bluuebunny/crossref_metadata_2025 huggingface dataset:
Person-Centered Care for Family Caregivers: Evaluating an Education Program for the Healthcare Workforce
Authors: Anderson Sharon , Parmar Jasneet , Pollard Cheryl , Dobbs Bonnie , Leslie Myles , McGhan Gwen
Published: December 2021

Background: While family caregivers [FCGs] provide 75-90% of care for people living in the community, most healthcare providers are not trained to provide person-centered care to FCGs. We followed research recommendations that the healthcare workforce receive competency-based education to identify, assess, support and partner with FCGs. Objective: Mixed methods evaluation healthcare workforce education program. Approach: We began by coining the concept “caregiver-centered care,” defining it as a collaborative working relationship between families and healthcare providers aimed at person-centered support for FCGs. From this definition, interdisciplinary stakeholders including FCGs (n=101) co-designed the Foundational Caregiver-Centered Care education. Learning resources included six competency-aligned educational modules with videos and interactive exercises that encourage reflection. Kirkpatrick Barr’s healthcare training evaluation framework underpinned our mixed methods evaluation. We measured participant’s reaction to the education (Level 1) and changes in learner’s knowledge and confidence to work with FCGs (Level 2). Results: 352 healthcare providers completed the education online (caregivercare.ca). Learners were satisfied with quality of education (Mean 4.75/5; SD=.5) and the education increased their motivation to learn more about caregiver-centered care (Mean 4.75/5; SD .5). Student’s paired samples T-test indicates pre-post education changes in knowledge and confidence to work with FCGs were significant [Pre (M=37.8, Sd=7.6) to post (M=47.2, SD=3.5) t (125) = -14.39, p<.0005 (two-tailed)]. Qualitative results derived from open responses mirrored the quantitative results. Conclusion: The Caregiver-Centered Care education provides a foundation for educating healthcare providers working with FCGs to provide care to FCGs to maintain their wellbeing and sustain care.
Advancing State and Local Home Modification Practice and Policy: Findings From Aging Network Surveys
Authors: Overton Julie , Pynoos Jon , Nabors Emily , Terzaghi Damon , Blair Elizabeth , Wilson Traci , Steinman Bernard , Kunkel Suzanne
Published: December 2021

Home modification (HM) can promote older adults’ functioning as their needs change, reduce fall risks, and support caregivers. A supportive home environment is increasingly important as homes become healthcare delivery sites for home and community-based services (HCBS). HM is funded and administered by disparate agencies, often hindering access to HM services for at-risk older adults who need them the most. The Aging Network (State Units on Aging (SUAs), Area Agencies on Aging (AAAs), and Title VI organizations serving Native American older adults) plays an important but not well understood role in HM. To address this lack of research, the USC Leonard Davis School of Gerontology, ADvancing States, and the National Association of Area Agencies on Aging in cooperation with Scripps Gerontology Center conducted three national surveys, with support from the Administration for Community Living: 1) directors of the 56 SUAs with an 89% response rate; 2) directors of the 618 AAAs with a 79% response rate; and 3) directors of 276 Title VI programs with an 84% response rate. Exemplary practices included HM advocacy through interagency coalitions; state and local plan priority setting; creative HM financing with housing, disability, and health care sectors, including partnerships with Medicaid agencies; and integration of HMs into state and local HCBS, including nursing home transition and caregiver support programs. Findings on the types of HM activities, service delivery barriers, funding sources, collaborations, and targeted populations will inform HM policy and practice for the Aging Network’s critical state and local agencies serving low-income older adults.
Education of Caregivers and Veterans to Improve the Care of the Geriatric Psychiatric Patient
Authors: Sorocco Kristen
Published: December 2021

The geriatric psychiatry outpatient clinic provides assessment of the elderly Veteran with mental illness and behavioral and psychological symptoms of dementia. I will describe strategies developed and implemented in this setting to provide education to the caregiver (family) to improve early identification of delirium, depression and cognitive impairment. This education proved to reduce the number of pharmacological treatment and increase the use of nonpharmacological interventions based on "what matters to the patient" and following the BEERS criteria guidelines. One of the most important outcomes of the education and evaluation in the geriatric psychiatric clinic was a decrease in number of emergency room visits of elderly, specifically those with dementia.
Using Implementation Science to Inform and Evaluate Health Policy
Authors: Bobitt Julie , Prusaczyk Beth
Published: December 2021

