bluuebunny/crossref_metadata_2025 huggingface dataset:
ASSOCIATION BETWEEN PET OWNERS’ AND PETS’ PHYSICAL ACTIVITY LEVELS: A SYSTEMATIC REVIEW
Authors: Notthoff Nanna
Published: December 2023

Social support can promote physical activity (PA) participation. According to socioemotional selectivity theory, engaging in PA with or for important social partners may be particularly motivating for older adults. Recently, pets have been recognized as important social partners. Although studies and literature syntheses have compared PA levels of people with vs. without pets, less is known about whether humans and pets are actually active together, i.e., whether their activity levels are associated. We examined this question in a systematic literature review. Through searches in Web of Science and PubMed with a priori specified inclusion and exclusion criteria, we identified 17,565 potential records. A two-step screening process yielded 9 studies for inclusion in the systematic review. Using a modified version of the STROBE checklist, we rated their quality as M = 21.89 (SD = 2.93) out of 30 possible points. Of the 9 included studies, only 5 explicitly calculated the association between human and pet PA; 4 found a positive association and 1 found no association. Of the 9 included studies, 4 studies explicitly included older adults 60+ years. However, variations in the association between human and pet PA by age were not examined. It seems that humans and their pets are active together. A more thorough examination of this question could provide a basis for an intervention aimed at increasing human PA by incorporating pets. Such an intervention may be particularly suitable for older adults who have lost important human social partners or who have difficulty accessing PA group programs.
MULTILEVEL SOCIAL FACTORS OF HEALTH AND AGING AMONG DIVERSE POPULATIONS
Authors: Surachman Agus , Lawrence Jourdyn , DiMaria-Ghalili Rose Ann
Published: December 2023

While a large body of evidence increasingly documents how individual-level modifiable risk factors shape where and how people age, the aspects of the social environment in which people grow older deserve more focus. Here, we aim to identify examples of multilevel social factors that shape health and aging among samples from diverse populations and datasets. The overarching goal of this work is to yield evidence of the impact of social factors on healthy aging, specifically focusing on cognitive functioning, physical activity, unmet needs, and psychological distress for middle-aged and older adults. Our panel includes four studies focusing on distinct aspects of the social environment and outcomes that affect healthy aging. Specifically, the first presentation uses instrumental variable analysis to estimate a causal association between racial discrimination within institutional settings (e.g., housing, employment) and cognitive function measures. The second study considers neighborhood deprivation (measured using the area deprivation index and personal belief in the neighborhood) as a structural context that may strongly limit adults’ engagement in daily physical health. The third presentation identifies an association between the home environment (i.e., home disorder and disrepair) and unmet care needs (e.g., going without needed assistance with everyday activities such as eating or bathing). Our last presentation shows relationships between measures of economic status (e.g., food insecurity), social support impact, and psychological distress. We close by integrating critical findings from each study and consider the implications of each study on future research and interventions.
INSTITUTIONAL EXPERIENCES OF RACIAL DISCRIMINATION AND COGNITIVE FUNCTION: INSTRUMENTAL VARIABLE ANALYSIS
Authors: Lawrence Jourdyn , Kawachi Ichiro
Published: December 2023

In addition to enduring the ongoing and persistent legacy of structural racism in the United States, Black adults often encounter sources of social stress, like racial discrimination, that have documented associations with health outcomes. As inequities in cognitive aging persist for Black adults, research has worked to examine modifiable factors, like racial discrimination, that may serve as the basis for intervention development. The dysregulation of inflammatory biomarkers has been proposed as one pathway through which racial discrimination becomes embodied to contribute to racial inequities in cognitive function. We assessed how racial discrimination occurring in institutional settings affects cognitive function among a sample of Black and white adults from the Coronary Artery Risk Development in Young Adults (CARDIA) study. To mitigate the influences of measurement error and unmeasured or residual confounding on our findings, we used an instrumental variable analysis to estimate the unbiased, causal association between racial discrimination in institutional settings and a battery of standardized cognitive function measures. We found that increased experiences of racial discrimination had adverse impacts on cognitive function. Understanding how racial discrimination in these settings influences cognitive outcomes supplies insight into points of potential intervention at institutional and policy levels.
SOCIOECONOMIC STATUS, SOCIAL SUPPORT, AND PSYCHOLOGICAL DISTRESS IN AGING KENYANS
Authors: Muruthi James
Published: December 2023

