bluuebunny/crossref_metadata_2025 huggingface dataset:
Support, Health, Activities, Resources, & Education (SHARE): New Program Innovations for Early-Stage Families
Authors: Whitlatch Carol , Zarit Steven , Zarit Steven
Published: December 2020

Persons living with a recent diagnosis of dementia experience great uncertainty and stress as they and their families try to adjust to the new reality of their lives and futures. One fruitful strategy for intervening with these families is to include both the person living with dementia and their family care partner in the program. Although dyadic approaches are rare among early-stage programs, promising examples exist. The SHARE Program (Support, Health, Activities, Resources, and Education) is one exception where dyadic materials address: 1) current and long- term needs of care partners, and 2) how the family can develop a realistic plan of care based on their care values and preferences. This symposium describes the development and positive outcomes of the original SHARE intervention and the promising adaptations that expand how and to whom the intervention is delivered. Presentations explore: 1) the original SHARE for Dementia program and strategies for expanding its reach into chronic conditions populations (Orsulic-Jeras & Whitlatch), 2) a group version translated into Spanish (“EPIC: Early-stage Partners in Care,” Dr. Coon), and 3) the development of a remote needs assessment and unobtrusive in-home monitoring technology platform that guides care planning and helps to maintain independence (“SHARE-sense,” Dr. Miller). Discussion will focus on the challenges, unique solutions, and positive outcomes when adapting SHARE to different settings and populations (Dr. Zarit).
When Helping Hurts: Nonabusing Family, Friends, and Neighbors in the Lives of Elder Mistreatment Victims
Authors: Breckman Risa , Burnes David , Ross Sarah , Marshall Philip , Suitor J Jill , Lachs Mark , Pillemer Karl
Published: December 2020

Research conducted by the NYC Elder Abuse Center (NYCEAC) at Weill Cornell Medicine and colleagues found that concerned persons experience significant distress knowing about elder abuse and trying to assist victims. Data will be presented from a nationally representative survey which included items on concerned persons in elder abuse. Thirty-one percent of all respondents reported that they had a relative or friend who experienced elder abuse; of these, 61% had attempted to help the victim and over 80% reported the experience is very or extremely stressful (2017). By both knowing about and becoming involved in elder abuse situations, concerned persons experience significant emotional and practical problems and often need professional help. NYCEAC’s Elder Abuse Helpline for Concerned Persons is the first of its kind in the country. The Helpline’s services and structure will be explained, and possibilities for replication in other locations will be explored.
Cultural Adaptation of the Home-Based Tailored Activity Program in Chile
Authors: Gajardo Jean , Aravena Jose , Navarrete Ignacia , Slachevsky Andrea , Gitlin Laura
Published: December 2020

Chile is currently implementing policies addressing dementia care with efforts to translate evidence-based programs towards culturally sensitive models of care. This study describes the cultural adaptation of the Tailored Activity Program (TAP). A complementary mixed-method design was performed following the 4-phase Dynamic Adaptation Process (DAP) model by Aarons et al, 2012. Ten dyads (family caregivers and people with dementia) completed a regular 8-session home-based TAP intervention during 2017-2018. Qualitative data was collected through interviews and observation with caregivers, and weekly follow-up and a focus group with provider occupational therapists. Quantitative data in pilot testing was obtained through assessments at baseline and after intervention. The TAP was well accepted by family caregivers, and sociocultural adaptations on content, context, target level, and training were identified. Significant reduction of frequency and severity of neuropsychiatric symptoms in individuals with dementia was found, and caregivers reported reduction of depressive symptoms, improved perceived well-being & self-confidence. Part of a symposium sponsored by the Behavioral Interventions for Older Adults Interest Group.
PTSD Symptoms Among Vietnam, Persian Gulf, and Post-9/11 Combat Veterans: Findings From VALOR
Authors: Kurth Maria , Aldwin Carolyn , Settersten Richard
Published: December 2020

Much is known about the mental health of combat Vietnam Veterans, but less is known about Persian Gulf and post-9/11 veterans and how they compare to those from earlier eras. Using data from an online survey of Oregon veterans, we examine how PTSD symptoms differ by combat exposure across these three cohorts. The sample (N=167, Mage=57.86, SD=12.09), was largely composed of White (88%), male (69%) Veterans. Most served in the Persian Gulf (41%), followed by Vietnam (36%) and post-9/11 (23%) eras. ANCOVAs showed significant cohort differences in PTSD, after controlling for severity of combat exposure and demographics (age, gender, education, income) (F(2, 157) = 4.24, p < .05). Post-9/11 veterans had significantly lower PTSD symptom severity than Vietnam-era veterans but were comparable to Persian Gulf. There were no cohort differences for noncombat veterans. Future research should investigate why Vietnam veterans continue to have worse mental health than younger veteran cohorts. Part of a symposium sponsored by the Aging Veterans: Effects of Military Service across the Life Course Interest Group.
Loneliness and Daily Stressors: The Protective Role of Daily Positive Events
Authors: Hong Joanna , Charles Susan , Sin Nancy , Almeida David
Published: December 2020

