bluuebunny/crossref_metadata_2025 huggingface dataset:
REMOTE TELEASSESSMENT AND TELEREHABILITATION OF A COMPREHENSIVE EXERCISE TRAINING PROTOCOL FOR OLDER ADULTS
Authors: Subramaniam Savitha , Wilson Edwina , Bhatt Tanvi
Published: December 2022

Background

With the increased implementation of interactive technologies for assessment and rehabilitation, it would be optimal to exhibit the reliability of physical assessment measures via tele-assessment. Aim: To determine the test-retest and intra-rater reliability of physical function outcome measures routinely used in the balance and gait rehabilitation using real-time online tele-assessment.

Methods

Community-dwelling healthy older adults (N=30) participated in three experimental tele-assessment sessions. During each session, a real-time online tele-assessment was performed on five major domains that evaluate balance and gait function: lower limb strength and endurance (30-second chair stand test), aerobic endurance (2-minute step test), static balance (One-legged stand test), dynamic balance (4-step square test), and gait (Tinetti).

Results

Coefficient of determination (R2) was used to determine the test-retest (TRT) and intra-rater (IR) reliability for all outcome variables. Excellent reliability was shown by Tinetti (TRT-1.0; IR-1.0) and one-legged stand test (non-dominant leg TRT-0.92; IR-0.97 and dominant leg TRT-0.89; IR-0.92). Excellent to good reliability was shown by 4-step square test (TRT-0.89; IR-0.74), 2-min step in place test (TRT-0.85; IR-0.78), and 30-second chair stand test (TRT-0.86; IR-0.80).

Conclusion

The reliability of individual outcome measures ranged from good to excellent, suggesting that these outcomes have sufficient sensitivity for detecting change with telerehabilitation.
UNDERSTANDING THE CARE NETWORKS OF INFORMAL CAREGIVERS OF SOUTH ASIANS WITH BREAST CANCER USING ATLAS CAREMAPS
Authors: Trivedi Ranak , Pukhraj Ambri , Desai Shreya , Jain Akanksha , Risbud Rashmi , Schapira Lidia , Gallagher-Thompson Dolores , Lorenz Karl
Published: December 2022

Breast cancer rates are increasing among individuals with a South Asian heritage, i.e., from India, Pakistan, Nepal, Bhutan, Sri Lanka, Maldives, and Bangladesh. Informal caregiving is vastly understudied among this population, despite being influenced by cultural mores such as collectivism, cancer-related stigma, and gender roles. The South Asian Family Approaches to Disease (SAFAD) study took a mixed-methods, observational approach to describe the care networks of informal caregivers via an adapted version of Atlas CareMaps. Thirteen caregivers (43.9+/-14.8y, 30.8% female) were interviewed and included 6 husbands, 1 wife, 2 daughters, 1 son, 1 brother, and 1 friend of the breast cancer survivors. Semi-structured interviews were designed to develop an adapted Atlas CareMap, a visual representation of the caregivers’ care network at the time of the interview. Atlas CareMaps depicted the number of people supported by caregivers, and who provide support; their relationship; the frequency, intensity, and type of care; and modes of communication used. Immediate or extended family members were the most common people included. Results indicated that: 1) caregivers reported 8.8□3.5 individuals in their care network, provided care to 3.5+/-1.8 individuals and received care from 7.3+/-3.5 individuals; 2) caregivers primarily received emotional support from others; 3) their survivors’ care teams were often included as a source of support and medical knowledge for survivors, but only three noted that the care teams supported them directly. Describing these networks is a key step to developing culturally-concordant programs that can support South Asian caregivers, even as they care for breast cancer survivors.
USEFULNESS OF REVISED SIMPLIFIED SHORT-TERM COGNITIVE SCREENING TEST (STMT-R) IN ACUTELY ILL GERIATRIC PATIENTS
Authors: Yamamoto Hiroshi , Ogawa Kenichi , Hisamatsu Yasushi , Ishitake Tatsuya
Published: December 2022

Background

Dementia can be a major cause of mortality and morbidity in geriatric patients. So, it would be essential to assess their mental state.Aims: We aim to appraise the impact of cognitive dysfunction on the long-term prognosis on STMT-R as a quicker and sensitive cognitive identification in acutely ill geriatric patients.

Methods

The inclusion criteria were to measure geriatric patients by STMT-R at admission, age≧50yo and being non-critical ill. Between October 2014 and September 2015, 836 were enrolled (52.4% female, mean age: 78.9 years). STMT-R≦4 was considered as cognitive dysfunction. Following the collection of clinical data, survival was subsequently measured for 7-8 years until January 2022. Cox’s proportional hazards regression models were used to evaluate the hazard of death according to the dementia severity, with adjustment for potential covariates. Survival was estimated using Kaplan-Meier method.

Results

Among enrolled subjects, 144 were unable to complete the test due to severe dementia (ITG). 433 had cognitive dysfunction (STMT-R≦4; CDG) and 259 didn’t have cognitive dysfunction (STMT-R>4; NCDG). The survival curves for death among three groups were significantly decreased in the CDG and ITG compared with the NCDG. The risks for mortality in the ITG and CDG are 3.92 (hazard ratio; 95% confidence interval:2.74-5.61, p< 0.001) and 1.82(1.33-2.51, p< 0.001) compared with the NCDG as reference.

