-centered care and healthy aging outcomes in diverse, low-resource, LTC settings.
Measuring What Matters Across International Long-Term Care Settings
Authors: Lepore Michael , Corazzini Kirsten
Published: December 2021

Measuring what matters most to residents, relatives and staff in residential long-term care settings is critical, yet underdeveloped in our predominantly frailty and deficits-focused measurement frameworks. The Worldwide Elements to Harmonize Research in Long-Term Care Living Environments (WE-THRIVE) consortium has previously prioritized measurement concepts in the areas of care outcomes, workforce and staffing, person-centered care, and care context. These concepts include knowing the resident and what matters most to the resident, and outcomes such as quality of life, and personhood. We present findings of our currently recommended measures, including both general population and dementia-specific measures, such as the Person-Centered Care Assessment Tool (PCAT), the Personhood in Dementia Questionnaire (PDQ), and the ICEpop CAPability Measure for Older People (ICECAP-O). We also describe remaining gaps in existing measures that will need to be addressed to fully specify common data elements focused on measuring what matters most to residents, relatives and staff.
Activity Fractionation Moderates the Relationship of Gait Speed With Alzheimer’s Disease Risk
Authors: Tian Qu , An Yang , Schrack Jennifer , Kuo Pei-Lun , Wanigatunga Amal , Simonsick Eleanor , Resnick Susan , Ferrucci Luigi
Published: December 2021

Older adults with slow gait have a modestly elevated risk of Alzheimer’s disease (AD). Whether strategies to maintain function, such as interlacing periods of activity and rest, modify this relationship is unknown. We analyzed 577 initially cognitively normal participants aged 50+(53%women,26%Black) who had baseline data on gait speed and fractionation via ActiHeart. Diagnoses of mild cognitive impairment (MCI)/AD were adjudicated during an average 7.3years follow-up. We examined gait speed, fractionation, and their interaction with MCI/AD risk using Cox proportional-hazards models, adjusted for demographics and APOE-e4. Each 0.2m/sec faster gait speed was associated with 24% lower risk of MCI/AD(p=0.04). Fractionation was not associated with MCI/AD risk(p>0.05). There was a significant gait*fractionation interaction(p=0.013). At high fractionation, gait was not predictive of MCI/AD. Slow gait speed is less predictive of future MCI/AD in individuals who fractionate their activity to maintain function, possibly indicating brain function that drives such compensatory strategy is still conserved.
Cellular Resilience as a Potential Predictor of Lifespan
Authors: Salmon Adam
Published: December 2021

The progressive decline of resilience during the aging process across multiple functional systems suggests basic biological mechanisms of regulation. We exploited a primary cell model to identify markers of cellular resilience or the ability of cells in culture to respond and return to homeostasis following acute challenge including metabolic, oxidative, or proteostatic stress. Using primary fibroblasts from minimally-invasive skin biopsies of genetically heterogeneous mice, we are able to determine individual cellular resilience as well as the normal lifespan and healthspan of each donor. Our studies suggest donor age and sex affect cellular resilience and that this measure of resilience can predict functional outcomes in some interventional studies. While longevity studies continue, these studies point to a potential highly important marker of healthspan and longevity as well as a model to delineate the biology of resilience in animal and translational models.
Epidemiologic Determinants of Dynamics in Heart Failure Prevalence and Mortality in Older U.S. Adults
Authors: Yu Bin , Akushevich Igor , Yashkin Arseniy , Kravchenko Julia
Published: December 2021