Lonely individuals are particularly vulnerable to daily stressors. Yet, less is known about the protective role of daily positive social events on days lonely individuals experience a stressor. The current study examined whether experiencing a positive social event on the same day as a stressor helps lonely individuals maintain their daily emotional well-being. Participants from the Midlife in the United States Survey II and the National Study of Daily Experiences II reported their trait-levels of loneliness. A subset of the participants (N=1,730) also completed eight days of daily interviews and reported experiences of stressful events, positive social events, and emotions. On days lonely individuals reported experiencing a stressor, experiencing a positive social event was associated with a less increase in daily negative affect. However, this buffering effect did not generalize to non-lonely individuals. Results highlight a protective asset that might be important for helping lonely individuals maintain daily well-being.
Family Caregivers’ Decision-Support Needs Beyond the Decision Aid
Authors: Britt Katherine , Schlag Karen
Published: December 2020

Of the estimated 16 million U.S. family members currently providing essential yet unpaid caregiving for persons with dementia (PWD), many will also make end-of-life (EOL) care decisions as surrogates, a process that can be fraught with uncertainty. Even with dementia death rates rising, many families delay advanced care planning (ACP) discussions, and surrogate decision makers often lack crucial information and support, implicating the need to further study this topic in aging. While decision aids (DA) serve as a support tool for caregivers, they can be less effective when failing to address unresolved decisional needs. Utilizing the Ottawa Decision Support Framework (ODSF), which asserts caregiver decision needs affect decision quality, this study sought to identify surrogate decision-support needs extending beyond general ACP. This mixed study used cognitive interviews and focus groups with family caregivers (N=13) and healthcare professionals (n=14) to assess their knowledge and understanding of hospice and artificial hydration and nutrition. Data were audio-recorded, transcribed verbatim, and analyzed with thematic content analysis. Three main themes were identified: DAs alone aren’t enough to foster quality decision making for surrogates; individualized communication is necessary to clarify PWD and caregiver value priorities and disease trajectories; and clarification of the impact of care choices within situational contexts is quintessential. Further development is needed to create a practice protocol from these themes to inform professionals assisting surrogates in ACP at EOL. Practical implications from this study include highlighting the importance of individualized communication between PWD, providers, and caregivers in addressing EOL care decisional needs.
Changing Demographics of Aging and Disability: Implications for Advancing Knowledge of Disablement and Life Course
Authors: Campbell Margaret
Published: December 2020

Increased survivorship and longevity have resulted in dramatic improvements in life quality for people with significant disabilities and impairments. However, the fields of rehabilitation and gerontology have tended to divide this phenomenon into people aged under 65 aging with lifelong and early onset disabilities, and those aged 65 plus who are aging into late onset disability. But for both groups, increased survivorship also translates into more years living with comorbidities associated with the underlying condition and increased risk for premature onset and higher rates of age-related chronic conditions. Despite these widely acknowledged trends, we have no national data systems that estimate the overall prevalence of the ‘aging with long-term disability’ population and monitor its status. Acknowledged is that the lack of national data and reliance on chronological age undermines our knowledge of the disablement experience across the life course and the needs for services and supports associated with diverse trajectories. Part of a symposium sponsored by the Lifelong Disabilities Interest Group.
The Impact of Perceived Neighborhoods in Childhood and Adulthood on Daily Cognitive Function
Authors: Munoz Elizabeth , Pasquini Giancarlo , Allan Alexa , Mogle Jacqueline , Sliwinski Martin , Scott Stacey
Published: December 2020

Neighborhood experiences may have a cumulative effect on cognitive health outcomes across the lifespan. We investigated independent and combined associations between current and retrospective childhood neighborhoods and daily cognitive function in 209 adults (Mage=47.07; range: 25-65) who participated in a 14-day ecological momentary assessment study. Participants reported perceptions of their current neighborhood and the neighborhood they lived in at age 5; including neighborhood cohesion, safety, violence, and physical conditions. Greater current neighborhood violence was independently associated with poorer spatial working memory. Childhood neighborhood violence was not significantly associated with performance. The interaction between current and childhood neighborhood ratings was significant: individuals who reported greater childhood neighborhood violence, but lower current violence had better performance than those who experienced consistently high or low neighborhood violence. Effects for other neighborhood domains were not significant. Results indicate that neighborhood influences on cognition in adulthood may be moderated by childhood neighborhood experiences.
Neighborhood and Housing Conditions and Risk of Falls
Authors: Lee Haena , Ailshire Jennifer
Published: December 2020

