bluuebunny/crossref_metadata_2025 huggingface dataset:
APPLYING THE AGE-FRIENDLY 4MS FRAMEWORK TO IDENTIFY NEEDS OF INDIVIDUALS ENROLLED IN CDSMP
Authors: Teply Abby , McKibbin Christine , Clapp Joshua , Carling Stacy , Schenck Sabine , Carrico Catherine , Dabrowski Barbara , Punke Elizabeth
Published: January 2025

The Age-Friendly framework is an evidence-based approach to guide health care with older adults that emphasizes 4Ms: “What Matters,” “Medication,” “Mentation,” and “Mobility.” The Self-Management Resource Center’s evidence-based Chronic Disease Self-Management Program (CDSMP) aligns with this framework. Therefore, this study applied the 4Ms to identify needs of participants from CDSMP. Participants (n = 147) were predominantly White (n = 139; 94.6%) females (n = 18; 80.3%) with a mean age of 75.21 (SD = 18.83). The sample included caregivers/supporters (n = 68; 45.3%) and individuals with chronic illnesses (n = 79; 53.7%). Participants completed pre-post measures consistent with the 4Ms (e.g., provider communication, medication adherence, depressive symptoms, and exercise). A latent profile analysis was conducted to extract unobserved subgroups identified by common profiles of response at baseline. Indices of model fit suggested a two-profile model was appropriate. Profile 1 (labeled “Needs Support”) was characterized by poor medication adherence and mild depressive symptoms. High medication adherence and minimal depressive symptoms, in contrast, distinguished profile 2 (labeled “Coping Well”). T-tests revealed a significant difference between profiles on frontier and remote area (FAR) ratings, t(91.999) = -2.107, p =.038. On average, those in profile 1 lived in areas with higher FAR ratings (M = 1.10, SD = 1.24), suggesting greater remoteness, compared to those in profile 2 (M =.68, SD =.99). No differences were found on age, gender, education, etc. Rural living may complicate self-management. Additional research is needed to understand the implication of profile membership for program outcomes.
EXPLORING STRESSORS AND SELF-MANAGEMENT BEHAVIORS IN RURAL AGING AFRICAN AMERICANS WITH DIABETES: A PILOT STUDY
Authors: Harvey Idethia Shevon , Nittinger Sophia , Harris Maude , Wiggins Arika , Mkuu Rahma
Published: January 2025

Background

Rural African Americans with diabetes encounter unique challenges related to managing their condition, including diabetes-specific distress, financial stress, and interpersonal stressors. This study investigated the associations between these stressors and self-management behaviors in a small population sample.

Methods

Fifteen rural African American adults (mean age = 66.08 yrs.; SD = + 6.16) with diabetes participated in this cross-sectional study. Participants completed validated measures, including the Summary of Diabetes Self-Care Activity (SDSCA), Center for Epidemiologic Studies Depression Scale (CES-D), Perceived Stress Scale (PSS), Partner Strain, Parental Stress Scale, Diabetes Distress, Everyday Discrimination, and Cost-FACIT. Descriptive statistics and correlational analyses examined the relationships between stressors and self-management behaviors.

Results

Participants reported moderate levels of financial, relational, and perceived stress, and diabetes distress. Higher levels of financial stress were associated with poorer diabetes self-care activities (r = -0.628, p < 0.05). Emotional burden (r = 0.804, p < 0.01) and interpersonal distress (r = 0.600, p < 0.05) are significantly correlated with perceived stress. Financial stress is significantly associated with everyday discrimination (r = 0.508, p < 0.05).

Conclusion

Despite the small sample size, our findings highlight the intricate interplay between diabetes distress, financial stress, relationship stress, and self-management behaviors among rural African Americans with diabetes. Tailored interventions addressing these stressors and promoting effective coping strategies may be crucial in improving diabetes management outcomes in this population. Further research with larger samples is warranted to confirm these findings and inform targeted interventions for better diabetes care in rural African American communities.
HEALTH CARE PROVIDER PERSPECTIVES ON MENTAL HEALTH CARE WITHIN CHRONIC CARE MANAGEMENT: A RURAL STUDY
Authors: Punke Elizabeth , Wall Lucas , Dabrowski Barbara , Teply Abby , Richardson Katy , Carrico Catherine , McKibbin Christine
Published: January 2025