Recent declines in heart failure (HF) prevalence and increases in mortality among older adults in the US suggest the need for research to investigate the relative contribution of the epidemiological determinants of these two processes to their historical and current trends. Study data were derived from a 5% sample of Medicare beneficiaries, 1991-2017. Partitioning analysis was used to decompose age-adjusted prevalence and incidence-based mortality (IBM) into their constituent components. HF prevalence trend decomposition demonstrated three phases: (a) Decelerated Increasing Prevalence (1994-2006) mainly driven by decreasing incidence, overpowering increasing survival, (b) Accelerated Declining Prevalence (2007-2014) and (c) Decelerated Declining Prevalence (2015-2017), mainly driven by declining incidence, overpowering declining survival. For HF IBM four phases were identified: (a) Decelerated Increasing Mortality (1994-2001) with declining incidence and increasing survival driving deceleration, (b) Accelerated Declining Mortality (2002-2012), (c) Decelerated Declining Mortality (2013-2016), mainly driven by declining incidence, overpowering declining survival, and (d) Accelerated Increasing Mortality (2017) mainly driven by declining survival, overpowering declining incidence. Study findings suggest that the recent decade-long decline in HF prevalence and 15-year decline in HF mortality mainly reflected decreasing incidence, while the most recent increase in mortality was due to declining survival, which may be associated with the Hospital Readmission Reduction Program. If current trends of incidence and survival persist, HF prevalence and mortality are forecasted to grow, suggesting that actions to reduce HF risk factors and improve treatment and management of HF after diagnosis are warranted.
Reluctance to Accept Palliative Care and Recommendations for Improvement
Authors: Cardenas Valeria , Rahman Anna , Zhu Yujun , Enguidanos Susan
Published: December 2021

Although insurance companies are increasingly paying for home-based palliative care (HBPC), enrollment remains low. To identify patient and caregiver perceived barriers to HBPC and their recommendations for overcoming these barriers, we conducted semi-structured individual interviews. Our interview protocol elicited participants’ perspectives on HBPC services; positive and negative aspects of the palliative program explanation; and suggestions for improving HBPC messaging. Seventeen patients and eight caregivers who were eligible for a randomized controlled trial of HBPC were interviewed. Themes related to HBPC referral barriers included reluctance to have home visits, enrollment timing, lack of palliative care knowledge, and patients’ self-perceived health condition. Themes related to recommendations for overcoming these obstacles included ensuring that HBPC referrals come from healthcare providers or insurance companies and presenting HBPC more clearly. Findings reinforce the need for palliative care education among seriously ill patients and the importance of delivering palliative care information and referrals from trusted sources.
Interventions for QoL and Other Outcomes Among Caregivers of Older Adults With Visual Impairments
Authors: Hazzan Afeez , Haibach-Beach Pamela , Lieberman Lauren , Williams Jamia
Published: December 2021

Unpaid family caregivers play a critical role in the care of older adults with visual impairments (VI). Caring for older adults with VI requires much time and energy, often resulting in psychological stress and reduced quality of life (QoL). However, there is a paucity of data on the impact of caregiving on QoL and related outcomes among these caregivers. The purpose of this study was to conduct a scoping review examining issues of QoL, health, stress, burden, and barriers among unpaid caregivers of older adults (i.e. aged 60 years or more) with VI. The study aimed to summarize interventions for addressing these issues. This study followed the Arksey and O’Malley (2005) five stage approach for scoping reviews. We performed a search of published peer-reviewed articles available in PubMed, CINAHL Complete, and PsycINFO to identify relevant studies. Two reviewers conducted the screening of titles, abstracts, and full-texts. Of the 452 records identified, 24 were eligible for full-text screening and five articles met the final inclusion criteria. The following four themes were identified: (1) prevalence of QoL-related barriers among unpaid caregivers of older adults with VI; (2) adverse events among unpaid caregivers of older adults with VI; (3) interventions for unpaid caregivers of older adults with VI; and (4) potential impacts of intervention on unpaid caregivers of older adults with VI. These findings reveal a lack of interventions for unpaid caregivers of older adults with VI, despite the prevalence of QoL-related barriers and adverse events. Research addressing these issues are urgently needed.
Adaptation of the Care Ecosystem Intervention for Individuals with Dementia in a High-Risk, Care Management Program
Authors: Forester Brent , Donelan Karen , Vogeli Christine , Ritchie Christine
Published: December 2021

The Care Ecosystem (CareEco) model is a telephone-based dementia care program providing standardized, personalized and scalable support and education for caregivers and persons living with dementia (PLWD), medication guidance, and promotion of proactive decision-making. It has demonstrated improvement in quality of life for PLWD and reduced unnecessary healthcare expenditures. We initiated a pragmatic, embedded randomized pilot trial of an adapted CareEco model for nurses who provide high-risk care management and are embedded in primary care practices within a large healthcare system. Outcomes include feasibility of collecting emergency department visits, usability and acceptability of the intervention by nurse care managers, caregiver strain, behavioral symptoms of dementia and healthcare expenditures. Challenges of implementation include engaging key care management leaders, adaptation of the CareEco training modules for nurses, identification of primary caregivers, training and reinforcing knowledge and skills of the nurses, embedding clinical assessments into care manager workflows and integration with the EMR.
Policy Series: Update on Polling and Policy Efforts on Loneliness, Telehealth, Caregiving, and Advance Care Planning
Authors: Solway Erica , Lindberg Brian
Published: December 2021

