bluuebunny/crossref_metadata_2025 huggingface dataset:
CULTURAL COMPETENCE TRAINING AND EVALUATION AMONG NURSING HOME STAFF
Authors: Okolie Tochukwu , Sandri Tina , Booker Staja , Ekoh Prince , Udeh Kingsley
Published: January 2025

The dynamics of cultural and ethnic identity in healthcare has become more salient in the United States due to the growing population diversity. In particular, significant number of nursing home staff are from diverse sociocultural groups, which necessitates cultural competency in nursing homes in order to provide quality care to older adults. Cultural competency in nursing homes is usually analyzed in terms of the interplay between staff members and the older adults, but this study investigated the relational cultural competency between staff members in the workplace. First, cultural competency training on promoting inclusion and respecting diversity, and communication/teamwork was provided to staff members working in a nursing home in Washington, D.C. To evaluate the level of cultural competency post-training, a semi-structured in-depth interview was conducted with 16 nursing home staff. Participants were purposefully selected to capture variation in cultural identity and ethnicity, national origin, work experience and position at the organization. The interviews were conducted individually and audio-recorded after consent was obtained. The audio files were transcribed verbatim and analyzed with the aid of Nvivo12. Findings show that the training was positively perceived as having impacted their outlook of culture and identity in the workplace. Most of the participants were comfortable with working with individuals from different cultures and identified techniques used in communicating when there are language barriers, including utilizing interpreters and translation tools. Participants recommended that organization’s leadership should create more opportunities for intercultural exchange among staff members through potlucks, and recognizing national holidays of staff members.
DIGITAL HEALTH AND OLDER ADULT WELL-BEING: THE MEDIATING ROLE OF SOCIAL TECHNOLOGY USE
Authors: Power Shannon
Published: January 2025

Older adults engage in digital health use (DHU) and social technology use (STU) to connect with health care providers and loved ones. DHU has expanded as an accessible health care option, though its effects on well-being are underexplored. Meanwhile, STU is known to improve quality of life for older adults. This study investigates the association between DHU and well-being and determines whether STU mediates this association. Data from the 2022 National Health and Aging Trends Study were analyzed, with a sample of 5,773 U.S. Medicare beneficiaries, ages 65 and older. The sample was primarily White (64%), female (58%), 65-79-years-old (52%), and urban-living (84%). Structural equation modeling captured the complex relationships of the latent constructs of DHU (e.g., telehealth visit, sending portal messages), STU (e.g., video chat, texting, social media), and well-being (e.g., belief in one’s life purpose, self-determination, confidence). Confirmatory factor analyses with sufficient fit indices established validity of the measurement models. In the full model, DHU was negatively associated with well-being (β=-0.22, p<.001); however, a mediation analysis revealed a strong partial mediation (β=0.32 (CI 0.24-0.46), SE=0.055, z=6.163, p<.001) with acceptable model fit. Adding STU as a mediator reversed the direction and increased the magnitude of the association between DHU and well-being. The significant negative path between DHU and well-being may indicate that DHU is not a preferred option for older adults, but the partial mediation suggests that STU offers familiarity with communication technology that strengthens the association towards well-being. Future research should clarify the reasons underlying these significant associations.
ENHANCING SOCIAL CAPITAL IN OLDER ADULTS: STRATEGIES IN THE ASIAN CONTEXT
Authors: Chan On Fung , Lum Terry , Lu Shiyu , Chui Hiu-kwan
Published: January 2025

Research on enhancing social capital among older adults in East Asia often neglects the aspects of trust, norms, and reciprocity, focusing primarily on social participation. Moreover, it frequently overlooks the capacity of older adults for collective action within society. This study addresses these gaps by exploring strategies that enable older adults in Hong Kong to shift from being passive service recipients to active participants in community and collective action. Using a qualitative research design. We conducted focus groups with 43 participants over 60, who were committee members of various socially beneficial groups, including self-initiated and NGO-led groups. These groups engaged in activities such as promoting age-friendliness, ageing in place and ecological conservation. Data were collected through semi-structured interviews and analyzed using deductive and inductive thematic analysis based on Nahapiet and Ghoshal’s framework. The findings identified five key strategies to enhance social capital among older adults: establishing connections with trusted intermediaries, transforming individuals to share collective goals, providing stable platforms for trust-building, facilitating informal interactions to enhance cohesion, and leveraging influential figures to reinforce group norms. These strategies empower older adults and integrate them into the broader social fabric, thereby contributing to collective action. The study provides actionable insights for policymakers and social workers to develop interventions that enhance social capital among older adults, thereby leveraging their potential as active societal contributors.
EXPLORING RELUCTANCE: HEALTH PROFESSIONS STUDENTS AND GERIATRIC CARE
Authors: Zheng Mingyang , Frasier Pamela , Philippi Jr. H George
Published: January 2025