The incidence of psychological distress is on the rise among aging Africans. Studies have indicated that in the absence of public support, relying on informal social networks might benefit the psychological health of aging Africans. However, the associations between social support, economic status, and psychological distress remain unclear in this population. This study investigated the prevalence of psychological distress among aging Kenyans and examined its relationships with economic status (indicated by standard measures for low- and mid-income populations) and perceived social support (multidimensional and provided by family, neighbors, and religious communities). Participants from rural and urban areas of Kenya completed computer-assisted personal interviews in May 2022 (N = 376). Overall, 61% reported high psychological distress. Structural equation modeling results indicated that food insecurity (β = .236, SE = .074, p < .001), sex (β = .146, SE = .056, p < .05) and self-reported physical health (β = .386, SE = .051, p < .001) positively predicted psychological distress while educational status (β = .146, SE = .058, p < .05), and flooring material (β = .107, SE = .056, p < .05) were negative predictors. The dimensions of social support were not significantly associated with the outcome variable. The findings illuminate that psychological distress is a critical health concern for the sample and needs targeted health interventions. They also underline the critical role of economic status on the psychological distress of aging Kenyans. Future studies should further explore these relationships, especially using longitudinal and representative data.
IDENTIFYING NEW INTERVENTION TARGETS TO REDUCE RISK OF ELDER ABUSE AND NEGLECT IN DEMENTIA FAMILY CAREGIVING
Authors: Pickering Carolyn , Winstead Vicki , Hernandez-Tejada Melba
Published: December 2023

Persons living with dementia experience higher rates of abuse and neglect than their cognitively intact peers. Caregiver burden, including stress related to management of behavioral symptoms, has been repeatedly shown as a risk factor for family caregivers’ use of abusive and neglectful behavior. However, interventions intended to reduce caregiver burden and stress and improve management of behavioral symptoms often produce only small effect sizes and are not successful in translation. Therefore, it is important to identify other modifiable risk factors to serve as intervention targets to reduce and prevent elder abuse and neglect in dementia family caregivers. The purpose of this symposium is to understand the role of three potential targets for which there are efficacious interventions available: alcohol consumption, family conflict and self-compassion. The first paper presents the differential impact of screening positive for alcohol use disorder and daily drinking patterns on risk of neglect, physical and psychological abuse. The second paper examines the role of family conflict on a caregiver’s use of abusive and neglectful behaviors, including how risk varies by the relationship type (e.g., adult child caregiver vs spouse). The third paper discusses the protective effect of self-compassion on daily risk of abuse and neglect, including the buffering effect it has on daily stress appraisal. The discussant will highlight implications and future directions for intervention research, including how the field may shift to a personalized approach to intervention delivery to match the right intervention to the right person.
DYNAMIC IMPACTS OF FAMILY CONFLICT ON ELDER ABUSE AND NEGLECT AMONG ADRD CAREGIVERS
Authors: Browning Wesley , Chilatra Jessica Hernandez , Yildiz Mustafa , Winstead Vicki , Pickering Carolyn
Published: December 2023

Conflict with other family members impacts dementia caregivers’ well-being and stress-appraisals and may also influence their use of elder abuse and neglect (EAN). To test this, we utilized latent class analysis to classify spouse, adult child, grandchild, and nontraditional (step- and in-laws) caregivers (N = 453) based on family conflict levels at baseline. Caregivers were classified into four groups: “low,” “moderate,” “high,” and “EAN accusations.” Spouses were significantly more likely to be in the “low” class compared to other classes. Nontraditional caregivers were more likely to be in the “EAN accusations” class versus the “moderate” class (β = 1.73, SE = .70, p < .05). Belonging to the EAN accusations class predicted EAN at baseline (t = 3.728, p < .001). Next, dynamic structural equation modeling was used to test whether stress from family conflict on a given day predicts use of EAN behaviors. Family conflict stress predicted EAN on the same day (β = 0.05, 95% CI = 0.03-0.07), but not the subsequent day (CL= -0.01, 95% CI = 0.03-0.02). Similar models were conducted for each relationship type. The effect of family conflict stress on EAN was not significant for spouse and grandchildren but remained significant for adult child and non-traditional caregivers. Findings suggest interventions related to conflict management and communication among caregiving families may be beneficial new intervention targets for reducing EAN in ADRD. Addressing family conflict may be most important when the caregiver is an adult child or nontraditional relationship.
ALCOHOL CONSUMPTION AND ABUSIVE/NEGLECTFUL BEHAVIORS AMONG FAMILY CAREGIVERS OF PEOPLE LIVING WITH DEMENTIA
Authors: Chilatra Jessica Hernandez , Browning Wesley , Yildiz Mustafa , Winstead Vicki , Pickering Carolyn
Published: December 2023

