bluuebunny/crossref_metadata_2025 huggingface dataset:
LIVED EXPERIENCES OF OLDER FEMALE SEX WORKERS AT SONAGACHI, KOLKATA: A CASE STUDY
Authors: Chakravarty Esha , Chakravarty Indrani
Published: December 2023

Older sex workers are marginalised because of their former professional engagement and old age. This study captured the experiences of older female sex workers (FSWs), aged sixty and above, who delivered sexual services at Sonagachi, Asia’s largest pleasure market. Exploratory research design was used to understand their lived experiences through a qualitative intervention. The study was content driven, not hypothesis driven. Six older FSWs were selected through purposive sampling, primary data was collected through case study method. Their experiences were recorded starting from childhood, entry into sex trade, daily professional challenges and experiences during old age. Data collected was thematically analysed. Older Sonagachi FSWs are a heterogeneous group in terms of socio-demographic variables, health condition, place and nature of work, average load of clients they entertained per day. This study found that economic adversities and poverty during growing years have been the foremost reasons for choosing sex trade. Many of them remained in the sex industry because of lack of alternative professional opportunities. They experienced various forms of community perpetrated exploitation and some had acquired sexually transmitted infections. Other reasons for them to be in this trade were childhood poverty, early marriage, early motherhood, lack of education, lack of employment, neglect and abuse. They were destitute, had no caregivers, struggled to be part of mainstream society. The study suggests the need to develop policies for vocationally training them to generate alternative income sources and to initiate welfare schemes including pension plans and developing separate old age homes for older FSWs.
POPULATION AGING IN INDIA: A MICROLEVEL ESTIMATE USING GRIDDED POPULATION DATA
Authors: Sarif Nawaj , Hemalatha Sruthi Anilkumar
Published: December 2023

Population aging is a significant demographic trend that is transforming societies worldwide. Aging populations pose significant challenges to governments and societies, particularly in developing countries such as India, where a large segment is still impoverished and lacks access to adequate health care and social security systems. A lack of accurate data on older populations has been a significant impediment to developing effective policies to address the needs of this vulnerable group. To address this gap, this study tried to examine the micro-level trends and patterns of population aging in India using gridded population data. The study also attempted to estimate the share of the older population in India for the years 2030 and 2040. The study found that India has undergone a dramatic shift in population aging trends, with large intra-state variability. The share of older populations is predicted to rise considerably over the next two decades, highlighting the urgent need for effective policies to address their needs. The study also revealed that population aging patterns differ across India, suggesting that national and state-level measures alone will not suffice to address the needs of older people. Instead, policies directed at smaller units, such as districts and neighborhoods, are critical to ensuring the well-being of older populations. Furthermore, the study highlights the need for accurate and timely data on older populations in India. Such data can enhance policy decisions and help identify areas of need, enabling governments to develop targeted policies that can improve the well-being of older people.
WHO ARE THE PORTUGUESE WHO REACH 100 YEARS OF AGE? A DEMOGRAPHIC ANALYSIS USING 2021 CENSUS DATA
Authors: Ribeiro Oscar , Araujo Lia , Teixeira Laetitia
Published: December 2023

Portugal is considered one of the oldest countries of Europe as a conjugation of low birth rates and high life expectancy. The age group of 100+ is one of the fastest growing, with 270 centenarians in 1990 to 1961 centenarians in 2020 (Teixeira et al., 2020). In this study we present the profile of centenarians based on real data of the last Portuguese Census 2021. There are 2801 centenarians, showing a significant increase in relation to the previous censuses (589 centenarians in 2001, and 1526 centenarians in 2011). Most centenarians are women (82.0%), widowed (84.6%), attended school (61.0%), have social pension as main income source (96.3%), are catholic (93.9%) and were born in Portugal (98.6%). The average number of reported difficulties in vision, hearing, mobility, self-care, memory/concentration, and communication is of 5.12, meaning that the current cohort of centenarians face high constrains in their daily living and most probably depend on any sort of care support. Overall, Portugal follows the longevity phenomenon of a growing number of centenarians as verified in USA, Japan, and other European countries (United Nations, 2022). Profiling centenarians’ main characteristics with reliable data is a starting point for outlining the specific social, medical, and financial needs of those reaching very advanced ages, and for defining government policies and age-sensitive interventions.
ANALYSIS OF REPORTING GUIDELINE AND TRIAL REGISTRATION POLICIES AMONG GERIATRIC JOURNALS: A CROSS-SECTIONAL STUDY
Authors: Ward Shaelyn , Corwin Logan , Duncan Jacob , Smith Caleb , Brewer Danya , Hughes Griffin , Vassar Matt
Published: December 2023