Approximately 59% of older adult Medicare beneficiaries experience two or more chronic conditions. This rate is even higher among those dually-enrolled in Medicare and Medicaid (i.e., 77%; Boersma et al. 2021). In 2015, the Centers for Medicare and Medicaid Services introduced Chronic Care Management (CCM), a value-based care program, to provide reimbursement to practices for care coordination services that support the management of patients with multimorbidity. Importantly, physical and mental health conditions are often interrelated; however, providers often struggle to adequately treat mental health needs in the context of physical illness (Lattie et al., 2020). The purpose of this study was to examine healthcare providers’ perspectives on serving individuals with mental health diagnoses enrolled in CCM within primary care practices. Investigators developed an interview for this qualitative study. Employees of six practices that have implemented CCM participated. Participants completed sociodemographic, professional, and practice history measures, and a qualitative interview. Participants (n = 13) were predominantly White, cisgender females (n = 12; 92%) and represented care coordinators, primary care providers, allied health professionals, and administrators. All participants completed a 60-minute interview, which was audio recorded, transcribed verbatim, and subjected to thematic analysis. Four themes were identified: Types of Chronic Health Conditions Treated, Access to Mental Health Services, Provider Experience and Comfort, and Educational Needs. Participants expressed a willingness to complete mental health training but faced challenges identifying particular training needs. Future training efforts should address foundational knowledge in mental health disorders and strategies to serve people with common mental health comorbidities.
HEART FAILURE AND SIT-TO-STAND SCORE ON LOWER BODY MOBILITY DISABILITY: NATIVITY DIFFERENCES
Authors: Navos Melanie , Snih Soham Al
Published: January 2025

We examined nativity differences in the relationship of heart failure and five-times sit-to-stand scores with lower body mobility disability over 12-years of follow-up among Mexican-American aged ≥ 75 years who were non-disabled at baseline. Participants (N=987) were from the Hispanic Established Population for the Epidemiologic Study of the Elderly (2004/05-2016). Measures included socio-demographics, heart failure (HF), multimorbidity, falls, depressive symptoms, cognitive function, handgrip strength, sit-to-stand (STS) test, and lower body disability (limitations in ≥ 1 of transferring, bathing, toileting, and walking across the room). Participants were grouped into four groups: No HF-high STS (n=402), no HF-low STS (n=381), HF-low STS (99), HF-high STS (n=105). We used the generalized estimating equation models to estimate the odds ratio (OR) and 95% confidence interval (CI) of lower body disability as a function of HF and STS groups. Compared to those with No HF-high STS group, foreign-born in the HF and high STS group had lower odds (OR=0.48, 95% CI=0.24-.95) of reporting mobility disability over time after controlling for all covariates. Foreign-born and US-born in the groups of HF and low STS had greater odds (OR=2.31, 95% CI=1.14-4.67 and 7.03, 95% CI=3.57-13.81) of reporting mobility disability over time after controlling for all covariates. In conclusion, Mexican-American older adults with HF who performed high in five-times STS were at lower risk for lower body disability and the risk differed by nativity. Interventions to improve strength in lower extremities in those with HF may prevent or reduce disability in this population
LONELINESS AND SELF-EFFICACY AMONG INDIVIDUALS WITH CHRONIC CONDITIONS: THE MEDIATING ROLE OF DEPRESSION
Authors: Dabrowski Barbara , McKibbin Christine , Carrico Catherine , Goodwin Laurance , Carling Stacy , Punke Elizabeth , Teply Abby , Schenck Sabine
Published: January 2025

Approximately 60% of Americans live with one or more chronic conditions (CDC, 2023). Chronic disease self-management programs empower individuals to take an active role in their health management. Self-efficacy is an important construct determining self-management behaviors. Recently, low self-reported ratings of self-efficacy for managing chronic disease have been associated with high loneliness ratings (Lee et al., 2023); however, other variables that may be important regarding the relationship between loneliness and self-efficacy are less known. Depressive symptoms are associated with both loneliness and management of chronic disease. This study examined the mediating role of depressive symptoms in the relationship between loneliness and self-efficacy among individuals with chronic disease participating in the Self-Management Resource Centers, Chronic Disease Self-Management Program (CDSMP). The sample (n = 48, M = 63.0 years old, SD = 18.0) comprised primarily White females (n = 37; 77%) who presented with chronic conditions and completed a CDSMP workshop. Regression analyses revealed that baseline loneliness predicted baseline depressive symptoms (β =.49, p <.001). Both baseline loneliness (β = -.46, p <.006) and depressive symptoms (β = -.75, p <.001) predicted baseline self-efficacy. The relationship between loneliness and self-efficacy became non-significant (β = -.12, p =.301) after controlling for depressive symptoms. Examination of loneliness and depression to changes in self-efficacy pre- to post-intervention showed similar results. Depressive symptoms are important in the relationship between loneliness and self-efficacy among participants in the CDSMP. Addressing depressive symptoms may support improvement in self-efficacy among CDSMP participants experiencing loneliness.
BLACK STRUCTURAL RESILIENCE ACROSS THE LIFESPAN
Authors: Kim Boeun , Cooke Alicia , Riser Tiffany , Szanton Sarah
Published: January 2025