Physical conditions of living environments can impact risk of falls, however, prior work has focused typically on one domain at a time—either neighborhood or home, capturing limited environmental boundaries of older adults. We extend prior work by considering both neighborhood and home as important residential contexts and examine their impact on the onset of falls over time. Data are drawn from two waves of the Health and Retirement Study (2012 and 2016; N = 2,244). We used interviewers’ report on outdoor and indoor dwelling conditions to assess environmental risk factors. One-third of respondents reported at least one fall years later. The presence of green space such as a park near the housing unit and clutter in the home appears to increase the risk of falls over a four-year period. This finding suggests that falls in old age may be determined by a combination of outdoor and indoor risk factors.
Life in the Living Room: An Expression of Personality in Late Life?
Authors: Fingerman Karen , Ng Yee To , Zhang Shiyang
Published: December 2020

Recent research has found that micro environments (i.e., residential spaces) provide information about psychological processes in young adults. This study examined older adults’ living spaces. Participants (N = 171) from the Daily Experiences and Well-being Study completed measures of personality. Interviewers took 3 to 4 photographs of the room where participant spends the most time. Independent coders rated the rooms for 33 features (e.g., cleanliness, light, clutter) on a 5 point scale. Regression analyses revealed that personality was associated in anticipated ways. For example, conscientiousness was associated with rooms in better condition, neuroticism with less brightness, and by contrast, extraversion with greater brightness and more color. Discussion focuses on bidirectional emotional aspects of home environments that may contribute to well-being. Macro environments (e.g., neighborhoods) shape late life well-being, but understanding micro environments where older adults spend the majority of their time also may contribute to advances in the field.
The Burden of Serious Falls Among Older Adults: Evidence from Hospitalizations in Philadelphia, PA
Authors: Todd Megan , Pressley Kevin , Pharis Meagan
Published: December 2020

Falls among older adults cause acute injury, are associated with subsequent mortality, and cost billions of dollars in medical expenses each year. However, research on falls is lacking compared to other causes of morbidity. In our rapidly aging world, a better understanding of the populations at greatest risk is urgently needed. In this paper, we used 2018 data on every inpatient hospitalization in Philadelphia and from the American Community Survey to estimate the prevalence of serious falls among older adults (60+) by age, sex, and race/ethnicity. We further assessed the relationship between age, sex, and race/ethnicity and fall outcomes (length of hospital stay (LOS), total medical charges) with linear regression models. In 2018, the rate of falls serious enough to warrant a hospital stay in Philadelphians aged 60+ was 243 per 10,000. This rate increased dramatically with age, from 116 per 10,000 (60-64) to 649 per 10,000 (85+). Men were at higher risk than women for each 5-year age group except those top-coded at 85+. Compared to white older adults, black older adults had greater risk at younger ages (60-69) and lower risk at older ages (70+). In linear models we found that charges and LOS decreased with increasing age. Both charges and LOS were higher for men than women. Hispanic patients had significantly higher charges than non-Hispanic patients, despite having similar lengths of stay. Future work will attempt to explain differences in charges and LOS by examining mortality, discharge location (e.g., home, hospice, rehab), and co-morbidities.
Successful Aging: Re-Conceptualized
Authors: Eustice-Corwin Alexander , Missell Rachel , Sörensen Silvia
Published: December 2020

A review of the aging literature yields 105 operational definitions of “successful aging” in use. These theoretical discrepancies have caused some investigators to question the utility of the concept (Cosco et al., 2014). Investigators who remain committed to the concept acknowledge its conceptual messiness, but have found no consensus for resolution. We propose a revised concept of successful aging, combining a life-course perspective (Rowe & Kahn, 2015) with a neo-Aristotelian theoretical framework. Such a framework justifies certain changes to the definition of “successful aging;” it situates our concept of successful aging within a broader view of human development, is more inclusive, and suggests empirically adequate research questions. Specifically, conceptualizing “successful aging” along neo-Aristotelian lines means defining it as the maintenance of proper human functioning across the life-course and into late adulthood. For Aristotle, proper human functioning entails realizing one’s potential as a “rational social animal,” with rational implying goal-oriented thinking, means-ends reasoning, other forms of instrumental rationality (not excluding emotionality). Social suggests active engagement in a community, within the limits of an individuals’ comfort and ability. These two criteria determine “success” in older age. Recent research on successful aging reveals that absence of disease and disability does not appear to be a constituent of “successful aging.” Therefore, physical health is neither necessary nor sufficient for “success.” Our re-conceptualization of “successful aging” could be tested using confirmatory factor analysis, with social and reasoning/problem-solving factors loading onto a second order Successful Aging factor. This understanding allows for greater empowerment of older adults.
The Potential of Artificial Intelligence, Machine Learning, and Novel Analytic Methods to Promote Successful Aging
Authors: Boot Walter
Published: December 2020