The use of reporting guidelines and clinical trial registration policies by academic journals reduces bias and improves transparency in clinical research. It is unknown whether geriatric and gerontology journals mention, recommend, or require their use for the studies they may potentially publish. The purpose of this study is to assess the submission guidelines of the top geriatric and gerontology journals for their editorial recommendation or requirement of predetermined reporting guidelines and clinical trial registration. We identified the top 100 journals in the “Geriatrics and Gerontology” subcategory using the 2021 Scopus CiteScore tool. We probed each journal’s “Instructions to Authors” for statements regarding reporting guidelines for popular study designs and extracted them as “Not Mentioned”, “Recommended”, “Does Not Require”, or “Required”. Further, we classified each journal’s reference to clinical trial registration in a similar manner. Of the 100 examined journals included in our analysis, the QUOROM statement was not mentioned by any journals, whereas the CONSORT statement (44/100, 44%) was mentioned and recommended/required the most often. PRISMA guidelines were not mentioned by 57 journals (57/100,57%). Furthermore, 45 journals (45/100,45%) did not mention study registration. Therefore, the recommendation or requirement of reporting guidelines and clinical trial registration in the top 100 geriatric and gerontology journals is inconsistent. Journal editors should strongly recommend that author’s follow validated reporting guidelines to reduce potential bias and improve transparency in the articles they publish.
CONSIDERING HOSPITAL CLOSURES IN ALABAMA: NATIONAL POLICY IMPLICATIONS
Authors: Shah Avani , Swain Joseph , Lewy Hailey
Published: December 2023

Hospital closures have increased over the past 10 years nationally, particularly in rural areas and states that did not receive Medicaid expansion funds (American Hospital Association). These closures can impact older adults health care, employment opportunities, and mortality rates. Recently, the Alabama Hospital Association reported that 12 hospitals are at risk of closing. For this study, we evaluated the locations of hospital closures since 2009 in Alabama to understand gaps geographically in healthcare. We obtained information about current hospitals through Alabama Department of Public Health (ADPH). We searched for news articles to obtain a list of hospitals, which closed between 2009 and 2020. Next, we obtained data from the ADPH on the mortality rates by county and year. We also obtained information about the finances of hospitals in Alabama and classified hospitals with 20% losses as potentially at risk. Using GIS, we mapped areas of hospital closures and at risk hospitals as well as the location of current hospitals as of 2020. We chose to average mortality rates from 2009 to 2019 (pre-COVID) and map these by county. Since 2009, Alabama has closed 13 hospitals: with two reopening at a later date. Based on GIS, we found potential health care gaps in several rural areas and in Southwest Alabama, or the Black Belt area, which has a high rate of poverty, and poor health outcomes. The mean mortality rate for rural counties was significantly higher than urban populations between 2009-2019 t(54)=4.8, p<.0001. Policy implications will be discussed.
NURSING HOMES’ FIVE-STAR QUALITY RATING SYSTEM: FORECASTING THE FUTURE STABILITY AND VOLATILITY
Authors: Gupta Shivani , Kadam Ashay , Bhandari Neeraj
Published: December 2023

The utilization of publicly reported quality measures such as nursing homes’ five-star quality rating system to hold providers accountable for their quality of care has increased over the years. Therefore, nursing homes have invested significant resources into maintaining or improving the ratings awarded to them by CMS. This study utilizes statistical models to analyze the past rating histories to predict future evolution of ratings of nursing homes. Data on all U.S. nursing homes for the years 2017 - 2021 was derived from CMS Nursing Home Compare. Primary variable represents the overall five-star quality rating of nursing homes. A Markov chain model and a Mover Stayer model are used to predict changes in ratings of nursing homes. The one-year rating transition probabilities are estimated using maximum likelihood estimation. The key findings indicate the likelihoods of future upgrades and downgrades in nursing homes’ ratings. Nursing home administrators are under constant pressure to strategically allocate resources for maintaining or improving the five-star ratings awarded to them by CMS. The findings of this study could help nursing home administrators in forecasting future change in their rating and making better resource allocation decisions such as those related to preventing a rating downgrade. The study findings could also be used by policymakers to focus on nursing homes facing downgrades and assisting them in improving their quality of service based on the potential change in their rating. The same results could also be utilized to assess the stability of ratings given to nursing homes.
THE EFFECT OF RESILIENCE ON USING COMMUNITY ORGANIZATIONS AMONG KOREAN AMERICAN OLDER ADULTS DURING COVID-19
Authors: Kim Eunhye , Yeo Hyesu , Choi Y Joon
Published: December 2023

Objectives

This study aimed to examine how resilience and perceived racial discrimination are associated with receiving support from ethnic community organizations (ECO) among Korean American older adults during COVID-19.

Background

With the vulnerability of Korean American older adults and increasing racial discrimination, ethnic community organizations’ roles are important during COVID-19. Although previous studies have proven the association of resilience and racial discrimination with older adults’ well-being, there is little research on how those factors impact using ECO.

Methods

A cross-sectional survey was conducted with 132 first-generation Korean American adults aged 50 or older. A logistic regression analysis was conducted to determine which factors, including resilience, discrimination, age, gender, marriage, health, residence years, Language, and income, within the model made them more likely to receive support from ECO.