Resilience, which is the ability to resist, recover, or adapt in response to adverse events, can be cultivated through interactions with societal, community, family, and individual factors across the life course. However, structural resilience, signifying the extent of recruiting resources at societal and community levels, has been overlooked. Furthermore, no study has examined structural resilience using a life course approach, although structural resilience is likely to change over time. This study employed a qualitative descriptive design to understand better the structural resilience and their supportive roles in maintaining or promoting health over the life course through older African Americans’ lived experiences. This study focused on African Americans, who were known to have higher levels of individual resilience than White Americans, to learn what resources helped them to thrive despite adverse circumstances. We conducted semi-structured interviews with 15 self-identified African American adults aged 50 and older living in Baltimore City. Two study team members coded the transcripts using an inductive approach, and themes were generated from the constant comparative approach. The five themes emerged: 1) underwent extraordinary adversities over the life course, 2) accessible resources during childhood, adulthood, and late adulthood, 3) emergence of grassroots organizations to provide support, 4) roles of structural resilience in response to adversities, and 5) dynamics of structural resilience across the life course. This study contributes to a better understanding of the mechanisms that preserve health under stressors. The findings may help to resolve the public health tragedy of health equity faced by older African Americans.
DEVELOPING A MODEL FOR COLLEGE STUDENT VOLUNTEERING IN RESPITE CARE
Authors: Rodriguez-Galan Marta
Published: January 2025

The purpose of our study is to evaluate college student volunteer’s learning on aging and caregiving through EXHALE, a grant-funded pilot respite program for family caregivers developed by Lifespan or Greater Rochester and St. John Fisher University. We are sharing the results from the first year of student participation (the program will be funded for 3 years). In addition to promoting student service learning in the field of aging, this evaluation will help in the development of a toolkit that can be used by other higher education institutions. The specific aims of the evaluation research are: 1) To evaluate students’ changes regarding attitudes towards aging, specifically towards frail older adults 2) To evaluate specific areas of learning regarding aging that were more salient in their volunteer experience (e.g. working with older adults with dementia, working with low-income minority elders, etc.) 3) To identify content areas for the development of the “toolkit” that will be used as a model for training future volunteers in higher education institutions. To assess student learning in the program we used the following three

methods

1) The Kogan’s attitudes towards older people scale; 2) Student Reflections after each volunteer session at the respite care; 3) Bi-weekly debrief sessions with the professor. Furthermore, one of the student volunteers also served as a research assistant during the summer and received more personalized mentoring. Our findings show that students challenge some of their initial attitudes on aging, and gain knowledge about caregiving and cultural competency through this volunteering program.
EXPLORING GENERATIVITY AMONG CULTURALLY DIVERSE OLDER ADULT VOLUNTEERS
Authors: O’Dea Eireann , Wister Andrew , Canham Sarah , Li Lun , Mitchell Barbara
Published: January 2025

Generativity, the desire to look beyond the self, and teach and guide the next generation, has been described by researchers as an important component of successful aging and a key part of why older adults choose to engage in activities such as volunteering. Recent research on generativity, including Rubinstein et al’s generativity framework (2015), describes how the expression of generativity can be influenced by cultural context, including traditions, sense of heritage, and family relationships. Despite this, so far little research has focused on generative expression among older adults with diverse cultural backgrounds, such as those belonging to ethnocultural minorities. Using Rubinstein’s framework and life history interview as a guide, this study explores generativity among older adult volunteers who belong to ethnocultural minority communities in Vancouver, British Columbia, Canada. 14 participants aged 65 and over participated in in-depth interviews about various life course experiences, in order to bring contextual understanding to their generativity and volunteer activities in later life. Preliminary findings suggest the unique ways in which generative action can develop over the life course, and how it can potentially be influenced by a sense of belonging to an ethnocultural group. Results also speak to the contributions that are made by ethnocultural minority older adults as volunteers in their communities.
WHAT FACILITATES INFORMAL SUPPORT AMONG COMMUNITY-DWELLING OLDER PEOPLE? THE ROLE OF CARING INITIATIVES
Authors: Xia Wenran , van Wijngaarden Jeroen , Buljac-Samardzić Martina , Huijsman Robbert
Published: January 2025

Background

In the context of accelerated global ageing and cutbacks in healthcare budgets, older people are encouraged to provide informal support to each other within their communities. However, the mechanism facilitating such informal support among older people is still not clear. This study aims to address this gap by investigating the perspectives and experiences of various stakeholders involved in initiatives aimed at stimulating informal support in the community setting. Method: A multiple case study was conducted in five initiatives in the Netherlands focused on facilitating informal support for older people. Semi-structured interviews were conducted with different stakeholders, including older residents who are informal support givers and receivers as well as coordinators and managers of the initiatives. A total of twenty-four participants were interviewed in twenty-one interviews. An inductive-deductive thematic analysis approach was conducted for the qualitative data.

Results

Analysis revealed that older people are facilitated to participate in the community-based informal support when they have abilities, are being motivated, and have opportunities to participate in informal support. Social cohesion in the community strengthens this mechanism. Additionally, community-based formal organizations contribute to stimulate on both the individual and community levels. Conclusions: This study explores the mechanisms facilitating informal support among community-dwelling older people. It emphasizes the combination of factors at the individual, community, and organizational levels. Relevant policies and practice should be formulated with consideration of these multi-level factors.
COGNITION PROFILES AMONG OLDER BLACK ADULTS, BY SCHOOL DESEGREGATION STATUS, EDUCATIONAL, OCCUPATION, INCOME
Authors: Perryman Collin , Thorpe Roland , Whitfield Keith E
Published: January 2025

Objective

We sought to identify the subgroups regarding the school environment (desegregated or segregated), educational attainment, occupation type, income, and cognition among older Black adults.