The Gerontological Society of America is celebrating its75th anniversary and in those75 years the world has undergone an amazing technological revolution. During this period, computers transformed from systems that once filled entire rooms to much more powerful devices that fit in our pockets. We have seen the introduction of wireless technologies, augmented and virtual reality, smart home devices, autonomous vehicles, and much more. This session focuses on a new technological advance that has the potential to support the health, wellbeing, and independence of older adults and caregivers: artificial intelligence (AI). This session will present applications of AI, Machine Learning (ML), and other novel analytic methods and how they have the potential to impact the lives of older adults in a variety of context. As AI is increasingly being involved in workplace hiring, the first talk focuses on older adults’ attitudes toward the role of AI in this decision making process. Next, novel ML approaches applied to social media are discussed in terms of understanding the needs of Alzheimer’s caregivers. Next, ML techniques are discussed in terms of developing biomarkers that can be applied in diagnosis and assessment of therapeutic responses by detecting mood, which may have important implications for older adults living with dementia. Then, the potential role of AI is discussed in terms of developing reminder systems to promote older adults’ adherence to technology-based health activities. Finally, novel analytic approaches are discussed in terms of harnessing digital metrics to detect the risk of cognitive decline.
The Transition to Family Caregiving: Does It Affect Biomarkers of Aging?
Authors: Chung Shang-En , Roth David , Bentley John , Walston Jeremy
Published: December 2020

Blood samples were collected from participants in the REGARDS study on two separate occasions. No participants in the Caregiving Transitions Study were caregivers at the first blood draw, but 251 became caregivers before the second blood draw 9 years later. These caregivers were matched with 251 noncaregiving controls. Six circulating biomarkers of inflammation (e.g., CRP, IL-6, TNFR1) and a measure of cellular aging (leukocyte telomere length) were assessed at both blood draws. All biomarkers except CRP showed overall aging effects (ps < 0.001). Caregivers had a small but significantly greater increase in TNFR1 levels (p = 0.03) than controls, but no significant differential changes were found on the other 5 inflammatory biomarkers or on telomere length. Preliminary findings from latent variable models indicated good model fit and found caregivers to be 0.27 SDs lower than controls on a latent construct of inhibitory, regulatory feedback of systemic inflammation (p = 0.03).
Vision and Cognition: Findings from the Longitudinal Aging Study in India—Diagnostic Assessment of Dementia
Authors: Ehrlich Joshua , Chien Sandy , Lee Jinkook
Published: December 2020

Vision impairment (VI) is associated with cognitive decline and dementia, however little research has been conducted in India. Using data from LASI-DAD, linear models tested the association of VI (better-seeing eye <20/60) with cognitive domains including orientation, learning/memory, language, attention, and total cognition. Models were adjusted for age, sex, geographic, and socioeconomic characteristics. VI was significantly associated with lower orientation (β=-0.47, p<.01), learning/memory (β=-4.6, p<.01), attention (β=-1.6, p<.01), and total cognition (β=-8.4, p<.01), but not language (β=-0.14, p<.1) scores. The association of VI with cognitive measures did not vary by sex. For each measure, VI was equivalent to 5-13 years of cognitive aging. In summary, VI is associated with poorer performance in most cognitive domains among older Indian adults. Longitudinal data are needed to determine directionality and causality. Since >80% of VI in India is treatable, poor vision may represent a modifiable risk factor for cognitive decline and dementia.
In-Home Video Telehealth for Caregivers and Veterans With Dementia
Authors: Gately Megan , Moo Lauren
Published: December 2020

Home Video Telehealth offers a unique opportunity to support already burdened caregivers of persons with dementia. Veterans Health Administration, through the MISSION Act, is increasingly using video telehealth to provide “care at the right time and in the right place.” Little is known about the benefits and challenges of using video telehealth for in-home caregiver support. We present findings from our seven years offering in-home dementia management to caregivers of Veterans with dementia, that includes supporting caregivers through supportive listening, tips for communication and safety strategies, and recommendations regarding non-pharmacologic management of behaviors. Perceived benefits of in-home video telehealth include an ‘in vivo’ perspective of the family’s natural context and remediating barriers to care such as decreased mobility. Perceived challenges include dealing with technology and privacy concerns. By describing considerations for in-home video telehealth to a clinical population with unique care needs, we inform broader application of a promising technology.
Digital Technologies as a Means to Reducing Mental Health Disparities: The Role of Ethnicity, SES, and Geography
Authors: Kim Giyeon
Published: December 2020

This presentation discusses the importance of using digital technologies on reducing mental health disparities among older adults from diverse backgrounds. This talk primarily focuses on the role of ethnicity, socioeconomic status and geography. First, the speaker presents the current status of digital technology use among older adults and how different levels of digital technology use affect mental health disparities by ethnicity, SES, and place of residence. Second, the speaker introduces a recently funded government project on developing an IoT-based home system (Internet of Things) to screen mild cognitive function for Korean older adults. Lastly, the speaker discusses potential implications, as well as directions for future research on using digital technologies to reduce mental health disparities among diverse populations.
Cardiovascular Health, Functional Disability, and Leisure Activities Profiles in Relation to Mental Aging
Authors: Cadar Dorina , De Looze Celine , McGarrigle Christine
Published: December 2020