Public health policies can be a tool for the promotion and protection of older adult’s well-being but how can we ensure that policies will be effective and applied as intended? This presentation will discuss how implementation science can be used to both inform and evaluate health policies. Scientific evidence developed by applying dissemination and implementation frameworks can be used to inform policy makers as they develop legislation. When used to evaluate policy, D&I frameworks can be applied to examine policy diffusion, how a state, community, or individual organization chooses to carry out the policy, and the impact that policy has on the intended population. D&I frameworks are an effective way to measure the difference between policy intent and what actually happens when a policy is implemented. Examples of how D&I frameworks have been used to inform and evaluate policy will be shared.
Age-Tastic: An Evidence-Based Intervention to Improve Health, Safety, and Well-Being in Older Adults
Authors: Pardasani Manoj , Berman Jacquelin , Powell Mebane , Gates Madison
Published: December 2021

Age-Tastic! is a holistic intervention that enhances the well-being, health and safety of older adults. Most evidence-based interventions aimed at older adults have focused on singular aspects of health such as cognitive health, falls prevention, depression, advanced care planning, etc. There are few interventions that encompass a holistic approach to health and safety. Age-tastic! is one such intervention that encompasses various aspects of health – social support, financial well-being, physical safety, mental health, health care management, and nutrition. Designed as a competitive board game to entice older adults, this intervention integrates concepts of cognitive restructuring, behavioral activation and game theory to educate, motivate and encourage healthful behaviors. At the core of this intervention is a focus on increasing awareness of health and safety issues, improving health literacy and changing harmful behaviors. A randomized control trial was conducted with 98 older adults assigned to an experimental and control group. Interviews were conducted at baseline, right after the intervention ended (8 weeks) and again after a short time (8 weeks after intervention ended). The results showed significant increases among experimental group participants in knowledge of healthy behaviors (p=0.05), perception of self-efficacy for engaging in healthful behaviors (p<0.001) and engagement in health behaviors (p=0.001). Regression analyses demonstrated that greater knowledge and self-efficacy were associated with behavioral change within the intervention group (p<0.001). Knowledge about the importance of preventing falls and communication with medical providers was positively correlated with the corresponding behavioral change (p<0.05). Implications for health literacy among older adults will be shared.
Gender, Tobacco Control Policies, and Recalcitrant Smoking Among Older Adults in 20 European Countries
Authors: Gao Manjing , Lee Chioun , Park Soojin
Published: December 2021

Little is known about sociodemographic and macro-level predictors of “recalcitrant smoking,” defined as persistent smoking when one has developed a health condition that is likely caused by smoking. We aim to investigate the impact of gender, education, and tobacco control policies on recalcitrant smoking among older adults in Europe from 2006 through 2013. Data from 33,839 respondents—aged 50 years and older with a smoking history and at least one smoking-related health condition—were pooled from the 2006–07, 2011, and 2013 waves of three harmonized longitudinal studies on ageing (SHARE, ELSA, and TILDA). We fitted gender-specific logistic regression models with two-way fixed effects and tested interaction terms between gender, tobacco control policies, and education, adjusting for age, marital status, GDP per capita, smoking prevalence, country, and year-fixed effects. Compared to men and individuals with higher levels of education, women and less educated individuals were more likely to be recalcitrant smokers. The association between education and recalcitrant smoking was stronger for women than men. The inverse association between the TCS and recalcitrant smoking was stronger for those having upper secondary education (for men: OR = 0.905, CI = 0.849–0.965; for women: OR = 0.897, CI = 0.834–0.964) and tertiary education (for men: OR = 0.802, CI = 0.717–0.898; for women: OR = 0.739, CI = 0.603–0.907), compared to those having less than upper secondary. As women and less educated individuals are vulnerable to recalcitrant smoking, future policies targeting these marginalized groups are needed to prevent recalcitrant smoking in old age.
Elders or Old Men?
Authors: Cole Thomas
Published: December 2021

Thomas R. Cole, GSA Abstract, 3.9.2021 Elders or Old Men? My book Old Man Country is about 12 successful, respected older men who think back on their lives and current aging. When starting my research, I first questioned my own aspirations for aging: What would my aging be like? Who would I become? What would be my purpose as an old man? Although I expected that strength and resilience would be the common thread of elderhood, it was actually their vulnerabilities that defined them (accepting losses, acknowledging dependency.) More so, these vulnerabilities did not demarcate a descent but rather a continuous uphill struggle that differentiates elderhood from growing old. Ultimately, I argue that elderhood is not a life stage or a right of passage but rather an individual process to be worked through, if one so chooses.
Elderhood in Protestant Religious Contexts: Stepping Stones in Religious Language
Authors: Spännäri Jenni
Published: December 2021

Elderhood is an emerging concept for making meaning in older age, often contextualized in spiritual but not religious traditions. But what kinds of frameworks for elderhood are woven into protestant religious contexts? This paper explores 943 texts written by Finnish older adults in study groups organized by a pensioners’ organization. A key finding is that religious language – known through religious songs and prayers learned by heart at school – offers a medium to explore and express their elderhood. The writers creatively use the rhythm and wordings of these textual patterns to position themselves as a group of older persons with a special contribution to make to society. These results will aid examining elderhood and its potential in various contexts where the concept might not be explicitly used. This examination potentially leads to new ways to support experiences of elderhood and thus to offer an alternative view to countering ageism.
Leveraging Free Public Use Data for Aging and Life Course Research
Authors: Cleveland Lara , Cagney Kathleen
Published: December 2021