Despite its suspected role in elder abuse and neglect (EAN), little is known about alcohol use disorders (AUD) among family caregivers of people with Alzheimer’s disease and related dementia (ADRD). As part of a micro-longitudinal study in which caregivers completed 21 daily surveys about their caregiving experiences, we examined the effects of daily drinking behaviors and screening positive for hazardous drinking (based on the Alcohol Use Disorder Identification Test (AUDIT-C)) on the daily risk of EAN. A generalized linear mixed model with days (n = 9513) nested within caregivers (N=453) was used to evaluate the relationships between caregivers’ alcohol consumption patterns and the odds of using an abusive and/or neglectful behavior. Caregivers’ alcohol consumption on a given day increases the odds of using physical abuse (OR=2.19; 95% CI=1.12–4.28; p=.022), psychological abuse (OR=1.40; 95% CI=1.01–1.94; p=.041) and neglect (OR=1.48; 95% CI=1.17–1.86; p=.001) that same day. Screening positive for AUD significantly increases the odds of a caregiver’s use of neglect on a given day (OR=2.43, 95% CI=1.52–3.88, p=<.001), but not physical or psychological abuse. There were no interaction effects between AUD and daily drinking, meaning AUD increases the risk of neglect independent of daily drinking behavior. Interventions to manage AUD may reduce the risk of neglect among ADRD caregivers experiencing hazardous drinking. Interventions focused on daily drinking behaviors are needed to reduce the general risk of EAN among ADRD caregivers. Findings show that subpopulations exist within ADRD caregivers who engage in EAN behaviors that would benefit from different targeted interventions.
BUILDING BRIDGES AND CATALYZING RESEARCH FOR EVIDENCE-BASED INFECTION CONTROL: PROJECT ECHO FOR NURSING HOMES
Authors: Behrens Liza , Heilbrunn Emily , Boltz Marie
Published: December 2023

Nursing homes were ill-equipped for the pandemic; though facilities are required to have infection control staff, only 3% have taken a basic infection control course. Significant research has focused on infection control in the acute care setting; however, little is known about the implementation of infection control practices in long-term care communities. In this symposium, we will describe findings from the Project ECHO for Nursing Homes- a national, Patient-Centered Outcomes Research Institute (PCORI) funded study. First, Dr. Kraschnewski will present over all study findings from the stratified, cluster randomized controlled trial of 136 nursing homes that participated in up to 33 weeks of best-practice training to improve COVID-19 infection control practices. Next, Dr. Calo will present on implementation outcomes at 6-months including readiness for change and the implementation climate in the NH. Next, Ms. Heilbrunn will discuss the impacts of implementing evidence-based infection control practices through COVID-19 on NH residents’ well-being. Finally, Dr. Behrens will describe NH leadership perspectives (n=14) on preparing and maintaining care quality during times of diminishing resources. Data presented in this symposium can guide NHs in strategies to implement evidence-based infection control in their homes and informs researchers who are looking to implement similar implementation studies in the NH setting.
SLEEP REGULARITY, SLEEP TIMING, AND COGNITIVE PERFORMANCE AMONG WOMEN ENTERING EARLY OLDER AGE
Authors: Derby Carol , Hood Michelle , Hall Martica , Joffe Hadine , Thurston Rebecca , Kravitz Howard , Swanson Leslie
Published: December 2023