We investigated cardiovascular health, functional disability and leisure activities profiles independently and in relation to cognitive decline and dementia in high and low-medium income countries using data from the English Longitudinal Study of Ageing, Irish Longitudinal Study on Ageing and Brazilian Bambui Cohort Study of Aging. Functional loss among older Brazilians has shown a hierarchical sequence over the 15-year follow-up, with the highest incidence in functional disability reported for dressing, followed by getting out of bed, bathing/showering, walking across a room, using the toilet and eating (de Oliveira). Using the Life’s Simple 7, an ideal cardiovascular health scoring system evaluating the muscular strength, mobility and physiological stress, we showed a reliable prediction of cognitive trajectories in a representative sample of Irish individuals (De Looze). Within the same cohort, we report discrepancies between men and women in functional decline driven by domestic tasks, rather than determining differential cognitive trajectories (McGarrigle). In an English representative sample, we found that participants with an increasing number of functional impairments over almost a decade were more likely to be classified with subsequent dementia compared with those with no impairments and this may imply a more comprehensive ascertainment during the prodromal stage of dementia (Cadar). In contrast, a reduced risk of dementia was found for individuals with higher levels of engagement in cognitively stimulating activities, that may preserve cognitive reserve until later in life (Almeida). Identifying factors that influence cognitive aging and dementia risk in a multifactorial perspective is critical toward developing adequate intervention and treatment.
Functional Impairments and Dementia Incidence in the English Longitudinal Study of Ageing
Authors: Cadar Dorina , Llewellyn David , Batty G David , Steptoe Andrew
Published: December 2020

Functional disability might be related to an increased risk of dementia or could represent a prodromal stage. We examined the occurrence of functional impairments over eight years follow-up and their association with dementia incidence in 1,666 participants aged 65+ from the English Longitudinal Study of Ageing. Growth models with distal outcome were used to examine whether different trajectories of functional abilities (activities of daily living (ADL); and instrumental activities of daily living (IADL)) between 2002/03 and 2010/11, were associated with dementia incidence four years later (2014/15). Participants with an increasing number of functional impairments (Class III), were more likely to be classified with subsequent dementia compared with those with no impairments (Class I). An increased risk was also observed for individuals with raised levels of impairments (Class II). We found IADLs more sensitive than ADLs, and this may imply a more comprehensive ascertainment during the prodromal stage of dementia.
A Social Justice Field Education Model for Addressing Isolation and Other Social Determinants of Behavioral Health
Authors: Bullock Karen , Stansbury Kim , Fitzpatrick David
Published: December 2020

Behavioral health and substance use disorders are significant problems among older adults who are experiencing homelessness. This presentation describes the components of a social work field education model for preparing practitioners to work effectively in community-based agencies using the Hartford Practicum Partnership in Aging Educational (HPPAE) model. A planned and systematic transition from one field setting to another with the goal of giving students a range of practice experiences with various service delivery systems to address social isolation and other social determinants of health. This exploration of demographic and social action factors that may impede or foster success among community-dwelling older adults offer insight and guidance for constructing a conceptual and theoretical model a social justice framework in geriatric social work practice and research.
The Unique Challenges and Contributions of Diverse Caregivers
Authors: Choula Rita
Published: December 2020

Caregiving in the U.S. 2020 oversampled African Americans, Hispanics, Asians, and people over the age of 75. Six in ten caregivers report being non-Hispanic white, 17% are Hispanic, 14% non-Hispanic African-American or black, 5% Asian/Pacific Islander, and 3% some other race or ethnicity, including multiracial. The session will emphasize the unique context of diverse caregivers, including African American, Hispanic, Asian, and LGBT+ caregivers. The session will begin by discussing the portrait of the typical caregiver of each of these groups. It will follow with a discussion of the challenges facing diverse caregivers in the aggregate and the opportunities to recognize and support them across settings.
Challenges for Prevention of Elder Abuse in Japan: Viewpoints From Legal and Practice Settings
Authors: Thomas Cynthia , Kuo Tsuann
Published: December 2020

This symposium begins by fist comparing features of the Japanese elder abuse prevention law to 3 other abuse prevention laws - child abuse, domestic abuse and abuse against people with disabilities. It highlights amendments that have been made to the child abuse and domestic abuse prevention laws since their enactment based on implementation experience, drawing contrast to the lack of amendments made to the elder abuse prevention law despite its three-year requirement for amendment review. Overall strengths and weaknesses of the elder abuse law are discussed including needed areas of revision. Second, a case study of nearly two decades of elder abuse prevention activities in Matsudo-city are presented and the subsequent enactment in April 2020 of a new regulation of the city is discussed. In addition, interim outcomes of a related research study in Matsudo-city on elder abuse involving non-caregivers for elderly people that will expand understanding of abuse prevention efforts are presented. Third, how can we abolish elder abuse in institutional settings will be discussed by analyzing elder abuse case studies. Finally, the most updated research outcomes conducted in in-home care service settings in 2020 will be presented. Its preliminary analyses revealed out of 1,417 responses, 2.9% were found to be ”body restraints.” Such abusive actions are less likely to be detected by others. The symposium concludes by assessing challenges for preventing elder abuse in policy and practice.
Using Applied Conversation Analysis in Medical Education
Authors: Halpin Sean , Roulston Kathryn , Konomos Michael
Published: December 2020