This symposium will showcase life course and aging research that is possible using freely available integrated census and survey data available via IPUMS. This session is organized by the Network for Data-Intensive Research on Aging (NDIRA) initiative at the University of Minnesota’s Life Course Center. NDIRA seeks to build and support an interdisciplinary community of scientists leveraging powerful data resources in innovative ways to understand health outcomes at older ages, as well as the demography and economics of aging. The session features papers that illustrate how to examine aging-related topics including health at older ages, work and socioeconomic conditions, and living conditions with a common thread of examining heterogeneity within groups. These papers all leverage freely available census and nationally-representative survey data, highlighting the potential value of these data for studying aging and the life course. By combining papers on an array of topics from a variety of data sources, this symposium highlights exemplar papers that demonstrate the types of novel research possible using public use census and survey data that NDIRA seeks to foster.
Derailed by the COVID-19 Economy? Older Adults' Paid Work by Intersections of Age, Gender, Race-Ethnicity, and Class
Authors: Flood Sarah , Moen Phyllis , Pedtke Joseph
Published: December 2021

This paper addresses the uneven employment effects on older Americans (Boomers and Genxers, ages 50-75) of the COVID-19 pandemic. Drawing on monthly CPS data from January through December 2020 (IPUMS) with an intersectional approach, we first chart shifts in employment and non-employment for population subgroups defined by age, gender and race/ethnicity, including explanations for not working (unemployment, retired, disabled, not in the workforce for other reasons – NILF-other). We then examine uneven transitions --monthly individual-level shifts out of and into paid work for population subgroups, considering also disparities by educational level. We find increases in proportions unemployed, especially for women in their 50s, as well as increases in the proportions reporting they are NILF-Other, especially for Asian and Hispanic women, with small increases for Asian and Hispanic men as well. There is little change in age-graded reports of being retired, regardless of gender or race/ethnicity, though there are education-level effects.
Changes in Sociodemographic and Disease Prevalence Among Five Birth Cohorts of Older Latinos
Authors: Garcia Catherine , Ailshire Jennifer
Published: December 2021

Latinos are often treated as an amalgamated group without respect to Latinos' composition included in sampling designs in different periods. This matters because the Latino population is continuously changing over time with respect to migration patterns, socioeconomic status, sociocultural characteristics, and geographic dispersion across the U.S., which may influence disease patterns in later life. We use data from the Health and Retirement Study and the National Health Interview Survey to investigate changes in older Latinos' composition by examining five birth cohorts. Results indicate that there have been significant demographic and health changes over time among older Latinos, with later-born cohorts more racially and ethnically diverse, more educated, and exhibiting a higher prevalence of hypertension, diabetes, and obesity. Understanding these shifting dynamics is imperative for crafting strategies and public policies that meet this group's health needs, reduce the cost of health care, and increase the quality of life for older Latinos.
Influence of Labor Market Disparities on Sex and Gender Inequalities in Cognitive Decline
Authors: Avila-Rieger Justina , Esie Precious , Manly Jennifer
Published: December 2021

State-level labor market disparities have been linked to health outcomes. The current study examines how labor market disparities may shape different patterns of sex/gender inequalities in cognition across race/ethnicity, place, and time. We leverage cognitive outcome data from multiple cohort and nationally representative longitudinal studies, as well as historical data on labor force participation and occupational status from IPUMS CPS. Multilevel modeling analyses was used to examine heterogeneity in sex/gender inequalities in cognitive trajectories within and between race/ethnicity and U.S. state of birth and determine whether such variability is explained by a state-level labor market opportunity composite. We expect women to demonstrate an advantage over men on cognitive measures. Women’s advantage will be more pronounced in states with a small sex/gender gap in labor market opportunities and less pronounced in states with a large gap. The magnitude of this advantage will be greater for White women compared with Black women.
Federal Interventions Targeting Social Isolation and Loneliness: An Exploratory Review
Authors: Palmer Lauren , Howard Jennifer , Voltmer Helena , Ferrell Abigail , Mulmule Natalie , Levinson Abbie , Karon Sarita
Published: December 2021