Older adults and their caregivers experienced dramatic changes in many aspects of their lives during the COVID-19 pandemic which resulted in important shifts in organizational and federal priorities and policies. To explore older adults’ changing experiences and perspectives amidst the pandemic, the University of Michigan National Poll on Healthy Aging (NPHA), a recurring, nationally representative household survey, polled over 2,000 adults age 50-80 at multiple timepoints through January 2021 about their feelings of loneliness and use of telehealth. In June 2020, the NPHA also surveyed adults age 50-80 about advance care planning before and during the COVID-19 pandemic and asked family caregivers about their care challenges in the three months since the pandemic. This session will start with a presentation of results from these polls, first exploring change over time in loneliness and telehealth use and then focusing on experiences related to advance care planning and caregiving challenges. Next, presenters from diverse national coalitions and organizations, including the Coalition to End Social Isolation and Loneliness, the National Academy for State Health Policy, the National Alliance for Caregiving, and the Coalition to Transform Advanced Care will describe their organizations’ efforts, including their work with research and advocacy partners, state and federal agencies, and the Biden administration to facilitate dialogue and advance activities and policies related to these timely topics.
Dementia Family Caregivers’ Ambivalent Feelings and Cardiovascular Risk: Longitudinal Correlates
Authors: Romero-Moreno Rosa , Vara-García Carlos , Barrera-Caballero Samara , olazarán Javier , Mausbach Brent , von Känel Roland , Olmos Ricardo , Losada-Baltar Andrés
Published: December 2021

Cross-sectional data show that caregivers’ ambivalent feelings are associated with psychological distress. The association of ambivalent feelings with caregivers’ cardiovascular risk has not been studied. For this purpose we analyzed preliminary data from the Spanish Longitudinal Caregiving Spanish Longitudinal Study (CUIDA-LONG). One-year follow-up data were available for 96 dementia family caregivers. The following variables were assessed: sociodemographics, body mass index (BMI), disruptive behaviors, ambivalence, depressive symptomatology and cardiovascular risk with the inflammatory biomarker C-reactive protein (CRP). A hierarchical regression model was tested. Sociodemographic variables and change over time in stressors, ambivalence and depression were entered as predictors of change in CRP. 27% of the variance in CRP was explained through the model. More time since being a caregiver, higher BMI and greater increase in ambivalence contributed significantly to an increase in CRP. Ambivalent feelings contribute significantly to the cardiovascular risk of those who care for a relative with dementia.
An Intensive Longitudinal Study of the Association of Stress With Hyperglycemia Using Real-Time Data Collection
Authors: Mausbach Brent
Published: December 2021

Caregivers of persons with dementia (PWD) are at significantly elevated risk for cardiovascular disease (CVD)s. A higher risk for diabetes is one potential mechanism of morbidity in caregivers. Diabetes has been associated with dyslipidemia, hypertension, oxidative stress, increased low-grade inflammation, and endothelial dysfunction, which all place individuals at risk for CVD. Elevated blood glucose, even in the nondiabetic range, is a significant risk marker for the development of CVD. The current study examined the semi-continuous association between stress and glucose. Participants wore a continuous glucose monitor that measured blood glucose every 5 minutes for a period of 10 days (n = 2,880/participant). Ecological Momentary Assessment (EMA) was used to measure stress, positive affect, negative affect, and dietary intake 3x/day over the 10-day period. Hierarchical linear models indicated significant within-person associations between stress and blood glucose levels (t = 3.88, df = 3.92, p = .018; R2 = 26.2%).
Age Discrimination During the COVID-19 Pandemic: Associations With Daily Well-Being
Authors: Ong Lydia , Klaiber Patrick , DeLongis Anita , Sin Nancy
Published: December 2021