Results

Results showed that a high level of resilience was negatively associated with the use of ECO[OR 0.93, CI 0.87, 0.99]. Korean American older adults who were female [OR 5.60, CI 1.44, 21.50] and lower income [OR 4.42, CI 1.35, 14.48] were more likely to receive support. Those who were healthy [OR 2.15, CI 1.08, 4.26] and had lived longer in the U.S.[OR 1.07, CI 1.00, 1.14] were more likely to use ECO.

Conclusion

Findings from the study highlight the importance of improving and expanding support for vulnerable ethnic minority older adults in order for them to access services and develop effective coping strategies during the health crisis.
A GREEN ACTIVITY PRESCRIPTION PROGRAM FOR CHINESE AMERICANS LIVING WITH DEMENTIA
Authors: Belli Hayley , Lassell Rebecca , Luo Jun , Thorpe Lorna , Wong Jennifer , Yi Stella , Brody Abraham
Published: December 2023

Asian Americans account for approximately 161,000 cases of Alzheimer’s disease and related dementias (AD/ADRD) among adults ages 65 and older in the United States. Chinese Americans have among the highest incidences of AD/ADRD, and have experienced underdiagnosis, cultural stigmas, and less access to dementia care. In New York City specifically, 28.6% of Chinese American seniors live in poverty, leading to environmental racism, a lower likelihood of engagement in activities, decreased quality of life, and an increased risk of cognitive decline and developing dementia. Recommendations to support activity engagement among Chinese Americans include fostering social cohesion and linking individuals to local activity resources. Green activity prescriptions (GAPs) are one approach to achieving these objectives, and combine nature, social contexts, and meaningful activities to improve health and well-being. GAPs are co-designed with participants based on their interests, needs, and available community resources. Examples include: animal-assisted interventions, gardening, green exercise (walking), and conservation projects (composting). Past studies have provided evidence that these components have improved well-being for PLWD, supported function, and provided meaningful engagement. Yet, these early studies neglected Chinese Americans. GAPs have potential to support the health and well-being of Chinese American PLWD by addressing health inequalities and providing accessible, low-cost care, all while sustaining local green resources. Here we present the study design and implementation outcomes, including recruitment and engagement strategies, of a GAP intervention utilizing a community-based participatory approach aimed at supporting the health and well-being of Chinese American PLWD residing in lower-socioeconomic households within Brooklyn, NY.
CULTIVATING CULTURAL COMPETENCE WITH INTERDISCIPLINARY TEAMS IN SERIOUS ILLNESS CARE
Authors: Bullock Karen , Stansbury Kim
Published: December 2023

A workforce of gerontologists that is prepared to go beyond cultural humility to achieve baseline levels of awareness, skills, and transferrable knowledge to address racial disparities is necessary for creating equity in serious illness care with older adults. Cultural competence, the complex integration of awareness, knowledge, and skills enhances one’s capacity to engage effectively across cultural and racial groups to achieve equitable outcomes. Research Objectives The goal of this research was to design and assess outcomes of an innovative curriculum using simulation and role-play to train practitioners how to deliver patient-centered, goal concordant care with patients and families of racial groups that have been historically excluded from equitable healthcare in the U.S. Procedures: Interdisciplinary competency-based curriculum was developed and facilitated by an interdisciplinary team of educators and researchers. Advanced practice social workers were key members of serious illness care teams. With specialty training, they were prepared to be leaders in teaching learners how to conduct psychosocial assessments and interventions that beyond superficial levels of curiosity to applying competency-based practices with racially and culturally diverse populations. Implications: Addressing the impacts of the COVID19 pandemic in gerontology research and practice with racially diverse patients and families warrants a social justice framework for designing healthcare interventions that are inclusive of populations that have been most adversely impacted due inequities woven into the fabric of our society. Conclusion: This cultural competence training (CCT) program was effective in preparing learners to address racial inequities in healthcare for patients and families living with serious illness.
LIVING ARRANGEMENTS, HOUSING CHARACTERISTICS, AND PSYCHOLOGICAL WELL-BEING AMONG OLDER ADULTS IN CHINA
Authors: Fu Rong
Published: December 2023

Objectives

Living arrangements is an essential component of social environments for older adults. This study examines the impact of living arrangements and housing characteristics on the psychological well-being of older adults in China.

Methods

Data were derived from the 2011-2012 wave of the Chinese Longitudinal Healthy Longevity Survey. The final sample consisted of 4,746 Chinese older adults aged 80–105 years. Multivariate logistic regression models were used to estimate the odds of negative psychological outcomes, predicted by living arrangements, housing characteristics and other covariates.

Results

Overall, older adults who lived in a three-person household were less likely to feel lonely than their counterparts living in other household sizes. Participants who reported at least one housing problem (e.g., exposure to mold, minor home damage) were more likely to feel anxious and depressed than those who did not report any housing problems. Having a private bedroom was associated with better psychological well-being for both older men and women.