Conclusion

1) It was suggested that severity of cognitive dysfunction at admission has independently an impact on survival rate in acutely ill geriatric patients.2) STMT-R may also be useful for the future bedside or remote cognitive assessment.
ASSOCIATION BETWEEN SUBJECTIVE COGNITIVE DECLINE AND STRENGTH TRAINING IN US ADULTS AGED 45+ YEARS
Authors: Schroeder Matthew , Waring Molly , Fowler Nicole , Pagoto Sherry
Published: December 2022

Subjective cognitive decline (SCD) can be an early marker for Alzheimer’s disease and related dementias. Data supports physical activity to delay cognitive impairment and to improve cognitive functioning. We examined strength training engagement by middle-aged and older US adults with and without SCD. We used data from 121, 059 participated aged 45 years or older from the 2019 Behavioral Risk Factor Surveillance System (BRFSS) from 31 states and Washington, D.C. SCD was assessed by asking participants if they had experienced confusion or memory loss during the past 12 months (yes/no). Participants reported how often they engaged in strength training (e.g., using weight machine, free weights) in the past month. We dichotomized strength training engagement as meeting physical activity recommendations (2+ times weekly) or not (< 2 times weekly). An adjusted logistic regression model, controlling for confounding variables, estimated the likelihood of strength training in relation to SCD. Analyses were weighted; results are nationally representative. SCD was reported by 11.0% (SE: 0.2%) of middle-aged and older US adults. Three in 10 (29.1%; SE: 0.7%) of US middle-aged and older adults who reported SCD engaged in strength training 2+ times a week compared to 34.0% (SE: 0.3%) of US adults without SCD (aOR, 0.9; 95% CI: 0.9-1.0). While middle-aged and older US adults with SCD were less likely to strength train than those without SCD, only a third engaged in recommended strength training regardless of SCD status. Primary care providers should encourage strength training among middle-aged and older adults regardless of cognitive status.
SENSORY IMPAIRMENT, COGNITIVE FUNCTION, AND DEPRESSION AMONG CHINESE OLDER ADULTS
Authors: Xu Shu , Su YanJhu
Published: December 2022

Sensory impairment (SI) is a contributor to poor mental health and cognitive decline for older adults, and the likelihood of having sensory impairment increases with age. However, the association between sensory impairment and cognition is still under-investigated and the potential mechanisms for the SI-cognition link is still not clear. This study examines the relationships between sensory impairment, depression, and cognitive function among older adults in China. Using nationally representative data from the China Health and Retirement Longitudinal Study 2018, we conducted cross-sectional analysis on adults age 60 years and older (n=7,026). Sensory impairment is defined as having vision impairment (VI) only or hearing impairment (HI) only or dual sensory impairment (DSI). Cognitive function was measured by the Mini-Mental State Examination and depression were assessed by the 10-item Center for Epidemiologic Studies Depression scale. Descriptive analysis showed that 10.66% of older adults experienced sensory impairment. Linear regression analyses revealed that HI and DSI were associated with cognitive declines among older Chinese adults (HI: β=-0.75, p<.01; DSI: β=-1.45, p<.01). SEM results showed that depression partially mediate the relationship between SI and cognition. Sensory-impaired older adults were more likely to have depression (HI: β=1.71, p<.001; DSI: β=4.76, p<.001), which lead to worse cognitive function (HI: β=-1.09, p<.001; DSI: β=-2.80, p<.001). Models were controlled for age, gender, education, social activities, and other covariates. Findings suggest that Chinese older adults experiencing sensory loss are at greater risk of cognitive function declining and that depression play an important role in the relationship between SI and cognition.
LAYING THE REPORT FOUNDATIONS: A CONCEPTUAL MODEL OF NURSING HOME QUALITY OF CARE
Authors: Saliba Debra , Ersek Mary , Rantz Marilyn
Published: December 2022

The committee began its work by developing a conceptual model for achieving resident-centered care. The model draws on existing evidence about the multiple dimensions of resident quality of life and the complexity of nursing home care and environments. Dr. Debra Saliba, a professor in UCLA’s Borun Center and Los Angeles VA GRECC with expertise in long-term care policy and delivery, will describe this model and how it guided the committee’s recommendations. She also will discuss how each presentation fits within the model’s domains
PSYCHOSOCIAL WORKING CONDITIONS IN MID-LIFE AND COGNITIVE AND PHYSICAL IMPAIRMENT IN OLDER AGE
Authors: Sindi Shireen , Kiasat Shadi , Kåreholt Ingemar , Nilsen Charlotta
Published: December 2022

Background

Psychosocial working conditions have been associated with cognitive and physical impairment among older adults. However, less is known on whether psychosocial working conditions are associated with a combination of cognitive and physical impairments. The aim of this study was to investigate the associations between midlife psychosocial working conditions and physical and cognitive impairment among older adults, and to assess whether there are sex differences in these associations.

Methods

The data were derived from two Swedish nationally representative surveys (n=839) with a follow-up time of 20-24 years. Multinomial and binary logistic regressions were used to assess the associations between work stressors according to the job demand-control model, and a combination of cognitive and physical impairment.