During the COVID-19 pandemic, ageist attitudes have been pervasive in public discourse, interpersonal relationships, and medical decision-making. For example, older adults have been portrayed as vulnerable while younger adults have been portrayed as reckless. The current study examined age discrimination during COVID-19 and associations with daily affect and physical symptoms. Positive events and age were examined as moderators. From March to August 2020, 1493 participants aged 18-91 (mean=40) in the U.S. and Canada completed surveys for seven consecutive evenings about discrimination, positive events, affect, and physical symptoms. Multilevel models controlled for age, race, income, education, sample (university students vs. community), and country of residence. Results indicated that individuals who reported more age discrimination had higher negative affect (b=36.44, SE=3.97), lower positive affect (b=-19.07, SE=4.10), and increased physical symptoms (b=3.85, SE=0.49; p<0.001 for all), compared to those with fewer reports of age discrimination. Within-persons, days with age discrimination were associated with higher negative affect (b=3.66, SE=1.36, p=0.008), lower positive affect (b=-2.60, SE=1.23, p=0.037), and increased physical symptoms (b=0.26, SE=0.11, p=0.02), compared to days on which age discrimination was not reported. Positive events moderated the between-person association of age discrimination with physical symptoms such that individuals with more age discrimination and more frequent positive events reported fewer daily physical symptoms than those with more age discrimination and less frequent positive events. Age did not moderate the associations. Age discrimination was associated with poorer daily well-being during the COVID-19 pandemic and may have long-term impacts on intergenerational solidarity and attitudes toward aging.
Older Adults’ Experiences Participating in Aging Strong 2020 Programs
Authors: Hudson Janella , Ungar Rachel , Albright Laurie , Schaeffer James , Wicker Ellen
Published: December 2021

User satisfaction assessments are integral to demonstrating intervention efficacy. Towards that end, older participants across the Aging Strong 2020 suite of offerings participated in semi-structured interviews (n = 248) to provide feedback about their experiences in the program and resulting satisfaction. Overall, most participants were satisfied with the Aging Strong 2020 interventions and reported gaining new skills, tools, or coping strategies. Participants endorsed program features that facilitated social interaction, community building, and social support. Program content specifically adapted for older adults and appropriate life stage concerns and/or areas of interest were considered especially helpful. Results demonstrate that the current test and learn model offers an opportunity for participant feedback to refine and improve future iterations of project offerings. Participant feedback led to key improvements in subsequent versions of the Aging Strong 2020 programs and their contributions to successful aging among older adults.
Prevalence and Impact of Comorbid Cancer and Dementia on Health Outcomes in Older Adults: A Longitudinal Study
Authors: Parajuli Jyotsana , Berish Diane , Jao Ying-Ling , Liao Yo-Jen , Johnson Lee Ann
Published: December 2021

Dementia and cancer are two common chronic conditions in older adults. However, there are few studies examining the prevalence of comorbid cancer and dementia and the longitudinal impact of these comorbid conditions on health outcomes. This study investigated the prevalence and longitudinal impact on health outcomes in older adults with comorbid cancer and dementia. This is a secondary analysis, using data from the 2010 and 2016 waves of the Health and Retirement Study (HRS). The health outcomes of the study included nursing home stay, hospital stay, home care use, activities of daily living (ADL) limitations, instrumental activities of daily living (IADL), self-rated health status, mortality, and the out-of-pocket medical expenditure in older adults with cancer and dementia. Data were analyzed using descriptive statistics, logistic regression, and linear regression analyses. The results revealed that the prevalence of comorbid cancer and dementia ranged from 2.6% to 2.8% over the 6-year period. Older adults with comorbid cancer and dementia demonstrated higher likelihood of nursing home stay, ADL and IADL limitations, and mortality; but a decreased likelihood of homecare use and hospital stay compared to older adults with cancer only or dementia only (some outcomes were not significant for dementia only group). Findings point out the risk of increased functional decline and mortality in older adults with comorbid cancer and dementia. Future research is needed to explore the contributing factors of the risk and identify interventions to promote physical function and reduce mortality for this population.
Caregiving Through Turbulent Times: Findings From the MIT AgeLab’s Longitudinal Study of Family Caregivers
Authors: Miller Julie , Miller Julie
Published: December 2021