Even prior to the COVID-19 Public Health and Medical Emergency, the experiences of chronic social isolation and loneliness (SIL) were growing among older adults. Countries began increasing national visibility for these issues and implementing programs and services focused on addressing them. In the United States (US), however, little is known about successful national interventions or their effectiveness in tackling SIL among older Americans. We conducted a rapid review of the peer-reviewed and grey literature from 2009-2019, focusing on existing federal programs, health systems, and health care models in the US that address SIL among older adults. Of the 110 articles identified, 36 met the inclusion criteria and were synthesized. Our review found few federal interventions that directly address SIL; several may be addressing SIL as an auxiliary outcome to addressing social determinants of health, such as group exercise, transportation support, or food insecurity. While these interventions may provide a promising opportunity, implementation and evaluation challenges were identified. Thus, federal and state agencies face significant obstacles to understanding the impact of existing interventions and their effectiveness in addressing SIL, hampering progress toward large scale implementation. As SIL receives increasing attention, we add another voice to existing literature that indicates significant heterogeneity among existing programs; we found that few evidence-based, scalable federal initiatives exist in the US that target SIL. Without resources from federal and state agencies, the ability of health entities, community-based organizations, and direct care providers to implement effective interventions is significantly diminished.
Association of Social Relationships and Depression Among Older Mexican Adults: Does a Rural or Urban Context Matter?
Authors: Downer Paige , Wong Rebeca
Published: December 2021

Social characteristics such as strong community and family ties have been associated with positive mental health outcomes in older adults. However, this evidence is based primarily on non-Hispanic White populations and may vary according to living in a rural versus urban community. We hypothesize that the positive impact of available social networks, perceived support, and social participation on older Mexican adults’ likelihood for high depressive symptoms (i.e., depression) will be greater for those living in rural (community < 2,500 people) than urban communities. Data came from the 2012 Wave of the Mexican Health and Aging Study. Depressive symptoms were measured using a 9-item version of the Center for Epidemiologic Studies Depression Scale. Social participation is the respondent’s self-reported participation in hobbies, religious activities, volunteering, and visits with neighbors. Available social network is measured as having relatives and/or good friends living in the neighborhood. Perceived support is the respondent’s perception of friends/family’s willingness to help with finances and personal care. The final sample of 6,266 respondents was majority (62.4%) female, mean age of 69 years, 17.8% lived in a rural community, and 34.5% with depression. Logistic regression models stratified by rural/urban indicated that available social network and perceived social support were not associated with depression in rural or urban communities. In general, the social participation activities were associated with significantly lower odds of depression for older adults living in urban but not rural communities. This research highlights the influence of older adults’ community on their social relationships and mental health.
Podcasts and YouTube Videos: Innovative Tools for Disseminating Mental Health and Dementia Education to the Public
Authors: Koepp Regina , Edmonds Natali
Published: December 2021

This symposium will discuss two examples of innovative public education tools used to disseminate evidence-based information to the general public about mental health and aging and Alzheimer's Disease and related dementias. The first is the Psychology of Aging Podcast hosted by Regina Koepp, Clinical Geropsychologist. Since it’s launch in April 2020, there have been 50 weekly episodes and more than total 25,000 downloads. The goal of the Psychology of Aging podcast is to facilitate access to information and education about mental health and brain health among older adults with the hope of de-stigmatizing mental health care for older adults, reducing ageism, and promoting access to mental health and dementia care for older adults and their families. The second is Dementia Careblazers, created and hosted by Dr. Natali Edmonds, board certified Geropsychologist. The goal of Dementia Careblazers videos is to offer easy to access information to family members who care for someone with dementia. In her weekly videos, Dr. Edmonds provides actionable, evidence-based information and resources focused on dementia caregiving in brief videos. Since it’s launch on YouTube November 2016, Dementia Careblazers, has 65,000 subscribers, has posted 231 videos, and has had more than 4 million views nationally and internationally. Drs. Koepp and Edmonds will discuss the role podcasts and YouTube videos play in public education and share tips for professionals wanting to start an evidence-based program of their own. This virtual modality may be of increased interest considering recent health risks through face to face interactions and advancements in technology.
Dementia Careblazers YouTube: Public Education Tool for Sharing Evidence-Based Dementia Care Information
Authors: Edmonds Natali
Published: December 2021

Dementia Careblazers, created and hosted by Dr. Natali Edmonds, board certified Geropsychologist, offers weekly YouTube videos to family caregivers of people living with dementia. These free brief videos provide actionable, evidence-based information and resources focused on dementia caregiving. This virtual modality is particularly relevant for caregivers of people living with dementia given the difficulty family caregivers have in finding supervision and care for the person with dementia in their absence and considering recent health risks through face to face interactions. Furthermore, the free archive of Dementia Careblazers videos allows for access to evidence-based dementia care information at any time, regardless of geographic location or time zone. During this session, Dr. Edmonds will discuss the role YouTube videos play in public education and share tips for starting an evidence-based YouTube channel.
Public Policy Panel Interdisciplinary Symposium
Authors: Simon-Rusinowitz Lori , Rozario Philip , Lindberg Brian
Published: December 2021

