bluuebunny/crossref_metadata_2025 huggingface dataset:
THE IMPORTANCE OF EMOTIONAL CAPITAL ACROSS THE LIFESPAN: WHY THE LITTLE MOMENTS IN MARRIAGE MATTER
Authors: Neff Lisa , Walsh Courtney , Beer Jennifer
Published: November 2019

Throughout a marriage, couples will share countless ordinary moments together, such as laughing together or engaging in leisure activities. Although these moments may seem trivial in isolation, research suggests that accumulating small positive moments together helps couples build emotional capital, which serves as an essential resource for protecting marriages from the harmful consequences of relationship challenges. This study explored whether emotional capital may buffer couples not only from the negative effects of relational stressors, but also from the negative effects of life stressors encountered outside the relationship in a sample of younger (age 30-45) and older (age 60+) married couples. Drawing from theories of socioemotional expertise, we also examined whether the buffering effects of emotional capital may be stronger for older adults. One hundred forty-five couples completed a 21-day daily diary task assessing shared positive experiences with the partner, negative partner behaviors, marital satisfaction, life stress, and mood. Spouses who generally accrued more shared positive moments with their partner across the diary days maintained greater marital satisfaction on days of greater partner negativity compared to spouses who accrued fewer positive moments. Moreover, spouses who generally accrued more shared positive moments with their partner across the diary days also reported lower levels of negative mood on days in which they experienced more life stress compared to spouses who accrued fewer shared positive moments; in both cases, the buffering role of emotional capital was significantly stronger for older adults. All results held when adjusting for relationship length and general marital happiness.
CONDUCTING CLINICAL TRIALS AMONG PERSONS WITH DEMENTIA: METHODS, CHALLENGES, AND OPPORTUNITIES FOR IMPROVEMENT
Authors: Sefcik Justine S , Hodgson Nancy
Published: November 2019

Evidence-based interventions for persons with dementia and their caregivers are important to improve both their quality of life and quality of care. Conducting rigorous clinical trials is essential to build evidence, guide research, and inform clinical practice. Clinical trials involve multifaceted phases which present opportunities and challenges to the research team. In this presentation, we discuss obtaining consent, gathering information to inform refinement of an intervention, adaptation of an intervention, and fidelity checks to ensure the rigor of intervention delivery. The first session will discuss initial challenges faced when consenting nursing home residents with dementia and tailored approaches to enhance clinical trial enrollment. The second session will share highlights of usability testing of a novel mobile app to refine and improve its ease in a future clinical trial of use for persons with dementia and their caregivers. The third session will describe findings from focus groups that generated recommendations for culturally adapting an intervention to promote quality of life among older Latinos with dementia. The final session will discuss the advantages, disadvantages and ethical considerations of in-person fidelity monitoring during a home-based intervention clinical trial involving persons with dementia and their caregivers. Together, these presentations describe the complex nature of implementing clinical trials and highlight the important lessons learned to strengthen study implementation.
LESSONS LEARNED FROM SAVVY EXPRESS: A FEASIBILITY STUDY OF A PSYCHODUCATIONAL INTERVENTION FOR CARE PARTNERS
Authors: Aranda Maria P , Cherry Debra
Published: November 2019

An increasing number of families, funders, and community providers seek very brief psychosocial caregiver interventions, yet the evidence for such condensed interventions is not established. Based on the Savvy Caregiver Program, we explored the feasibility, acceptability, and outcome trends for a condensed 3-session version titled, Savvy Express. Based on a single-group, pre- and post-test intervention design, we examined post-intervention and 3-month data on 116 English-speaking racially and ethnically diverse care partners caring family members with Alzheimer’s disease and related dementias. 41% of the sample was non-Latino white and comprised of Latinas, African Americans and Asian American/API. Most care partners were either adult children or spouses caring for someone with AD or other dementia. Over 80% were college educated. Two of three participants completed all 3 classes. Our findings indicate significant improvements in caregiver levels of depressive symptomatology and anxiety, competence, management of the situation, reduction of expectations, making positive comparisons, and reactivity to the family member’s memory behavior. Upwards of 90% would recommend the program to other caregivers. Savvy Express is a brief caregiver intervention with high acceptability and feasibility. Improvements in care partner psychosocial outcomes signal a promising practice to reduce the burden of caregiving. A major focus of the paper focuses on barriers and facilitators to uptake of the study procedures and intervention with community-based partners. Future work is needed to establish the efficacy of Savvy Express across a longer observation period, and with less educated, low-income participants, and limited English-speaking families.
PAACC: A MINDFULNESS-BASED MULTICOMPONENT PROGRAM FOR FAMILY CAREGIVERS OF PERSONS WITH DEMENTIA
Authors: Hagemann Lauren , Luci Katherine , Sapra Mamta , Savla Jyoti , Jacobs Lindsey , Yates Tonda
Published: November 2019