Poor sleep health is a modifiable behavior linked to cognitive impairment risk. While prior work has focused primarily on sleep quantity and quality, emerging evidence suggests the importance of sleep timing and regularity. We examined whether sleep timing and regularity were associated with cognitive performance within a diverse cohort of women ages 60.5-72.2 years, and tested whether associations were independent of sleep duration and quality (wake after sleep onset). The sample included 1178 SWAN women who completed 4-7 nights of actigraphy and cognitive testing at the 15th SWAN follow-up in 2015-2016, [Mean age 65.5 (± 2.63 years); 25% Black, 12% Chinese, 6% Hispanic White, 11% Japanese, 46% Non-Hispanic White]. Sleep timing was defined as the midpoint time between sleep onset and waking, averaged across nights and was dichotomized as healthy (2am – 4am) or unhealthy (outside 2am – 4am). Sleep regularity was defined as the standard deviation of the sleep midpoint across nights. Associations of sleep regularity and timing with verbal episodic memory (East Boston Memory immediate (EBMT-I) and delayed (EBMT-D)), and processing speed (Symbol Digit Modalities) were examined using linear regression. Covariates included sleep duration and quality, age, race/ethnicity, education, economic hardship, depression, comorbidities, medications, alcohol use, vasomotor symptoms and testing language. Greater sleep irregularity was associated with worse verbal memory (EBMT-I β= -0.29; p=0.02; EBMT-D β= -0.36; p=0.007). Sleep midpoint outside the healthy range was associated with slower processing speed (β= -1.48; p=0.017). Sleep timing and regularity may be important targets for interventions aimed at preserving cognitive health.
ACCESSING AND UTILIZING SWAN DATA AND BIOSPECIMENS FOR NEW RESEARCH QUESTIONS
Authors: El Khoudary Samar , Santoro Nanette , Harlow Sioban , Colvin Alicia , Avis Nancy , Karvonen-Gutierrez Carrie , Brooks Maria
Published: December 2023

Sharing scientific resources is a critical component of contemporary research. Data and specimens from established studies can be used for manuscripts on special topics and research projects from experienced investigators and advanced trainees. Researchers external to a study, however, may find it challenging to identify available resources and to determine the steps required to access them. This presentation will describe the SWAN datasets, specimens and documents that are housed at the NIA Aging Research Biobank. It will review the process for requesting the archived resources, provide tips for successful applications, and explain the data and/or material transfer agreements created for research projects. The SWAN longitudinal cohort study aims to understand variations in the experience of reproductive aging and its impact on midlife and early old age outcomes across multiple racial and ethnic groups. SWAN includes 3302 women aged 42-54 years from 7 sites in the United States and consists of a baseline and 17 follow-up visits. The study has repeated measures of reproductive hormones, menopausal symptoms, sleep, genitourinary and sexual function, physical and cognitive function, cardiometabolic and bone health, psychological well-being and quality of life. Serum, plasma, and urine specimens were collected at each clinic visit, and a substudy obtained daily urine for ≤50 days annually for ≤10 years. An expansive collection of SWAN biospecimens and datasets are available to external investigators and trainees. Understanding the existing resources and processes required to access them provides researchers the opportunity to use these valuable resources to advance academic research.
CONTEXTUAL FACTORS IN AGING AND LONG-TERM SERVICES AND SUPPORTS RESEARCH
Authors: Fabius Chanee , Ornstein Katherine
Published: December 2023

In the coming years, there will be more older Americans living in the community with extensive medical and long-term care needs increasing the need for long-term services and supports (LTSS) that assist with routine daily activities (e.g., bathing, dressing, medication management). Increasingly research studies are examining factors associated with receipt of LTSS including care preference, family availability and financial resources. Yet LTSS care experiences are likely a result of factors that extend beyond personal preference or individual factors, such as neighborhood quality. availability of home care workers, and state policy characteristics (e.g., state Medicaid generosity). Little research to date has examined how the LTSS environmental context affects the health and well-being of older adults with disabilities and their caregivers. In order to improve LTSS research we need to expand analyses to consider relevant contextual factors. This symposium will feature five presentations that provide novel insight regarding social and physical contextual factors contributing to LTSS using multiple data sources. We will describe (1) a conceptual framework of LTSS-relevant environmental domains and associations between select LTSS-relevant characteristics and older adult care experiences, (2) the relationship between neighborhood deprivation and place of death, (3) care experiences of older Medicare-Medicaid enrollees living in counties with Medicaid Managed Long-Term Services and Supports, (4) trends in paid home care employment and state public financing, and (5) associations between adverse consequences due to unmet, LTSS use, and social isolation.
ASSOCIATION BETWEEN NEIGHBORHOOD DEPRIVATION AND PLACE OF DEATH: A POPULATION STUDY
Authors: Mather Harriet
Published: December 2023