Chair: Lori Simon-Rusinowitz;Panelists: Representatives of GSA Sections - Phillip Rozario (SRPP), Stephen Helfand (BS), Tamara Baker (BSS), Cynthia Brown (HS), Judith Howe (AGHE), Darina Petrovsky (ESPO); Discussant: Brian Lindberg. This interactive session is an interdisciplinary look at policy issues in aging with the speakers representing views from their sections. This session, organized by the GSA Public Policy Panel, will provide both GSA section leadership and attendees an opportunity to have an open dialogue on important public policy issues of significance in the field of aging. Presentations will likely address the COVID-19 pandemic, how GSA, each section and its members, and the federal government responded during the past year; how the policy work has been influenced by the increased acknowledgement of institutional and societal racism; and member experiences with the influx of additional economic relief, research funding, and funding for aging supports and services programs.
TBD
Authors: Baker Tamara
Published: December 2021

Chair: Lori Simon-Rusinowitz;Panelists: Representatives of GSA Sections - Phillip Rozario (SRPP), Stephen Helfand (BS), Tamara Baker (BSS), Cynthia Brown (HS), Judith Howe (AGHE), Darina Petrovsky (ESPO); Discussant: Brian Lindberg. This interactive session is an interdisciplinary look at policy issues in aging with the speakers representing views from their sections. This session, organized by the GSA Public Policy Panel, will provide both GSA section leadership and attendees an opportunity to have an open dialogue on important public policy issues of significance in the field of aging. Presentations will likely address the COVID-19 pandemic, how GSA, each section and its members, and the federal government responded during the past year; how the policy work has been influenced by the increased acknowledgement of institutional and societal racism; and member experiences with the influx of additional economic relief, research funding, and funding for aging supports and services programs.
TBD
Authors: Petrovsky Darina
Published: December 2021

Chair: Lori Simon-Rusinowitz;Panelists: Representatives of GSA Sections - Phillip Rozario (SRPP), Stephen Helfand (BS), Tamara Baker (BSS), Cynthia Brown (HS), Judith Howe (AGHE), Darina Petrovsky (ESPO); Discussant: Brian Lindberg. This interactive session is an interdisciplinary look at policy issues in aging with the speakers representing views from their sections. This session, organized by the GSA Public Policy Panel, will provide both GSA section leadership and attendees an opportunity to have an open dialogue on important public policy issues of significance in the field of aging. Presentations will likely address the COVID-19 pandemic, how GSA, each section and its members, and the federal government responded during the past year; how the policy work has been influenced by the increased acknowledgement of institutional and societal racism; and member experiences with the influx of additional economic relief, research funding, and funding for aging supports and services programs.
Structure and Change: New Developments in Research on Cumulative Dis/Advantage
Authors: Dannefer William , Estes Carroll
Published: December 2021

In a time of heightened social inequality and concern to reckon with its sources and consequences, the relevance of cumulative dis/advantage (CDA) to understanding patterns of aging has become even clearer, and CDA research has continued to expand in several fresh directions. Papers in this symposium will review the current state of knowledge regarding CDA and will present new analyses addressing key questions of its intersections with social change and its structural patterning. We will begin with a review of knowledge on comparative evidence regarding cumulative dis/advantage and its cross-national patterning. With regard to change, will examine the compare the effect of the 2008 recession and subsequent recovery across generational cohorts through a comparative examination of trajectories of income inequality. We will also present evidence on the impact of gender, focusing on women’s late-life health.
Trajectories, Turning Points, and Interruptions: How Social Inequality Shapes Women’s Later-Life Health
Authors: Kelley Jessica , Gilbert Marissa
Published: December 2021

We explore women’s health in midlife and later life at the nexus of structural sexism and the life course perspective, applying Dannefer’s (2018) concept of life course reflexivity, which emphasizes social dynamism with potential health-changing ‘input’ at all ages. We present three types of reflexive changes in the gendered life course that shape women’s health as they age: (1) trajectories of lifetime labor market disadvantage leading to limited health-protective resources in later life; (2) turning points in family structure and need, with draining caregiving demands; (3) interruptions in midlife, such as divorce, erasing the social and economic benefits of marriage. We provide support for critical arguments that theoretical work on the life course has too-often utilized the ‘privileged’ or the ‘male’ life course with insufficient attention to structural sexism as a fundamental cause of women’s health disparities in later life.
Migration and Aging in the Right Place: Older Puerto Rican Adults’ Narratives
Authors: Jespersen Brooke
Published: December 2021