Discussion

This study demonstrates that both household sizes and housing conditions may influence health and well-being in advanced age. Living with family members and having adequate personal space at home have protective health benefits for older adults. This study has policy implications regarding household sizes and improvement in housing conditions.
NEIGHBORHOOD IMPACT ON OLDER ADULTS’ HEALTH OUTCOMES IN KOREA
Authors: Kim Seon
Published: December 2023

Background

The health of older adults is not only affected by biological factors but also strongly influenced by their social determinants. Neighborhood characteristics have been identified as structural contexts that significantly impact the health outcomes of older adults. As older adults tend to spend more time in their homes and neighborhoods than young adults, it is important to understand the neighborhood factors that affect their health outcomes.

Objectives

This study aims to explore the neighborhood characteristics that impact the health outcomes of older adults in Korea. Method: This study used the 2020 National Survey of Older Koreans data, which was collected from 10,097 Korean older adults aged 65 and older. Neighborhood characteristics considered in this study included satisfaction with neighborhood characteristics (e.g., safety, transportation, social cohesion) and proximity to infrastructure in the neighborhood (e.g., senior centers, hospitals, supermarkets). The health outcomes considered in this study were self-rated health, the number of chronic diseases, and mental health among older adults.

Results

The regression results showed that satisfaction with the neighborhood was related to older adults’ better self-rated health (B=.014, p<.001), lower number of chronic diseases (B=-.007, p<.001), and better mental health (B=.034, p<.001). On the other hand, proximity to infrastructure in the neighborhood was only related to older adults’ better mental health (B=-.018, p<.001) among older adults. Implications: These results suggest that policymakers should consider neighborhood characteristics when addressing older adults’ health outcomes. Especially, for the better mental health, policymakers should consider both proximities to infrastructures and satisfaction with the neighborhood.
SOCIAL DETERMINANTS AND HEALTH EQUITY AMONG NYC OLDER ADULTS
Authors: Nguyen Duy , De Fries Carson , Cheung Ethan Siu Leung
Published: December 2023

Of the vast opportunities in New York City, older adults from racial/ethnic minority groups face the challenges of social determinants on their health. This study applies the WHO’s Commission on Social Determinants of Health model to examine health inequities among older adults in New York City. A deeper understanding of interrelationship between structural and intermediary determinants is crucial to promoting successful aging in an urban environment. Data were extracted from the NYC Community Health Survey to focus on older adults, aged 65 and over (N=1,921). Weighted, limited information regression models were used to test the contributions of structural and intermediary determinants on self-reported daily activity difficulties and self-reported health. The sample comprised of 46% Non-Hispanic White older adults, 20% Black/African American, and another 20% Hispanic. One third of the sample endorsed being in poor health. One in 5 older adults reported having a daily activity difficulty. Multivariate analyses showed Black older adults reported more difficulties with daily activities compared to non-Hispanic Whites. Meanwhile, Hispanic older adults reported being in poor health less frequently than non-Hispanic Whites. Further limited information modeling shows the centrality of daily activity limitations on poor health such that the indicator partially mediates the relationship between race/ethnicity and poor health. Overall, the results reveal a fuller picture of the impact of social determinants on health equity among older adults in New York City. Future research needs to specify the sociocultural and economic dimensions of health equity to provide empirical results that can inform practice and policy.
IMPORTANT COMMUNITY FEATURES AND SERVICES IN DIVERSE OLDER ADULTS
Authors: Kim Kyeongmo , Hong Andy
Published: December 2023

Many cities and towns have tried to create neighborhood environments favorable to older adults. However, it raises the question of whether community aging initiatives reflect the diverse needs of older adults. This study examined how much different types of neighborhood physical and social environments were essential to the life of diverse older adults. This study used data from the 2018 AARP Home and Community Preferences Survey with 762 adults aged 50 and older in the USA (female: 50%; White: 70%, Black: 17%, Hispanic: 12%, other race: 5%). The outcome variables were participants’ rates on the relative importance of seven community features (i.e., outdoor space, housing, transportation, street, social participation, civic engagement, and job). We ran multiple regression analyses to examine the relationships between the importance rating of community features and diverse older populations. Women thought all community features were important in their daily life compared to men, except for transportation. Black and Hispanic older adults valued all seven community features more highly than White older adults. People with disabilities thought housing and civic engagement were essential daily; people who experienced loneliness thought housing, transportation, social participation, and civic engagement were important. This study adds to the growing literature on identifying the diverse needs of older adults in developing and creating age-friendly environments. Community features and services were essential to women and racial and ethnic minority adults. Depending on older adults’ demographic and health-related characteristics, policymakers and practitioners should develop a plan to reflect the diverse needs of older adults.
CLINICIAN EXPRESSIONS OF CONDOLENCE AFTER THE DEATH OF A PATIENT: AN INTERNATIONAL SURVEY
Authors: Van Ogtrop Katlynn , Nelson Sofie , Nouryan Christian , Carratu Kevin , Carney, MD Maria
Published: December 2023