Results

Low control jobs were significantly associated with higher odds of both cognitive and physical impairment as well as a combination of cognitive and physical impairment. Passive jobs (low control, low demand) were associated with higher odds of cognitive impairment, and cognitive and physical impairment in combination. Active jobs (high control, high demand) were associated with lower odds of cognitive impairment. Sex-stratified analyses showed stronger associations among men than among women. Among men passive jobs were significantly associated with both cognitive and physical impairment. Low strain jobs were significantly associated with less physical impairment.

Conclusions

These results highlight the importance of midlife psychosocial working conditions for late-life physical and cognitive impairment, and especially among men. Jobs characterised by higher control, lower strain and active jobs may promote resilience and cognitive reserve among older populations.
ACHIEVING QUALITY PATIENT-CENTERED CARE IN THE NURSING HOME SETTING
Authors: Galambos Colleen
Published: December 2022

In 1987, The Nursing Home Reform Act was enacted as part of the Omnibus Reconciliation Act of 1987 (OBRA 87). At that time, the Health Care Finance Administration (now Centers for Medicare and Medicaid Services) issued comprehensive regulations and survey processes to “ensure that residents of nursing homes receive quality care that will result in their highest practicable physical, mental, and social well-being.” Despite this landmark legislation, nursing homes struggle to provide quality care, and are additionally challenged by natural disasters and pandemics. This presentation will report on recommendations that examine, structures, policies, and care models that promote change and innovation, with a focus on safety, environmental modifications, patient centered approaches, and quality care. Dr. Colleen Galambos, a professor at University of Wisconsin-Milwaukee, with expertise in nursing home care delivery and quality improvement will present the care delivery recommendations from the NASEM report.
COGNITIVE AND PSYCHOSOCIAL OUTCOMES OF DRIVING DIFFICULTIES IN OLDER ADULTS: A 5-YEAR STUDY
Authors: Hwang Yeji
Published: December 2022

Many older adults find it difficult to drive a car as they age. However, there are lack of studies on the outcomes of driving difficulties among older adults. The aim of this study was to examine the cognitive and psychosocial outcomes of driving difficulties in older adults. This study was a secondary data analysis using National Social Life, Health, and Aging Project Wave 2 (2010-2011) and 3 (2015-2016). This study followed 1,638 older adults that were of the age 65 and older, who had no difficulties driving a car at Wave 2. Montreal Cognitive Assessment Scale, Center for Epidemiological Studies Depression Scale, Hospital Anxiety and Depression Scale, and Perceived Social Isolation Scale were used. For data analysis, chi square tests, t-tests, and regression analysis were used. After 5 years, 11.1% of people began to have difficulties in driving a car (n=180), and 88.9% of people maintained to have no difficulties driving a car (n=1,441). Compared to people who maintained no difficulties of driving a car over time, people who began to have difficulties had more severe cognitive decline (t=4.59, p< 0.001) and more depressive symptoms over time (t=3.253, p=0.001). Univariate regression analysis also indicated that having difficulties of driving resulted in more severe cognitive decline over time (b=0.137, p< 0.001) and more depressive symptoms over time (b=0.097, p< 0.001). Driving difficulties were not related to anxiety or social isolation. As difficulties in driving are related to poor cognitive and psychological outcomes, healthcare professionals should pay more attention to people who experience driving difficulties.
“IS IT TIME TO STOP DRIVING?”: A RANDOMIZED TRIAL OF AN ONLINE DECISION AID FOR OLDER DRIVERS
Authors: Omeragic Faris , Meador Lauren , Fowler Nicole , Johnson Rachel , Boland Elizabeth , Peterson Ryan , Betz Marian
Published: December 2022

The decision to stop or continue driving can be challenging for older adults. In a prospective two-arm randomized trial, we sought to test whether an online driving decision aid (DDA) would improve decision quality. We recruited 301 English-speaking licensed drivers, age ≥70 years, without significant cognitive impairment but with ≥1 diagnosis associated with increased likelihood of driving cessation, from clinics associated with study sites in three states. They were randomized to view 1) the online Healthwise® DDA for older adults addressing “Is it time to stop driving?”; or 2) a control condition of web-based information. Our primary outcome was decision conflict as estimated by the Decisional Conflict Scale (DCS; lower scores indicate higher quality). Secondary outcomes were knowledge and decision self-efficacy about driving decisions. We examined differences in post-randomization outcomes by study arm using generalized linear mixed-effects models with adjustment for site and pre-randomization scores. Intervention participants had a lower mean DCS score (12.3 DDA vs 15.2 control; p=0.017) and a higher mean knowledge score (88.9 DDA vs 79.9 control; p=0.038); we found no difference between groups in self-efficacy scores. The DDA had high acceptability; 86.9% of those who viewed it said they would recommend it to others in similar situations.The online Healthwise® DDA decreased decision conflict and increased knowledge in this sample of English-speaking, older adults without significant cognitive impairment. Use of such resources in clinical or community settings may support older adults as they transition from driving to other forms of mobility.
SOCIAL NETWORKS AND HELP-SEEKING AMONG US CHINESE OLDER ADULTS REPORTED ELDER MISTREATMENT
Authors: Chao Ying-Yu , Seo Jin Young , Dong XinQi
Published: December 2022

Purpose

Older immigrant adults are reported to be more tolerant of abusive situations and less likely to seek help. This study aimed to examine the associations between social networks and help-seeking among U.S. Chinese older adults reported elder mistreatment (EM).