Nearly one in five Americans is an unpaid family caregiver, and the need for family caregivers is projected to grow over the next several decades in the face of longer lifespans (AARP 2020). Yet the increasing centrality of family caregivers for providing care to an aging population highlights two knowledge gaps: first, the degree and experience of burden and stress caregivers manage around balancing care with other family and work responsibilities; and second, a lack of knowledge about the caregiver journey and the microtasks of care, including how caregivers leverage – or not – different tools, technologies and resources to support the care they provide. To develop a deeper understanding of these questions and others, the MIT AgeLab has built a research panel of over 1200 caregivers providing care to another adult family member. This symposium will present findings from the MIT AgeLab Caregiver Panel, including: 1) an examination of the extent to which family caregivers identify as such and how they feel about their roles; 2) how family caregivers experienced the COVID-19 pandemic both personally and around the care they provide; 3) caregivers’ use of and attitudes toward technology to support the care they provide; and 4) what caregivers identify as their key unmet needs. The session will include a facilitated discussion around the intersection of COVID-19 with caregivers’ technology use, experience of caregiving, and future needs, as well as to identify additional research questions and directions for future research with the MIT AgeLab Caregiver Panel.
Caregivers’ Language and Emotions Around Care
Authors: D'Ambrosio Lisa
Published: December 2021

Caregiving encompasses a range of roles and activities, but not all people providing care identify as “caregivers.” Understanding the vocabulary and emotions that caregivers have should first, contribute to an understanding of caregiving and caregivers per se, and second, aid in communicating with them more effectively. Analysis of survey data from members of the MIT AgeLab Caregiver Panel shows variance in self-identification as caregivers and in language and emotions around caregiving, reflecting diversity in the care experience, but consensus around the core concept of a caregiver. This presentation will report on how caregivers’ relationships, gender and care tasks affect their language and identify a caregiver experience-identity gap: a space between what caregivers do and what they report. We highlight how an understanding of caregivers’ experiences of what they do – as opposed to a catalog of tasks they do – may be more important for understanding their experience of strain.
Technologies and Services to Support Care: Caregivers’ Experiences and Perspectives
Authors: Lee Chaiwoo
Published: December 2021

Technologies developed to make life easier for the general population – including smart home products, internet-enabled services, communication platforms, and health management systems – also have the potential to assist individuals who provide care to loved ones. While caregivers may be eager users of technology to support their responsibilities, some technologies remain untapped resources. An in-depth survey conducted with the MIT AgeLab Caregiver Panel around attitudes toward and use of technology for themselves and for caregiving showed that while caregivers use a wide range of technologies for themselves, their use for caregiving is limited. However, while caregivers did not universally use technologies or services to support the care they provided, those who did so generally reported positive feelings about their use. This presentation will report on technology experiences – including perceived usefulness, ease of use and integration, impacts, and overall satisfaction – among caregivers of various characteristics and conditions.
Age Limitations for Presidential Candidates? Exploring Student Perspectives Using Classroom Debates
Authors: Garbarino Jason
Published: December 2021

Ahead of the 2020 Presidential Election, Donald Trump (age 73) and his primary opponent, Joseph Biden (age 76) received extensive criticism regarding the aptness of their candidacies based upon their current ages. While the United States Constitution requires candidates to have “attained the age of thirty-five years”, no age cap for presidential candidates exists. In response to timely public discussion, undergraduate interprofessional gerontology students worked in assigned groups to prepare to debate either in favor of, or in opposition to a constitutional amendment capping the age of presidential candidates. Following classroom debates, course faculty moderated in-depth conversation examining cogent arguments made throughout the debates. After attending this session, participants will understand the logistics of planning in-class debates, moderating post-debate student discussions, and evaluation methods of student debate performance and on a corresponding reflective writing assignment. Student and faculty takeaways and prospective classroom debate ideas will be provided.
House Hunters, Gerontology Style: A Unique Classroom Activity for Undergraduates
Authors: McDarby Meghan
Published: December 2021

Small group discussion activities that capitalize on students’ interest in technology may generate enthusiasm for course content in gerontology. We describe a unique classroom activity that supports discussion about retirement issues in older adulthood by leveraging student dexterity in utilizing web applications. In this activity, students act as real estate agents for a retired older adult couple who is relocating to be closer to family. Students are presented with details about the couple, including demographic information (e.g., age, functional limitations, hobbies) and the couple’s “wish list” for features and amenities of their future home. Then, students use these details to choose a home for the couple on Zillow and prepare a “pitch” of the home that is presented to the class and judged by the course instructor. Feedback from students suggests that this activity offers a “real world application to course material” and facilitates enthusiasm about course content.
Leveraging a Population-Based Dyadic Data Set to Promote Health Equity Among Chinese Americans
Authors: Dong XinQi , Kong Dexia
Published: December 2021