While recent decades have witnessed an overall trend away from deaths in hospitals and facilities and towards deaths at home, socioeconomic disparities persist. Minoritized individuals while less likely to die in a nursing facility are more likely to die in hospital and (except for dementia) less likely to die at home; more educated individuals are also less likely to die in a nursing facility but conversely less likely to die in hospital and more likely to die at home. Despite growing interest in the role of neighborhood-level factors in health disparities, no studies have examined the impact of neighborhood deprivation on place of death. Using a representative sample of Medicare beneficiaries (n = 3043) drawn from the National Health and Aging Trends Study, we examined the association between census-tract level social deprivation index (quartiles) and place of death (home vs all else, hospital vs all else, nursing facility vs all else, hospice residence vs all else) in a series of multivariable regression models, adjusting for relevant sociodemographic (age, sex, race, education, income) and clinical covariates (dementia, heart disease, lung disease, cancer). Compared with residence in the least deprived quartile, residence in a neighborhood in the most deprived quartile was associated with reduced odds of home death (aOR: 0.66 (0.45, 0.99)) and increased odds of death in a nursing facility (aOR: 1.68 (1.00, 2.80)). Future studies should confirm these findings and examine mechanisms through which neighborhood deprivation impacts place of death (including availability and quality of home-based clinical care.
CHARACTERISTICS AND CARE EXPERIENCES OF OLDER DUAL-ENROLLEES LIVING IN AREAS WITH MEDICAID MANAGED LTSS
Authors: Jopson Andrew , Fabius Chanee , Wolff Jennifer
Published: December 2023

Medicaid-funded long-term services and supports (LTSS) are foundational in helping older dual-enrollees with disabilities remain in the community. Over the past decade, nearly half of U.S. states have transformed LTSS delivery through managed LTSS (MLTSS) with the goal of improving care coordination and avoiding unnecessary health care utilization. Despite this rapid growth, no prior studies describe whether characteristics and care experiences of older dual-enrollees differ between counties with and without MLTSS. We draw on the nationally representative 2015 National Health and Aging Trends Study (NHATS) linked to the census tract of participants’ place of residence to examine differences in demographic characteristics, health, and care experiences of older dual-enrollees with LTSS need (n=462) by county-level presence of MLTSS. We broadly defined LTSS need as receiving assistance with one or more self-care or mobility activity or having probable dementia. More than half (56.9%) of older dual-enrollees with LTSS need lived in counties with MLTSS. Hispanic/other individuals were three times more likely to live in counties with (versus without) MLTSS presence (54.2% vs. 15.8%, p<0.0001) while individuals living in rural regions less likely to live in counties with MLTSS presence (8.8% vs. 31.8%, p<0.05). There were no differences in age, gender, self-reported health, dementia status, or number of chronic conditions of the sample population by MLTSS presence. Similarly, no differences were observed in experiencing adverse consequences from unmet care needs or social participation restrictions by MLTSS presence. These results are a foundational step toward building evidence and understanding who MLTSS programs are serving.
THE GROWTH OF THE HOME CARE WORKFORCE FROM 2000 TO 2019 AND THE ROLE OF PUBLIC FINANCING
Authors: Shen Karen , Ballreich Jeromie , Fabius Chanee , Ornstein Katherine , Reckrey Jennifer
Published: December 2023

Between 2000 and 2019, employment in home care industries grew from under one million workers to more than 3.5 million workers in 2019. However, there is significant variation across states in this growth, with some states experiencing over 300% growth in the share of the population employed in home care, and some states experiencing growth of less than 30%. This study uses state-level data from a variety of sources to explain this variation in growth across states and to quantify the contribution of different demand- and supply-side factors to the growth in the home care workforce. On the demand side, we consider changes in public financing (Medicaid HCBS spending, Medicare home health and hospice reimbursements), population aging and chronic disease burden, and nursing home capacity. On the supply side, we examine changes in the share of the non-elderly population in a state that is foreign-born, and the share without a college education, as these populations are significantly more likely than average to work in the home care industry. We find that demand-side factors can explain almost all of the variation in growth across states. In particular, the growth of public financing in Medicaid and Medicare–which nationally increased by 222% and 140%, respectively, over this period–can explain the majority of the variation in growth across states. These results have implications for understanding differences in the size of the workforce across states, which may impact older adults and persons with disabilities’ access to paid home care.
FEATURES OF LEARNING FROM HIGH-FREQUENCY COGNITIVE ASSESSMENTS AS DIGITAL BIOMARKERS OF COGNITIVE CHANGE
Authors: Oravecz Zita , Vandekerckhove Joachim , Wang Cuiling , Katz Mindy , Hakun Jonathan , Sliwinski Martin
Published: December 2023