This research examines meanings of aging in the “right” place (Golant, 2015) among older adults who have grown up and grown older in migratory contexts. This qualitative research is based on semi-structured and life history interviews with 30 low socio-economic status Puerto Rican adults over the age of 60 who reside in Cuyahoga County, Ohio and have engaged in Puerto Rico-US migration throughout the life course. Inductive thematic analysis of interviews revealed fraught, multi-scalar narratives of aging in the “right” place. At the level of residence type, older adults’ narratives exhibited a tension between interdependence and independence. That is to say, they struggled to reconcile cultural preferences for family-based living arrangements with fears of becoming a burden. At the level of nation, a similar tension manifested. Older adults reported navigating differential citizenship rights, access to healthcare and social services, natural disasters, and experiences of social inclusion and exclusion via migration between Puerto Rico and the US mainland. Thus, aging in the “right” place was complex, if not altogether elusive, as inequitable circumstances obliged older adults to make tradeoffs regardless of where they lived. These findings extend scholarship on aging in the “right” place, which has focused on residence type, by considering how older adults negotiate aging within and across households, communities, and nations. Moreover, these findings highlight how challenging aging in the “right” place can be for migrating and disadvantaged populations.
Moving the Needle on Outcome Measurement: A Longitudinal Analysis of Frailty Among Home-Delivered Meal Recipients
Authors: Juckett Lisa , Oliver Haley , Bunck Leah , Kurzen Crystal , Devier Andrea , Page Fannisha
Published: December 2021

Frailty is a complex condition highly associated with malnutrition and can lead to the devastating loss of independence among older adults. Home-delivered meals (HDMs) aim to combat frailty and malnutrition and provide nutritional support to nearly 10 million older adults each year. Though self-reported metrics indicate that HDMs help older adults maintain their independence, few studies have systematically collected longitudinal data that objectively represent the health benefits of HDMs. The present study implemented two evidence-based instruments designed to measure frailty levels of HDM recipients (age 60 to 99 years) at two time points. HDM staff at one organization underwent multifaceted training to implement The Home Care Frailty Scale and the Clinical Frailty Scale with HDM recipients at the start of HDM enrollment and at three-month follow-up. Activity of daily living impairments (B = .46, p < .001) and instrumental activity of daily living impairments (B = .28, p < .001) were significant predictors of higher frailty levels at baseline (N = 245). Sixty-two recipients were analyzed at 3-month follow-up. Clinical Frailty Scale scores indicated stable frailty levels from baseline to follow-up (4.08 vs. 4.08). Home Care Frailty Scale scores indicated a slight increase in frailty levels (7.4 vs 7.63) though not statistically significant, t(61) = -.34, p = .74. These stable frailty metrics suggest that HDMs contribute to older adults’ ability to remain living in their own homes and communities and can support the importance of increased financial investments in HDM programs at the state and national levels.
Caregivers' Cannabis Use: Does Burden Lead to Blunts?
Authors: Arora Kanika
Published: December 2021

Research on risky health behaviors among caregivers is limited. In this paper, we examine the association between informal caregiving and marijuana use and whether this association varies by age. Using data from Behavioral Risk Factor Surveillance System (2016-2019), a multivariable logistic regression model compared marijuana use in “caregivers” and “expectant caregivers.” We stratified the analyses by age and also assessed the association between caregiving intensity and marijuana use. Among younger individuals (18-49 years), informal caregiving was associated with higher odds of marijuana use. In this group, higher prevalence of marijuana use was positively associated with care intensity. There was no detectable association between caregiving and marijuana use among older individuals (50 years or older). Health behaviors among caregivers differ by age. Combined exposure to informal caregiving and marijuana in young adulthood may lead to adverse long-term health consequences. Immediate effects of marijuana use may negatively influence care recipient outcomes.
Cannabis Use Among Veterans: It Should be Easier to Get Some
Authors: Bobitt Julie
Published: December 2021

and PTSD. From December 2020 – February 2021 we conducted 32 semi-structured interviews with Veterans who responded to our initial and follow-up surveys and agreed to discuss their cannabis use. We coded and themed the interviews using inductive thematic analysis. We found that many Veterans are using cannabis in place of other medications such as opioids and benzodiazepines and often do so to avoid the negative side effects. However, barriers such as Veterans Administration policies and cost of medical cannabis affect Veterans ability to obtain medical cannabis. Our results inform clinicians and policy makers on the use of cannabis as an alternative to prescription medications for treating chronic pain and other conditions in older Veterans.
Cannabis at the End of Life: A Road More Traveled
Authors: Croker J Alton
Published: December 2021

This study examines medical cannabis as a complement or alternative to palliative care (PC). Using cross-sectional survey data from 708 terminal patients in the Illinois Medical Cannabis Program, we compare those in PC (n = 115) to those who are not (n = 593). Increased odds of PC utilization were observed for prior military service, cancer diagnosis, low psychological wellbeing, and medical complexity. PC was positively associated with improvement scores for pain, and ability to manage health status. Higher pain levels were also observed for PC patients who indicated concurrent use of cannabis and opioids, compared to those not using opioids. While most terminal patients use cannabis as an alternative to PC, medical cannabis does operate as a therapeutic complement for individuals in PC to help manage pain and overall health status, and is used at higher levels of pain when patients are also using opioids.
Well-Being During the COVID-19 Pandemic: The Roles of Age, Race, and Gender
Authors: Newton Nicky , Lodi-Smith Jennifer
Published: December 2021