There is little literature about expressions of condolence from providers to family members of those that have died, and no known literature reported during the COVID-19 pandemic. This study utilized an investigator-developed survey of healthcare clinicians about contacting families of patients who have died. It conducted via email and online from October to December 2021. Of 131 respondents, 67% were female, from 23 states, Canada, and UK. Half (49%) had >15 years experience, and most (85%) were attending physicians. The majority (99%) reported that a patient had died in their care within last year, while 18% reported lost >10 patients per month. Methods of condolences were phone calls, and personal letters. Most (67%) reported no change in contacting families, while 23% increased. When asked if they would be interested in education on expressing condolences, 47% responded “yes.” Barriers to condolences were time (64%), unsure of what to say (20%), afraid family will be upset (19%), medical/legal reasons (10%), no training (8%), and no personal relationship (7%). Most, (85%) reported that most calls “went well or better than expected.” Females (vs. male) reported often/always sending letters (45% vs 20%, p=0.13), and often/always calling by phone significantly more (71% vs 63%, p=0.04). Younger (< 40) clinicians (vs. older) reported being very/moderately comfortable talking to families (72% vs 78%, p=0.79), phone calls (64% vs 69%, p=0.68) and personal letters (27% vs 42%, p=0.91). Nearly half of respondents requested training. This is a practice that should be further studied for clinician and family experience purposes.
MAINTAINING PERSONHOOD AND AUTONOMY: A GROUNDED THEORY OF COMMUNITY-BASED HOSPICE CARE TRANSITIONS
Authors: Mann Catherine , Sullivan Suzanne , Chang Yu-Ping
Published: December 2023

Supporting care transitions as decline occurs for patients facing serious illness and their families necessitates ongoing identification of person-centered, family-oriented goals. However, little is known about the process patients and caregivers undergo when making decisions while transitioning to home hospice care. Using a Straussian grounded theory approach, we explored processes patients and caregivers use when transitioning from cure- to comfort-focused care. Data were collected through eight interviews of patients, patient and caregiver dyads, and hospice nurses (n=11). Participants were recruited from hospice and palliative care agencies serving three counties in Western New York. Interviews were recorded and transcribed verbatim. Data were analyzed using constant comparative method. Our results generated a theory grounded in the process of maintaining personhood and autonomy (e.g., changing roles, losing sense of self, wanting to be heard, wanting privacy) while making decisions to transition to hospice care. This process includes five contemporaneous steps: Shopping for the right services (e.g., recognizing existing care limitations, overcoming systemic barriers), Involving caregivers (e.g., acting as an advocate, filling other family members in, accepting the patient’s decisions), Navigating the business of dying while living (e.g., dealing with legalities, planning for the end), Processing and expressing emotions (e.g., fear, anger, trauma, loss), and Seeking input as health declines/recognizing futility (e.g., pursuing a diagnosis, validating what is happening with the nurse and physician, recognizing options). The process identified in the study reveals important mechanistic targets for the development of interventions that promote patient-centered hospice care transitions in the home setting.
SERVICE PROVIDER PERSPECTIVES ON ADVANCE CARE PLANNING USE IN RURAL DEMENTIA PATIENTS AND CAREGIVERS
Authors: Zhang Peiyuan , Nketsiah Ebow , Noh Hyunjin
Published: December 2023

Compared to urban areas, advance care planning (ACP) utilization remains very limited in rural communities. ACP earlier in the disease trajectory is particularly important for people with dementia (PWD) due to its progressive nature affecting their decision-making ability. Considering well-documented benefits of ACP in improving quality of end-of-life (EOL) care, the rural vs. urban disparity may indicate poorer EOL quality for rural PWD. Moreover, research on factors affecting ACP use among PWD has been primarily based in metropolitan/urban areas. To address the knowledge gap, this study aimed to explore barriers and current resources for ACP of PWD from perspectives of health and social service providers in rural Alabama. Using a qualitative approach, semi-structured face-to-face interviews were conducted with 10 health and social service professionals serving older adults and their caregivers in rural communities of Alabama. Thematic analysis was used to find recurrent themes and patterns from transcribed interview data. Our analysis revealed four areas of barriers to rural PWD’s ACP: (1) PWD’s and caregivers’ lack of knowledge about ACP, dementia, EOL care options, and available resources, (2) misconceptions of completing formal documentations, (3) emotional barriers, and (4) limited access to existing resources. Elder law clinic and local Area Agencies on Aging were the most prominent, existing resources for ACP in rural Alabama. Participants also showed a type of misconception that a lawyer and/or a notary is required for ACP. The study highlighted an urgent need for social policy in ACP education for both caregivers and service providers in rural settings.
HEALTH STATUS AND ENVIRONMENTAL FACTORS ASSOCIATED WITH OLDER ADULTS’ MOBILITY IN 2021 COMPARED TO 2020
Authors: Choi Namkee
Published: December 2023