Methods

Data from older Black adults (n=602; age range: 48 to 95 years) from the Baltimore Study of Black Aging—Patterns of Cognitive Aging (BSBA-PCA) was used to explore the various cognitive function subgroups. We conducted a latent class analysis (LCA) to understand the cognitive domain subgroups. The continuous indicators were several cognitive domains (global cognition, reasoning, memory, immediate recall, working memory, language, and perceptual speed), and the categorical indicators were school type, educational attainment, occupation type, and income.

Results

We identified subgroup for each cognitive domain. For global cognition (1) highest educational attainment, (2) untrained occupation, and (3) most segregated; working memory (1) high educational attainment, (2) segregated, and (3) low monthly income; reasoning (1) high educational attainment; (2) mostly desegregated, and (3) segregated; memory (1) highly educated, (2) lowest income, and (3) segregated; perceptual speed (1) highly educated, (2) lowest income, and (3) segregated. Given all the indicators, each subgroup exhibited an incremental increase in mean cognition scores.

Conclusion

Our study provides insights to how cognition varies by school setting, educational attainment, occupation type, and income among older Black adults who attended desegregated or segregated schools in their early-life.
DOES SOCIAL ACTIVITY PARTICIPATION MODERATE THE RELATIONSHIP BETWEEN AGE AND COGNITION? EVIDENCE FROM THE HRS
Authors: Santana Layla Katharine , Meng Hongdao , Peterson Lindsay , Le Minh Quan , Li Mingyang , Dobbs Debra
Published: January 2025

Active participation in social activities contributes to increased social engagement and may have a positive impact on cognitive health in later life. Despite the well-documented association between social activity and cognitive function, the potential moderating role of social activity in age-related cognitive decline has not been well understood. In this cross-sectional study, we used data from the Health and Retirement Study (HRS), a nationally representative dataset of U.S. adults aged 50 and above (n=9,919), to examine the hypothesis that social activity participation moderates the relationship between age and cognition. Cognition was assessed by using a 27-point cognitive functioning. Social activity participation was measured by a validated 10-point scale, which measures self-reported activity participation. We estimated multivariable linear regression models in which cognitive functioning was regressed on age, and social activity participation while controlling for individual characteristics and potential confounders. We used the Hayes conditional process analysis and Johnson-Neyman plot to test the hypothesized relationships. The average age of the study sample was 67 years (SD=10.27), 59.5% were female, and 66.1% were non-Hispanic White. As expected, age was negatively associated with cognition (β = -0.924; p <.001), and social activity participation was positively associated with cognition (β = 0.122; p <.001). The interaction between age and social activity participation was statistically significant (β = 0.0409; p = 0.005), indicating a significant moderating relationship. These findings suggest that social engagement may be a protective factor. Future studies should examine whether the findings can be replicated in a longitudinal study.
DOES THE IMPACT OF COGNITIVE INTERVENTION ON MOBILITY VARY BY CHRONIC DISEASE?
Authors: Dadson Deborah , Ball Karlene
Published: January 2025

Mobility loss has been associated with chronic diseases, sedentary behavior, and fear of falls among older adults with approximately one-third of 70-year-olds and 80-year-olds reporting restrictions on mobility. Even though physical activity and exercise have been shown to enhance mobility and improve activities of daily living, only a few older adults are able to exercise due to several limiting factors. Cognitive training has been shown to enhance cognition, gait and motor functions, and consequently mobility among older adults. As such, this study aimed to examine how the impact of cognitive interventions on life space mobility varies by chronic disease. Using data from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) Clinical Trial, a sample of 2802 community dwelling older adults who were 65 years and older were examined using Multiple Linear Regression with interaction. Analyses included predicting life space mobility from the cognitive intervention trainings (reasoning, memory, and speed of processing), with gender, age, race, and mobility at baseline as covariates. Diabetes, cancer, and heart disease were entered into the model as moderators. Results indicated that speed of processing training, years of education and heart disease significantly predict Life Space Mobility (all p <.05). Reasoning training, memory training, gender, age, race, diabetes, and cancer were not uniquely associated with Life Space Mobility. These findings highlight the need to consider cognitive interventions, specifically speed of processing to ensure functional performance in everyday activities of older adults. Keywords: Mobility, cognitive intervention, chronic diseases, ACTIVE Clinical Trial
IS VARIABILITY IN COGNITIVE PERFORMANCE ALWAYS MALADAPTIVE? THE MODERATING ROLE OF SOCIODEMOGRAPHIC FACTORS
Authors: Klepacz Laura , Cerino Eric , Pierce Matthew , Hamm Jeremy
Published: January 2025