Few interventions for family caregivers of persons with dementia (PwD) focus on both dementia care skill-building and the enhancement of acceptance and compassion towards oneself and the PwD. We designed a multicomponent, mindfulness-based 4-session caregiver intervention (Practice of Acceptance, Awareness, and Compassion in Caregiving, or “PAACC”) to reduce burden in caregivers of family members with Alzheimer’s disease and related dementias (AD/ADRD) and TBI-related AD. A prospective, randomized trial design is being implemented to compare the effectiveness of PAACC to the well-known, evidence-based REACH-VA intervention. Seventeen family caregivers (Mean Age = 68.71 years; 82% women; 30% had high school or less education) have participated in the trial thus far and provided qualitative responses to acceptability questions. High acceptability was noted for all intervention components of PAACC. Participants completed 95% of mindfulness homework during the study period. A majority also reported practicing spontaneous, informal mindfulness while engaged in daily activities (e.g., going for a walk, cooking). One participant noted incorporating mindfulness in her daily spiritual practice. The majority remarked that PAACC taught them to be more aware and accepting of the PwD’s illness. Others mentioned becoming more aware of which stressors triggered them, and that they were able to avoid arguments with the PwD because of this increased awareness. Overall, our results suggest that this mindfulness-based multicomponent intervention is a promising method for promoting stress reduction for family caregivers of persons with dementia regardless of age, stage of dementia, education level, or rurality. Implications for research and practice will be discussed.
SUPPORTING FAMILY CAREGIVERS: HOW DOES RELATIONSHIP STRAIN OCCUR IN CAREGIVING DYADS? A QUALITATIVE STUDY
Authors: Avent Elizabeth S , Rath Laura , Meyer Kylie , Benton Donna , Nash Paul
Published: November 2019

Family members and spouses are usually the primary caregivers for older adults. Providing direct care can be stressful, strenuous, and time-consuming for caregivers, potentially leading to frustration and anger towards care recipients. This can be detrimental to the relationship quality of the caregiving dyad. Though caregiver strain and burden have been extensively studied, there is limited information on the development of relationship strain. To explore how relationship strain occurs between caregivers and care recipients, 8 focus groups (N=62) and 8 semi-structured telephone interviews were conducted with caregivers in Los Angeles, inquiring about relationship quality with their care recipients and when frustration and anger occurs. Inductive coding was used to create coding schemas. Findings showed that most caregivers reported relationship strain occurring after taking on the caregiving role, and frustration and anger arose when providing ADLs, especially during bathing and toileting. Although these caregivers had initially experienced strain in their relationships, a recurring theme that emerged was that they developed strategies to decrease frustration and anger and improve the quality of their relationships with their care recipients. Direct communication with caregivers is important in designing a structured and effective intervention. These findings help inform an intervention for new caregivers to help them identify what can lead to relationship strain, as well as teach them reliable strategies to manage frustration and anger towards their care recipients.
ASSOCIATION BETWEEN COGNITION AND FALL RISK BASED ON THE STEADI ALGORITHM: PROJECT VIBE
Authors: Hughes Tiffany F , Carramusa Cara , Van Dussen Daniel J
Published: November 2019

Falls are a growing concern among older adults with estimates that one in four fall each year. Older adults who experience a fall are at higher risk for poor health outcomes that threaten independence and increase risk of death. Impairment in cognitive function is known to be associated with greater fall occurrence; however, cognitive testing is not an integral part of clinical fall risk assessment. The purpose of this study is to examine cognitive performance in relation to fall risk level and its components determined using the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) algorithm. One hundred eight community dwelling older adults (mean age 79(SD 7.3) years, 76% women, and 56% college or higher education) were included. Cognition was assessed with the Montreal Cognitive Assessment (MoCA; >= 26 normal). The STEADI algorithm was used to assess fall risk (low vs. moderate/high) based on the Stay Independent screening (>= 4), impairment in gait (Timed Up and Go (TUG)), strength (30-second chair stand), and balance (4-stage balance), and number of falls (>= 2). Associations between cognition and fall risk and its components were assessed using logistic regression adjusting for age, gender, and education. Normal cognitive status was marginally associated with lower likelihood of moderate/high compared to low fall risk (OR 0.42, 95% CI 0.17-1.04), and with a lower likelihood of TUG impairment (OR 0.22, 95% CI 0.07-0.66). These results suggest cognitive status may contribute important information about older adults’ fall risk and should be considered an integral part of fall risk assessment.
USABILITY OF A MOBILE APP TO IMPROVE GOAL-DIRECTED BEHAVIOR: CHANGING APATHY INTO ACTION IN PERSONS WITH DEMENTIA
Authors: Massimo Lauren M , Miller Alexander , Schiffrin Daniel , Lydon Sean , Mechanic-Hamilton Dawn
Published: November 2019

Impairment of goal-directed behavior, often labeled apathy, is the most common and disabling of the behavioral and psychological symptoms of dementia. Activi-daily is a mobile app that targets key and distinct components of goal-directed behavior (initiation, planning and motivation) found to contribute to apathy in persons with dementia. This presentation will focus on usability testing of Activi-daily in persons with dementia and their caregivers. After 1 week of at-home use, we gathered feedback via focus groups on features and usability of Activi-daily. Usability of Activi-daily and its’ potential as an intervention for treating apathy were viewed favorably. Feedback regarding usability revealed that the app was easy for dyads to use and enhanced the patients’ ability to complete their daily tasks with greater independence. Suggestions to improve app usability included adding a voice to text feature, a progress bar to visualize progression towards daily goals and gamification features to enhance motivation.
FRAILTY IN REACH II CAREGIVERS: A SECONDARY DATA ANALYSIS
Authors: Elkins Jeananne , Griffiths Patricia C
Published: November 2019

