bluuebunny/crossref_metadata_2025 huggingface dataset:
Irritated and Feeling Better? Aging Parents’ Marital Status and Daily Interaction With Grown Children
Authors: Kim Yijung , Kim Kyungmin , Fingerman Karen
Published: December 2020

Aging parents’ marital status shapes their ties to family members, but less is known about its link to their daily mood and interaction with grown children. This study examined married, widowed, or divorced/separated aging parents (N = 203, Mage = 79.80) from the Family Exchanges Study, who completed a 7-day daily diary on their daily mood (positive, negative) and interactions (any contact, irritable, enjoyable interaction) with the grown children (N = 771, Mage = 53.20). Findings from multilevel models indicated that widowed parents were more likely to report irritable interactions with their grown children than the married ones. Furthermore, married and widowed parents tended to report more negative mood, whereas separated parents tended to report less negative mood on days they had irritable interactions with grown children. This study highlights the centrality of aging parents’ daily interaction with grown children and suggests that the dynamics of family composition warrant attention.
It Has Not Been a Good Day: Managing Difficult Behaviors of Relatives With Dementia
Authors: Roberto Karen , McCann Brandy Renee , Savla Tina , Hoyt Emily , Blieszner Rosemary , Knight Aubrey
Published: December 2020

Most family caregivers provide appropriate care and a supportive environment for their older relatives with dementia (PwD), yet the stress and strain associated with caregiving can trigger potentially harmful responses. Although much has been written about dealing with memory problems, researchers know less about how caregivers cope with difficult behaviors such as hallucinations, violent outbursts, or refusing food, medicine, or bathing. Interviews with 30 relatives providing care to community-dwelling PwD in rural Virginia revealed that caregivers typically used four behavior management strategies: reasoning with PwD; redirecting PwD’s attention; forceful actions, such as shouting at PwD; and withdrawing from interactions. Forceful management strategies and withdrawing from interactions were usually employed after reasoning and redirection failed to elicit desired behavior. Understanding whether caregivers’ expectations of PwD’s capacities are realistic, and why and when caregivers use various behavior management strategies, can help service providers develop appropriate educational interventions for frustrated caregivers.
Why Increased Focus on Aging With Disability Matters to Gerontology Research, Policy, and Practice
Authors: Campbell Margaret , Janicki Matthew
Published: December 2020

This symposium elaborates on the theme of the 2020 conference, “Why Age Matters”, to include aging with disability. We ask: “can an increased focus on aging with disability within gerontological research, policy, and practice advance our knowledge of disablement across the life cycle and improve our design and implementation of health and social service interventions’? Five experts will address this from differing perspectives (including gerontology and rehabilitation). One presentation draws on national/ regional data to illustrate the changing demographics of aging and disability and highlights the health consequences of aging with- and aging into, long-term physical disabilities. A second uses data from a mixed methods study to demonstrate the unique challenges experienced by adults aging with spinal cord injury with a focus on the impact of specific environmental barriers and facilitators to maintain health and participation in social roles. A third covers three reports on data from a scoping review to document the exclusion of middle-aged and older adults with disabilities from behavioral clinical trials and describes how translational research strategies can be used to help close this gap. A fourth presents examples of how technologies, such as videoconferencing and voice activation, are being used to deliver and enhance existing EB interventions to improve health, physical activity, and participation for individuals aging with mobility impairments. The last one draws on research and scholarly work from both gerontology and rehabilitation to highlight the co-occurring issues of ageism and ableism and describes how reducing ableism is central to successfully reframing aging. Lifelong Disabilities Interest Group Sponsored Symposium.
Measurement of Inequality and Compression of Mortality in India for 4 Decades: 1970–2015
Authors: Parmar Mukesh
Published: December 2020

The studies relating to measurement of compression of Mortality in India is scarce. Most of the studies relating to mortality in India are focused on either life expectancy, or adult, and child mortality. We have used methods suggested by Kannisto (2000) and Canudos (2008) to measure the compression of mortality phenomenon for India for four decades viz. 1970-2015. Dispersion measures like simple mean, median, modal age at death; and some complicated measures like life disparity, standard deviation above mode, standard deviation in highest quartile, Interquartile range, Gini coefficient, AID and C-family were calculated for India from 1970-2015. We used the age specific death rates from abridged Life tables given by Sample Registration System published by Govt. of India. Our results show that inequality in mortality is decreasing in general but the gap between male and female is increasing. There was an average of three years difference in mean and modal age at death between male females in 2011-15. Overall, mean, median and modal age at death has increased in four decades but other inequality measures like Gini coefficient, AID, Standard deviation (SD) and coefficient of variation has decreased in four decades in India. C50 indicator, which indicates that 50 percent of deaths are happening in that age interval, declined from 26 years to 20 years for males and 27 years to 17 years for females, thus indicating the rate of compression of mortality is higher for females than males in India during 1970-75 till 2011-15.
Voice First as a Platform for Addressing and Measuring Social Isolation
Authors: Elza Ryan
Published: December 2020