Cognitive dispersion refers to an individual’s fluctuations in performance across a range of neuropsychological domains. Although past research has linked greater dispersion to cognitive decline in clinical populations, less is known about the characterization of dispersion in unimpaired, younger samples. The current study addresses this gap by identifying sociodemographic populations for whom dispersion may not be maladaptive and potentially linked to better cognitive performance over time. We pursued this aim by examining how age, sex, income, and education moderated the association between longitudinal changes in dispersion and corresponding shifts in cognitive performance using MIDUS data (n=2,518; age 55±11.2, Range: 33 – 83 years). Respondents completed a telephone-based battery of cognitive tests measuring several neuropsychological domains. Dispersion was calculated by generating an intraindividual standard deviation across 6 unique cognitive tasks. Results of OLS regression models showed that age (b=.01, SE=.00, p<.001), sex (b=.26, SE=.07, p<.001), income (b=-.01, SE=.01, p=.056), and education (b=-.02,SE=.01, p=.066) moderated the positive association between regressed change in dispersion and regressed change in mean performance. Specifically, increases in dispersion were most strongly associated with shallower 9-year declines in cognitive performance among comparatively older adults (b=.41, SE=.05, p<.001), women (b=.40, SE=.04, p<.001), individuals with less education (b=.35, SE=.05 p<.001), and those with lower income (b=.39, SE=.04, p<.001). Our study extends the literature by contributing to a more nuanced understanding of the populations for whom dispersion may not be maladaptive. These findings suggest that dispersion may reflect healthier cognitive aging in populations that are at greater risk for cognitive impairment.
A CONTENT ANALYSIS OF CHILDREN’S LITERATURE ON DEATH AND DYING
Authors: Manternach Celine , Domnick Hallory
Published: January 2025

The purpose of this project was to analyze children’s literature on death and dying published between 2014-today. This project builds on previous research published prior to 2014. N = 40 books were reviewed for the following content: Biological facts including type of loss, emotional responses, socio-cultural practices and beliefs, and the number of euphemisms used. Books available from local libraries and Amazon were used for this project. Examples from each book were included in Excel and frequencies and percentages were summed after analysis. A total of 10 (25%) books included biological facts, such as “heartbeat stops,” 18 (45%) included emotional responses such as “Dad’s eyes were red,” and 8 (20%) included socio-cultural practices and beliefs such as “we all have beliefs and we don’t know what happens when we die.”A total of 5(8%) books included euphemistic terms such as “gone to a better place” for death. Overall, findings demonstrated that authors tended to write about emotional responses related to grief most often, whereas fewer wrote about socio-cultural practices and beliefs. Given the diversity and complexity of practices and beliefs on death and dying, additional children’s books published in this area are needed to capture the diversity of experiences. While explaining death to children can be challenging, literature is a tool that parents can use to guide the conversation. However, not all children’s books are created with the same intent, and it is important for adults to pre-screen books to determine how appropriate the book is for their child.
CHOOSING TO FORGO: LIFE-SUSTAINING TREATMENT DECISIONS FOR SELVES AND RELATIVES AMONG TAIWANESE ADULTS
Authors: Chen Duan-Rung , Hou Su-I , Young Yuchi
Published: January 2025

Purpose

Since its implementation in 2019, less than 2% of adults in Taiwan have signed Advance Directives (ADs) under the Patient Right to Autonomy Act (PRAA). This research explores how the public views the PRAA and its effect on the decision to decline life-sustaining treatments (LSTs) in hypothetical end-of-life scenarios. Method: In August-November 2022, an online survey was administered to 3,922 adults in Taiwan, of which approximately 1,488 (37%) were familiar with the PRAA. These 1488 respondents completed questions regarding their perceptions of the PRAA. They responded to questions about three hypothetical end-of-life situations: terminal cancer, irreversible severe brain damage, and terminal dementia.

Results

Over half of the participants declined to receive LSTs for themselves and chose similarly but less for their family members. A specific difference was noted in choices concerning terminal dementia, showing a greater reluctance to withhold LSTs, especially for parents, than for themselves. There were gender-based differences, with women more likely to choose against LSTs for themselves in various situations. In contrast, gender did not affect decisions made for family members. The perception of the PRAA and the degree of ACP engagement significantly influenced the refusal of LSTs for both the participants and family members. A positive view of the PRAA was significantly linked to decisions against LSTs for spouses.

Conclusion

These findings underscore the complexity of decisions around LSTs, influenced by personal beliefs, gender, legal perceptions, and engagement for advance care planning.
EXAMINING COGNITIVE FUNCTION IN BEREAVED OLDER PARENTS: THE MEDIATING ROLE OF DEPRESSIVE SYMPTOMS
Authors: Rubinstein Stephanie , Zelinski Elizabeth
Published: January 2025