Frailty, a reduction in reserve capacity in people who are otherwise considered healthy, affects between 9 and 13% of adults who are older. Frailty is a poorly understood syndrome; however, frailty is correlated with negative CV procedure outcomes, falls and institutionalization. Little is known about frailty in caregivers. A secondary data analysis was conducted using the REACH II publicly available dataset and the Groningen Frailty Index (GFI). At consent two percent of REACH II caregivers had difficulty going to the toilet while 11% had difficulty walking outdoors. More than 1/3 had hearing and vision losses. 75% felt sad or dejected. 82% were taking more than 4 medications. Based on their calculated GFI, between 61% and 64% of the REACH II caregivers were frail. Frail caregivers and their care recipient were less likely to go to the emergency department (-0.110 coefficient; p = 0.004 95% CI -0.184 -0.035) and were less likely to be hospitalized overnight during the past 6 months (-0.121 coefficient; p=0.004; 95% CI -0.203 -0.040). Frailty is an under-recognized syndrome in caregivers. Little is known about the impact of frailty on the caregiving dyad; however, ED utilization and hospitalization was decreased in these caregivers and their care recipients. This decrease may imply a delay in seeking care; and, in fact, lead to worse health outcomes for the dyad. With the aging of Baby Boomers and the continued dependence for long term care delivered by unpaid caregivers, implementation of programs to prevent and treat frailty in caregivers is essential.
THE BUILT ENVIRONMENT INFLUENCED THE INCIDENCE OF FALLS IN OLDER ADULTS LIVING IN THE UNDERSERVED COMMUNITY
Authors: Suzuki Rie , Blackwood Jennifer , Shah Shailee , Ganai Sabah , Warden Kimberly
Published: November 2019

The built environment is commonly cited as a facilitator to local walking. Although health promotion programs targeting physical activity are available, few studies have investigated the associations of the perceived neighborhoods with the incidence of falls in the minority communities. Hence, the purpose of this preliminary study was to understand whether the perceived built environment influenced the fall experiences in older adults living in the underserved community. The preliminary cross-sectional survey was conducted at the regional health clinic in Flint, MI. Descriptive statistics and analysis of variance (ANOVA) were performed using SAS v8.4. The eligibility criteria included over 65 years old and Flint residents. Of 132 participants, the mean age was 69.75 (SD=5.00). The majority were female (68%), African Americans (80%), single, divorced or widowed (80%), and > GED (84%). The ANOVAs supported that “had fallen in the past year” was associated with “stores are within easy walking distance,” “easy to walk to a transit stop” and “there is a dirt strip that separates the streets from the sidewalks.” The fall experience was more likely to associate with the sedentary lifestyle and the comorbidities such as diabetes, fatigues, muscle spasms, and chronic pain. To summarize, the built environment increased the incidence of falls in the past year. Those who had fallen had poor health conditions. Further studies are needed for older adults to engage in physical activity. It is essential to develop the age-friendly support systems and accommodations to local walking in this community.
SOCIAL ISOLATION AND FALLS RISK AMONG COMMUNITY DWELLING OLDER ADULTS: THE MEDIATING ROLE OF DEPRESSION
Authors: Burr Jeffrey , Quach Lien
Published: November 2019

Relatively little is known about the relationship between social isolation and the risk of falls among older adults. Yet, a considerable amount of research demonstrates that lack of sufficient social relationships, broadly defined, represents a modifiable risk factor for many indicators of well-being in later life. This study examines the association between two types of social isolation and the risk of falls. The study also examines whether depression mediates the association between social isolation and risk of falls. Longitudinal data from the Health and Retirement Study (2006-2012) were collected from community-dwelling participants aged 65 and older (N=8,464). The outcome variable was number of falls self-reported over the observation period. Independent variables included perceived isolation (feeling lonely, perceptions of social support), social disconnectedness (e.g., having no friends or relatives living nearby, living alone), and number of depressive symptoms. Results from regression models indicated that social disconnectedness was associated with a 5% increase in the risk of falls (IRR=1.05, 95% CI=1.01-1.09). Perceived social support was associated with a 21% increase in the risk of falls; when examined together, perceived social support and loneliness were associated with a combined 37% increase in falls risk. Depression was associated with a 47% increase in falls. Depression mediated the association between perceived isolation and falls. Further, perceived isolation mediated the association between social disconnectedness and falls. Reducing perceived social isolation and social disconnectedness may be an avenue for designing interventions to reduce the risk of falls, especially for older adults with depression.
A MIXED-METHODS EVALUATION OF A NURSE-LED INTERPROFESSIONAL INTERVENTION FOR COMMUNITY-DWELLING OLDER ADULTS
Authors: Montano Anna-Rae L
Published: November 2019