Recognizing the central role of family-oriented values in Chinese culture, developing a family-based understanding of health and wellbeing in Chinese Americans is imperative. By linking two unique population-based datasets (one on Chinese older adults, and another on their corresponding adult children caregivers), the purpose of this symposium is to present interactive analyses of dyad-level data to achieve an interpersonal understanding of health outcomes of Chinese older adults and their adult children within the family context. Data were obtained from 807 Chinese older adults-adult children dyads by merging data from two epidemiological studies, namely the Population Study of ChINese Elderly in Chicago (the PINE study) and the PIETY study of corresponding adult children caregivers of PINE participants. Specifically, this symposium presents findings from five interconnected research projects. Session 1 provides an overview of study design and sample characteristics of the dyadic dataset. Session 2 examines the relationship between adult children’s endorsement of the filial piety value and older parents’ mental health outcomes. Session 3 investigates the level of congruence between older parents’ self-perceived mental health and adult children’s evaluation of their parents’ mental health. Session 4 investigates the extent to which depressive symptoms among older parents were associated with those of their adult children. Session 5 explores the relationship between older parents’ physical function and adult children’s perceived caregiving burden. Taken together, this symposium presents potential contributions of dyad-level analyses in advancing minority population health. Study findings have the potential to inform the development of family-centered intervention strategies targeting Chinese Americans.
Dyadic Data on U.S. Chinese Older Adults and Their Adult Children: Study Design and Sample Overview
Authors: Kong Dexia , Dong XinQi
Published: December 2021

This paper aims to describe study design of the unique dyadic older Chinese American-adult children dataset, and present sample characteristics of the dyads. A total of 807 older parents were matched with their adult children (characteristics of matched versus not matched participants will be compared). On average, adult children were 48 years old, had 12 years of education, lived with 3 persons in household, had 2 children, and lived in U.S. for 17 years. Approximately 65% of the adult children sample were female, 82% married, 93% preferred to speak Chinese dialects, and over 97% foreign-born immigrants. On the other hand, older parents were 74 years old, had 7 years of education, lived with 3 persons in household, had 3 children, and lived in U.S. for 17 years on average. About 60% of the older parent sample were female, 73% married, over 99% foreign-born immigrants who preferred to speak Chinese dialects.
Perceptions of Mental Health Clinicians Working in Long-Term Care Facilities During the COVID-19 Pandemic
Authors: Hanks Roma , Brown Lisa , Ward Rachel , Rose Savannah , Lind Lisa
Published: December 2021

During the COVID-19 pandemic, mental health clinicians were initially not considered essential workers, and most were prevented from entering long-term care (LTC) facilities. This study investigated the perceptions and experiences of licensed clinicians who were providing services in LTC settings before and during the pandemic. Respondents included 126 clinicians from 31 states who completed a 90-item survey to assess the impact of COVID-19. Visitor restrictions were perceived to have had a negative effect on patients' emotional, behavioral, and cognitive status. The pandemic adversely impacted clinicians financially, personally, and emotionally, with more than half (67%) reporting that they experienced burnout. This study found that the COVID-19 pandemic adversely impacted clinicians working in LTC settings, their patients' wellbeing, and the delivery of mental health services. Understanding the impact that the COVID-19 pandemic has had on LTC patients and clinicians alike has implications for the provision of services during future pandemics.
Mental Health of Holocaust Survivors and Other Older Adults During the COVID-19 Pandemic in Israel
Authors: Cohn-Schwartz Ella , Bachner Yaacov , Carmel Sara
Published: December 2021

Holocaust survivors could be especially vulnerable to the negative effects of the COVID-19 pandemic due to their early life traumas. Thus, the current study examines the effects of the pandemic on the mental health of Holocaust survivors in Israel, compared to adults who did not experience the Holocaust. We collected quantitative data from 305 adults aged 75+ (38% Holocaust survivors) in Israel during the COVID-19 pandemic. The results indicate that Holocaust survivors were worried to a greater extent from COVID-19 and reported greater depression which became worse during the pandemic. On the other hand, despite these differences, the two groups were similar in their will to live. In conclusion, Holocaust survivors seem to be more vulnerable to the COVID-19 pandemic, strengthening the vulnerability hypothesis, while also showing resilience in their will to live. Policy makers and practitioners should pay special attention to this particularly vulnerable population during these difficult times.
Association Between Arterial Stiffness and Fatigability in Well-Functioning Older Adults
Authors: Karikkineth Ajoy , Ferrucci Luigi , Simonsick Eleanor
Published: December 2021