The COVID-19 pandemic has had significant negative impact on life-space mobility of people of all ages around the world. Using the 2019-2021 National Health and Aging Trend Study (N=3,063, age 70+) and the socioecological mobility framework, we examined the changes in the frequency of going outside among U.S. older adults between 2020 (during the pandemic) and 2021 (post-COVID vaccine). Respondents self-reported changes in their frequency of going outside: no change (=about the same), increased frequency (=more often), and decreased frequency (=less often). We then fit multinomial logistic regression to examine the associations of the changes in the frequency of going outside with physical, psychosocial, and cognitive health, environmental (COVID concerns and transportation) factors, and social media use, controlling for the 2020 frequency of going outside. We found that in 2021 compared to 2020, 13% and 16% of those age 70+ reported increased and decreased frequencies, respectively. Increased frequency was associated with social media use. Decreased frequency was associated with poor physical health, depression/anxiety, and perceived memory decline. COVID concerns and transportation problems, as well as female gender, age 90+, and being non-Hispanic Black, were also significant correlates of decreased frequency. In conclusion, most U.S. adults age 70+ appear to have resumed their 2019 level of frequency of going outside in 2021 after the COVID vaccines became available; however, 16% reported decreased frequency of going outside in 2021 compared to 2020. Older adults with physical, mental, and cognitive health challenges need help to increase their frequency of going outside.
NEIGHBORHOOD CHARACTERISTICS AND SLEEP PROBLEMS: MEDIATING ROLES OF HEALTH BEHAVIORS AND MENTAL HEALTH
Authors: Cheung Ethan Siu Leung
Published: December 2023

Existing studies have well-documented the relationship between the neighborhood environment and health among older adults. Yet very few have focused on how the neighborhood environment predicts late-life sleep quality. Using longitudinal data (Rounds 7-9) from the National Health and Aging Trends Study, this study examined the cross-sectional and longitudinal associations between neighborhood characteristics (physical disorder and social cohesion) and sleep problems among Americans aged 65 or older, as well as whether health behaviors and mental health mediated these associations. The analytical sample included 4,029 adults aged 65 or older. Logistic regressions with a lagged dependent variable were adopted to test longitudinal associations. Longitudinal mediation analyses were also used to examine the mediation effects of health behaviors and mental health. The results suggested that neighborhood physical disorder was a significant predictor of sleep problems cross-sectionally, whereas social cohesion was both cross-sectionally and longitudinally associated with sleep problems. Moreover, mediation analysis revealed that health behaviors and mental health significantly mediated the longitudinal relationship between social cohesion and sleep problems, though the strength of the indirect effect diminished over time. These findings suggest that neighborhood physical disorder and social cohesion are significant predictors of late-life sleep problems among older Americans. The study also highlighted older adults’ resilience and adaptability to adverse neighborhood environments and the long-term health benefits of social cohesion in late-life sleep quality. Therefore, community health interventions that facilitate older adults’ physical and social activity, along with mental health programs, may help community-dwelling older adults improve their sleep quality.
A SCOPING REVIEW OF LGBTQ+ MULTIGENERATIONAL PROGRAMMING: GAPS AND OPPORTUNITIES
Authors: Zhou Leyi , Perone Angela
Published: December 2023

Extensive research has revealed disparities in health, housing, employment, and economics among LGBTQ+ older adults (Emlet, 2016). However, the LGBTQ+ community has a long-standing tradition of multigenerational support that can potentially alleviate some of these challenges. Innovative caregiving models and non-traditional support systems involving multigenerational networks have emerged during crises such as the AIDS epidemic of the 1980s and 1990s and the recent COVID-19 pandemic (Cahill & Valadéz, 2013; Hafford-Letchfield et al., 2022). Nevertheless, despite the growing attention to LGBTQ+ multigenerational programs, the current state of scholarly research in this area remains uncertain. To address this gap, this scoping review aims to map the literature on intergenerational interventions for the LGBTQ+ community. This study includes peer-reviewed research in English with various study designs related to different categories of intervention, program, or activity that involve LGBTQ+ participants from more than one generation. To ensure accurate and reliable results, we conducted a comprehensive search on seven databases: PsycINFO, PubMed, Web of Science, Scopus, Sociological Abstract, Embase, and CINAHL. After deleting duplicates, 130 peer-reviewed articles were identified. Preliminary findings from the scoping review reveal historical moments when research on multigenerational programming surged, which aligns with pivotal crisis moments in the LGBTQ+ community. It also underscores emerging trends in multigenerational programming, including critical inquiry about what constitutes “multigenerational” and deeper commitment to inclusion of communities of color and transgender communities. These findings provide important insights for practitioners, policymakers, and researchers to strengthen services and support for LGBTQ+ older adults.
COVID-19 SYMPTOMS AND RISK OF COGNITIVE FUNCTION IMPAIRMENT/DEMENTIA AMONG COMMUNITY-DWELLING OLDER ADULTS
Authors: Amini Reza
Published: December 2023