The aging population in the United States is growing rapidly, yet a shortage of healthcare workers persists, with health profession students showing limited interest in geriatric care. It is urgent to understand the reluctance of working with older adults among health profession students to develop interventions to address the workforce shortage issue. This study aims to understand the factors influencing these students’ intentions to work with older adults using the Theory of Planned Behavior. Using a cross-sectional survey design, the study surveyed 244 health profession students at a mid-sized public comprehensive university in the Southeast. Structural equation modeling demonstrated a good fit (χ² = 625.981, df = 340, p < 0.001, CFI = 0.918, RMSEA = 0.059, SRMR = 0.064, TLI = 0.908). The results indicated that attitudes (β = 0.930, p < 0.001) and subjective norms (β = 0.864, p < 0.001) play critical roles in shaping health profession students’ intention toward geriatric care, while perceived behavioral control (β = 0.169, p = 0.118) and self-efficacy (β = 0.008, p = 0.976) were not significant predictors. These findings suggest that educational interventions should focus on improving attitudes toward older adults and leveraging social influences to enhance the desirability of geriatric careers. Future research should explore longitudinal changes in health profession students’ attitudes and evaluate targeted interventions on students’ career intentions. Addressing biases and enhancing the educational curriculum are crucial steps toward mitigating the workforce shortage in geriatric care.
FACTORS ASSOCIATED WITH HOME HEALTH CARE VERSUS SKILLED NURSING FACILITY REFERRAL FOLLOWING HOSPITAL DISCHARGE
Authors: Turner Natalie , Sabbatini Amber
Published: January 2025

Among post-acute services, home health care has markedly increased following hospitalization. Home health care is less expensive compared to other post-acute services, namely skilled nursing facilities, and is more aligned with older adults’ desire to remain at home. The objective of this study was to identify individual, hospital, and community factors associated with home health care referral among Medicare beneficiaries. Multivariate logistic regressions with hospital-level fixed effects were used to estimate the patient, hospital and community-level factors associated with home health care referral among Medicare beneficiaries at hospital discharge. Older age, being female, and dual enrolled beneficiary status were associated with decreased odds of home health care referral. Beneficiaries living in rural compared to urban settings had higher odds of home health care referral. Communities with a higher proportion of people of color had a lower odds of home health referral, while having a greater percentage of residents living in poverty was associated with higher odds. The decision to refer to home health care was largely driven by patient-level factors. However, the racial and ethnic composition of a community as well its economic status and rurality may affect the odds of a home health care referral beyond both the patient characteristics and the specific hospital in which they were treated. Ensuring equitable access to home health care necessitates increased investment in care infrastructure and policies that dismantle structural barriers to preferred post-acute care settings.
HEALTH AND WELL-BEING OUTCOMES OF MEALS ON WHEELS: A SYSTEMATIC REVIEW FOR A COMPLEX INTERVENTION
Authors: Wright Bernadette , Owens Victoria , Wilson Sanjaya
Published: January 2025

Meals on Wheels programs deliver nutritious meals to older adults’ homes, providing the opportunity to address social and safety needs that affect health. To make informed decisions on programs and policies, decision-makers need to understand which Meals on Wheels services lead to specific impacts, identifying the affected populations, locations, and mechanisms involved. We investigated these questions through a systematic review of studies demonstrating Meals on Wheels’ effects on older adults’ health and health-related outcomes. Forty-eight publications met inclusion criteria, representing 47 studies and 105 outcome analyses. Outcomes frequently examined included diet quality (20), nursing home use/living independently (17), food insecurity (12), healthcare utilization (11), social connection (10), falls/home safety (6), nutrition (5), and other outcomes (24). Study designs included single group quasi-experiments (13), analyses of perceived outcomes (12), comparison group quasi-experiments (9), single-group pre-post studies (8), and randomized experiments (5). Majorities of studies were from the U.S. (38), in peer-reviewed publications (35), and published in the past 10 years (27). Risks of bias included unaccounted-for variables (11) and underpowered samples (9). Eighty-eight analyses (45 studies) found evidence of beneficial effect. Studies attributed success in part to meeting participant preferences and nutritional needs, serving those with greatest need, offering more meals/food, and ensuring opportunity for social connection. Seventeen analyses (9 studies) did not find positive effects, most frequently explained by methodological issues or participants not receiving enough services. These findings suggest that Meals on Wheels services that meet participants’ preferences and needs can reduce barriers to health and aging in place.
HEALTH OUTCOMES AND RISK FOR MORTALITY IN OLDER ADULTS WITH ATTENTION DEFICIT/HYPERACTIVITY DISORDER SYMPTOMS
Authors: Cooper Tara , Piccinin Andrea
Published: January 2025