Successful implementation of patient medical education is contingent on the communication strategies used by nurses, patients, and caregivers. Applied conversation analysis (A-CA) is a sociological and linguistic technique aimed at understanding how interaction is accomplished. In this demonstration of A-CA, the authors draw on an 18-month iterative-formative evaluation of patient education that precedes autologous stem cell transplant for persons diagnosed with multiple myeloma (N=70), a type of cancer which disproportionately impacts older adults. In this study, patients and caregivers received supplemental education videos before their formal education session with a nurse coordinator. Using A-CA, we examined how nurses, patients, and caregivers orient toward the videos; including demonstrated knowledge by patients and caregivers. Nurses justified repeating topics from the videos. Through a focus on the function that language plays in sequences of interaction, it may be possible to determine strategies for improving patient education, and, consequently positively impact patient care..
Identifying Cost-Burdened Older Adults: What Is the Best Measure?
Authors: Scheckler Samara , Mawhorter Sarah , Molinsky Jennifer , Hermann Alex , Airgood-Obrycki Whitney
Published: December 2020

While affordable housing typically describes housing costs that fall within 30 percent of total income, older adult spending systematically differs from younger cohorts. For instance, budgets may skew away from mortgages and towards home modifications while medical or personal care expenses can drive monthly costs. This research uses the Health and Retirement Study (HRS) to explore various older adult housing cost burden measures and identify their relative advantages. Measures of cost burden are applied to HRS respondents and different cost burdened groups are defined. The welfare of each group is then assessed using metrics such as unmet need and caregiver stress. Findings suggest that traditional cost burden measures identify many vulnerable older adults. However, other measures of cost burden can highlight older adults who are disproportionately impacted by medical cost. This research should help professionals better align the metric that defines their target population members with their policy area.
Evaluating an Integrated APS–Elder Advocate Intervention Model in the State of Maine
Authors: Burnes David , Connolly Marie-Therese , Kimball Patricia , Lewis Stuart , Salvo Erin
Published: December 2020

Despite recommendations to include a distinct intervention phase in Adult Protective Services (APS), most APS programs close cases following investigation/substantiation phases without engaging in a defined intervention phase. This study implements and evaluates a novel APS service planning/intervention model in the state of Maine. Using an experimental efficacy trial design with stratified random sampling at the level of Maine APS offices, this study compares standard APS care with an enhanced/integrated APS intervention model involving “elder advocates”. Advocates were trained in motivational interviewing, supported decision-making, teaming, restorative justice, and goal attainment scaling to develop capacity to work with both the older adult victim and perpetrator and to strengthen the family and social systems surrounding the victim-perpetrator dyad. This presentation will present results on the efficacy of this integrated APS/elder advocate model and discuss the challenges and successes in conducting elder abuse intervention research in collaboration with APS and APS clients. Part of a symposium sponsored by Abuse, Neglect and Exploitation of Elderly People Interest Group.
My Neighborhood Is Fuzzy, Not Hard and Fast: A Mixed-Methods Study of Neighborhood Size Among Aging Americans
Authors: Finlay Jessica , Jang Joy Bohyun , Esposito Michael , Tang Sandra , Khan Anam , Clarke Philippa
Published: December 2020

In this exploratory sequential mixed-methods study, interviews with 125 adults aged 55-92 living in the Minneapolis (Minnesota) metropolitan area suggest that neighborhood boundaries are “fuzzy”. Qualitative analysis of neighborhood perceptions identified race, mobility, driving status, social connections, housing insecurity, land use, urbanicity, and crime as key themes. Over 8,000 REGARDS participants (mean age 72) indicated how many blocks composed their neighborhoods (mean=9.9, SD=35.4). Linear regression models showed that being over the age of 85, white, less educated, lower income, less physically and cognitively healthy, and living outside of a metropolitan area significantly predicted smaller self-reported neighborhood sizes. Further, there was significant variation among participants residing in the same areas as other respondents. The mixed-methods results indicate that neighborhoods are fluid and dependent on a mix of personal and geographic factors. Findings inform the scale of environmental audits, place-based interventions, and community outreach programs targeting older adults.
Parks and Safety: How Cognitive Decline May Impact Access and Perception
Authors: Clarke Philippa , Esposito Michael , Jang Joy Bohyun , Tang Sandra , Khan Anam , Sylvers Dominique , Finlay Jessica
Published: December 2020