Voice First solutions offer the opportunity to promote social connectedness and independence. AARP Foundation has been successful in deploying Voice First devices (Amazon Alexa, Google Home Assistant) in senior living and affordable housing communities and developing Voice First solutions through its Connect2Affect Connected Communities program. Connected Communities empowers older adults through voice first solutions to help them obtain the social support resources needed to stay socially connected, remain independent and age in place. AARP Foundation has developed three Voice First solutions 1) Community Hub, a voice application that encourages participation in group activities by voice-enabling a community’s calendar of events and allowing older adults to discover, register and receive reminders for events, 2) A data collection voice application that administers the 10-item version of the Duke Social Support Index (DSSI) at regular intervals to assess an older adults’ condition of isolation, 3) Social Check-in, a guided risk assessment for social isolation that helps older adult understand their individual risk factors.
Overview of REJOIN: A Clinical Trial to Use Exercise to Relieve Joint Pain in Older Breast Cancer Survivors
Authors: Bluethmann Shirley , Truica Cristina , Olsen Nancy , Sciamanna Christopher , Klepin Heidi , Chinchilli Vernon , Schmitz Kathryn
Published: December 2020

Aromatase Inhibitors (AIs) are recommended for survival in hormone-sensitive breast cancer survivors, yet are underutilized, especially in older survivors. Joint pain is a prevalent AI-related symptom that is associated with low adherence. The aims for this randomized clinical trial (n=76) are to: 1) adapt a self-management (exercise + education) intervention for older survivors planning to take AIs; 2) Test the effect of a pilot intervention on arthralgia; and 3) Test its effect on AI medication adherence behaviors. We will adapt a program for seniors that includes bi-weekly 60-minute sessions of supervised exercise plus 30 minutes of education. The 16-week program includes: 8-weeks in person plus 8-weeks at home with phone counseling. We will conduct geriatric plus baseline assessment of exercise, joint pain, and AI adherence (repeated 4, 6 and 12 months). More research with geriatric survivors is required to address treatment needs and to promote survival. Part of a symposium sponsored by the Cancer and Aging Interest Group.
Reframing the End Stage of Renal Disease: How Age Matters
Authors: Waldrop Deborah , Denny Patricia , Lauer Sandra , Grimm Kathleen
Published: December 2020

End Stage Renal Disease (ESRD) conveys high symptom burden, multimorbidity and the greater likelihood of hospital death than other serious illnesses. Increases in people with ESRD occurred most sharply among adults age 75+. Despite high mortality risk, few with ESRD consider end-of-life preferences or discuss with a physician. The purpose of this study was to explore the nature of advance care planning in ESRD. The study utilized mixed methods and both qualitative and quantitative data was collected during in-depth chairside interviews with 31 people while they were on hemodialysis. Participants ranged in age from 29-85; Mage=60; (N=13 [40%/)60). The data was divided above and below the Mage, and distinct differences were found in the nature of advanced care planning by age group. Greater numbers of people >60 (N=11[61%]) were not considering a transplant while (N=9[69%]) of those under 60 had a failed transplant and were again on the waiting list. Although the majority of participants had a health care proxy (N=27[87%]), more who were >60 had a proxy who knew their wishes (N=14[78%]) compared with (N=9[69%]) who were 60 compared with none <60. The qualitative data illuminated these age-differentiated responses in themes: Older age and (1) Multimorbidity; (2) Frequency/intensity of hospitalization; (3) Diminished hope of transplantation; and (4) More acute death awareness. The need for disease-specific advance care planning—with hopes and expectations about transplant--and attention to the influence of age and decline cannot be overstated.
Detecting ADRD Caregivers’ Information Wants in Social Media: A Machine Learning–Aided Approach
Authors: Xie Bo , Wang Zhendong , Zou Ning , Luo Zhimeng , Hilsabeck Robin , Aguirre Alyssa
Published: December 2020

ADRD caregivers increasingly use social media to meet their health information wants (HIW). Machine learning (ML) tools may help understand caregivers’ HIW as expressed via social media. This pilot study explored a collaborative, iterative process between domain experts and ML tools to identify ADRD caregivers’ HIW from social media data. The HIW-ADRD framework was adapted from an existing HIW framework. Through multiple rounds of iteration between the experts and the ML tools, the framework was expanded to include 11 types of health information. Each type included corresponding keywords developed through a hybrid approach that included keywords from both the theoretical constructs (top-down) and caregivers’ posts (bottom-up). These keywords were then used to enhance the ML tools’ ability to code 106 recent posts extracted from an ADRD social media group in March 2020. When compared with expert coding results, ML tools accurately predicted 56% of HIW. Further work is underway.
The Spiritual Dimensions of Friendship
Authors: Achenbaum Andy
Published: December 2020