Losing a child is a unique and exceptionally traumatic experience, often resulting in chronic and severe depressive symptoms. This is of increasing concern as the loss of adult children has become increasingly more common since 2010. Bereaved parents represent a psychologically vulnerable group about whom we know relatively little. In this study, we use data from a nationally representative sample of 5,265 community-dwelling older adults over age 50 from the Health and Retirement Study (HRS) to examine the relationship between child loss, depressive symptoms, and cognitive function. We hypothesize that being bereaved is significantly associated with worse cognitive scores and that this relationship will be mediated by the number of reported depressive symptoms. We conducted a cluster-adjusted path analysis on repeated cross-sectional data from 1995-2020. Controlling for sociodemographic and health factors, our findings confirmed these expectations. Both bereaved individuals and those with depressive symptoms exhibited significantly worse cognitive scores, respectively (β=-0.20, p<.001; β=-0.15, p<.001). Bereaved individuals were also significantly more likely to report depressive symptoms (β=0.09, p=.001). Depressive symptomology was found to partially mediate the relationship between bereavement and cognitive function, explaining approximately 7% of the variance. These results suggest that losing a child is associated with poorer cognitive function in older adults. This relationship is partially explained by the presence of depressive symptoms, likely associated with said loss. Our findings highlight the importance of addressing mental health concerns, such as depressive symptoms, within the context of bereavement to mitigate potential adverse effects of cognitive well-being in later life.
PROLONGED GRIEF DISORDER IN ADULTS OVER 65: A REVIEW IN LIGHT OF POST-COVID-19 LOSSES
Authors: Friedland Hannah , Stripling Ashley , Crocker Jillian
Published: January 2025

Prolonged Grief Disorder (PGD) entered the DSM-5-TR in 2022, standardizing criteria and research. As COVID-19 continues to disproportionately affect adults over 65, both directly and by disrupting traditional grieving rituals, understanding PGD in this group is essential. The review seeks to synthesize existing research on PGD in adults over 65 to guide research and practice. A PRISMA review utilizing “older adults” and “prolonged grief disorder” was conducted within APA PsychInfo and Google Scholar from 2013 to 2023. All English-language journal articles relating to the area of study were read, and relevant exclusion criteria were applied (i.e., empirical, mean age >65, prolonged grief symptoms for >1 year). Among the 15 articles meeting inclusion, PGD prevalence rates ranged between 0.5% and 21%. Participants were predominantly White women recruited from community and hospice samples. PGD risk factors included preexisting depression and type of relationship with the deceased, with the highest incidence rates following partner or child deaths. Co-occurring symptoms included sleep disturbances, lower quality of life, loneliness, and dysregulated cortisol. Given PGD’s addition to the DSM and inconsistent prevalence rates, accurate diagnosis and effective treatment are imperative, particularly for more impacted groups. Notably, death rates from COVID-19 are disproportionate among age, race, and ethnicity. As a true understanding of how PGD manifests in adults over 65, future research is warranted following the COVID-19 pandemic. Implications of the current presentation include translating findings into recommendations focused on the provision of adapted PGD interventions and assessments for adults over 65.
PUBLIC ATTITUDES TOWARD PHYSICIAN-ASSISTED DYING: A CROSS-SECTIONAL SURVEY IN TAIWAN
Authors: Chen Duan-Rung , Wu Kevin Chien-Chang , Kuo Chun-Tung
Published: January 2025

Purpose

This study aims to assess public attitudes towards Physician-Assisted Dying (PAD) in Taiwan, where legal support for PAD is notably absent despite its public endorsement in broader Asia, including Japan, South Korea, and China. Method: Utilizing an online survey, we gathered data from 3,922 Taiwanese adults from August to November 2022 to evaluate their support for PAD across different contexts: terminal illnesses, unbearable non-terminal pain, and severe cognitive impairments.

Results

The findings revealed substantial support for PAD, with 86.2% in favor of terminal illnesses, 79.2% for unbearable non-terminal pain, and 72.6% for severe cognitive impairments. Support for PAD correlated with younger age, male gender, lower levels of religiosity, non-medical professional background, and a positive attitude towards advance directives.

Conclusion

The public attitudes towards Physician-Assisted Dying (PAD) in Taiwan reveal a significant cultural transition towards valuing individual autonomy in end-of-life decisions. The study indicates a cultural shift towards valuing individual autonomy in end-of-life decisions among the Taiwanese public. It underscores the need for policymakers to align legal frameworks with public opinion on PAD, emphasizing the prioritization of individual rights in end-of-life care.
“UKE CAN DO IT”: A REFLECTION ON A UKULELE CLASS INITIATIVE FOR OLDER ADULTS LIVING WITH DEMENTIA AND CARE PARTNERS
Authors: Wong Joey , Fu Jason , Gregorio Mario , Hung Lillian
Published: January 2025