The association between vascular health measured by arterial stiffness and fatigability, a marker of future mobility decline, is unknown. We examined 1210 men (47.7%) and women from the Baltimore Longitudinal Study of Aging, mean age 66.6 ± 13.9 years. Perceived fatigability was assessed after a 5-minute, treadmill walk using Borg rating (range 6-20). Arterial stiffness was determined by carotid femoral pulse wave velocity (PWV). In linear regression analyses fatigability and PWV were associated in men (Beta/P-value) (0.160/0.001) and women (0.136/0.008). Adjustment for mean arterial and pulse pressure attenuated the association in women (0.104/0.050) but not men (0.160/0.001). The association was significant among those with slower usual and rapid gait speeds, longer 400m walk time and slower repeated chair stands pace (all p<0.05). Arterial stiffness is associated with a greater proneness to fatigue especially in older adults exhibiting poorer mobility. The underlying mechanisms appear to differ between men and women.
Use and Disuse of Technology Among Persons With Memory Concerns and Their Caregivers During the COVID-19 Pandemic
Authors: Millenbah Ashley , Albers Elizabeth , Mikal Jude , Finlay Jessica , Jutkowitz Eric , Mitchell Lauren , Horn Brenna , Gaugler Joseph
Published: December 2021

Social distancing and shelter-in-place orders designed to curb the spread of COVID-19 increased isolation among persons with memory concerns (PWMC) and increased the burden on individuals providing their care. Technology, such as smartphones or tablets, has demonstrated potential to improve the social connections and mental health of older adults; however, older adults historically have been reluctant to adopt new technology. We aimed to understand why some PWMC and their caregivers used new technology to adapt to lifestyle changes during the COVID-19 pandemic while others did not. In this study, we used data collected in 20 qualitative interviews from June to August, 2020 with PWMC and their family caregivers to assess changes in and barriers to technology use. Qualitative thematic analysis identified three themes which explained motivations for using new technology during a pandemic: 1) seeking relief from caregiver burden, 2) alleviating boredom, and 3) maintaining social connection. Results further revealed lingering barriers to PWMC and caregiver adoption of technologies, including: 1) PWMC dependence upon caregivers, 2) a lack of familiarity with technology, and 3) difficulties using technology. This in-depth investigation suggests that technology has the ability to provide caregivers relief from caregiving duties and provide PWMC with more independence during periods of pronounced isolation
WLS-ILIAD: Initial Lifetime’s Impact on ADRD
Authors: Herd Pamela
Published: December 2021

Between 2021 and 2025, WLS will collect two new waves of data, which will capture detailed measures of cognitive change and dementia as the cohort reaches their early to mid 80s. In this session, I will provide an overview of the data that we’re collecting, as well as opportunities to explore early and mid-life determinants of cognitive change and dementia onset in this unique study. Compared to existing studies, the WLS offers some novel opportunities. First, it will provide one of the only opportunities to study how early and midlife life conditions and experiences, on data gathered prospectively, can shape cognitive trajectories and dementia in later life. Second, its unique sibling design provides significant analytic advantages, improving causal inference. Third, the study includes a large group of rural participants, allowing for closer examinations of how rural conditions may shape risk and resilience against cognitive decline and dementia in later life.
Implementation of Transitional Care Innovations: Considering the Organizational Context and Process is Key
Authors: Fakha Amal , de Boer Bram , van Achterberg Matheus , Hamers Jan , Verbeek Hilde
Published: December 2021

Many transitional care innovations (TCI) are implemented to improve long-term care services for older persons during the transition between various care settings. Nevertheless, multiple contextual factors (barriers; facilitators) influence the implementation of TCI at different levels such as but not limited to the organizational environment, outer setting, or innovation’s characteristics. By conducting a modified Delphi study involving 29 international experts from 10 countries, eleven influencing factors were prioritized and agreed upon (with ≥ 85% consensus level) as the most important for implementing TCI. These top factors were linked mostly to the organizational setting (e.g. resources, financing) or the implementation process (e.g. engaging key stakeholders). Moreover, the feasibility to address the majority of these factors with implementation strategies was rated as difficult. Our work concludes a compilation of major factors to be aware of and aim to tackle when preparing to implement a new TCI in any long-term care setting.
Where to Start the Journey to Advance Age Inclusivity at Your Institution
Authors: Porter Michelle , Bergman Elizabeth
Published: December 2021