It was the spiritual dimensions of my friendship with Vern Bengtson that I treasure most. Vern was always willing to discuss the dark sides of himself and to listen to my spiritual pain. His empowering way of advancing the meanings of aging were a spiritual gift. This presentation will address the value of spiritual friendship in human aging. Part of a symposium sponsored by the Religion, Spirituality and Aging Interest Group.
Tracing the Religious Life Course: Intergenerational Sources of Later Life Religiosity
Authors: Silverstein Merril , Hwang Woosang , Blankholm Joseph
Published: December 2020

The development of religiosity in later life has its origins in earlier phases of the life course, yet few studies have investigated the contribution of early forms of religious exposure to religious beliefs and behaviors in old age. This investigation uses multigenerational data from the Longitudinal Study of Generations taken from 385 baby-boom children age 16-26 and their parents, linked to religious orientations of these children in midlife and old age. Relying on the “chains of risk” perspective, we found that parental religious intensity in 1971 strengthened their children’s behavioral and cognitive religiosity in later life through their indirect effects on children’s early and midlife religiosity. Our results demonstrate both intergenerational and life course forms of stability in religious belief and practice. Evidence suggests that parental influence creates religious momentum in their children that carries from adolescence/young adulthood through the unfolding of human lives into old age. Part of a symposium sponsored by the Religion, Spirituality and Aging Interest Group.
Older Adult Peer Specialists’ Role in Reducing Loneliness Among People With Mental Health Conditions
Authors: Fortuna Karen , Mois George , Brooks Jessica , Myers Amanda , Bianco Cynthia
Published: December 2020

PeerTECH is a peer-delivered and technology-support integrated medical and psychiatric self-management intervention developed by peers. A pre/post trial by our group has shown PeerTECH is associated with statistically significant improvements in self-efficacy for managing chronic disease and psychiatric self-management skills. This presentation will discuss the feasibility and potential effectiveness of using ecological momentary assessments (EMA) with older adults with mental health conditions to allow us to recognize early signs of loneliness and intervene as early as possible in real-world settings. EMA involves repeated sampling of an individual’s behaviors and experiences in real time, real-world environments on the smartphone application. Then, we will discuss the main and interactive effects of loneliness and factors linked to mortality. In conclusion, we will discuss potential effectiveness of PeerTECH with older adults with SMI.
Prevention and Reduction of Care Against Someone’s Will in Cognitively Impaired People at Home: A Feasibility Study
Authors: Mengelers Angela , Bleijlevens Michel , Verbeek Hilde , Moermans Vincent , Capezuti Elizabeth , Hamers Jan
Published: December 2020

Sometimes care is provided to a cognitively impaired person against the person’s will, referred to as involuntary treatment. An intervention (PRITAH) was developed to prevent and reduce involuntary treatment comprising 4 components: client-centered care policy, workshops, coaching on the job by a specialized nurse and the use of alternative interventions. A feasibility study was conducted including 30 professional caregivers. Feasibility was assessed by attendance lists (reach), a logbook (dose delivered and fidelity), evaluation questionnaires and focus group interviews (dose received, satisfaction & barriers). The workshops and coach were positively evaluated and the average attendance rate was 73%. Participants gained more awareness and knowledge and received practical tips and advice to prevent involuntary treatment. Implementation of the intervention was feasible with minor deviations from protocol. Recommendations for improvement included more emphasis on involvement of family caregivers and general practitioners and development of an extensive guideline to comply with the policy. Part of a symposium sponsored by Systems Research in Long-Term Care Interest Group.
Racial Differences in Post-Acute Transition After Hip Fracture in Medicare Patients With ADRD
Authors: Roy Indrakshi , Karmarkar Amol , Kumar Amit , Warren Meghan , Pohl Patricia , Shaibi Stefany , Rivera-Hernandez Maricruz , Rudolph James
Published: December 2020

The incidence of hip fractures in patients with Alzheimer’s disease and related dementias (ADRD) is 2.7 times higher than it is in those without ADRD. However, there are no standardized post-acute transition models for patients with ADRD after hip fracture. Additionally, there is a lack of knowledge on how post-acute transitions vary by race/ethnicity. Using 100% Medicare data (2016-2017) for 120,179 older adults with ADRD, we conduct multinomial logistic regression, to examine the association between race and post-acute discharge locations (proportion discharged to skilled nursing facility [SNF], inpatient rehabilitation facility [IRF], and Home with Home Health Care [HHC]), after accounting for patient characteristics. Compared to non-Hispanic Whites, Hispanics have a significantly lower odds ratio for discharge to HHC 0.62 (95%CI=0.53-0.73), IRF 0.44 (CI=0.39-0.51), and SNF 0.26 (CI=0.23-0.30). Improving care in patients with ADRD and reducing racial and ethnic disparities in quality of care and health outcomes will be discussed.
Balancing Practicality and Validity of Elder Abuse Measures: Data From Adult Protective Services Investigations
Authors: Conrad Kendon , Liu Pi-Ju , Hass Zachary , Conrad Karen
Published: December 2020