In measurement burst designs, participants’ cognitive performance is measured multiple times per day, for several days, forming a measurement burst. Ideally, these are repeated once or twice a year as people age. Such rich longitudinal data are generated by multiple processes (e.g., aging and learning) that operate on multiple timescales. We propose a Bayesian process model that can extract person-specific, substantively meaningful features of learning and change from such data. We show how to model retest gains across measurement bursts, as well as warm-up effects within a burst, while quantifying change across bursts in peak performance and accounting for short-term within-person variability. Individual differences in these features are also linked with psychosocial variables and biomarkers of cognitive decline in a one-step analysis. We also highlight how this approach allows for drawing intuitive inferences on cognitive decline with Bayesian posterior probabilities.
ASSISTED LIVING ADMINISTRATORS’ PERSPECTIVES OF HOW COVID-19 AFFECTED DIRECT CARE STAFF
Authors: Vogel Carlyn , Dobbs Debra , Peterson Lindsay , Molinari Victor , Meng Hongdao
Published: December 2023

Background

Coronavirus disease 2019 (COVID-19) presented many new challenges within assisted living communities (ALCs) and exacerbated preexisting challenges. With high quality of care in ALCs as the continuous goal to achieve, it is important to recognize challenges faced in these communities, especially those related to staffing and COVID-19. Objective: The objective was to investigate issues related to staffing and the effect of COVID-19 in ALCs, including staff absence, leadership, impacts on staff, and impacts on staff retention.

Methods

Participants were ALC administrators (N=129) from the parent study of the Strategic Approach to Facilitating Evacuation by Health Assessment of Vulnerable Elderly in Nursing Homes II (SAFEHAVEN II) funded by the National Institute on Aging. Quantitative analysis was used to determine structure and process characteristics of ALCs during COVID-19 that impacted a process outcome. Qualitative analyses were used to gain perspectives of administrators about the impact of COVID-19 within their ALCs.

Results

Provision of memory care services (structure characteristic), challenge with staff sent home to comply with COVID-19 precautions, challenge paying staff for time off due to COVID-19, and staff anxiety (process characteristics) were significant predictors of staff absence from work (process outcome). Three key themes interpreted from administrators’ interviews were Leadership Shown Toward Staff, Impact of COVID-19 on Staff, and Impact of COVID-19 on Staff Retention. Implications: This dissertation discusses implications for research, policy, and practice to inform continual efforts to improve aspects of staffing and the quality of resident care in ALCs.
DEVELOPMENT AND VALIDATION OF THE MINNESOTA AL REPORT CARD FOR RESIDENT QUALITY OF LIFE DOMAINS
Authors: Bucy Taylor , Shippee Tetyana , Kohli Nidhi
Published: December 2023

Assisted living (AL) describes long-term residential care settings that emphasize person-centered services and choice in a “home-like” environment. There is considerable variability in how AL is defined, what services are provided, and how quality is measured. Minnesota serves as a unique policy environment in which to study AL. In May 2019, Minnesota funded the development of an AL Report Card to measure and report on the quality of AL from resident and family perspectives, created in partnership with the University of Minnesota. Literature review, stakeholder feedback, and pilot testing were completed in 2020-21 and the survey was implemented statewide in 2021-22. Using 2021 AL resident quality of life (QoL) survey pilot data (N=1,392), the goal of this work was to assess the reliability and psychometric properties of the survey in measuring 7 QoL domains: food, staffing, environment, engagement, autonomy, culture, and security. The 7 domains were measured using 6, 10, 3, 6, 5, 3, and 6 items, respectively. We found acceptable internal consistency for four QoL domains: food, staff, security, and engagement (McDonald’s omega and Cronbach’s alpha ≥0.6). Confirmatory factor analysis was performed for each individual factor using diagonally weighted least squares for ordinal data. We found high interfactor correlations between the three domains with poor internal consistency (environment, culture, and autonomy). We collapsed these three domains into one overarching domain – climate – and found satisfactory data-model fit. Findings of stability and validity of QoL report card domains have important implications for adoption outside of Minnesota.
POSTTRAUMATIC GROWTH DURING COVID PANDEMIC AMONG OLDER ADULTS: A MIXED METHODS STUDY
Authors: Chiang-Hanisko Lenny , Liehr Patricia
Published: December 2023