In the early months of COVID-19, behavioral modifications (i.e., social distancing) were the only means available to ameliorate contagion. These had widespread ramifications for well-being, although older adults showed relatively less disruption and high resilience than their younger counterparts (Carney et al., 2021). Early findings highlight the need for a life course perspective when examining reactions to COVID-19, based on social structure, personal agency, and individual differences such as age, gender, and personality (Settersten et al., 2020). The presentations in this symposium contribute to a developing body of research that delves deeper into individual lived experiences during COVID-19. Using data from the Health and Retirement Study, Ryan examines cohort and age differences in pandemic-related social contact, communication, loneliness, and well-being for women in the US, revealing that the impact of pandemic-attributed psychosocial experiences on well-being differed by age group. Newton et al. examine associations between perceptions of future time, COVID-19 disruption, and psychological well-being among older Canadian women, finding that COVID-19 disruption moderated the relationship between constrained time horizons and well-being. Birditt and colleagues assessed racial disparities in relationships between COVID-related stress, social isolation, and depression among adults aged 18-97 from the Survey of Consumers, and found ethnic/racial minorities reported greater pandemic-related stress and that stress and social isolation had detrimental effects on well-being. A discussion by Lodi-Smith will emphasize the necessity to include individual differences – age, race, gender, cohort, cultural context –when examining pandemic-related well-being in order to provide a more nuanced body of research.
The Pandemic and Older Women in the United States: Impacts on Social Networks and Well-Being
Authors: Ryan Lindsay
Published: December 2021

The current study examines the unique impacts of the ongoing COVID-19 Pandemic on the well-being of middle aged to older women from the 2020 Health and Retirement Study (n = 1252) and how their reports of social contact during the pandemic compare to age-matched women from 2018 (n = 2063). Although up to a third of women across age categories reported changes in social contact due to the pandemic, their rates of communication with friends and family were not significantly different from their counterparts in 2018. Results find expected age patterns in satisfaction with life during the pandemic), where the young-old report the highest levels. However, the association of life satisfaction with the extent to which women reported more loneliness during the pandemic was only significant among the young old and oldest old. Age differences in pandemic-specific experiences in relation to well-being are discussed within a life course developmental framework.
Comparison of Association Between Divorce and Access to Healthcare Services Among Married Immigrants
Authors: Bae Suyeong , Graham James , Nam Sanghun , Hong Ickpyo
Published: December 2021

The number of married immigrants is increasing in Korea, and family dissolution is also growing in this population. Although divorce could impact immigrants' health status, it is unclear whether they have difficulties accessing healthcare and medical services. Thus, we examined whether divorce in married immigrants is independently associated with access to healthcare services. A retrospective analysis of 11,778 adults who participated in the 2018 National Multicultural Family Survey. We used three different covariate adjustment methods (multivariate logistic regression, inverse probability of treatment weighting, 1:1 greedy propensity score matching) to examine the association between divorce and access to healthcare services after accounting for various demographic and clinical characteristics. Overall, 5.8% (n = 691) of married immigrants reported a history of divorce. The divorce group included 107 (15.5%) males and 584 (84.5%) females, with an average age of 45.17 years (SD = 10.9). The non-divorced group included 1992 males (18.0%) and 9095 (82.0%) females, with an average age of 39.1 years (SD = 10.5). After propensity score matching, all variables were balanced (all p>0.05). Individuals who experienced divorce were more likely to have difficulties in healthcare service access than those who did not experience divorce (adjusted odds ratio 1.423, 95% CI [1.075, 1.882]). Our findings revealed that divorce increased the risk of limited healthcare services among immigrants in Korea. Healthcare policymakers should be aware of the healthcare access issues in this minority population. In addition, to improve the lifestyles of minority populations, it is necessary to study their overall lives.
Feasibility and Acceptability of an mHealth ACP Tool in Primary Care
Authors: Mohan Desh , Cherry Katelin , Fofanova Tatiana , Huffman Taylor , Davis Glenn , Comito Anthony , Kozlov Elissa
Published: December 2021