Research in Adult Protective Services suffers from the problems of small sample size, low completion rates, and poor data quality. To address the “small sample size” issue, data were generated on 1,472 elder abuse cases over six months in California using the Identification, Services and Outcomes (ISO) Matrix. The problem of poor data quality was addressed by testing psychometric properties of Short-Forms on each type of abuse. Good reliability and predictive validity were found for all measures except those that were very rare. Finally, even shorter Mini-Forms were developed and tested in order to contribute to improved completion rates. Mini-Form results were mixed, and some will require further research on their reliability and validity, as well as examination of their ability to improve completion rates. Ongoing adoption by two California counties and the State of Montana demonstrate sustainability and increasing sample sizes using the ISO Matrix for research and practice.
Age Also Matters for Gerontologists: Personal and Professional Perspectives on Growing Older
Authors: Clark Phillip , Perkinson Margaret
Published: December 2020

Gerontology is a unique field of scientific inquiry, because it embodies both professional and personal dimensions of experience and poses questions for its researchers. How does our work help us understand our own personal experience of aging? How does the reality of growing older change our teaching and research? As gerontologists, we embody two narratives of the aging experience, one academic and professional (with its dependence on theory and scientific research), the other intimately personal (with its own lived experience and practical insight acquired over the life course). How this dynamic unfolds is as personal as each of us as individuals, and embodies our own disciplinary backgrounds; yet collectively it has implications for how we approach an understanding of what it means to grow old. This symposium explores different facets of this dynamic from four perspectives of different individuals and differing disciplines. The first paper assesses the limitations of both quantitative and qualitative research paradigms in revealing the deeply idiosyncratic nature of personal aging. The second develops the metaphor of “double agent of aging” to characterize the two narratives of professional and personal aging. The third uses Erikson’s theory of psychosocial development to weave together the professional, practical, and personal dimensions of gerontology. Finally, the last develops the metaphor of arcs and stages in conceptualizing a gerontological career. The symposium concludes with recommendations for the integration of theoretical, practical, and personal insights into teaching, research, and service in a way that embraces, enhances, and extends the field of gerontology.
Ageism and Its Impact on Older Persons’ Health
Authors: Levy Becca
Published: December 2020

Ageism has been called a silent epidemic. The extent to which ageism impacts the health of older persons in different countries was not well understood. In this presentation we will focus on the reach of ageism including negative age beliefs, on older individuals’ health. In an exhaustive systematic review, we found that ageism influenced older individuals in 45 countries and 11 health domains, with the prevalence of significant findings increasing over time (p < .001). In this presentation, we will also explore the mechanism by which this impact occurs and steps that can be taken to address this epidemic.
Future Nursing Home Placement, Health, and Relationships by Sexual Orientation: Findings From the HRS
Authors: Singleton Mekiayla , Gassoumis Zach , Enguidanos Susan
Published: December 2020

This study compares LGB and heterosexual adults on anticipated need for future nursing home (NH) placement and factors that influence NH placement. Using data from the 2016 HRS, we found a trend toward higher anticipated NH placement among LGB adults (M=34.0, SD=29.2) as compared to heterosexual adults (M=26.9, SD=27.3; p=0.05). Compared with LGB respondents (n=137), heterosexual adults (n=3,469) were more likely to have living child/children (37% vs. 82%, p<.001). Although there was no statistical difference in marital status between LGB (50% married/partnered) and heterosexual adults (65% married/partnered; p=.06), married/partnered LGB respondents were more likely to be very/quite close to their spouse/partner (99% vs. 90%, p<0.01) compared to heterosexual respondents. There was no difference in number of health conditions between groups. This study suggests that LGB adults may have higher rates of anticipated need for NH, thus NHs must ensure their workforce is educated and prepared to support this growing population. Part of a symposium sponsored by Rainbow Research Group Interest Group.
Serious Mental Illness and Dementia in Assisted Living
Authors: Hua Cassandra , Cornell Portia , Thomas Kali
Published: December 2020

Little is known about trends in the prevalence of serious mental illness (SMI) and Alzheimer’s disease and Related Dementias (ADRD) in assisted living (AL). We summarize changes in the prevalence of SMI and ADRD in larger AL settings (25+ beds) from 2008-2017 using Medicare claims data. We compare these changes to nursing home (NH) and community rates of SMI and ADRD. We also examine state variability in SMI and ADRD in AL in 2017. The prevalence of SMI in AL increased 37%, from 7.8% in 2008 to 10.7% in 2017; ADRD prevalence increased 34%, from 27% to 36.4%. Over time, NHs exhibited the greatest increases in SMI (53%), followed by AL (37%) and the community cohorts (27%). Increases in ADRD were highest in AL. Rates of SMI in AL ranged from 3.5% in Wyoming to 28.7% in New York. We discuss implications for future research and policy.
Learning Lessons From Long-Term Care Policy Financing Efforts in the United States
Authors: Lepore Michael
Published: December 2020