Attention deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that persists into older adulthood with important implications for healthy ageing. Previous research documents significant disparities for children and adolescents with ADHD compared to their neurotypical peers on various social determinants of health. Critically, previous research reports a significantly higher risk for mortality in adults with ADHD followed since childhood. The literature on health outcomes of older adults with ADHD is sparse. Therefore, the purpose of this research was to examine social determinants of health and risk for mortality associated with ADHD symptoms in a sample of older adults. Participants from the Longitudinal Aging Study Amsterdam (n= 986) were screened for childhood and current ADHD symptoms in 2008/2009 and followed until death or most recent assessment (August, 2021). Based on symptoms reported currently and evidence of childhood onset, participants were assigned to either an ADHD symptom (ADHD-sx) group (n= 147) or a non-ADHD group (n= 839). Survival analysis revealed no significant risk for mortality associated with ADHD-sx (HR:.90, 95% CI [.63, 1.29], p=.58). Furthermore, although older adults with ADHD-sx reported more chronic health conditions (p <.001), group differences were not observed in terms of income (p=.49), education (p=.95), social participation (p=.63) or occupational attainment (p=.94). These results suggest that selection and survival bias are important considerations when studying older adults with neurodevelopmental disorders. Future directions for research on ADHD in healthy ageing are presented.
HEALTH, SOCIAL ISOLATION, AND 12-YEAR MORTALITY ACROSS DIFFERENT COMMUNITY-BASED SENIOR HOUSING TYPES
Authors: Ahn Seoyeon , Park Sojung , Kwon Eunsun , Kim BoRin
Published: January 2025

The literature on subsidized senior housing for low-income older adults primarily focuses on affordability and health outcomes like mortality. In contrast, research on other senior housing models often emphasizes the social environment, creating a disconnect that may lead to misunderstandings about factors influencing health and well-being across different housing types. This study examines the influence of socio-economic status, health conditions, and social isolation on 12-year mortality across various community-based senior housing types. Data were drawn from twelve waves of the National Health and Aging Trend Study (2011-2022), involving 6,534 community-dwelling adults (obs=29,929) aged 70 or older who died during the study period. Housing types were categorized into five groups: 1) subsidized senior housing (SSH), 2) senior housing with low-income status and housing cost burden (HCB), 3) senior housing without low-income status and non-HCB, 4) traditional homes with low-income status or HCB, and 5) traditional homes without low-income status and non-HCB. A hierarchical discrete-time event history model using logistic regression was employed to assess the influence of health conditions, social isolation, and housing type on mortality risk. We found that (1) low income or HCB significantly increased mortality risk across all housing types; (2) chronic health conditions and severe social isolation were strong predictors of higher mortality; and (3) socially isolated individuals had a lower mortality risk when living in senior housing compared to traditional homes. These findings highlight the importance of housing affordability policies and suggest that congregate senior housing offers protective benefits for socially vulnerable older adults.
HEARING LOSS AND COGNITIVE DECLINE: POLICY RECOMMENDATIONS
Authors: Hemrajani Girish , Dobbs Debra
Published: January 2025

Hearing loss is the third most common health condition in older age after arthritis and heart disease. With a rapidly increasing older adult population, hearing loss cases are expected to grow from 38 million to 73 million by 2060. Hearing loss in midlife has been estimated to account for 9% of cases of dementia, a huge – but potentially reversible – disease burden given that dementia affects 47 million people worldwide.

Methods

The systematic literature review was included from the Ageline database, containing articles published in English from January 2013 to June 2024. The search terms ‘hearing loss,’ ‘cognitive decline’ and ‘older adults’ produced 161 results and out of these 18 relevant articles were chosen for the review.

Results

In eight articles, hearing interventions were found to reduce cognitive decline in cognitively healthy older adults with hearing loss and slow down the progression of cognitive decline. One article found the provision of hearing aids would have a 48% protective effect on cognitive changes compared to the control over three years. The other articles were equally divided as “not sure” and “need further investigations”. Implications: The review highlights the importance of addressing hearing loss as a preventative measure and suggests policy measures and prevention strategies to maximize cognitive well-being in older adults. Age related sensorineural hearing loss is widely treatable with hearing aids and targeted intervention for hearing loss may play a fundamental role in dementia prevention. Key words: hearing loss, cognitive decline, hearing aid.
HIGH CONFIDENCE IN MANAGING COMMON GERIATRIC PROBLEMS AMONG RURAL FRONTLINE CLINICIANS
Authors: Stone Alison , Dryden Eileen , Moo Lauren , Hung William , Kennedy Meaghan , Pimentel Camilla , Riley Jessica , Caprio Thomas
Published: January 2025

Background

Older rural Veterans often have less access to specialty care services, including geriatrics. The Veterans Health Administration’s (VHA) GRECC Connect is a national program that provides virtual geriatric services for patients and geriatric education for rural clinicians through a case conference series focused on the 5Ms (Mind, Mobility, Medications, Multicomplexity, and Matters Most), a hallmark of high-quality geriatric care. We aimed to measure rural frontline clinicians’ confidence in managing common geriatric problems to inform future education efforts.

Methods

We conducted an electronic survey-based needs assessment during three case conferences in Spring, 2024. The survey included a brief demographic section and 16 questions on respondents’ confidence addressing clinical issues within the 5Ms (e.g., polypharmacy, falls prevention, goals of care).

Results

Forty nine percent (211/430) of conference participants completed the survey, including social workers, pharmacists, nurses, and physicians. On average, 69% of respondents reported being ‘confident’ or ‘very confident’ (range 53%-84%) across the 16 questions. Highest confidence levels were in the ‘Matters Most’ domain. Topics rated lower included managing depression, deprescribing, and managing behaviors in patients with dementia. Confidence varied according to health professions and the responsibilities associated with each role. Providers who serve a higher percentage of rural Veterans reported feeling more confident than their urban colleagues across all questions.