Older adults’ perceptions of the presence and quality of neighborhood resources provide important information about the potential benefit of those resources but are not necessarily concordant with the actual physical resources available in that environment. There is debate about whether subjective perceptions of local context are more important for individual behavior and well-being than objective indicators of resources. However, little research has examined how cognitive function is related to differences in the perceived availability and quality of neighborhood resources among older adults. We found that subjective reports of neighborhood safety and adequacy of parks were positively associated with objective measures of property crime and park density. Cognitive function was associated with higher subjective neighborhood evaluations, but adults with lower cognitive function reported more discordance between objective and subjective measures of neighborhood resources. These findings inform how neighborhood resources may have different consequences for older adults experiencing cognitive decline.
Material Disadvantage and Positive Subjective Health of Older Homeless and Older Irish Travelers
Authors: Carroll Bridin , Walsh Kieran
Published: December 2020

Focusing on older Irish Travellers and older homeless people (OTOH) as two marginalised sub-sections of the older population, this paper investigates life-course and structural forms of material disadvantage, and its implications for positive health and accessing community care in older age. With growing interest in strengthening home care structures for older people, it is critical to interrogate the relevance of these structures for those who experience environmental uncertainty in later life, and possess significant trajectories of disadvantage. The analysis draws on 50 life-course interviews with OTOH aged between 50-72 years. The findings illustrate significant life-course experiences of material and multi-faceted forms of disadvantage, including stigma and discrimination, with implications across health and social lives. Housing deprivation was a multi-factorial player, causing certain physical illnesses, hindering some health treatments, and contributing to precarious conditions and sense of self worth. Findings are discussed in relation to flexible models of home care delivery.
Social Isolation and Loneliness: Develop a More Robust Evidence Base
Authors: Julianne Holt-Lunstad
Published: December 2020

This paper reviews the evidence base for the health impacts of SIL on older adults, the risk factors, and the potential moderators and mediators of those relationships. Substantial evidence indicates that SIL are associated with physical, cognitive, and psychological morbidity; health-related behaviors; and health-related quality of life. Social isolation in particular is associated with a significantly increased risk of premature mortality from all causes. The evidence base for interventions in the clinical setting is also reviewed. Finally, the report’s specific recommendations are discussed, including the need for basic science research, increased funding, key elements in the design and evaluation of interventions, and gap areas (including trends among current younger adults and approaches for specific understudied groups of at-risk older adults). Part of a symposium sponsored by Loneliness and Social Isolation Interest Group.
Amendments Made to the Older Americans Act Titles III, IV, and V
Authors: van Heumen Lieke
Published: December 2020

This presentation discusses amendments made to the Older Americans Act titles III, IV and V through the most recent reauthorization. Title III reauthorizes Title IV programs, Title IV reauthorizes title V programs and Title V reauthorizes title VI programs. The reauthorizations each include a seven percent increase in fiscal year 2020 and a six percent increase per year for the next four fiscal years. New in title III are an amendment that allows projects that address traumatic brain injury among older adults to be included in grant programs, an amendment that improves an existing transportation grant program and an amendment that improves an existing grant program for multigenerational collaboration. Additionally, existing falls prevention and chronic disease self-management programs are codified within title III. New in title IV is an amendment that allows eligible previously incarcerated individuals to be considered a prioritized population for the Senior Community Service Employment Program.
The Impact of Changes in Direct Care Staffing Policies and Outcomes for Assisted Living Residents With Dementia
Authors: Thomas Kali , Cornell Portia , Zhang Wenhan , Carder Paula , Smith Lindsey , Hua Cassandra , Rahman Momotazur
Published: December 2020

We identified a cohort of 410,413 Medicare beneficiaries residing in 10,623 large (25+bed) assisted living (AL) communities between 2007 and 2017. We conducted linear probability models with a difference-in-difference framework to examine the association between hospitalization and changes in regulations pertaining to staff training (model 1) and staffing levels (model 2), adjusting for time trends, resident characteristics, and state-license fixed effects. During this 11-year period, six states changed their staff training requirements and two states introduced/increased direct care staffing levels. A change in regulations related to staffing levels was associated with a reduction in the probability of hospitalization during the month of -0.0056 percentage points (95%CI=-0.008,-0.003). A change in regulations related to staff training was associated with a reduction in the probability of hospitalization during the month of -0.0035 percentage points (95%CI=-0.006,-0.002). The policy effects represent clinically important differences of approximately 21% in the mean monthly hospitalization rate. Part of a symposium sponsored by Assisted Living Interest Group.
The Political Economy of Aging Services in the United States Since the Aging Enterprise
Authors: Polivka Larry
Published: December 2020