Methods

Data were from the Population Study of Chinese Elderly in Chicago (PINE). Social networks were assessed with network size, volume of contact, emotional closeness, proportion kin, proportion female, and proportion coresident. Informal/formal help-seeking (intentions and actual behaviors) were measured. Descriptive statistics and regression analyses were performed.

Results

A total of 450 participants reported EM. Participants had a mean age of 72.73 ± 8.03 years old (range 60-97). Participants had a mean of 3.29 (SD ± 1.31) network members, a mean of 3.24 (SD ± 0.67) emotional closeness, and average contacts of 6.62 (SD ± 1.10) times per year with network members. Smaller network size (p = .00) and less emotional closeness (p = .03) were associated with an increase in intentions of seeking help from formal sources. Compared to not seeking help, smaller network size (p = .04) and more emotional closes (p = .03) were associated with a higher likelihood to seek help from informal sources among U.S. Chinese older adults who reported any EM. Conclusion/implication: This study highlights the dynamic nature of social networks of help-seeking among this underserved population. Culturally tailored interventions are suggested to promote help-seeking through increasing strong ties and improving the quality of social networks for U.S. Chinese older immigrants with EM.
THE ROLE OF FORMAL RESOURCES ON ELDER MISTREATMENT HELP-SEEKING BEHAVIORS AMONG ASIAN OLDER ADULTS
Authors: Lee Eun Jeong , Choi Ga-Young , Koh Eun
Published: December 2022

Elder mistreatment is one of the most difficult topics to talk about among Asian older adult immigrants in the U.S. because they are unfamiliar and uncomfortable to disclose the issue due to their unique cultural values and limited English language proficiency. We recruited 494 community dwelling older adults from five cities who identified themselves of Asian ethnicity, and were 55 years old and older. Participants had various Asian ethnic and language backgrounds (e.g. Korean, Chinese, Filipino, and Vietnamese). Most of them were foreign-born (84.6%) with the mean age of 69.0 (SD = 8.47). Using the participant survey data, we focused on examining difference regarding elder mistreatment experience, perceptions, and help-seeking intentions between the Senior Community Service Employment Program (SCSEP) group and the non-SCSEP group that may or may not participate in paid workforce. The SCSEP is the federally paid workforce program for low-income older adults aged 55 or above aiming at fostering older adults’ community service and economic self-sufficiency. There was a significant difference in emotional mistreatment experiences between SCSEP and non-SCSEP participants. Furthermore, the two groups were significantly different in their likelihood of seeking help from Adult Protective Services (APS). Those who ever participated in the SCSEP were more likely to seek help from APS (X2 = 1, N = 284) = 4.674, p ≤ .05. Implications for future research and gerontology services are discussed to enhance Asian older adults’ awareness of elder mistreatment, and APS and other formal sources of help.
IMPACT OF NEIGHBORHOOD GREEN INFRASTRUCTURE ON ACCESS TO SOCIAL CAPITAL ACROSS THE LIFE COURSE
Authors: Webster Noah , Sampson Natalie , Nassauer Joan
Published: December 2022

While the impact of neighborhood characteristics on access to social capital is well established, less is known about how neighborhood landscape design interventions play a role in shaping access to this resource and how this varies across the life course. In this study we examined the association between age and perceived impact of recently installed neighborhood block-scale green infrastructure (GI) on frequency of social interactions with neighbors. We also examined age variation in how alternative GI designs were perceived (e.g., how well cared for), and how these perceptions were associated with the anticipated impact on frequency of neighbor interactions. Data are from the Neighborhood, environment, and water research collaborations for green infrastructure (NEW-GI) project based in Detroit, MI. Four neighborhood GI interventions were installed in two Detroit neighborhoods in 2016. Surveys were conducted with residents living around the interventions in 2017-18 (n=171), and in nearby neighborhoods (n=145). Age was significantly associated with perceived impact of the landscape interventions on frequency of social interactions with neighbors. Specifically, older adults were significantly more likely to report that the landscape interventions that they were most familiar with resulted in increased frequency of interactions with their neighbors. Further, design alternatives perceived as more well cared for were anticipated to result in greater increases in the frequency of interactions with neighbors among older compared to younger adults. Results suggest neighborhood landscape interventions can improve access to social capital particularly among older adults, and perceptions of landscape care play a role in this process.
HOUSING CHARACTERISTICS, NEIGHBORHOOD ENVIRONMENTS, AND SELF-RATED MENTAL HEALTH AMONG OLDER CANADIANS
Authors: Cheung Ethan Siu Leung , Mui Ada
Published: December 2022