A decades-long policy impasse has crippled our national capacity to finance long-term care (LTC) sufficiently or equitably, leaving large swaths of the US population at risk of going broke paying privately for LTC or having unmet LTC needs, while also draining state and federal budgets. By reviewing past LTC financing policy efforts—from the passage of the Social Security Act and the enactment of Medicaid and Medicare, to the LTC financing proposals advanced by 2020 presidential candidates—the political interplay of budgetary concerns in government spending and social justice concerns regarding access to care emerged as a primary LTC policymaking issue. Establishing national consensus on the prioritization of these fiscal and social justice concerns, and their respective values, could help lawmakers craft policy capable of generating the political will needed to overcome political gridlock. Clarifying how LTC benefits would be paid for appears to be a relatively straightforward technical task in comparison.
Challenges for Private LTC Service Providers for Preventing Elder Abuse
Authors: Ikeda Naoki , Tsukada Noriko
Published: December 2020

his paper aims to identify factors that differentiate long-term care (LTC) service providers into the two categories: those who are successfully growing and those who are going out of business. During the past 5 years, about one out of 100 private LTC service providers has gone bankrupt in part due to issues of client abuse. This paper uses case studies to demonstrate differences between LTC service providers who have histories of elder abuse and those that do not. Business traits such as mission, client trust, and quality of LTC workers is considered along with implementation of abuse prevention practices including management approaches, oversight of workers, and atmosphere where LTC workers have their working conditions and concerns addressed, which in turn enhances workers satisfactions, accordingly, yielding better quality of care provisions.
Economic Uncertainties in Retirement: Risk Factors, Strategies, and Resilience
Authors: Bishop Christine , Zurlo Karen
Published: December 2020

Even with forethought and planning, a lot can threaten economic wellbeing in the years ahead for older adults retiring at typical retirement ages. Although results for any individual cannot be predicted with certainty, some risks are quantifiable: for example, mortality/ longevity and disability risks are reasonably well-defined. Risk of dementia is not so well understood, and may be changing. Financial risk might be seen as manageable, but older adults relying on retirement income sources can be especially vulnerable to unprecedented shocks to the general economy. We consider four aspects of this dilemma. First, older adults retiring with outstanding debts may have difficulty weathering financial shocks. Our first presentation provides up-to-date information about trends in indebtedness at older ages, especially focusing on newly salient types of indebtedness: medical and student loan debt, and debt incurred to smooth finances in the recent recession. Stewardship of finances during retirement can be a challenging personal management undertaking. Our second presentation will consider how dementia can complicate this process. Protection against outliving one’s resources is more complex and costlier in the era of defined contribution retirement accounts. Our third presentation will discuss strategies to combine retirement assets, including Social Security claiming, to hedge longevity risk. Finally, needs for long-term services and supports may be met with either paid or informal (family) care, or both, but cannot be predicted with certainty. Our fourth presentation examines the long-term impacts on families due to the difficulty in insuring against this risk. Economics of Aging Interest Group Sponsored Symposium.
Grandparents Caring for Grandchildren, Family Structure, and Depressive Symptoms in China
Authors: Tang Fengyan , Li Ke
Published: December 2020

It is a cultural norm for Chinese older adults to engage in co-parenting and caring for grandchildren. Previous research documented health advantages for grandparents who provide occasional, extensive, or even custodial care to grandchildren in China. Yet there is little information regarding the impacts of living arrangement and its interaction with grandchild care on grandparents’ psychological well-being. Using three waves of the 2011-2015 China Health and Retirement Longitudinal Study (CHARLS) data, this study examined the longitudinal association of depressive symptoms with grandchild care intensity and living arrangement among adults aged 40 and above (N=5,037). Mixed effects regression models were applied to examine changes in depressive symptoms and the associations with explanatory variables. At baseline, about half of respondents reported caring for their grandchild (ren). And nine percent lived with grandchildren only, that is, in a skipped-generation household and taking a custodial grandparent role. Overall, depressive symptoms did not change over time. After controlling for sociodemographic and health covariates, we found that providing medium level of care (i.e., between three to 10 hours per day) was associated with fewer baseline depressive symptoms, whereas grandparents living with grandchildren had more symptoms at baseline relative to those living with others. Further, an increased level of caregiving in the skipped-generation households was associated with more depressive symptoms. Given that custodial grandparenting is a growing phenomenon in China, further research needs to investigate how to reduce caregiving burden and associated adversary effects and how to promote overall well-being in this population.
Older African Americans’ Perspectives on Exposure to Structural Discrimination Across Contexts and the Life Course
Authors: LaFave Sarah , Szanton Sarah , Thorpe Roland
Published: December 2020