This study aims to assess the relationship between an Interprofessional Collaborative Practice (IPCP) intervention for community-dwelling older adults, Geriatric Outreach and Training with Care! (GOT Care!), and the observed 26% reduction in Emergency Department (ED) visits for the 51 older adults who participated. This study utilized a convergent parallel mixed-methods design that included a historical prospective matched cohort study and semi-structured interview surveys. The 51 GOT Care! participants were retrospectively matched to 51 control participants on several variables and ED visits were assessed for each group at 6, 8 and 12 months. Mixed effects generalized linear modeling, with a Poisson response, a log link function, and a random effect for pair, was conducted to analyze the quantitative data. Stakeholders, including hospital administrators and faculty clinicians, of GOT Care! responded to electronic semi-structured interview surveys regarding the relationship between GOT Care! and the observed reduction in ED visits. Content analysis of the responses was completed. The themes from the stakeholder interviews were integrated into the historical prospective matched cohort study to further explore the relationship between GOT Care! and the reduction in ED visits. The results of this study are still pending. This study has implications regarding the utilization of an IPCP model within an academic-practice partnership in the aim of reducing ED visits for vulnerable community-dwelling older adults. Hospital administrators can also utilize the results of this study to gauge the value of IPCP models within their hospital systems.
ASSESSMENT OF PALLIATIVE CARE TRAINING NEEDS FOR CERTIFIED NURSING ASSISTANTS
Authors: Kim Jinsook , Gray Jennifer A
Published: November 2019

It is unknown whether certified nursing assistants (CNAs) receive up-to-date palliative care training through continuing education. Also unclear is whether existing trainings cover the issues that CNAs encounter at work or are tailored to CNAs’ learning styles and preferences. This study aimed to assess the palliative care training needs of CNAs working at skilled nursing facilities (SNFs) in northern Illinois. CNAs (n=127) from 6 SNFs completed an online survey regarding palliative care training experience, perceived needs for palliative care training, and demographic and work-related information. The majority of the participants were female (88%) and White (58%) or African American (20%). On average, participants were 34 years old and worked for 8 years in the field. Four out of five preferred a training 90 minutes or shorter. Approximately one half preferred in-person training, and the rest preferred a hybrid (32%) or online delivery (19%). Discussions and videos were most preferred in training, while quizzes and mobile apps were least preferred. CNAs who worked longer in the field were less likely to have received training than their counterparts. The least-trained areas included utilizing advance directives and discussing death with patients. The most needed training areas were talking to a patient who wants to hasten death and addressing the complex needs of dying patients. The results indicate a relative deficiency of palliative care training among CNAs who have worked longer in the field. Training areas needing more attention include advance directives, discussing death with patients, and the complex needs of dying patients.
EFFECTIVENESS OF A SIMULATION-BASED EMPATHY ENHANCEMENT PROGRAM WITH MINDFULNESS ON SOCIAL WORKERS
Authors: Han Areum , Kim Taehee
Published: November 2019

Empathy enhancement programs and mindfulness-based practices may reduce care practitioners’ burnout and stress while increasing satisfaction, caring efficacy, and well-being. No study has been conducted to measure the effectiveness of a simulation-based empathy enhancement program combined with mindfulness practice on professionals working with older adults living alone. This study, therefore, assessed the effectiveness of a simulation-based empathy enhancement program with a brief mindfulness practice session on social workers working with older adults living alone. This study was a quasi-experimental study involving 105 social workers in South Korea. The experimental group received a simulation-based empathy enhancement program with mindfulness practice, and the attention control group watched a 30-minute-long educational video about empathy. Data were collected prior to the intervention and at two weeks after the intervention using self-reported questionnaires measuring empathy, caring efficacy, psychosocial stress, compassion satisfaction, burnout, and secondary traumatic stress. The experimental group had significantly lower levels of psychosocial stress compared to the attention control group. Both groups showed significant improvements in empathy but in different empathy measures. Also, the experimental group only showed significantly lower levels of burnout and secondary traumatic stress after the intervention while the attention control group only showed significant improvements in compassion satisfaction and caring efficacy. Although between-group differences were found in psychosocial stress only, pre-and post-test differences in different outcome measures from experimental and attention control groups indicate limited but possible effectiveness of each of the empathy enhancement programs on people in caring professionals.
VIRTUAL REALITY MEDICAL EDUCATION PROJECT ENHANCES EMPATHY
Authors: Gugliucci Marilyn R
Published: November 2019