Most studies investigating the correlation between cognitive function (CF) and COVID-19 are cross-sectional, with less than one-year intervals post-contracting COVID-19. Using three waves of the National Health and Aging Trends Study (NHATS), this study aims to investigate the correlation between COVID-19 and CF impairment/dementia among community-dwelling older adults. After excluding known cases of dementia, we used before (2019 N=3,292), during (2020 N = 2,756) and one year after COVID-19 pandemic (2021 N=2,379) data. The severity of the disease and COVID-19 preventing contact with family and friends (CFF) were self-reported (in 2020), executive function (EF) was measured by Clock Drawing Test (CDT), memory using delay 10-words recall test (DWRT), and NHATS dementia classification (in 2021). Multivariable ordered logistic regression results showed no significant correlation between dementia (i.e., normal, probable, and possible) and self-reported COVID-19 symptoms or preventing CFF. COVID-19 symptoms did not predict the risk of EF impairment. However, controlling for race/ethnicity interaction with CFF showed Blacks with limited CFF were 74% and 136% more likely to have dementia and EF impairment than their White counterparts, respectively. Experiencing COVID symptoms in 2020 increased the risk of delayed memory impairment in 2021 by 63%, while limited CFF increased this risk by 39%, which was 120% higher for Blacks than Whites. In conclusion, experiencing COVID-19 symptoms can affect delayed memory when this effect cannot be specified as dementia. The impact of social isolation caused by the COVID-19 pandemic on CF and increasing the risk of dementia is more harmful among Blacks than Whites.
FOSTERING PRACTICE CHANGE BY INTEGRATING INTERPROFESSIONAL EDUCATION IN A COMMUNITY HEALTH COLLABORATION
Authors: DeGennaro Jennifer , Bodenheimer Lisa , Perweiler Elyse , Avallone Margaret , Mock Marilyn , Prakash Sreelekha
Published: December 2023

NJGWEP undertook an interprofessional community/public health initiative collaborating with Rutgers University School of Nursing-Camden, Stockton University, NJ Housing and Mortgage Finance Agency, and four affordable housing sites located in underserved communities, with a potential to reach approximately 600 older residents. An IPE curriculum delivered to faculty, students, and staff from multiple health professions disciplines prepares them for assessing residents with chronic health problems using the 4Ms framework (What Matters, Mind, Medications, Mobility), adding the Geriatric 5th M for multi-complexity. Using a Resident Health Risk Assessment (RHRA) to assess residents’ health/biopsychosocial needs by capturing critical information needed to support “aging in place,” students and staff develop person-centered plans of care that address maintenance of independence, health, and referral to needed services/supports to delay or prevent institutional placement. From 2019-2022, 84 students from multiple disciplines (i.e., nursing, social work, counseling, OT) participated in community-based rotations, completed 279 RHRAs, and developed 101 IPE case reviews and person-centered plans of care. Evaluating residents’ co-morbid conditions (Hypertension 46%, Diabetes Mellitus 42%, Mental Health 40%; 8.6 medications per/resident, 44% Mini-Cog < 3; 19% PHQ+, 51% + Falls Screen; 48% TUG>12; 58% ADL/IADL deficits) highlighted the 5th M, Multi-Complexity. IPE is a sustainable venue for training a health care workforce that acknowledges/values the person-centered approach and encourages learning the roles and responsibilities of other disciplines. Implementation of a customized database in 2022 facilitates longitudinal tracking of outcomes related to resident needs, referrals, interventions, access to services to support aging in place, and informs policy and practice change.
CHALLENGES OF E-INTERVENTION RESEARCH: LESSONS FROM THE ISUPPORT FOR DEMENTIA-PT FEASIBILITY STUDIES
Authors: Teles Soraia , Paúl Constança
Published: December 2023

E-interventions have become popular in delivering healthcare services, offering benefits such as increased accessibility and scalability. However, they also present ethical, technological, and research-related challenges. This poster aims to identify challenges of e-intervention research by analyzing feasibility studies of “iSupport for Dementia-PT”, an online training and support program for informal dementia caregivers (IDC) culturally adapted to Portugal from the original version by the Word Health Organization. A mixed-methods study collected data on user satisfaction and requirements for the program’s contents and interface through focus groups and usability test sessions with IDC (N=17) and health/social support professionals (N=13). A subsequent pilot study followed a mixed-methods experimental parallel between-group design with two arms (iSupport, N=21 and e-book, N=21). Ethical challenges unearthed by both studies included data privacy, e-consent reliability, equity in accessing e-health interventions, and e-health literacy. Challenging methodological decisions for an RCT protocol included defining criteria for a per protocol analysis in the context of a self-help e-intervention, timing for post-test or follow-up assessments, managing attrition, and the implications of resorting to online outcome measurements. The feasibility studies suggest that iSupport for Dementia-PT is a promising resource to support informal dementia caregivers. However, innovation is required in e-intervention research as replicating conventional procedures and methods have shown to be inadequate. Guidelines are needed on how to address the ethical, technological, and research-related challenges in e-intervention research.
IDEA-EXECUTION ABILITY, SELF-DETERMINATION, AND CHEERFULNESS PREDICT DEMENTIA ONSET OVER NINE YEARS
Authors: Tu Yufang , Undem Teri , O’Connor Melissa
Published: December 2023