With only 7% of Medicare beneficiaries having completed Advance Care Planning with their physicians, engagement in Advance Care Planning in the clinical setting has been historically low. This study investigated the feasibility of introducing the Koda Health Advance Care Planning software platform in the primary care setting, and whether patients would engage in advance care planning through this medium. The Koda platform is a video-driven, web application that guides patients through advance care planning concepts, including values and quality of life exploration, surrogate decision maker selection, life-support treatments, and advance directive completion. The study was completed over a six-month period in two primary care clinics in the Houston, Texas area. Inclusion criteria were age 55 or older, English-speaking, and capacity for medical decision making. 339 patients met eligibility criteria and had a median age of 73 (range 59-89). All participants were offered the platform, and 262 (77%) created an account and began planning for their care. Of the patients that created an account, 87% completed all ACP steps on the platform and 72% identified a surrogate decision maker. The median time spent on the platform was 18 minutes. The Koda platform appears to be a useful tool for patients and providers to improve engagement in advance care planning and improve surrogate decision maker identification. Further research is needed to understand whether the Koda platform aids in providing goal-concordant care.
Pain Among African American Family Caregivers: Association With Health Outcomes
Authors: DeGroot Lyndsay , Taylor Janiece , Travison Thomas , Skolasky Richard , Szanton Sarah , Han Haera , Saylor Martha Abshire
Published: December 2021

African Americans experience high rates of undermanaged pain as they age. African Americans often become family or informal caregivers, and undermanaged pain may have implications for their overall health and ability to perform caregiving tasks. The purpose of this study was to examine if pain was related to overall health and number of caregiving activities among African American caregivers. We used data from round 7 of the National Study of Caregiving (N= 646 African American caregivers, mean age= 57 years [SD=15]). Pain over the prior month was participant-assessed. Of this sample, 451 (69.7%) were women, 324 (50.1%) had pain, and 309 (47.8%) had multiple comorbidities. The number of caregiving activities ranged from 8 to 14 with mean of 11.6 (SD= 1.4). In a logistic regression model, controlling for income, education, and comorbidities, we found having pain in the last month was associated with lower likelihood of very good or excellent health (Adjusted OR 0.48; 95% CI 0.33 to 0.69) and greater likelihood of having depressive symptoms (Adjusted OR 2.04; 95% CI 1.34 to 3.10). In a linear regression model, however, pain was not significantly related to the number of caregiving activities (R2 = 0.04). Findings suggest that while pain is related to poorer physical and mental health outcomes among African American caregivers, even pain does not deter them from providing care for care recipients. Management of pain among African American caregivers may be beneficial for improving their own overall health and mental health.
Worship Experiences of Black Families at Dementia-Friendly Churches: A Multiple-Case Study Design
Authors: Epps Fayron , Gore Janelle , Sainz Mayra , Brewster Glenna
Published: December 2021

Literature supports the significance of religiosity as a protective factor to promote well-being for Black families facing dementia; However, minimum reports exist on the worship experiences of these families. The purpose of this multiple-case study was to report the experiences of Black families facing dementia who attended worship services at dementia-friendly churches. Data were collected through participant observations of family caregivers (n = 4) and persons living with dementia ( n = 4) during worship services and semi-structured interviews with the family caregivers over six months. Data were analyzed case by case followed by a cross-case analysis. Four overarching themes emerged: welcoming church culture, the significance of support with differences in perceived and actual support, engagement during worship service, and connectedness between the caregiver and their family member living with dementia. Family caregivers reported that their family member with dementia was attentive and expressed moments of clarity during and immediately after worship services. Religious worship can play an essential role in the quality of life among Black families affected by dementia. Health practitioners are encouraged to acknowledge the influences of religion among dementia families and integrate religious practices within interdisciplinary care plans and programs.
The Association of Meal Timing With Body Composition and Cardiometabolic Health in Obese Older Adults
Authors: Farsijani Samaneh , Glynn Nancy W , Newman Anne
Published: December 2021

Objectives: To determine the association between eating window and time of last calorie intake with body composition and cardiometabolic health in obese older adults. Methods: We performed a cross-sectional analysis on 36 community-dwelling, overweight-to-obese (BMI 28.0-39.9 kg/m2) older adults, recruited to participate in a weight loss and exercise trial. Time of food intake were extracted from three 24-hour food recalls. Eating window was calculated as the time elapsed between the first and last food intake. We recorded the time of last calorie intake either from food or drink. Blood glucose, triglycerides, high-density (HDL) & low-density (LDL) lipoprotein cholesterols were measured as markers of cardiometabolic health. Total fat and lean mass were assessed by DXA. Partial correlation was used to determine the relationships between eating window and last calorie intake with body composition and cardiometabolic markers, while controlling for sex, age, and total calorie intake. Results: On average, participants’ eating window was 12.0±1.1 hours. Time of last calorie intake in 86% of participants was between 6:00-8:00 PM. After controlling for potential confounders, longer eating windows were associated with higher triglyceride levels (P=0.032) and lower HDL (P=0.035), while no association was observed with the other cardiometabolic markers. We observed negative trends, though not statistically significant, between longer eating windows and greater weight, BMI, and fat mass. No association was observed between time of last calorie intake, body composition and cardiometabolic markers. Conclusions: Our results suggest that timing of food intake may influence cardiometabolic risk and obesity in older adults.