Previous studies have established a clear association between the surrounding environment and mental health. Whereas most literature has focused on neighborhood environment, very few studies have examined the role of housing characteristics in self-rated mental health (SRMH). Using data from the 2018 Canadian Housing Survey, this study investigated the relationships between housing characteristics, neighborhood environment, and SRMH among older Canadians and whether the relationships varied by education and gender. Using a sample of 21,725 Canadians, SRMH was measured by older adults’ self-evaluation of mental health on a 5-point scale. We categorized education into three groups: high school or less, some college, and university or beyond. Hierarchical linear regressions showed that men and women with high school education and women with some college educations were more likely to report worse SRMH when living in low-income housing. Reporting a home maintenance need was a unique risk factor of SRMH for men with a university education, whereas living in uninhabitable conditions uniquely predicted better SRMH for men with some college education. Regarding neighborhood environment, safer community was a protective factor of SRMH for women with university education only. Sense of belonging was positively associated with SRMH for all subgroups, except for men with a university education. Expressing a need for community service was significantly associated with lower SRMH for women who completed a high school education or some college. Findings of this study shed light on the diverse need for environmental improvement and maintenance programs to improve SRMH among older Canadians.
DIURNAL CORTISOL SECRETION AND SELF-REPORTED AND CAREGIVER-REPORTED QUALITY OF LIFE IN PEOPLE LIVING WITH DEMENTIA
Authors: Dong Fanghong , Aryal Subhash , Hodgson Nancy
Published: December 2022

Introduction

People living with dementia (PLwD) report lower quality of life (QoL), compared to healthy older adults. The poorer QoL is not fully accounted for by the severity of dementia. Dementia is associated with prominent neuroendocrine changes, however, there is a lack of research examining whether biological factors are related to QoL in PLwD. This study examined relationships between cortisol, symptom severity, and QoL in PLwD.

Methods

A total of 143 participants aged 55-94 years (65.7% women) in the Healthy Patterns Study (NCT03682185) provided three saliva samples at wake-up (AM1), 30 minutes (AM2) after waking, and bedtime (PM) on two consecutive days. We derived cortisol awakening response (CAR), wake to bedtime cortisol slope, and diurnal mean cortisol secretion. Sociodemographic and severity of dementia were assessed by interviews and questionnaires. Self-reported and caregiver-reported QoL was measured using the Quality of Life in Alzheimer’s Disease (QoL-AD).

Results

Poorer QoL was associated with more severe dementia rating. Flattened cortisol slope was significantly correlated with overall poorer self-reported QoL (β=0.43, p=0.017), but not caregiver-reported QoL (p=0.12), after controlling for severity of dementia and demographic variables. We did not find a significant relationship between CAR and diurnal mean cortisol with QoL.

Conclusions

This study provides novel evidence linking neuroendocrine mechanisms to QoL in PLwD. The findings indicate that dysregulation of the hypothalamic-pituitary-adrenal axis is linked to poorer QoL, independently of the severity of dementia. Biopsychosocial approaches to QoL for PLwD may lead to a greater understanding of the underlying mechanisms.
UTILITY OF SIX-MONTH PROGNOSIS TO PREDICT SURVIVAL AMONG NEWLY ADMITTED NURSING HOME RESIDENTS WITH CANCER
Authors: Vu Long , Warner David , Schiltz Nicholas , Rose Johnie , Cullen Jennifer , Owusu Cynthia , Sajatovic Martha , Douglas Sara
Published: December 2022

A prognosis of less than 6 months life expectancy has potential to be useful in planning and evaluating end-of-life care; however, its agreement with actual survival data has not been assessed. Here, we measured the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the nursing home (NH) Minimum Data Set (MDS) 6-month prognosis indicator among individuals diagnosed with incident breast (female), colorectal, lung, pancreatic, or prostate cancer during the years 2004-2017 and admitted to a NH between 2012-2017 (n=254,183). Cancer patients were identified from the linked Surveillance, Epidemiology, and End Results (SEER) Registry. The median age was 80 years, 52.6% were women, and 15.15% were non-White. Only 7,541 (2.97%) of patients were deemed by a physician to have a life expectancy of less than 6 months as recorded in their first comprehensive MDS assessment; of those, 83.0% died within 6 months, and 12.3% died after 6 months. Sensitivity and specificity were 7.8% and 99.3%, respectively, for the prognosis indicator predicting mortality within 6 months; PPV was 83.0% and NPV was 69.9%. In conclusion, although very few patients had received a physician designation of their 6-month prognosis, a high percentage actually died within 6 months. Conversely, among those without a 6-month prognosis, nearly one-third died within 6 months. A terminal diagnosis appears reasonably predictive of death — when made. However, its low sensitivity demonstrates that a vast majority of terminal patients are not properly captured, calling into question its greater application.
THE LINGERING EFFECTS OF LOSS: WIDOWHOOD AND SUBSTANCE USE IN THE LGBT POPULATION
Authors: Barrett Anne , Noblitt Jessica
Published: December 2022

The immense stress of widowhood can lead to unhealthy coping strategies, including substance use. Relatively little is known, however, about widowhood’s effects on substance use among sexual minorities. Of the few studies examining LGB widowhood, none employ large, nationally representative samples or consider whether effects depend on current partner status. We address these issues using a sample of 2,258 respondents aged 50 and older who participated in the 2010 Aging with Pride: National Health, Ageing, and Sexuality/Gender Study. Multivariate regression analyses reveal that widowhood is associated with higher odds of being a current smoker and of using drugs in the past year. These results are found for individuals who are currently partnered, as well as those who are not. This observation suggests that widowhood’s negative effects on use of these substances are not attenuated by the potentially protective effect of current partnership. In contrast, the effects of widowhood on alcohol use do appear to be diminished by current partnership. Among those who have experienced widowhood, those with a current partner are less likely than those without a partner to report problematic drinking. Our results suggest that current partnership may protect against problematic use of more socially acceptable substances like alcohol, but it may not prevent less acceptable behaviors like smoking or drug use. In sum, our study suggests that current partnership may not completely counter the lingering effects of partner loss in the LGB population.
LATER-LIFE TRAJECTORIES OF MARITAL QUALITY FOR WOMEN AND MEN
Authors: Bulanda Jennifer , Yamashita Takashi , Brown J Scott
Published: December 2022