This presentation reports on findings from the first phase of a mixed methods study aimed at developing an instrument to assess older African Americans’ exposure to structural racial discrimination. We conducted semi-structured interviews with older African Americans about their perspectives on and exposure to structural discrimination. Participants (n=20) were community-dwelling African Americans aged fifty and older in Baltimore, MD. Participants described exposure to structural discrimination that had accumulated across the life course and across the contexts of education, employment, healthcare services, criminal justice system, neighborhood factors, media and marketing of unhealthy products, environmental toxin exposures, and income, credit and wealth. In the next phase of the study, we will incorporate these findings into the development of instrument items. Developing and testing a tool to assess exposure to discrimination beyond the interpersonal level is an important step in identifying solutions to mitigate the contribute of discrimination to racial health disparities.
Identifying Care-Related Needs of Family Caregivers of People With Dementia: Beyond the Stress Process Model
Authors: Moss Sara , Gebhardt-Kram Lauren , Dabelko-Schoeny Holly , Cheavens Jennifer
Published: December 2020

The psychosocial stress process model (Pearlin et al., 1990) remains a dominant theoretical framework characterizing the transactions between factors affecting outcomes of informal caregivers of people with dementia (PWD). Despite widespread agreement that the model provides an important framework for understanding caregiver experiences and predicting caregiver outcomes, it is not sufficient to clarify the needs of caregivers. Needs are conceptualized as the skills and resources that could be used to ameliorate the negative impacts of caregiving and promote quality of life (Gitlin & Hodgson, 2015). Determining caregiver needs requires appreciation of the complex background, contextual, and stress-related variables described in the stress process model and requires empirically- and theoretically-driven understanding of the diverse resources, materials, and skills that individuals require for global health and functioning. In this study, we conducted a content analysis of existing measures of dementia caregiver needs (N = 54), content analysis of materials related to evidence-based dementia caregiver interventions and government reports and documents (N = 28), and semi-structured in-depth interviews with current caregivers of PWD (N = 12) to identify the personal and care-related needs of family caregivers of PWD. We propose a framework of five inter-related need categories (Health-related needs, environmental needs, psychological needs, social needs, and needs related to the care and functioning of the PWD) that transact with the factors described in the stress process model, ultimately influencing functioning. In the future, we plan to test this model empirically with a nationally representative sample of caregivers.
Caring for Older Patients With Cancer: Estimates of the Prevalence, Burden, and Unmet Needs of Caregivers in the United States
Authors: Kent Erin
Published: December 2020

In 2020, ~1.8 million Americans are expected to be newly diagnosed with cancer, with approximately 70% of cases diagnosed over the age of 65. Cancer can have a ripple effect, impacting not just patients themselves, but their family caregivers. This presentation will provide an overview of the estimates of the number of family caregivers caring for individuals with cancer in the US, focusing on older patients, from several population-based data sources: Caregiving in the US 2020, the Health Information National Trends Survey (HINTS, 2017-2019), the Behavioral Risk Factors Surveillance System (BRFSS, 2015-2019), and the National Health and Aging Trends (NHATS) Survey. The presentation will compare features of the data sources to give a comprehensive picture of the state of cancer caregiving. In addition, the presentation will highlight what is known about the experiences of cancer caregivers, including caregiving characteristics, burden, unmet needs, and ideas for improving support for family caregivers.
Where to Begin: Assessing Caregiver Readiness
Authors: Marx Katherine , Gitlin Laura
Published: December 2020

There have been many interventions targeting family caregivers for people living with dementia (PLwD) that have been found to have efficacy and effectiveness. However, very few of these interventions have been widely adopted. One reason may be that clinicians and other professionals working with caregivers are unsure of what intervention to use. One measure that may help with where to begin is Caregiver Readiness. This presentation will provide case studies on the use of the Caregiver Readiness Scale in one intervention, the Tailored Activity Program (TAP). We will highlight three cases that have low, moderate and high readiness scores and how the TAP interventionists use the readiness scores to tailor the intervention to match the caregiver’s need. Knowing a caregiver’s readiness to receive an intervention may help clinicians and providers identify where to being in helping the caregiver.
Cardiometabolic Risk Among Older Renters and Homeowners
Authors: Mawhorter Sarah , Ailshire Jennifer , Crimmins Eileen
Published: December 2020

Researchers consistently find adverse long-term health outcomes among renters as compared with homeowners, yet more proximal health measures are needed to understand whether there is a direct link between tenure and health. In this paper, we compare cardiometabolic risk (CMR) levels among older renters and homeowners, and ask whether this health disparity can be explained by socioeconomic differences between renters and homeowners, or poor housing conditions for renters. Using Health and Retirement Study 2010/2012 biomarker data for adults aged 50-84 (N=10,480), we measure CMR by a scale of C-reactive protein, hemoglobin A1C, cholesterol, heart rate, blood pressure, and waist circumference metrics. We find that renters have greater CMR, even accounting for socioeconomic characteristics and health behaviors. Certain housing and neighborhood conditions, such as perceived safety, are associated with CMR. These results suggest potential pathways through which homeownership confers health advantages over renting.
The Implementation of the Music and Memory Intervention in Nursing Facilities in Virginia
Authors: Inoue Megumi , Ihara Emily , Tompkins Catherine , Rumrill Kristen Suthers , Barrett Kendall , McNeil Kathryn , Clark Christi
Published: December 2020