Introduction: It is particularly important that innovative learning modalities are utilized to augment medical students’ learning about empathy in relation to older adult health care. As the older population increases and lives longer, their health care utilization is predicted to increase dramatically. Methods: 1st year osteopathic medical students (N=174) at the University of New England were required to complete the National Network of Libraries of Medicine (NN/LM) New England Region (NER) grant funded Embodied Labs’ “We Are Alfred” Virtual Reality (VR) module (15 min) and a pre/post-test. The students assumed the role of Alfred, a 74 y/o African American male with macular degeneration and hearing loss. “We Are Alfred” utilizes a virtual reality headset, headphones, and a hand-tracking device to immerse students into Alfred’s experiences as a patient. Descriptive statistics and t-tests were applied for data analyses. Results: Learning was broad and significant: 94% reported increased empathy; 92% reported increased learning about macular degeneration; and 90% reported increased learning about hearing loss. Qualitative data collected from the pre-tests and post-tests supported learning on empathy with 4 associated themes (Personal Experiences, Perceptions of Older Adults, Thoughts about Health, Descriptors of Aging).. Conclusion: Virtual reality was deemed a successful medical education learning tool for these medical students. Utilizing this technology to create an immersive case study taught these medical students about the aging experience from the first-person patient perspective.
MEDICARE COVERAGE CHANGES: THE ROLE OF INDIVIDUAL CHARACTERISTICS AND INTERNET USE
Authors: McGarry Brian E , Grabowski David C
Published: November 2019

An important challenge to the success of consumer choice within the Medicare program is older adults’ proclivity to assess their coverage on an annual basis and make changes when appropriate. Every year, relatively few beneficiaries alter their coverage (e.g., by switching Part D plans, switching between MA and traditional Medicare coverage) despite annual coverage changes and new market entrants. Little is known about the factors that encourage re-evaluation of Medicare coverage choices or the role of technology in facilitating changes. The latter knowledge gap is particularly relevant as the internet is an increasingly important delivery mechanism for Medicare information and consumer support tools. This study uses a nationally-representative sample of Medicare beneficiaries to describe Medicare coverage changes, the individual factors that predict such changes, and the relationship between Medicare-related internet use and plan switching. On average, 12% of Medicare beneficiaries made changes to their coverage in a given year, with 25% of beneficiaries making a change at any point during the study period. Between 2011 and 2015, the self-reported rate of using the internet to handle Medicare/insurance matters increased from 5% to 11%. In adjusted models that included individual-level fixed effects and other time-varying characteristics (e.g., health status, prescription drug needs), Medicare-related internet use was associated with a 65% increase in the probability of making a coverage change. Although using the internet to handle insurance matters remains relatively rare among older adults, it may an important mechanism for obtaining information that encourages plan changes, facilitating such switches, or both.
SEX AND THE BIOPSYCHOSOCIAL MODEL: SEXUAL ACTIVITY AND GENDER DISPARITY IN OLDER ADULTS
Authors: Reinhardt Rebecca , Moore Zaver D , Nuccio Alexandria
Published: November 2019

The biopsychosocial model emphasizes relational factors such as quality and availability as key components to older adult sexual activity (Gillespie, 2017). Supporting these findings, a previous study found that older adults aged 65 and over reported having more sex in the past six months but fewer sexual partners in the past year than younger adults. The current study seeks to further explore sexual activity by gender specifically, number of sex partners in the last year, and frequency of sex over the past six months in older adults. To better understand sexual activity and gender differences, 499 (male=59.7%, female 40.3%) participants aged 65 to 93 were selected from the de-identified Survey of Midlife in the US database (MIDUS-3). A Weltch T-test was used examining sexual activity among older adults based on gender. Results indicated that the number of sex partners within the past year was similar for females (M=1.10, SD=.49) and males (M=1.04, SD=.28), t(477)=1.62, p=.10, d^=.07. Further, results indicated sex frequency within the last six months was similar between females (M=3.41, SD=1.55) and males (M=3.66, SD=1.48), t(415)=1.76, p=.08, d^=.14. Contrary to previous research, the present findings suggest there are no gender differences in number of sex partners or sex frequency for older adults. The current findings draw attention to potential discrepancies within this under-explored subject area. While implications of these findings can improve communication regarding sexual health, future research should focus on how aspects of the biopsychosocial model can be a protective factor for the sexual health of older adults.
THE PROTECTIVE ROLE OF SOCIAL SUPPORT ON DEPRESSIVE SYMPTOMS AMONG AGING SEXUAL MINORITY CANADIANS
Authors: Stinchcombe Arne , Hammond Nicole G , Wilson Kimberley
Published: November 2019

Sexual minority older adults face minority stressors that are associated with higher rates of mental illness. The stress buffering effects of social support within majority populations are well documented. Using a large population-based sample of aging Canadians, we sought to examine the relationship between sexual orientation and depressive symptoms, and determine whether this relationship is moderated by social support and sex. Baseline data from the Canadian Longitudinal Study on Aging (CLSA) were used (n = 46147). Participants were between the ages of 45-85 years at time of recruitment (mean age = 62.46, SD = 10.27), and self-reported their sexual orientation as heterosexual or lesbian, gay, or bisexual (LGB) (2.1%). Social support and depressive symptoms were measured using validated instruments. Four functional social support subscales were derived: tangible, positive social interaction, affectionate, and emotional/informational. Multiple linear regression models adjusted for relevant covariates were conducted. LGB identification was associated with greater depressive symptoms when compared to heterosexual participants (p = 0.032). As evidenced by a significant 3-way interaction (p = 0.030), increasing tangible social support was associated with a corresponding decrease in the risk of depressive symptoms; this relationship was most pronounced for lesbian and bisexual women. A significant 2-way interaction (p = 0.040) revealed that as emotional/informational social support increased, depressive symptoms decreased, with greater disparity between LGB and heterosexual participants at lower levels of social support. The results highlight the importance of social support in promoting mental health, especially among sexual minority older adults.
SEXUAL ORIENTATION AS MULTIDIMENSIONAL: AGE AND GENDER DIFFERENCES IN SEXUAL MINORITY OLDER ADULTS
Authors: Root Eve Z , Caskie Grace , Detwiler Bethany , Johnson Nicole L
Published: November 2019