It is essential to better understand older adults’ marital dynamics, as marital quality is consequential for older adults’ physical and mental health, relationships with other social network members, and risk of divorce. Although numerous studies examine marital quality during the early life course, much less is known about later life trajectories. Earlier work suggested marital quality followed a U-shaped curve, characterized by a later-life upswing, but more recent research finds patterns of stability or decline over time. Gender differences in marital quality are well established, but it is less clear whether older men and women experience different marital quality trajectories during later life. We use nationally-representative data from a sample of continuously-married adults over age 50 in the Health and Retirement Study (n=2,175) with measures of both positive and negative marital quality at three time points (2006, 2010, and 2014). Latent growth mixture models in Mplus estimate trajectories of marital quality over the eight-year time period. Results show small declines in both positive (b = -0.016, p < 0.05) and negative (b = -0.028, p < 0.05) marital quality over the observation period, but the declines in positive marital quality are limited to those in remarriages. Women have lower initial positive marital quality and higher initial negative marital quality than men, but there are no significant gender differences in change over time. Results support the stability and continuous-decline patterns of marital quality over the life course rather than a U-shaped curve, and suggest persistence of gender differences over time.
DO OPPOSITES ATTRACT OR AGGRAVATE? THE IMPACT OF INTERGENERATIONAL SOLIDARITY ON WELL-BEING
Authors: Scott Rachel , Lopez Acacia , Olson Marin , Nadorff Danielle
Published: December 2022

Family Systems Theory states that values are transmitted between generations within families and, while many of these values are similar between immediate generations, there may be more differentiation in values between generation gaps. Ideological differences between generations may potentially cause subsequent tension and fluctuations in well-being. The current study sought to examine the moderating effect of ideological differences (religious and political) on the relation between how emotionally close grandparents perceive themselves being with younger generations and grandparental well-being. Participants included 419 grandparents (age: M = 76, SD = 5.33), 716 adult children (age: M = 53, SD = 4.16), and 638 adult grandchildren (age: M = 29, SD = 5.52) from the 8th wave of the Longitudinal Study of Generations (LSOG) data set. Well-being in grandparents was positively correlated with perceived emotional closeness among both of the intergenerational dyads. Religious ideological differences between grandparents and grandchildren were found to negatively influence grandparental well-being; this relation was also found to be significantly different from political ideological differences within the same intergenerational dyad. While moderation was not achieved for either dyad, the overall model fit was found to be excellent, suggesting its utility for further research into the relation between the study variables. These findings indicate that there is a complex relation between perceived emotional closeness, ideological beliefs, and the well-being of grandparents that warrant additional attention within the literature and may inform interventions related to intergenerational communication and well-being. Further implications for these findings will be discussed.
WHAT CAUSES OLDER PARENT–ADULT CHILD ESTRANGEMENT?: A QUALITATIVE INTERVIEW STUDY
Authors: Nolte Julia , Cope Marie , Pillemer Karl
Published: December 2022

The life-course perspective’s emphasis on “linked lives” highlights the importance of positive parent-child relationships for adults’ well-being in mid-life and beyond. However, one in ten Americans experiences parent-child estrangement, defined as ending all contact and communication for a period of time. Despite the prevalence, the reasons underlying family estrangements are poorly understood. In this study, we conducted in-depth, qualitative interviews with 43 middle-aged and older adults (age range = 46-81, M = 65.05 years) who are or were estranged from an adult child (estrangement range = 1-26, mean = 6.53 years). On the basis of a jointly developed codebook, independent coding from the first and second author revealed 22 estrangement reasons across eight categories, with parents citing reasons from across four categories on average. Estrangement was most often attributed to the behavior, issues, or traits of the child (79%), problems surrounding a difficult in-law/ partner (72%), or disagreements about beliefs and values (67%). To a lesser degree, estrangements were linked to separation or divorce (49%), financial problems and conflicts (42%), adverse childhood experiences of the estranged child (30%), and interference from someone other than a partner (16%). More than half of the parents (58%) also endorsed other reasons, including their own traits and behaviors, communication issues, a family history of estrangement, and passive loss of contact. Older parent–adult child estrangements are perceived as multi-causal, with four out of five parents describing the estranged child as difficult or troubled. Implications of the findings for professionals working with older adults are discussed.
SUPPORTING DEMENTIA CAREGIVERS IN HEALTHCARE DELIVERY: RECOMMENDATIONS FROM A NATIONAL CONSENSUS CONFERENCE
Authors: Riffin Catherine , Griffin Joan , Bangerter Lauren , Brody Lilla , Falzarano Francesca , Pillemer Karl , Czaja Sara , Adelman Ronald
Published: December 2022