The Music & Memory intervention is a person-centered, non-pharmacologic intervention for people living with dementia. It is considered a personalized music intervention because the playlist comprises music genres that the individual prefers. Music has shown positive effects on behavioral and psychological symptoms of dementia. However, the findings from previous studies are often based on small sample sizes, insufficient descriptions of treatment fidelity, and lack of randomization. To address these issues, we began a randomized controlled trial implementing the Music & Memory intervention in nursing facilities in Virginia with support from the Centers for Medicare and Medicaid (CMS) Civil Money Penalty. We will present our research strategies as well as preliminary results suggesting that nursing facilities with higher occupancy rates are more likely to participate in this type of a program. In addition, study participants with dementia show positive emotional and behavioral reactions when listening to their favorite music.
Sexual and Gender Minority Caregivers of People With Dementia and Their Care Recipients
Authors: Anderson Joel , Flatt Jason , Tree Jennifer Jabson , Gross Alden , Rose Karen
Published: December 2020

Little is known about the unique experiences of sexual and gender minority (SGM) caregivers of people with dementia or their care recipients. We used an electronic survey to assess psychosocial measures within this caregiving population, including measures related to the care recipient. The majority of caregivers (N=285) were gay men (62%). Most respondents were white (80%), with a quarter identifying as Latinx. The majority of caregivers were a spouse/partner (59.3%) and were providing care for someone who identified as LGB (70%), with 20% caring for someone transgender. Half of care recipients did not have an advance directive. The majority of care recipients needed assistance with ≥5 instrumental activities of daily living (83%) and ≥1basic activities of daily living (74%). This study is the first to provide data regarding the unique needs of SGM caregivers of someone with dementia and will support the development of targeted interventions for this population.
We Want to Go, but There Are No Options: Facilitators and Barriers of Transportation Among Diverse Older Adults
Authors: Cao Quichang , Maleku Arati , White Katie , Ozbilen Basar , Dabelko-Schoeny Holly
Published: December 2020

Transportation plays an important role in social connectedness and quality of life among older adults. Despite the increasing number of diverse older adults in the U.S., few studies have explored the barriers and facilitators of transportation among this group. We conducted eight 90-minute focus groups in six languages (English, Nepali, Khmer, Somali, Russian and Mandarin) with older volunteers (N=70) in a large Midwestern metropolitan city. Using the Rapid and Rigorous Qualitative Data Analysis (RADaR) technique, four transportation determinants emerged: (1) Service: affordability, accessibility, availability, and reliability, lack of options, and service coordination (2) Built environment: safety and walkability; (3) Social environment: language barriers and lack of information, neighborhood cohesion; and (4) Individual determinants: ability to drive, walk, and family support system. Results reveal the interconnectedness of multi-level determinants and the need for a systematic approach to improve transportation access among diverse older adults.
Perception Versus Reality: Subjective and Objective Neighborhood Characteristics and Cognitive Function in REGARDS
Authors: Finlay Jessica , Clarke Philippa , Barnes Lisa
Published: December 2020

Does the world shrink as we age? The neighborhood captures a spatial area someone inhabits and moves through on a daily basis. It reflects a balance between internal perceptions and abilities, and the external environment which may enable or restrict participation in everyday life. We frequently hear that older adults have shrinking neighborhoods given declining functional mobility. This is associated with declines in physical and cognitive functioning, depression, poorer quality of life, and mortality. Knowledge of the interplay between objective and subjective neighborhood measurement remains limited. This symposium will explore these linked yet distinct constructs based on secondary data analyses of the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a racially diverse sample of 30,000+ aging Americans. Finlay investigates how someone’s perceived neighborhood size (in number of blocks) varies by individual and geographic characteristics including age, cognitive function, self-rated health, and urban/rural context. Esposito’s analyses focus on neighborhood size in relation to race and residential segregation. Clarke compares subjective perceptions of neighborhood parks and safety from crime to objective indicators, and examines variations by health and cognitive status. Barnes will critically consider implications for how older adults interpret and engage with their surrounding environments. The symposium questions the validity of neighborhood-based metrics to reflect the perspectives and experiences of older residents, particularly those navigating cognitive decline. It informs policy-making efforts to improve physical neighborhood environments and social community contexts, which are critical to the health and well-being of older adults aging in place.
The Differential Effects of Caregiving Intensity on Overnight Hospitalization in the Previous 2 Years
Authors: Meyer Kylie , Gassoumis Zachary , Wilber Kathleen
Published: December 2020