The prevalence of dementia and its negative effect on well-being has made it a global public health concern. It is important to understand factors that predict the onset of dementia above and beyond age and physical health, to aid in preventative efforts. The current study investigated idea-execution ability, self-determination, and cheerfulness as predictors of the onset of dementia across a nine-year period. Longitudinal data from the first nine waves of the National Health and Aging Trends Study (NHATS) were used. NHATS participants are nationally representative of Medicare recipients in the United States. Data were initially collected in 2011 and annually thereafter. The current study included 6780 participants; 678 participants reported having a diagnosis of dementia at either baseline or a follow-up visit. Cox regression was used to examine the following self-report items as predictors of months-to-dementia onset: idea execution ability (“when I really want to do something, I usually find a way to do it”); self-determination (“other people determine most of what I can and cannot do”); and cheerfulness (“how often I feel cheerful”). Each predictor was time-invariant and scored on a 3-point scale so that higher scores were more positive. Covariates included baseline age group (five-year groups), sex (dichotomized), years of education, and self-rated overall health. Statistically significant results were shown for idea-execution (HR=0.79, p=0.008), self-determination (HR=0.69, p< 0.001), and cheerfulness (HR=0.91, p=0.047). Each of these potentially modifiable variables was associated with reduced odds of developing dementia, above and beyond demographic and health factors.
RACIAL/ETHNIC AND MULTIMORBIDITY DIFFERENCES IN DEMENTIA ONSET AMONG MIDDLE-AGED AND OLDER ADULTS
Authors: Chen Siting , Nagel Corey , Botoseneanu Anda , Allore Heather , Newsom Jason , Thielke Stephen , Kaye Jeffrey , Quiñones Ana
Published: December 2023

Racial/ethnic minoritized older adults in the U.S. have higher prevalence of multimorbidity and experience higher risk of dementia relative to non-Hispanic White older adults. This study examined the relationship between race/ethnicity and dementia onset within the context of multimorbidity during middle and later life in the U.S. Data from the Health & Retirement Study (1998-2018, HRS and War Babies cohorts, N=8,031) were applied to discrete-time survival models to estimate differences in the risk of dementia onset using the Langa-Weir Classification for up to ten time intervals (1998-2018). Models were adjusted for race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic), multimorbidity (no/one disease, advanced cardiovascular multimorbidity, metabolic multimorbidity, advanced cardiovascular-metabolic multimorbidity, and neither advanced cardiovascular nor metabolic multimorbidity), age at baseline, sex, education, and whether a proxy provided the interview. Over the 20 years, 9.8% of the respondents (n=785) developed dementia. In covariate-adjusted models, non-Hispanic Black (adjusted Odds Ratio (aOR) =2.27, 95%CI: 1.90, 2.72) and Hispanic (aOR=1.59, 95%CI: 1.26, 2.01) respondents had higher risk of developing dementia compared with non-Hispanic White respondents. Regarding multimorbidity categories, respondents with advanced cardiovascular-metabolic multimorbidity (aOR=1.80, 95%CI: 1.45, 2.24) had significantly higher odds of dementia onset relative to the neither advanced cardiovascular nor metabolic multimorbidity category. Significant differences were observed in dementia onset for up to 20 years between racial/ethnic minoritized and White adults, as well as among multimorbidity combinations. Our findings highlight the need to intervene earlier on modifiable risk factors, such as multimorbidity, to reduce the risk of developing dementia among racial/ethnic minoritized adults.
ADAPTING A DEMENTIA CAREGIVER CURRICULUM ACROSS THREE HEALTH PROFESSIONS
Authors: Duthie Edmund , Denson Kathryn , Simpson Deborah , Barnes Stacy , McAlister Jennifer , Szymkowski Amanda , Kavanaugh Rachel , Betley Wendy
Published: December 2023

Unpaid caregivers provide >80% of the care for the 6.2 million Americans living with dementia, yet healthcare professionals rarely refer them to community services. The Alzheimer’s Association’s “Direct Connect” (DC) referral program is provider-initiated connecting patients/caregivers with resources to improve care and quality of life. Our interprofessional team created a 15-minute curriculum to educate students about DC and how to advocate for DC use at clinical sites. Champion faculty, from each profession, utilized a common presentation, with minor modifications for professional relevance. Delivery was both synchronous/asynchronous to learners from 2 different universities with knowledgeable clinician(s) available to answer questions. A Qualtrics survey collected feedback (N=218; 105 medicine, 57 nursing, 56 pharmacy). Relevance of the curriculum to each of the 3 professions was high (1-5 scale; mean range 4.46 – 5.00), with nursing rating it as most relevant. Feedback was also quite positive across the professions (78%-92% rated the curriculum quality as excellent/very good overall), with nursing giving the highest ratings. Most learners indicated a strong likelihood of using DC in clinical settings; 64-100% are very likely or somewhat likely to do so, with nursing being most likely to make referrals. In summary, a common dementia DC curriculum was successfully implemented for learners in 3 health professions; it was highly relevant to each profession, well accepted, and perceived to be clinically actionable. Nurses tended to be the most positive on these measures. While these results are promising, DC remains underutilized and initiatives to further increase referrals from providers must be expanded.