More than 6 million adults in the United States are affected by Alzheimer’s Disease and related dementias (ADRD), the majority of whom rely on assistance from an unpaid caregiver (family, friends). The goal of the 2021 Conference on Engaging Family and Other Unpaid Caregivers of Persons with Dementia in Healthcare Delivery, funded by the National Institute on Aging, was to establish a policy- and practice-aligned research agenda for enhancing ADRD caregiver engagement and support in healthcare settings. The Conference convened multidisciplinary thought leaders from across the United States to establish a set of actionable recommendations to advance the field. Recommendations centered on five key topics: 1) Identification and assessment of ADRD caregivers, 2) Reimbursement and financing for provider time spent on ADRD caregiver, identification, assessment, and support, 3) ADRD caregiver training and support, 4) Healthcare provider education, and 5) Technology. To support future work in each of the five priority areas, conference participants highlighted the importance of leveraging lessons from implementation science and models of equity and inclusion. Recommendations are intended to inform federal agencies and foundations about high-priority areas and motivate multidisciplinary collaborations to design care delivery systems that effectively engage and support ADRD caregivers.
FACTORS PREDICTING FAMILY MEMBER PROVISION OF ASSISTANCE WITH ACTIVITIES OF DAILY LIVING FOR SENIORS
Authors: Spetz Joanne , Ross Leslie
Published: December 2022

The aging of the U.S. population is leading to greater demand for assistance with activities of daily living. Much of this support is provided by family members, but changing family sizes and locations have raised concern that those needing support will be increasingly reliant on non-family assistance. This study examined patterns of provision of family, non-family, and paid caregiving to those 65 years and older who need assistance with activities of daily living, focusing on the impact of geographic location. We used the National Health and Aging Trends Study Restricted Metro-Nonmetro round five data file. We identified individuals who needed assistance with activities of daily living and/or instrumental activities of daily living. We merged information about the primary survey respondent (subject person, or SP) with data on “other people” (OP) in their supportive network, excluding spouses living with the respondents because nearly all spouses provided support. The final analytic data file consisted of 5,234 unique SPs. We used weighted and unweighted bivariate analyses as well as weighted multivariate logistic regression models to examine the association of family or non-family support and geographical location. We found that SPs who never were unmarried were more likely to have a non-spouse family helper compared to those married or living with a partner. Family who lived near the SP had a greater likelihood of providing help. SPs who were Black, non-Hispanic, multi-racial, and other non-Hispanic had more than twice the likelihood of having a family member helping them compared to White non-Hispanic SPs.
AN EXPLORATORY DESCRIPTIVE STUDY OF CARE PARTNERS’ PREFERENCES AND SKILL TRAINING NEEDS DURING HOSPITAL CARE
Authors: Vanias Kaitlyn , Yahr Andrea , Fields Beth
Published: December 2022

Care partners play a critical role in caring for an increasingly complex, aging population in the United States after hospital discharge. However, care partners’ preferences and needs are often not formally assessed during their loved one’s hospitalization. The Care Partner Hospital Assessment Tool (CHAT) is a standardized decision-support tool that facilitates the inclusion and training of care partners during hospital care. The purpose of this exploratory descriptive study was to understand the preferences and needs of 12 care partners of older adult patients admitted to a large academic hospital utilizing the CHAT. The majority (8 of 12) of care partners surveyed were spouses while the remainder were adult children of the patients. All care partners provided comparable support including physical and social support as well as healthcare management. Despite providing similar support, there were differences in the care preferences and needs of spouses compared to adult children. A greater proportion of spouses preferred to be present for care in the hospital and requested information on adaptive equipment and community services. All adult children desired access to the electronic medical record while there was a mixed response among spouses. The most common needs across care partners included training on mobility assistance and medical devices. Findings from this study demonstrate that care partners have varying preferences and training needs during hospital care and suggest differences across care partner relationships. Further investigation is necessary to better understand these patterns and improve hospital care for patients and their care partners.
CULTURALLY CONCORDANT CARE: CLINICIAN PERSPECTIVES ON PROVIDING CANCER CARE TO SOUTH ASIANS
Authors: Singh Nainwant , Manja Veena , Pukhraj Ambri , Risbud Rashmi , Desai Shreya , Schapira Lidia , Lorenz Karl , Trivedi Ranak
Published: December 2022

In many South Asian (SA) cultures, cancer is stigmatized, and family members are expected to become primary caregivers. Clinicians need to be familiar with these SA needs and values to provide culturally concordant care. The South Asian Family Approaches to Disease (SAFAD) study aims to understand cultural needs of SAs managing breast cancer. We conducted semi-structured qualitative interviews with multidisciplinary clinicians at a major academic medical center about caregiver interactions, cultural dynamics affecting clinical practice, unmet patient needs, and perceptions of culturally concordant care. Participants included physicians(8), a nurse practitioner(1), a social worker(1), and a physician assistant(1) with experience in palliative care(5), hematology/oncology(4), breast cancer(3), critical care(2), and radiation oncology(1) with one to 42 years in practice. Participants identified as Caucasian/White(6), South Asian(3), African American/Black(1), and Chinese(1). Clinicians noted the following: 1)SAs have greater family involvement in care and may defer treatment decisions to family members; 2)SAs seek clinician support with cancer management and nutrition; 3)SA emotions and hesitation around sensitive topics may result in non-disclosure; 4)SAs have diverse caregiver roles; and 5)individual SA needs cannot be generalized within the diaspora. “There’s still some stigma… with breast cancer… [it] may lead a patient to not want to share their diagnosis… then set up a patient for having less support… [We can] help them feel more comfortable opening up selectively.” Understanding such cultural needs is essential to cultivating trust and providing person-centered care. Interventions and resources to promote culturally concordant cancer care can target education in these areas.
PERCEPTIONS OF DEMENTIA CARE AMONG AFRICAN IMMIGRANTS IN MINNESOTA: INSIGHTS FROM COMMUNITY CONVERSATIONS
Authors: Yam Hawking , Nkimbeng Manka , Rosebush Christina , Russel Wynfred , Shippee Tetyana , Gaugler Joseph
Published: December 2022