COVID has impacted life for the older adult population living in residential settings affecting psycho-social well-being. Risk for COVID is associated with increasing age and pre-existing health conditions. The purpose of the study was to investigate the post-traumatic growth (PTG) experience among older adults, and the impact of COVID and associated regulatory precautions, on well-being for older adults living in a continue care community (CCC). A parallel mixed-methods approach was used to explore the experience of older adults with PTG. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed using content analysis to identify emergent themes most frequently reported from open-ended responses. Older adults (N=98) living in a single CCC completed the survey. Age ranged from 67-99 years (mean = 86) with over 90% identifying as non-Hispanic White; and female (75%). Over half (51%) reported social-psychological issues, including anxiety (32%) and depression (31%); 41% reported knowing residents who died during COVID, attributed to will to live (35%), social isolation (30%) and coexisting health conditions (75%). Qualitative analysis revealed 13 subthemes related to 5 major PTG concepts: New possibilities, relating to others, personal strength, spiritual growth and appreciation for life. This study provides a deeper understanding of how older adults residing in a CCC coped with COVID and their experiences. Results indicated that older adults experienced positive changes and PTG despite challenges. Healthcare providers should recognize these potential positive changes and growth and use them as a source for improving older adult well-being when facing pandemic challenges.
UNMET CARE NEEDS DURING THE COVID-19 PANDEMIC
Authors: Curl Angela , Roberts Amy
Published: December 2023

Background

Few studies have examined the characteristics of individuals who experienced unmet care needs during the COVID-19 pandemic (a time when more needs may have gone unmet).

Methods

Using 2020 data from the Health and Retirement Study, this study selected a sample of respondents over the age of 50 who reported difficulty with completing activities of daily living (ADL; eating, bathing, dressing, toileting, toileting; N=685). Unmet ADL need (outcome) was defined as having difficulty performing one or more ADLs but not receiving help performing that ADL. A logistic regression analyzed predictors of unmet ADL need, using the predictors of cognitive ability (range 0-27; Crimmins et al., 2011), self-rated eyesight, self-rated hearing, education, age, gender, race, marital status, and having a child living within 10 miles. Findings: Females were less likely to report an unmet ADL need (OR=0.66, p=.03), as were married/partnered respondents (OR=.52, p<.01). In contrast, respondents with higher cognitive ability were more likely to report unmet ADL needs (OR=1.04, p=.02). The remaining predictors were not statistically significant.

Discussion

Having difficulty with basic ADLs and lacking assistance through formal or informal caregiving can increase the risk for a serious adverse event or nursing home placement. While those with higher cognitive ability could make use of creative workarounds (e.g., assistive devices); they may also have been perceived as having less need of assistance from others. By identifying groups who are more likely to have unmet ADL needs, outreach, assessment, and intervention outreach efforts can be targeted to those at greatest risk.
METABOLOMIC SIGNATURES OF AGE, EXTREME OLD AGE, AND LONGEVITY IN LONG LIFE FAMILY STUDY PARTICIPANTS
Authors: Sebastiani Paola , Sog Zeyuan , Lustgarten Michael , Perls Thomas , Monti Stefano , Andersen Stacy , Schwaiger-Haber Michaela , Patti Gary
Published: December 2023

Serum metabolomics of aging has been a growing area of interest and several studies have identified metabolites that correlate with chronological age. The Long Life Family Study (LLFS) has generated serum metabolomics of individuals aged 30 to 110 years and several years of follow up, and offers a unique opportunity to identify (1) a robust signature of age; (2) a signature of extreme old age that differs from the age-related signature; and (3) a signature that predict survival. We analyzed 409 general metabolites and lipid species in approximately 2700 LLFS participants and used a state-of-the-art computational approach with mixed effect models and whole genome sequence data to model within family relation. The analysis identified 305 metabolites that correlate with age at 5% false discovery rate (FDR), 30 metabolites that are not age related and differ in centenarians compared to younger individuals, and 144 metabolites that predict survival at 5%FDR. The aging signature included well known markers: eg ergothioneine and tryptophan that decreased with older age, and was enriched for carbohydrates, organic acids, and several lipid classes. The extreme old age signature was enriched for glycerolipids and glycerophospholipids. The metabolomics signature of survival was enriched for nucleic and organic acids. Comparison with other studies showed strong agreement of results and also highlighted unique finding in extreme old individuals. The analysis also showed substantial variability of serum metabolomics at different ages, thus confirming the heterogeneity of molecular signatures of age and the opportunity to discover specific molecular profiles that promote heathy aging.
DEVELOPING A GERIATRIC EMERGENCY DEPARTMENT BY FOCUSING ON THE THREE PS: PEOPLE, PROCESSES, AND PLACE
Authors: Schumacher John , Melady Don
Published: December 2023