Recommendations to conceptualize sexual orientation as a continuum and as multidimensional rather than one dichotomous variable (e.g., DeBlaere et al., 2010; Kinsey et al., 1948) have been largely unexplored in sexual minority older adults, including how these dimensions might differ by age and gender. In this study, participants indicated their sexuality using three continua representing (1) attraction in general, (2) emotional attraction, and (3) physical attraction. Possible responses ranged from 0=exclusively opposite sex to 7=exclusively same sex. The current sample included 187 participants (50-86 years; 73 men, 114 women) self-identifying their sexual attraction in general as not exclusively to the opposite sex. Age groups were 50-55 (n=56), 56-64 (n=84), and 65-86 (n=47) years. MANOVA results indicated a significant multivariate age group by gender interaction (p=.040) that was significant for all three attraction variables---attraction in general (p=.035), emotional attraction (p=.010), and physical attraction (p=.029). In the 50-55 age group, the average response for physical attraction was closer to exclusively same sex for men than for women. For the 56-64 age group, the average response for attraction in general and emotional attraction was closer to exclusively same sex for women than men. Among those 65+, women responded closer to exclusively same sex than men only for emotional attraction. Gender differences on all three sexual attraction continua were not consistent across age groups, which may reflect a more fluid and complex understanding of sexuality in older LGB adults. Future studies should consider using multidimensional and continuous variables when measuring sexual orientation.
EXPLORING HOW AGE PREDICTS OUTNESS AND INTERNALIZED HOMOPHOBIA IN A LIFESPAN SAMPLE OF SEXUAL MINORITIES
Authors: Vale Michael T , Pasta Paige M , Bisconti Toni L
Published: November 2019

Minority Stress Theory posits that specific minority stressors, such as internalized homophobia and outness, predict negative health outcomes in sexual minorities. There has been substantial work in addressing these stressors in young adult samples; however, less in known about older adults. Older sexual minorities were socialized in a time in which same-sex relations were considered deviant and illegal, and therefore, have been exposed to a lifetime of marginalization. Although there is evidence that minority stressors negatively impact health in older adults, many studies exclude a complete lifespan sample. The goal of this study was to collect a sample of individuals in same-sex relationships ranging in age from 18-80 (N = 228, M = 40.93, SD = 15.87) and examine whether age correlates with outness and internalized homophobia. We found that older participants had higher degrees of outness (r = .21, p < .01) and less internalized homophobia (r = -.20, p < .01) resulting in less overall minority stress. We also analyzed different social resources that might explain the age-related decrease in minority stress and found that age was related to higher self-esteem (r = .24, p < .01). We tested whether self-esteem moderated the direct relationships between age and the minority stressors and found a significant interaction for internalized homophobia (B = .0175, p < .01), but not outness. Our findings provide support that older sexual minorities report less minority stress and more research is needed to explain what promotes these trends.
EXPLORING AGE, GENDER, AND RELATIONSHIP CLOSENESS DIFFERENCES IN RESPONSES TO IGNORED DISRESPECT
Authors: Steele Jenessa C , Chappell Amanda , Scott Rachel
Published: November 2019

Emotional responses to disrespect tend to be negative (Hawkins, 2015). Little is known about how responses to disrespect vary across age groups and relationship closeness. It is unknown whether older adults have more emotional protection against disrespectful experiences, or are more deeply affected due to relationship closeness. Overall, we might expect that older adults react less negatively to disrespect compared to young adults, as they are more-skilled emotion regulators (Carstensen, 1991; English & Carstensen, 2014). We aimed to explore if, and under which circumstances, older adults are more or less sensitive to disrespect compared to younger adults. Three hundred participants responded to six scenarios illustrating ignored disrespect. Participants were randomly assigned to close or distant relationship disrespect scenarios. Relationship closeness was first determined by requesting participants identify a person in each layer of Kahn and Antonucci’s (1980) Social Convoy Model. Identified names were then automatically inserted into the six scenarios. Emotional responses and sensitivity to each scenario were recorded. Participants in the close condition reported more sensitivity to disrespect and negative emotions than participants in the distant condition. Females reported more sensitivity to disrespect and negative emotions than males. We did not find overwhelming support for age differences in responses to disrespect. A single scenario indicated younger participants more sensitive to disrespect than older participants. Findings suggest it is more hurtful to be disrespected by someone close to you and females may be more sensitive to disrespect than males. More research investigating the role of age in disrespect is needed.
PORTRAYAL OF A CENTENARIAN: EXPLORING ACTOR INSIGHTS ON AGING AND LONGEVITY
Authors: Bishop Alex J , Finchum Tanya , Pearson-Littlethunder Julie
Published: November 2019