Immigrants and persons from diverse racial and ethnic backgrounds have a higher prevalence of dementia compared with their U.S.-born counterparts, yet the estimates of dementia prevalence, perceptions, and needs among African immigrants are not fully understood. This qualitative study examined African immigrants’ perceptions of dementia and dementia care. Specifically, it explored the community’s attitudes, care practices, and barriers toward dementia care. Community conversations (focus groups) were conducted with 24 African immigrants residing in the Northwest Minneapolis suburbs. Conversation transcripts were analyzed using thematic analysis in Nvivo. The majority of participants were women, 79% from Liberia, 43% were over the age of 65 years, and 65% held a bachelor’s degree or higher. Three themes were identified: 1) Perceptions of and attitudes toward mental health and dementia, which indicated that cultural issues limit awareness of dementia, but 2) Family care of a person living with dementia, meaning care happens in the home, and receiving care in a facility is the last resort; 3) Facilitators and barriers to dementia care, including distrust of health systems, immigrant status, and limited finances. This project offers unique insights on the dementia care and caregiving beliefs and attitudes among African immigrants that can inform policy and intervention efforts aimed at decreasing dementia care barriers in the African immigrant community.
SERIOUS MENTAL ILLNESS IN MINNESOTA NURSING HOMES: THE ROLE OF RESIDENT AND FACILITY CHARACTERISTICS
Authors: Shippee Tetyana , Bucy Taylor , Ng Weiwen , Woodhouse Mark , Fashaw-Walters Shekinah , Bowblis John
Published: December 2022

Multiple studies have shown an increasing prevalence of adults with serious mental illness (SMI) in nursing homes. As adults with SMI age, the reality of care needs that span physical, medical, and psychosocial services necessitates further consideration of the role of comprehensive, ancillary mental health services in nursing homes (NH). Yet, little work examines characteristics of those with SMI, their care needs & the role of facility structural factors. Using the 2011-2017 Minimum Dataset (MDS) assessment data for Minnesota, we examined resident-level demographic characteristics of NH residents with and without SMI, and facility-level characteristics including quality of life (QoL), quality of care (QoC), and state recertification survey scores. We defined SMI as a diagnosis of bipolar disorder, schizophrenia or schizoaffective disorder, or psychotic conditions other than schizophrenia present on the reference assessment. Individuals admitted with SMI were younger, had better physical health, were more likely to be racial/ethnic minorities, and more likely to be admitted to a facility with a higher proportion of racial/ethnic minority residents. SMI-only admissions were concentrated in larger, for-profit facilities with a high-reliance on Medicaid. Lastly, SMI-only admissions were more likely to occur in facilities with lower QoL, QoC, and inspection scores. There is a growing need for behavioral health services in NHs, yet access to services is inadequate and lacks equity based on geography, race/ethnicity and other system-level disparities.
NURSING HOME PALLIATIVE CARE DURING THE PANDEMIC: DIRECTIONS FOR THE FUTURE
Authors: Ninteau Kacy , Bishop Christine
Published: December 2022

For this qualitative, pilot study, seven Massachusetts nursing home Directors of Nursing (DONs) were interviewed remotely about palliative care provision before and during the COVID-19 pandemic. Interview data were analyzed using thematic analysis. Palliative care addresses physical, emotional, psychological, and spiritual suffering that accompanies serious illness. Symptom management and goals of care is especially valuable for seriously ill nursing home residents. We investigated the solutions nursing home staff developed to provide palliative care during the COVID-19 pandemic despite restrictions on external resources. Before the pandemic, palliative care was delivered primarily by nursing home staff depending on formal and informal consultations from palliative care specialists affiliated with hospice providers. When COVID-19 lockdowns precluded these consultations, nursing staff did their best to provide palliative care, but were often overwhelmed by shortfalls in resources, resident decline brought on by isolation and COVID-19 itself, and a sense that their expertise was lacking. Advance care planning conversations focused on hospitalization status and options for care given COVID-19 resource constraints. Nevertheless, nursing staff discovered previously untapped capacity to provide palliative care on-site as part of standard care, building trust of residents and families. Nursing staff rose to the palliative care challenge during the COVID-19 pandemic, albeit with great effort nursing home payment and quality standards should support development of in-house staff capacity to deliver palliative care while expanding access to the formal consultations and family involvement that were restricted by the pandemic.