Individuals with different stages of neurocognitive disorder or dementia respond to music even at later stages of the diagnosis. Music can offer collective experiences for people from diverse cultural backgrounds who have dementia. However, limited studies explore the journey of learning musical instruments by people living with dementia. Our team, co-led by a person living with dementia, initiated a 12-week basic ukulele program to explore the potentials of music and learning to foster social connections, alleviate loneliness and bring joy to older adults living with dementia and their care partners in Vancouver, British Columbia. Eighteen older adults from diverse backgrounds (15 individuals living with different stages of dementia and three care partners) participated in the classes facilitated by a ukulele instructor. Our team critically reflected on the ukulele program based on the in-class observations and summaries from the instructor through multiple in-person and Zoom meetings. The reflection resulted in five themes: 1) Social connections through music, 2) Respite for care partners, 3) Peer support and empowerment to contribute to collective learning experiences, 4) An emphasis on enjoyment over skills, and 5) Inclusiveness in creating programs for people living with dementia. This innovative ukulele program shows the positive impact of music and collective learning. The team reflections highlight the potential of offering musical instrument programs for older adults living with dementia and their care partners to alleviate loneliness and foster social connections. Future research can investigate the long-term impact of group musical learning on individuals living with dementia and care partners.
ACCEPTABILITY AND FEASIBILITY OF IMPLEMENTING THE DEMENTIA CARE PRACTICE RECOMMENDATIONS IN CARE COMMUNITIES
Authors: Kim Boeun , Belza Basia , Prophater Lorna , Waddington Emily , Johnson Shawn , Fazio Sam
Published: January 2025

With growing numbers of residents living with dementia in care communities, providing quality care is challenging. Alzheimer’s Association developed an intervention to increase the adoption of person-centered care in care communities using a coaching approach based on the Dementia Care Practice Recommendations (DCPR). A cluster randomized-controlled study has been implemented to evaluate the intervention since December 2022. This study aims to report interim findings. Care communities in an intervention group met with a coach monthly over 6 months to assess the level of adoption of DCPR and increase and maintain person-centered care practices. Care communities in a control group received monthly emails not relevant to person-centered care. Employee satisfaction (job satisfaction, team building and communication, scheduling and staffing, training, management and leadership), person-centered practices (workplace practices, individualized care and services, caregiver-resident relationships), and confidence in dementia scale were assessed pre-intervention (time1), post-intervention (time2), and 3-month follow-up after completion of the intervention (time3). As of February 2024, 292 care providers from 53 care communities enrolled, 164 care providers from 35 care communities completed the 6-month intervention, and 113 care providers from 25 care communities filled out 3-month follow-up assessments. We found that scheduling and staffing satisfaction (time3), management and leadership satisfaction (time3), overall employee satisfaction (time3), and person-centered practices in individualized care and services (time2 and 3) were significantly higher in intervention groups than control groups according to generalized estimating equation estimates. This study provides preliminary evidence of the efficacy of the DCPR intervention in promoting employee satisfaction and person-centered practices.
CHALLENGES IN SUPPORTIVE CARE DECISION-MAKING IN THE CONTEXT OF ALZHEIMER’S DISEASE AND RELATED DEMENTIAS
Authors: Taylor Jean , Turner Anne
Published: January 2025

In the United States, persons with ADRD face multiple decisions regarding supportive care transitions; however, their involvement in decision-making often declines as their condition progresses. The aim of the Decision Making in Alzheimer’s Research (DMAR) study is to center the voice of persons with dementia by understanding preferences and key factors influencing supportive care decisions. We conducted in-depth online interviews (n=79) with 24 older adults with dementia (aged 65 years and older), 37 informal caregivers, and 18 professionals who work with individuals with dementia. Interviews focused on decision making and identifying factors that related to supportive care decisions. Qualitative analysis of interview transcripts revealed that persons with dementia and caregivers were often not ready to think about or plan for supportive care changes. Challenges participants described in moving forward in planning supportive care included lack of understanding or acceptance of the diagnosis, inability to imagine future scenarios, and lack of openness to planning for the future. Tailored information about the course of dementia and potential future care options are needed. Suggestions by professionals for the best timing for provision of a decision tool ranged from “as soon as possible” to “soon after diagnosis”. Some professionals emphasized the need for ongoing conversations with trusted medical professionals as the disease progresses. Our study highlights the importance of early, tailored, and ongoing support in transition planning. We will share specific suggestions for how and when to implement a decision-making tool to assist with decisions about possible future needs.
COMMUNITY-BASED DEMENTIA SCREENING AND SUPPORTIVE SERVICES
Authors: Wilson Traci , Ek Mary
Published: January 2025

Early detection of dementia is important to help consumers and caregivers access information, treatment and supportive services. The majority of people living with dementia (PLWD) live at home and in the community. Community-based aging services providers, such as Area Agencies on Aging (AAAs), are positioned to play a critical role in screening for cognitive impairment or dementia and referring individuals for medical cognitive assessments. Past surveys have shown that AAAs provide specialized services for PLWD and caregivers, but little is known about the prevalence of screenings and the process for referrals. This poster shares findings from a 2024 survey of AAAs about their dementia screening and supports (n=180, response rate 28%) describing the formal and informal cognitive screening, assessment, and referral services that AAAs provide, the feedback available to consumers and the agency after referrals are made, and the types of services and supports available that are tailored specifically for PLWD. The most common screening or assessment service is referrals to external sources of information (84%), followed by agency and provider staff observing for signs and symptoms of dementia (55%), referring individuals to medical cognitive assessments (43%), and conducting screenings (31%). The results demonstrate that AAAs are involved in a variety of dementia-related screenings, services, and interventions.
DEMENTIA SEVERITY AND QUALITY OF LIFE OF CARE PARTNERS OF OLDER ADULTS WITH DIABETES AND DEMENTIA
Authors: Adeyemi Oluwaseun , Blaum Caroline , Tarpey Thaddeus , Dickson Victoria , Chodosh Joshua
Published: January 2025