Data for this study originated the Oklahoma 100 Year Life Project. A total N = 7 volunteer actors (n = 5 women; n = 2 men) were recruited to participant as actors to play the role of centenarians in a living history play based on oral historical narratives. Actors participated in preliminary (prior to play performance) and post (after play performance) focus group sessions. Focus group questions addressed four key ideas: (1) Perceptions of aging and human longevity; (2) Loss and decline in aging; (3) Narrative storytelling and; (4) Personal life goal(s). Qualitative content analysis was performed to assess general thematic evidence stemming from actor perspectives. Four predominant themes emerged suggestive of adaptation in actor perceptions about human aging and longevity. These themes included: (1.) Purpose seeking (e.g. "It was interesting to see how much you can get out of life."); (2.) Age-embodiment (e.g., “I really wanted to focus on my facial movements and the way I talked”); (3.) Creative curiosity (e.g., “It takes a little bit of creativity. . . someone who has curiosity”); and (4.) Self-actualization (e.g., “You just think it’s not going to happen to me. . . and then you’re like. . . I am probably going to live to 100 now.”). Results have implications relative to how oral historical narratives can be used to enhance the personification of aging on stage, as well as demystify personal myths about longevity. Applications for use within educational and community settings for theatrical performances will be shared.
ARTS AND HUMANITIES BRIDGING ACROSS CONTINUUM OF CARE: CASE STUDY, GEORGETOWN LOMBARDI COMPREHENSIVE CENTER
Authors: Langley Julia
Published: November 2019

How does a hospital-based arts and humanities program build towards a better healthcare system for older patients, caregivers and medical professionals? The Georgetown Lombardi Arts and Humanities Program (AHP) supports the continuum of care by encouraging a creative and constructive response to illness through the use of music, dance, expressive writing and visual arts. Artists-in-residence at MedStar Georgetown University Hospital work throughout the hospital, with in-patients and out-patients, in waiting rooms, intensive care units, and clinics. At the same time, the AHP recognizes the need to introduce the next generation of physicians, nurses, and medical professionals to the benefits of interacting with the arts to improve skills of observation, communication, empathy, and perspective-taking to serve all populations, especially older patients living with chronic illness. The AHP’s educational programs at the National Gallery of Art, and the IONA Senior Day Center will be highlighted along with their supporting evidence base
THE RELATIONSHIP BETWEEN MARITAL STATUS, COHORT, AND DEPRESSION SYMPTOMS IN TAIWAN
Authors: Huang Fang-Yi , Li Min
Published: November 2019

Objectives: The relationship between marital status and depression symptoms is well documented. However, how the negative economic shock affect relationship differ by gender and cohort is still indecisive. The dataset “2011 wave of the Taiwan Longitudinal Study in Aging” and logistic regression models were used in the study. The results: Marital status is related to depression symptoms, but it differs by gendered cohort. With considering financial shock, there is no difference of depressive symptom between divorced and married female. The divorced and widowed have 4.81 and 2.47 times higher of getting depression symptom than the married for baby boom female. Being divorced is 3.67 times higher of getting depressive symptoms than being married for baby boom male. For WWII female, the widows are 1.78 times higher to have depressive symptoms than the married. being divorced, widowers, and single are 3.32, 2.21 and 2.90 times higher of getting depressive symptoms than being married for WWII male. Being divorced is 3.67 times higher of getting depressive symptoms than being married for baby boom male. In conclusions, people with unstable marital statuses are more depressed than the married. In particular, the effect of unstable marital statuses on depression could be account for by financial decline for women but not men. Given the policy emphasis on those with unstable marital status and economic decline, divorce female and single baby boom female may represent particular groups in whom interventions designed to financially support.
PSYCHOSOCIAL FACTORS INFLUENCING DEPRESSIVE SYMPTOMS AMONG OLDER ADULTS FROM NORTHERN INDIA
Authors: Banerjee Kasturi , Baker Tamara A
Published: November 2019

Global data show a significant increase in the number of adults 65+ years of age in India. Despite this increase, there is a dearth of available resources to adequately service their mental health needs. Data indicate that residents in Northern India, in particular, report poorer mental health outcomes than those in the South. The prevalence and impact of neuropsychiatric disorders and depression remain particularly significant, but largely unexplored. The aim of this study was to examine possible psychosocial and health factors affecting depressive symptoms in North India. Data were taken from the Longitudinal Ageing Study in India (LASI). Participants included adults aged 45 years and above (n=792), from the states of Rajasthan and Punjab. A multiple linear regression model was calculated to determine the influence of identified demographic and psychosocial factors (e.g., financial and social support, life satisfaction) on depressive symptoms. Data show that low life satisfaction (β= -0.19,p<0.001), poorer self-reported health (β=0.15,p<0.01), and being a care provider (β= -0.12,p<0.01) were significant predictors of depressive symptoms. These results indicate an increased need for care-giver mental health support along with policy aimed at awareness about caregiver burnout, health care access, and economic instrumental support services. A magnified view of the impact of life satisfaction on depression will be of immense value for understanding the unique needs and challenges of working with this population.
THE ASSOCIATION BETWEEN MULTIPLE CHRONIC CONDITIONS AND DEPRESSIVE SYMPTOMS: DISTINCTIONS BY RACE, GENDER, AND AGE
Authors: Erving Christy L , Frazier Cleothia
Published: November 2019