Caregiving for a spouse is considered a major stressor many Americans will encounter during their lifetimes. Although most studies indicate caregiving is associated with experiencing diminished health outcomes, little is known about how this role affects caregivers’ use of acute health services. To understand how spousal caregiving affects the use of acute health services, we use data from the Health and Retirement Study. We apply fixed effects (FE) logistic regression models to examine odds of experiencing an overnight hospitalization in the previous two years according to caregiving status, intensity, and changes in caregiving status and intensity. Models controlled for caregiver gender, age, race, ethnicity, educational attainment, health insurance status, the number of household residents, and self-assessed health. Overall, caregivers were no more likely to experience an overnight hospitalization compared to non-caregivers (OR 0.92; CI 0.84 to 1.00; p-value=0.057). However, effects varied according to the intensity of caregiving and the time spent in this role. Compared to non-caregivers, for example, spouses who provided care to someone with no need for assistance with activities of daily living had lower odds of experiencing a hospitalization (OR 0.77; CI 0.66 to 0.89). In contrast, caregivers who provided care to someone with dementia for 4 to <6 years had 3.29 times the odds of experiencing an overnight hospitalization (CI 1.04 to 10.38; p-value=0.042). Findings indicate that, although caregivers overall appear to use acute health services about as much as non-caregivers, large differences exist between caregivers. Results emphasize the importance of recognizing diversity within caregiving experiences.
Social Isolation and Loneliness in Older Adults: A National Academies of Sciences, Engineering, and Medicine Report
Authors: Galambos Colleen , Lubben James
Published: December 2020

Social isolation and loneliness (SIL) are serious yet underappreciated public health risks for many older adults (AARP, 2018a). Strong evidence suggests that, for older adults, social isolation and loneliness are associated with an increased likelihood of early death, dementia, heart disease, and more (AARP, 2018b, Holt-Lunstad and Smith, 2016). While all ages may experience SIL, older adults are at increased risk because they are more likely to face predisposing factors such as living alone, the loss of family or friends, chronic illness, and sensory impairments. Health care providers may be in the best position to identify older individuals who are at highest risk for SIL – individuals for whom the health care system may be the only point of contact with their broader community. The National Academies of Sciences, Engineering, and Medicine (NASEM) developed a consensus study report on this issue. This symposium presents the study recommendations. Dr. Holt-Lunstad examines the recommendations to develop a more robust evidence base for effective assessment, prevention, and intervention strategies for social isolation and loneliness. Dr. Galambos examines the recommendations to translate current research into health care practices and to improve awareness of the health and medical impacts of SIL. Dr. Lustig examines the recommendations to strengthen ongoing education and training and to strengthen ties between the health care system and community-based resources. Dr. Demiris examines the role of technology across all of these recommendations. Loneliness and Social Isolation Interest Group Sponsored Symposium
The Intersection of Medicaid and Assisted Living for Residents with Dementia
Authors: Kaskie Brian , Taylor Seamus , Xu Lili
Published: December 2020

Medicaid has increasingly offered coverage to persons residing in assisted living (AL). However, the scope of coverage across states is unknown. We sourced 2019 state administrative regulations specific to Medicaid and AL and determined forty-five (45) states link Medicaid with AL. Twenty-seven (27) do so as part of their state plan, 32 use a §1915(c) waiver, and 11 use a §1115 waiver. Forty-four states limit Medicaid coverage to a specific population, 16 limit coverage to those with a diagnosed disability, and 1 state limits coverage to a specific geographic region. In addition, 33 states provide payment for room and board with 28 states upholding a payment cap. In regards to services, 13 states reimburse a limited range of services while 32 offer a more expansive range of services. As Medicaid programs have extended coverage to residents of AL, researchers must now consider the impact on AL access and residents’ outcomes. Part of a symposium sponsored by Assisted Living Interest Group.
State Variability in Emergency Department Visits among Assisted Living Residents With Dementia
Authors: Hua Cassandra , Zhang Wenhan , Cornell Portia , Rahman Momotazur , Dosa David , Thomas Kali
Published: December 2020

Emergency department (ED) visits are associated with poor outcomes; however, state variation in ED use among assisted living (AL) residents is not well understood. Using 2017 Medicare data, we identified a cohort of 88,880 beneficiaries with dementia residing in larger ALs (25+ beds) and calculated risk-adjusted rates of all-cause and injury-related ED use per 100 person years, by state, adjusting for demographics and chronic conditions. Risk-adjusted state rates of all-cause ED visits ranged from 129.5 visits/100 person-years (95%CI=114.6,148.2) in New Mexico to 246.1 visits/100 person-years (95%CI= 224.9,274.8) in Rhode Island. The risk-adjusted rate of injury-related ED visits ranged from 91.4 visits/100 person-years (95%CI=83.0,101.4) in New Mexico to 135.9 visits/100 person-years (95%CI=126.9,146.6) in Montana. Potential reasons for these state variations will be discussed. Part of a symposium sponsored by Assisted Living Interest Group.