Conclusion

The high level of confidence aligns with findings in the literature that report high self-efficacy ratings in the 5Ms domains among other VA providers and may be related to the VHA’s focus on Age Friendly Health Systems.
IMPACT OF PROVIDING IPADS TO OLDER ADULTS: LESSONS CALIFORNIA FUNDED PROGRAM
Authors: Navarro Sheila Salinas , Yan Mengzhao , Lomeli Sindy , Roman Carly , Wilber Kathleen
Published: January 2025

The California Department of Aging innovative Connections, Health, Aging, & Technology (CHAT) program has bridged the digital divide by providing free iPads with internet access to older adults aged 60 and over. This initiative sought to enhance mental and physical well-being through increased community engagement, information, and access to services. Our research employed a mixed-method approach to understand participants’ usage and motivations. We used Stata 18 to analyze data from 980 participants who completed a pre and post-test. Most used their iPads more than once a day (n=454; 46%) or once a day (n=211; 22%); 62 participants (6%) did not use the iPad. In a qualitative analysis conducted with Dedoose using grounded theory, we identified key themes for using the iPad, including the role of pre-test expectations and motivators identified in the post-test. Initially, participants anticipated using their iPads for communication, learning, well-being, technology, and simplifying life. However, post-test results revealed a fascinating shift in motivations, now centered on technology, education, entertainment, communication, and health. This shift underscores the profound impact of the CHAT program on the participants’ attitudes and behaviors. Understanding what motivates users is crucial for tailoring programs that support older adults in mastering advanced features and enhancing their connection to loved ones, information, the community, and healthcare providers. Our findings suggest that older adults are not only interested in but also actively engaged with technology for a variety of activities.
IMPROVING STUDENT CONFIDENCE IN APPLYING GERIATRICS BEST PRACTICES USING THE 4MS FRAMEWORK
Authors: DeGennaro Jennifer , Powell Leonard , White Christian , Overbeck Kevin
Published: January 2025

Recognized by the Institute for Healthcare Improvement as a Level II Age-Friendly Health System, the Rowan-Virtua School of Osteopathic Medicine (RVSOM) Department of Geriatrics and Gerontology is committed to infusing the 4Ms framework (What Matters, Medication, Mentation, Mobility) into all education initiatives as well as clinical practice. RVSOM medical students are exposed to the 4Ms in the second year of undergraduate courses and the framework is further emphasized during the required 4-week clerkship. To standardize content delivered to students rotating at a host of rotation sites and to augment the assigned self-study modules, a new initiative was introduced at the beginning of academic year (AY) 2024-2025. Students now participate in a full day of in-person didactics designed to teach them to use evidence-based screening tools and employ best practices when caring for older patients. A post-clerkship survey on the 4Ms approach was administered in AY 2023-2024 which allows an examination of differences between cohorts of students who received the in-person didactics and those who did not. Analysis of the data indicates that students benefit from the focused didactics as significant differences emerged on nearly half of the survey items [e.g., sufficient knowledge to perform a Geriatric Assessment [t(109) = 2.45, p =.016, d =.47] and confidence in initiating a conversation about Advance Care Planning [t(109) = -2.69, p =.008, d = -.51]). Findings indicate that enhanced training and exposure to Geriatrics best practices bolsters students’ confidence in understanding geriatrics issues and assessing older patients.
INTERGENERATIONAL CARE PROVISION AND THE CARE PLANNING OF SANDWICHED AGEING CARERS
Authors: Bai Xue , Liu Mengyu
Published: January 2025

An increasing number of people in their 50s and 60s are sandwiched between surviving parents and children. However, there is a research gap on the relationship between upward and downward care provision of sandwiched ageing carers and the impacts of intergenerational care provision on their care planning. Integrating theories on intergenerational transfer, resource depletion, and proactive coming, this study aims to answer two questions in Hong Kong’s context: (a) How do sandwiched ageing carers provide care across multiple generations? (b) Does intergenerational care provision influence sandwiched ageing carers’ care planning? Using data from the Survey on Sandwiched Ageing Carers in Hong Kong (N = 1500), we find that overall levels of upward and downward care provision of sandwiched ageing carers are positively correlated. However, the high care intensity attenuates such a positive relationship. When the percentage of household income spent for upward and downward care exceeds 12.2%, the association turns to negative. Moreover, the sandwiched ageing carers who provide more upward and downward care are less prepared for their future care. These findings deepen the understanding of intergenerational care provision and care planning experiences among ageing families in Hong Kong and enhance professionals’ and service providers’ awareness of care planning in multi-generational family contexts.
INVESTIGATING THE BUILT ENVIRONMENT SURROUNDING NATURALLY OCCURRING RETIREMENT COMMUNITIES (NORCS) IN TORONTO
Authors: Fusca Laura , Rochon Paula , Huynh Tai , Hahn-Goldberg Shoshana , Matai Lavina , Fu Longdi , Savage Rachel
Published: January 2025