Multiple chronic conditions (MCC)—the co-occurrence of two or more chronic diseases—is a serious concern due to its high prevalence among middle-age and older-adults, and its association with increased disability, mortality risk, and healthcare costs. A growing body of work has shown that chronic physical conditions are associated with depressive symptoms. While MCC and depression affect a substantial proportion of older adults in general, there are important status variations in disease burden along the dimensions of race, gender, and age. This study employs an intersectional and multi-hierarchical approach to assess how these status characteristics (race, gender, and age) may condition the MCC-depression association. We use data from the 1994-2014 waves of the Health and Retirement Study (HRS), a nationally representative data source providing a longitudinal survey of U.S. adults over the age of 50 biennially. Results revealed that MCC was positively associated with depression in general. However, Black Americans, women, and younger adults were more likely to experience depression relative to their White, male, and older counterparts, respectively. The findings suggest that the lived experience of MCC differs by social status, and is perhaps due (in part) to status differences in access to social resources to counteract the potentially deleterious psychological effects of MCC. This research has also has practical implications: given the strong MCC-depression association, older adults with MCC should be offered psychological services to decrease the likelihood of developing mental health problems due to the stress associated with having multiple chronic conditions.
HIGH RISK OF NEW PSYCHIATRIC DISORDERS AND SUICIDAL BEHAVIOR IN DEMENTIA
Authors: Lai Amy , Li Yixia , Byers Amy
Published: November 2019

Occurrence of new mental health (MH) disorders in patients with dementia is neglected, with next to nothing known. We examined association between dementia diagnosis and risk of new psychiatric disorders and suicide, and MH services use. We merged four national databases from US Department of Veterans Affairs. Sample included 2,529,181 patients (≥50 years) in fiscal years (FY) 2012-2013 with no MH disorders. Dementia, psychiatric disorders (mood, anxiety, substance), suicidal behavior (ideation, plan, attempt, death by suicide) were identified by ICD-9/10 codes and national suicide databases. Hazard ratios (HR) were estimated using Cox proportional hazard models, with time-to-event defined as age at first diagnosis of MH disorder during FY 2014-2016. Analyses adjusted for medical/sociodemographic factors. Compared to those without dementia, dementia patients showed roughly 2-fold increased risk of new mood (HR: 2.19, 95% Wald CI: 2.15-2.24, p<.001) or anxiety (HR: 1.56, 95% CI: 1.50-1.63, p<.001) disorders. Recent dementia diagnosis was associated with highest risk of these disorders than prior or no diagnosis; for example, patients with recent diagnosis showed 72% greater risk of anxiety disorders (HR: 1.72, 95% CI: 1.63-1.81, p<.001). Although patients with prior dementia diagnosis had lower risk of suicidal behavior, risk increased with recent dementia diagnosis. However, dementia patients with new MH disorders showed little MH services use (< 20%). Patients with dementia have increased risk of new MH disorders, especially recent dementia diagnosis. Furthermore, MH services are underutilized, highlighting critical need for integration of such services in caring for dementia patients.
NEUROPSYCHIATRIC SYMPTOMS AND FUNCTIONAL ACTIVITIES AMONG OLDER ADULTS: THE ROLE OF ETHNICITY AND COGNITIVE STATUS
Authors: Burke Shanna L , Grudzien Adrienne , Naseh Mitra , Cadet Tamara J
Published: November 2019

Little is known about the likelihood of future functional deficits based on current neuropsychiatric symptoms (NPSs). This study seeks to examine the impact of NPSs on functional activities (FAs) by cognitive status and ethnicity. A secondary analysis of the National Alzheimer’s Coordinating Center Uniform Data Set was conducted using ordered logistic regression to examine the effect of NPSs (based on the Neuropsychiatric Inventory Questionnaire [NPI-Q]) on FAs (based on Functional Assessment Questionnaire). Participants had a mean age of 74 (SD: 9.88) and were included if normal cognition was assessed at baseline (n= 13,470). Higher rates of NPSs were associated with higher dependency in almost all FAs. Among NPSs, apathy was the best predictor (p<.05) of FAs for participants in different cognitive groups and ethnicity subsamples. The impact of other NPSs varied. Anxiety and apathy were the best predictors of FAs among participants with cognitive impairment (but not MCI). Among those who eventually developed dementia (n= 6,818), delusions, hallucinations, agitation, depression, irritability, and motor disturbance were significantly associated (p<.05) with future deficits in FAs. Among Hispanics (n=1,095), hallucinations, agitation, apathy, and motor disturbance were significantly associated with dependency in FAs, while for non-Hispanics, all NPSs were associated with dependency in FAs, except elation and nighttime disturbance. Findings suggest as the severity of the NPSs increases, older adults experience higher levels of dependency in FAs. The nature and extent of NPSs’ impact on FAs varied based on cognitive status and ethnicity, suggesting the importance of considering these factors in service provision.