Each institution’s journey to becoming more age inclusive will to depend on its unique characteristics, and be dependent on its strengths and existing gaps. A good place to start is to explore how to build connections and leverage existing initiatives, such as research programs, community connections and importantly the institution’s strategic plan. At this point, elements to consider include coalition building, identifying strengths and gaps, and reframing aging. Because ageism can be a hindrance in many ways, strategies to address ageism should be included. GSA initiatives and tools such as the Reframing Aging Initiative, Ageism First Aid and AARPs Disrupt Aging will be highlighted in our presentation. Examples of how several universities have charted their course to becoming more age-inclusive and age-friendly will be outlined.
Developing a New Model of Interprofessional Education in Aging and IDD
Authors: Clark Phillip , Helm Faith , Ansello Edward
Published: December 2021

Health and social care providers are ill-equipped to address the complex needs of individuals growing older with IDD and their families when dementia is suspected or diagnosed. Addressing the growing need for professionals to acquire practical diagnostic, treatment, and management methods requires an interorganizational and interprofessional approach. A consortium of aging and IDD organizations developed a successful Project ECHO (Extension for Community Healthcare Outcomes) model to create a virtual community of practice connecting a hub team and participating spoke sites. This paper reviews reasons for the model’s success, including: (1) curriculum providing practical solutions to complex problems, (2) integration of interprofessional team approach, (3) “all teach, all learn” model promoting sharing among participants, and (4) the inclusion of case studies engaging participants in developing solutions and strategies to improve the quality of life of clients and families. Implications of this model and recommendations for future professional educational programs are presented.
Activity Engagement Patterns Among Older Chinese Immigrants
Authors: Tang Fengyan , Rauktis Mary
Published: December 2021

Activity engagement is a major component of well-being in later life. However, very few studies have focused on older immigrants who are often at risk for social isolation and psychological distress. We aim to map the pattern of activity engagement and examine its variations in relation to immigration-related factors and social aspects of neighborhoods in a representative sample of older Chinese immigrants. We used data from the Population Study of Chinese Elderly in Chicago (PINE), a population-based epidemiological study of US Chinese older adults that were conducted between 2011 and 2013 (N=3,157). Latent class analysis and multinominal regression analysis were conducted to identify activity engagement patterns and examine the associated factors. Four patterns of activity engagement were identified: restricted (15%), diverse (31%), informal social (32%), and community-based social (21%). Acculturation and family-oriented immigration differentiated the restricted from the diverse class membership. Positive attributes of social environment measured by social network size, positive social support, neighborhood cohesion, and sense of community were associated with the probabilities of class membership relative to the restricted class. Findings point to the importance of positive attributes of social environment in enhancing engagement with life among older Chinese immigrants. Efforts are needed to assist the vulnerable restricted group and recent older immigrants while meeting the demands of older immigrants who are less educated and less acculturated. Creating a supportive environment is important to provide information, access, and resources needed for activity engagement in the marginalized minority aging populations
Social Support and Diabetes Management Among Older American Indians
Authors: Goins R Turner , Grant Molly , Conte Kathleen , Lefler Lisa
Published: December 2021

We examined social support among older American Indians in relation to their diabetes management. In-depth interviews were conducted with 28 participants aged ≥ 60 years who were members of a federally-recognized tribe. We examined professionally transcribed audio recordings with a systematic text analysis approach. Main sources of social support were family/friends, clinicians/formal services, community/culture, and spiritual/God. Most of the support was instrumental in nature, including food shopping, meal preparation, and medication management. Social support had both positive and negative influences diabetes management while there were some participants who lacked support. The four main social support types were present, including instrumental, emotional, informational, appraisal support. Value orientations among American Indian families command lateral-group relational behavior rather than autonomy and independence with extended social systems fostering interdependence. A deeper understanding is needed of how social relationships can be better leveraged to aid in the effective diabetes management among older American Indians.