A positive built environment can improve the health of older adults and support aging in place by increasing access to amenities, physical activity, and social interaction. We investigated the walkability and amenity density surrounding Naturally Occurring Retirement Communities (NORCs) in Toronto, areas where many older adults live. This population-based descriptive study linked two built environment datasets with a provincial registry of high-rise NORC buildings in Ontario, Canada by postal code (PC). Mean (SD) walkability index scores and quartiles, as well as amenity density categories were compared for NORC and non-NORC PCs. Building and resident characteristics were also compared for NORC PCs in the least and most favourable categories for each outcome. Our analysis of walkability and amenity density included 49,295 (488 [9.9%] NORC) and 49,945 (489 [9.8%] NORC) Toronto PCs respectively. Walkability was significantly higher for NORC (mean 7.1 (SD 9.1)) versus non-NORC (4.9 (8.3)) PCs; although 57 (11.7%) NORC PCs were in low walkability neighbourhoods. NORC PCs were also more amenity dense, with 63.0% being classified as medium/high density compared to 50.5% of non-NORC PCs. Low walkability and amenity-poor NORCs tended to house older, immigrant, ethnically diverse and lower-income populations. Low walkability NORCs were also more likely to be apartments with supports and have residents without access to basic needs. Overall, our findings suggest that many NORCs are well-positioned to support aging in place given their walkability and amenity access, however action should be taken to support NORCs with suboptimal environment conditions.
LONG-TERM PATTERNS OF FAMILY AND PAID CAREGIVING BY CARE TYPES AND SOURCES
Authors: Shin Esther , Park Sojung , Park Soobin , Kim BoRin , Kwon Eunsun , Ahn Seoyeon
Published: January 2025

To support aging in place for community-dwelling older adults, sustainable long-term care and support are crucial. The existing literature often focuses on family caregiving, formal caregiving, or their relationship, such as whether they substitute for each other. This study aims to broaden the understanding of collaborative care by exploring the intersection of different care forms and caregiver sources, an area that is less studied. Using data from the National Health and Aging Trends Study (2011-2022), this research examines longitudinal patterns of caregiving, focusing on the types of services (ADL/IADL support) and their sources (unpaid informal, paid formal, and paid family caregivers). The study sample included individuals who received consistent caregiver support throughout the study period. Group-based multiple trajectory (GBMT) modeling identified four distinct care mix patterns: (1) consistently low care (72.2%), (2) increasing ADL informal care (18.3%), (3) increasing formal care (7.4%), and (4) decreasing formal care with increasing paid informal care (2.1%). Compared to the relatively healthy and less vulnerable “consistently low care” group, those receiving “increasing ADL informal care” were more likely to be married women, while those with “increasing formal care” tended to live alone, be male, and have dementia. Notably, individuals with “decreasing formal care but increasing paid family care” were often racial minorities, in poor health, and older, possibly utilizing consumer-directed care programs. These findings provide an initial empirical foundation for understanding care mix, highlighting the need for further research on gender-specific caregiving patterns and the impacts of these care trajectories on health outcomes.
MONTESSORI-BASED APPROACH FOR ALZHEIMER’S AND DEMENTIA: HANDBOOK FOR IMPLEMENTATION IN AN ADULT DAY CARE PROGRAM
Authors: Rodrigues Annette
Published: January 2025

Adult day care (ADC) programs serve as an intervention that offers a solution to the challenges faced by an increasing population of individuals living with dementia. Including activities for mental and physical stimulation such as games, exercises, and art, ADC offers dual benefits by providing community-based care for older adults and respite for caregivers. Studies indicate, however, that a lack of quality and standardization negatively impacts the quality of ADC programs, thereby reducing utilization. As program directors expand their services to address the needs of the current demographic, a Montessori approach to dementia care can serve as an effective method of delivering deliberate, evidence-based care. However, most existing applications focus on in-home and long-term care settings rather than ADCs. To address this gap, this project aimed to develop a handbook for implementation in an ADC setting. Montessori-Based Approach for Alzheimer’s and Dementia: Handbook for Implementation in an Adult Day Care Program was developed based on research, observations, and feedback from expert panelists. In the handbook, Montessori principles are presented, barriers and challenges are addressed, organizational strategies are offered, as well as recommendations for developing meaningful person-centered programs, preparing the environment, and addressing participants, staff, and family. By providing a comprehensive guide for an evidence-based standard of care, this handbook aims to advance the field of aging by combining existing research that supports Montessori-based dementia care and facilitating its implementation into an ADC program, with a goal of increasing utilization and improving quality of life.
NEIGHBORHOOD ENVIRONMENTAL CORRELATES OF FALLS AMONG OLDER ADULTS – IMPLICATIONS FOR FALLS PREVENTION PROGRAMS
Authors: Ackerson Leland , Procter-Gray Elizabeth , Le Qun , Kane Kevin , Li Wenjun
Published: January 2025