The Aging Enterprise was the first book length analysis of the origins and operations of the aging services system that grew out of the 1963 Older Americans Act and provided the first state system of community-based services. The book also featured an original critique of the aging services system based on an application of the theoretical perspectives that were new to social gerontology. This presentation will use one of these perspectives, the political economy of aging in the U.S., to chart changes in aging services systems since the publication of The Aging Enterprise. The presentation will show that Estes’ pioneering work on the application of the political economy perspective on aging policies and programs in the US, is more relevant to our understanding of these programs than it was 40 years ago, by describing and analyzing the increasing control of for profit corporations over the aging services systems. Part of a symposium sponsored by the Women's Issues Interest Group.
Intersectional Stigma and Barriers to Mental Health Among Older Adults With HIV in San Francisco
Authors: Nash Paul , Brennan-Ing Mark , Taylor Tonya , Karpiak Stephen
Published: December 2020

For older adults with HIV, forms of privilege and oppression (racism, poverty, limited access to quality education, and inequalities in criminal justice system) intersect with stigmatized social identities (immigrant status, non-cisgender identity, sexual orientation, depression, and addiction) that may increase cumulative burden of psychological distress, contribute to poor clinical outcomes, and create disparities in health care utilization. Using survey and focus group data from the San Francisco ROAH 2.0 (Research on Older Adults with HIV) site, we explored how layered intersectional identities (minority affiliation, gender and sexual orientation), life experiences (immigration, trauma) and forms of systemic oppression (poverty, low educational attainment, and incarceration) impact the utilization of mental health supportive services. Immigrants, minority women, and heterosexual men had higher burdens of depression compared to their white counterparts. Similarly, inhabiting multiple stigmatized identities resulted in both low and variable levels of mental health care utilization, suggesting need for targeted intervention efforts.
The Road to Improved Assisted Living Quality: State Efforts and New Metrics
Authors: Shippee Tetyana , Schwartz Lindsay
Published: December 2020

Assisted living (AL), a senior housing option that combines housing, support services, and health care, is recognized as one of the fastest-growing components of the long term care industry. AL is also a relatively expensive service, whether it’s paid for privately or publicly. Also, an increasing proportion of AL residents have diagnoses of Alzheimer’s and related dementias. However, little is known about AL quality, in part due to lack of measures. Quality of AL matters to residents, their families, and policy makers because AL is not only about the experience of receiving specific services, but about a place that many will call home. Concerns have been surfacing regarding the quality of AL, including poor staffing, inadequate teamwork, and poor management, which can negatively impact resident well-being and result in abuse and neglect in some cases. This symposium will feature four presentations that will review efforts from two states that have been actively developing measures to address AL quality: Oregon and Minnesota. We focus on new legislation in both states to address AL quality, the new metrics being adopted, and preliminary results. Individual presentations will describe 1) Oregon’s new quality measures for AL ;2) Oregon’s use of Resident VIEW project, including measures of person-centered care from the perspectives of residents; 3) Minnesota’s development of AL report card, and 4) development and results from MN pilot surveys of resident quality of life and family satisfaction in all licensed ALs in the state. Policy implications for other states and researchers will be discussed.
Identifying Domains of Assisted Living Quality for Minnesota’s Assisted Living Report Card
Authors: Shippee Tetyana , Akosionu Odichinma , Skarphol Tricia , Beebe Timothy
Published: December 2020

Concerns around assisted living (AL) quality have prompted the 2019 passage of the MN legislature, which provided funding for the development of an Assisted Living Report Card. We present results from the first two phases of this project. The first phase involved a national literature review of quality measures and technical advisory panels to understand the types of domains and indicators for AL quality that are measured. Nine quality domains were identified. The second phase focused on state-wide stakeholder engagement to determine priority rankings for nine AL quality domains and indicators identified. Quality of life, staff quality and resident safety were the top three domains across all stakeholder groups. The state will implement surveys of AL resident quality of life and family satisfaction as mandated by the legislature, but findings indicate that other aspects of quality such as staff-related measures and resident safety, are also important to address.
Eliciting Care Management Preferences with Engaged Caregivers and Individuals With Mild Cognitive Impairment
Authors: Majid Tabassum
Published: December 2020

The goal of this study was to engage individuals with mild cognitive impairment (MCI) in developing a survey instrument that assists in the selection and prioritization of meaningful treatment outcomes in health care decision making. A multi-stakeholder advisory panel was engaged throughout the first qualitative phase of the study. 15 in-depth, guided interviews were conducted with caregiver-care recipient dyads who had been recently diagnosed with MCI. In addition to questions about meaningful outcomes, individuals were asked about quality of life and the severity of their symptoms using the Functional Attainment Staging Tool. 14 thematic concepts identified in an earlier, non-engagement-based caregiver study were all endorsed as relevant to the dyads interviewed. However, participants included 6 more thematic concepts, many of which were focused on social and community factors relevant to health care decision making. Engaging patients and caregivers allowed for focused dialogue within the interviews on shared treatment goals.