Caring for persons living with dementia (PLWD) is known to adversely affect care partner health. Health impacts specific to care partners of PLWD who also have diabetes is unknown. To examine this issue further, we assessed the association between dementia severity and care partner quality of life when caring for PLWD with diabetes. We extracted cross-sectional care partner survey responses enrolled in the Enhanced Quality in Primary Care for Elders with Diabetes and Dementia study (N=311). We defined dementia severity as a three-level categorical variable (mild, moderate, severe) using the Dementia Severity Rating Scale. Quality-of-life outcome measures were treatment burden score (scored 0 to 15; higher score = higher burden) and physical and mental health state (scored 0 to 20; higher score = better health). We controlled for both care partner and PLWD’s relationship, age, sex, race/ethnicity, and educational level. We performed multivariable quantile regression analyses and reported adjusted median difference (aMD) in quality-of-life measures (plus 95% confidence interval (CI)). Mean (standard deviation) ages of PLWD and their care partners were 81.5 (7.4) and 55.2 (12.4) years, respectively. Care partners were predominantly women (77.5%) and non-Hispanic Whites (38.9%). Compared to care partners of those with mild dementia, care partners of persons with severe dementia had more treatment burden (aMD: 1.41; 95% CI: 0.49, 2.32), and poorer mental health (aMD: -2.34; 95% CI: -3.60, -1.08). Caring for PLWD with diabetes exerts substantial burden on care partners especially when dementia is more severe and may benefit from more diabetes-focused education and support.
EATING EXPERIENCES IN PEOPLE LIVING WITH DEMENTIA: A CONCEPT ANALYSIS USING RODGERS’S METHODOLOGY
Authors: Wang Zih-Ling , McHale Jenna , Belza Basia , Sonney Jennifer
Published: January 2025

In people living with dementia, eating has often been portrayed in the literature as a time-consuming process or task-centered activity. However, it is important to distinguish the experience of eating from the process and task-centered approach of feeding. This study clarifies the concept of eating experience by using Rodgers’ evolutionary approach to analyzing factors associated with eating experiences in people living with dementia present in the literature. Twenty-two articles met the inclusion criteria, identifying three key attributes of eating experiences (self-connection, the special journey of life, and self-interpretation). Antecedents, as framed by the socio-ecological model, were categorized to represent Intrapersonal (personal preferences, individual culture, mealtime routines), Interpersonal (social interaction), and Environmental (dining room environment, policies) factors. Consequences were divided into external (quality of life, nutritional health, and physical health) and internal (personhood, autonomy and independence, dignity and feeling valued, and mental well-being) domains. The identified attributes, antecedents, and consequences can be utilized in healthcare education, research, and intervention approaches. This presentation allows nurses and other health care professionals to understand better people living with dementia through the relationship between eating and interpersonal, intrapersonal, and environmental aspects to develop personalized interventions and care strategies to achieve an optimal quality of life.
EFFECTS OF DEMENTIA DIAGNOSIS ON HOSPITAL READMISSION AFTER DISCHARGE FROM A SKILLED NURSING HOME
Authors: Carnahan Jennifer , Slaven James , Ludden Emily Fox , Bowditch Corinne , Ryan Healey , Jiangqiong Li , Tu Wanzhu , Torke Alexia
Published: January 2025

High acute care utilization has been associated with dementia, but the risk of repeat acute care use following a skilled nursing home (SNH) to home transition is not well understood. We examined the association of dementia with 30-day hospital readmission after leaving a SNH. Data from the Health and Retirement Study from 2000-2018 was linked to Medicare and SNH claims. We analyzed the events of hospital readmission following SNH discharge using logistic regression while controlling for repeated within-subject readmissions. There were 5,912 discharges to the community from an SNH and 941 hospital readmissions. ICD codes for dementia were present with 1,754 of the SNH-to-home transitions and 314 of the hospital readmissions. In bivariate analysis, people with dementia were more likely to be readmitted (p=0.0074). Post-SNH readmissions were also more likely among people who were Black, male, dual eligible beneficiaries, longer pre-SNH hospital stays, higher Charlson Comorbidity Index, and greater activities of daily living deficits. In the multivariable logistic regression model, the odds of readmissions were still greater among persons with dementia, but significance was attenuated (OR 1.09; 0.90, 1.32; p=0.4065). Significant associations with readmissions include the Charlson Comorbidity Index (OR 1.07; 1.04, 1.09; p< 0.0001) and activities of daily living deficits (OR 1.11 (1.04, 1.17; p=0.0005). People with dementia may be at greater risk of readmission after SNH discharge but not when controlling for factors such as socioeconomic status, activities of daily living, and other comorbidities.