Neighborhood sociodemographic environmental factors may influence the risk of falling in older adults, which has important policy implications. We investigated the associations of neighborhood physical and social characteristics with rates of indoor and outdoor falls in a multi-racial cohort of 729 community-dwelling adults aged 65 to 99 residing in Massachusetts (2018-2024). Associations of Census tract-level sociodemographic and built environmental characteristics with fall rates were analyzed using negative binomial models. The overall rates of any, indoor and outdoor falls were 67.9 (95% CI: 63.9 – 72.2), 32.1 (95% CI: 29.4-35.1) and 35.6 (95% CI: 32.7-38.7) falls per 100 person-years, respectively. In crude analyses rates of any, indoor and outdoor falls were significantly associated with 12, 3 and 20 of the 80 neighborhood characteristics under analysis, respectively. After adjusting for individual age, sex, and race, 4, 7 and 6 remained statistically significant for any, indoor and outdoor falls, respectively (e.g., for outdoor falls % male, Hispanic population, % commuting 25-34 minutes, % of Black-occupied homes that are rented, % of Hispanic-occupied homes that are rented, and total number of Hispanic-occupied homes). After further adjustments for health-related risk factors, only a few neighborhood factors remained significant for either indoor or outdoor falls. In conclusion, neighborhood characteristics are more likely associated with outdoor falls than indoor falls. The observed associations likely result from compositional effects rather than contextual effects. When designing community-based falls prevention programs, the population compositional effects and geographic distribution of older adults with higher fall risks should be carefully considered.
NURSING HOME BARRIERS AND ENABLERS TO USING THE GOALS OF CARE VIDEO INTERVENTION
Authors: Chisholm Latarsha , Hickman Susan , Unroe Kathleen
Published: January 2025

Advance care planning (ACP) is a process that prepares individuals for communicating and making decisions about personal goals regarding medical care. Despite the benefits, ACP is limited across nursing homes (NHs) due to implementation challenges. It is essential to understand how to implement ACP, like Goals of Care (GOC) evidence-based intervention. The GOC video is intended to supplement ACP discussions to educate patients living with dementia and families. This study was performed to identify enablers and barriers to using the GOC video. We interviewed 12 staff from six Florida NHs. A pre-implementation guide was developed using constructs from the Consolidated Framework for Implementation Research 2.0. Enablers included: mission alignment (6 out of 6 NHs); physical space, use of information technology, and learning-centeredness (5 out of 6 NHs); and work infrastructure, communication, readiness, recipient-centeredness, and implementation facilitators (4 out of 6 NHs). Barriers included: design of the GOC video (6 out of 6 NHs; access to health education (5 out of 6 NHs); and patient readiness and culture as barriers (4 out of 6 NHs). NH staff reported various barriers and enablers to use the GOC video; however, some barriers and enablers were similar across NHs. Developing a standardized protocol that allows flexibility maybe helpful to nursing homes implementing the GOC video intervention.
ORGANIZATIONAL CULTURE AND SOCIAL ISOLATION IN NURSING HOMES
Authors: Martey Ebenezer , Morgan Jennifer , Skipper Antonius , Kemp Candace
Published: January 2025

Social isolation is a prevalent issue among nursing home residents, which can lead to various chronic diseases, such as depression, dementia, and chronic pain. Social integration refers to the active engagement in social ties, institutional connections, and participation in community-based activities. Organizational culture is a critical factor in providing person-centered care and fostering communication, teamwork, and quality improvement processes. Using a case study methodology, this study surveyed 49 nursing home staff and interviewed eight residents in one nursing center to understand the context of organizational culture and social integration among nursing home residents. Analysis of resident interview data indicated that communication challenges between staff and residents exist, as some residents report being uninformed, while others report great appreciation for staff responsiveness and personalized care. Social isolation was found to be a challenge for some residents due to a lack of meaningful engagement often exacerbated by health or mobility issues. Relationships between roommates often challenged resident well-being while supportive relationships among residents were essential to well-being. Residents noted that staff were very involved with encouraging residents to participate in activities and even take on specific responsibilities to foster a sense of community. The new availability of private rooms and bathrooms in this case study home was a big source of satisfaction for both residents and families. Private rooms appear to enhance satisfaction by enabling residents to exercise autonomy around daily schedules and promote dignity. Resident feedback on communication challenges revealed the need for organizations to practice greater transparency and consistent messaging.
PARTNERING WITH COMMUNITY ON A SUCCESSFUL FEDERAL FUNDING APPLICATION FOR MESOTHELIOMA CAREGIVERS
Authors: Woodward Amanda , Towe Maria , Hirsch Jen , White Julie
Published: January 2025

The Michigan State University School of Social Work (MSUSSW) and the Mesothelioma Applied Research Foundation (Meso Foundation) collaborated on a successful application for federal funding to develop and conduct feasibility testing of an online caregiver support intervention. The process of developing the proposal and the design of the four-year project follow key principles of the Community-Engaged Research Framework described by NORC at the University of Chicago. The research questions emerged from a survey the Meso Foundation administered to its community, thus aligned with a foundational component of community engaged research where the community drives the research focus. The team includes members with lived experiences whose time and expertise are incorporated through processes that promote shared decision making (e.g., co-principal investigators) and budgeted compensation for their work. Information about research processes, resources, and timelines are openly shared with all team members through password-protected cloud-based storage. Meeting schedules, modes of communication, workplans, and decision-making protocols are established collaboratively and revisited regularly throughout the work. The project itself engages patients, caregivers, those who have lost a loved one, and health professionals through in-depth interviews and focus groups to better understand the caregiver experience from diagnosis through end of life. Participant experiences and feedback will be used to develop and refine an online caregiver support intervention. The feasibility of the intervention will then be tested in an intervention-only design. This poster will describe the six key principles of community-engaged research and the ways we are implementing them in more detail.
PERSPECTIVES ON POLICIES TO IMPROVE EQUITY IN HOSPITAL AT HOME
Authors: Nnemnbeng Jeannys , Baim-Lance Abigail , Howard Brittni , Hart Julia , Leff Bruce , Levine David , Siu Albert , Gorbenko Ksenia
Published: January 2025

Hospital at Home (HaH) delivers acute hospital-level care at home as a substitute for traditional hospital care. Compared to traditional hospital care, HaH care demonstrates better patient satisfaction and care experience, lower readmission rates, and lower costs of care. There has been limited research on equity issues in HaH care delivery. We explored HaH program leaders’ views on the policy landscape and opportunities for equitable delivery of HaH across the US. We conducted a qualitative study using semi-structured interviews with healthcare leaders (1-4 leaders per program) at 18 HaH programs diverse by geography (region, rurality), size, and safety-net status. We conducted interviews via Zoom and used rapid template analysis and focused coding to identify key themes. We identified four areas supporting equitable HaH care delivery: (1) Technology access to promote more complete broadband coverage, particularly in rural areas; (2) Medicaid expansion to allow the enrollment of Medicaid beneficiaries, a frequent recommendation to increase lower-income individuals’ access to the program, including younger age groups that did not typically participate and would benefit; (3) Workforce role diversity to align with the needs of communities and therefore to include services like paramedicine familiar with delivering care at home; and (4) Sustainable and broadening of HaH funding including making the waiver permanent and expanding support for a package to connect patients with community-based care at discharge. HaH success in advancing equitable care delivery requires greater policy support to ensure equal access and solid funding mechanisms to support its ongoing growth.
PREPARING FUTURE HEALTH PROFESSIONALS FOR AGE, CULTURAL, AND TECHNOLOGY (ACT) FRIENDLY CARE IN HEALTH SCIENCES
Authors: Rayan-Gharra Nosaiba , Keisari Shoshi , Ring Lia , Engdau Shelly , Segel-Karpas Dikla , Zisberg Anna , Danial-Saad Alexandra
Published: January 2025

The aging population emphasizes the need for tailored training in welfare and health sciences, particularly for students who will work with culturally diverse older populations using advanced technological tools. This study examines how well the curriculum at the Faculty of Welfare and Health Sciences prepares students for Age, Cultural, and Technology (ACT) Friendly care. An online survey was conducted among 208 faculty lecturers, teaching mandatory undergraduate and/or graduate courses (BA only=65, MA only=82, both BA and MA=61). Respondents rated how extensively they address aging, multiculturalism, and technology in their courses. Only 15.4% had received training in aging studies, while 16.4% were involved in aging research. Aging-related topics were included in 31% of undergraduate and 27% of graduate courses. Multiculturalism was similarly integrated (28% for both programs), while technology was less addressed (13% for BA and 8% for MA courses). Only 17.3% of respondents extensively incorporated ACT topics in their teaching, and 65.7% did not address them at all. Multivariate analysis controlling for gender, seniority, and research area showed that involvement in aging, multiculturalism, or technology research predicted teaching these topics (p< 0.05). The findings highlight a significant gap in preparing students for ACT-friendly care, particularly at the graduate level, and a lack of integration of the three domains. This study underscores the need for ongoing assessment and curriculum development to equip future health professionals for age-appropriate, culturally sensitive, and technologically integrated care. Faculty development initiatives are also recommended to enhance educators’ capacity to incorporate these critical areas into their teaching.
PROXIMITY, CARE VALUES, AND CAREGIVING STRAIN: EVIDENCE FROM THE 2020 NAC/AARP NATIONAL SURVEY
Authors: Jin Tingan
Published: January 2025

The concept of distant caregiving emerged as family caregivers can care for older adults in settings other than living with their parents. Previous studies have illustrated that differences in geographical distance could lead to different caregivers’ experiences in terms of physical, emotional, and financial strain. This study uses the most recent nationally representative data on caregivers in the US from the National Alliance for Caregiving and AARP to explore the characteristics and values of caregivers with varying distances to care recipients and test the effect of geographical distance on various aspects of caregiving strain. The preliminary analysis conducted in June 2024 suggests that caregivers providing care at a distance reported lower physical and financial strain levels regardless of proximity intervals. Long-distance carers, namely those who live more than one hour away from their parents, show more physical strain (b=-0.236, p< 0.05) and financial strain (b =-0.228, p< 0.05) than those who live with or close to their parents. Findings regarding emotional strain were against previous studies, and we found that while those who live close to their parents reported lower levels of emotional strain (b=-0.171, p< 0.05), the pattern does not apply to long-distance caregivers with a positive, statistically insignificant relationship. Adding components regarding caregivers’ willingness and perceptions towards care provision, it is found that whether the respondents feel they had a choice to take care of their parents is a statistically significant predictor of physical (b=0.508, p< 0.05), financial (b=0.446, p< 0.05), and emotional strain (b=0.810, p< 0.05).
REALITIES OF DIVERSITY, INCLUSION, AND BELONGING IN ASSISTED LIVING: SAFETY, CONNECTION, AND COMMUNITY
Authors: Kohon Jacklyn , Himes Dani , Dys Sarah
Published: January 2025

This study centers the voices and experiences of those working and living in assisted living, residential care, and memory care (AL/RC) settings in Oregon to understand how workplace diversity, equity, inclusion, accessibility, and belonging (DEIAB) can promote well-being. From January to April 2024, we conducted individual and focus group interviews with a total of 68 people, including 25 direct care staff, 9 former direct care staff, 9 administrators, 7 management representatives and 18 current residents from 23 AL/RC communities. We highlight six primary themes: 1) Care staff face discrimination, physical and verbal abuse from residents and colleagues; 2) those experiencing discrimination or not belonging were more likely to be from a minoritized group; 3) there is inconsistency in the existence, awareness, and currentness of diversity, equity, and inclusion policies, making implementation challenging; 4) company culture can support feelings of connection and belonging among staff; 5) care staff rely on peers and coworkers for support; and 6) workplaces need infrastructure that reflects language diversity of residents and care staff. Participants noted discrimination can happen overtly and subtly. In many instances, overt discrimination can be easier to address and handle, while subtle forms of discrimination happen daily and many times are invisible or look like unspoken norms. Recommendations include comprehensive DEIAB policies with clear implementation plans, DEIAB training programs for residents, investing in linguistic accessibility resources, and training administrators and managers in inclusive leadership practices.
RECIPROCAL RELATIONSHIP BETWEEN LONELINESS AND LIFE SATISFACTION IN HONG KONG OLDER ADULTS
Authors: Tang Foong Yee Vivien , Chou Kee Lee
Published: January 2025

Given the limited research on the reciprocal relationship between loneliness and life satisfaction in the Chinese community, this study examines this dynamic and explores the mediating effect of neighbourhood collective efficacy. Loneliness, a prevalent issue among the aging population, significantly impacts psychological well-being and overall quality of life. Conversely, life satisfaction reflects an individual’s overall contentment with life and is a crucial component of successful aging. Utilizing a two-wave secondary data from 1,696 Chinese older adults aged 60 and above (53.9% female), this study analyzed how changes in loneliness predict subsequent changes in life satisfaction, and vice versa. Participants were assessed on their levels of loneliness, life satisfaction, sociodemographic factors, health, social resources, and social support. The findings indicate a reciprocal relationship: loneliness was associated with lower life satisfaction two years later (B = -1.44, p = 0.014), and reduced life satisfaction led to increased loneliness (B = -1.106, p < 0.001). Furthermore, neighbourhood collective efficacy was found to fully mediate the relationship between loneliness and life satisfaction (β = 0.18, p < 0.001). These results underscore the importance of addressing loneliness and life satisfaction simultaneously. Maintaining strong neighbourhood collective efficacy may help mitigate the negative impact of loneliness on life satisfaction. This highlights the potential for targeted, community-based intervention programs designed to enhance life satisfaction and alleviate loneliness among older adults.
REHOSPITALIZATION RISK AMONG VETERANS RECEIVING POST-ACUTE HOME HEALTH SERVICES: DIFFERENCES BY PAYOR SOURCE
Authors: McCreedy Ellen , Devone Frank , Gozalo Pedro , Gravenstein Stefan , Daus Marguerite , Jones Christine , Magid Kate , Thomas Kali
Published: January 2025

Medicare-eligible Veterans who require post-acute skilled home health (HH) after a hospitalization can have HH paid for by the Veterans’ Administration (VA) or Medicare. Our prior work showed Veterans enrolled in Medicare Advantage (MA) are more likely to have the VA pay for HH than MA. In this analysis, we look at differences in 90-day rehospitalization among MA-enrolled Veterans receiving VA-paid post-acute HH versus MA-paid post-acute HH. All Veterans enrolled in MA and receiving HH after an index hospitalization at a VA medical center between October 1, 2016 and September 30, 2019 were included. Data were extracted from the VA electronic medical record. We used inverse probability weighting to address baseline differences in age, patient complexity, and past utilization. We used cox proportional hazards models to estimate the effect of VA- versus MA-paid HH on the risk of 90-day rehospitalization. There were 14,501 eligible hospitalizations requiring HH; 8,753 (60.4%) received VA-paid HH, and 5,748 (39.6%) received MA-paid HH. On average, Veterans receiving VA-paid HH waited 3.7 days (SD: 3.2) to start HH, compared to 4.8 days (SD: 3.8) for Veterans receiving MA-paid HH. After preliminary weighting, Veterans who received VA-paid HH had a lower risk of 90-day rehospitalization, compared to Veterans who received MA-paid HH (adjusted hazard ratio=0.88; 95% CI: 0.83,0.93). Veterans whose HH was paid for by MA received services one day later, on average, and had higher risk of 90-day rehospitalization compared to Veterans receiving VA-paid HH. Potential implications on quality of post-acute care for MA-enrolled Veterans discussed.