Older patients’ emergency department (ED) visits in the U.S. rose a surprising 30% during the period 2015-2019 to about 28 million visits annually. Many EDs are now examining emerging geriatric emergency department (GED) models of care to address the care needs of this population. This paper provides a practical overview of how to develop a GED and introduces the 3 Ps model focusing attention on the ED’s People, Processes, and the Place thereby providing a clear framework for practical GED development. Key resources facilitating GED development includes: the national GED Collaborative (GEDC) organization, the nationally endorsed GED Guidelines, and resources associated with the Geriatric Emergency Department Accreditation process. Core clinical elements needed to create a GED’s operations are found in its care processes including: 1) General approaches to the patient; 2) Screening for high-risk conditions; 3) Enhanced assessment for older patients; 4) potential workflow alterations; and 5) Attention to transitions into and out of the ED. The paper concludes by provides additional practical guidance to EDs seeking to enhance the ED experience of older people and improve the quality of their outcomes.
EFFECTS OF MINDFULNESS ON COGNITION IN ADULTS WITH MILD COGNITIVE IMPAIRMENT: A META-ANALYSIS
Authors: Lin Rose , Su Jingjing , Heffner Kathi
Published: December 2023

Mindfulness, or present-moment awareness, has been linked to greater psychological well-being and cognitive health in older adults. Recent studies on mindfulness-based intervention further explored its cognitive benefits in adults at the preclinical stage of dementia, yet showing mixed results. Therefore, this meta-analysis synthesizes the effects of mindfulness-based intervention on cognitive function for adults with mild cognitive impairment (MCI). Literature search was conducted in MEDLINE, EMBASE, PubMed, CINAHL, Web of Science, and Scopus. Randomized controlled trials that examined the effects of a mindfulness-based intervention on cognitive function in adults with MCI were included. Study effects were calculated by standard mean difference (SMD) and its 95% confidence interval using random effects model. Meta-regression was conducted to test the effects of methodological quality and intervention characteristics (qualification of interveners, types of mindfulness approach and control treatment) on trial effectiveness. Twelve trials involving 530 participants (female=64.26%, mean age=71.21 years) were included. Half of the reviewed studies were pilot trials with a mean attrition rate of 18.7%. Pooled evidence suggested that mindfulness-based intervention exerts a small-to-moderate effect on global cognition (SMD=0.40;95%CI[0.14,0.66]), visuospatial ability (SMD=0.25;95%CI[0.03,0.48]) and long-term memory (SMD=0.21; 95%CI[0.01,0.41]). No significant effect was detected for short-term memory, executive function, and attention. Meta-regression showed that none of the covariates moderate the treatment effect. This meta-analysis suggested that mindfulness-based intervention might improve cognitive function and its more specific domains in adults with MCI. More research with larger sample is warranted to confirm the effectiveness and examine the underlying mechanism to explain the improved outcomes.
EVALUATE THE IMPACT OF INTERDISCIPLINARY EDUCATION AND TELEHEALTH PRIMARY CARE: QUALITY AND EFFICIENCY
Authors: Yoo Ji , Shen Jay
Published: December 2023

In a provider shortage area, an Interprofessional Education and Telehealth Primary Care (IPETC) for geriatrics workforce was developed in 2020. To analyze the impact of IPETC on quality and efficiency of care, we measured quality outcomes defined by the CMS defined quality measures - dementia caregiver education/referral and advance care plan, and efficiency outcomes by estimating healthcare cost savings from reducing hospitalization. Two-hundred forty-four community-dwelling adults aged 60 to 97 with mild to moderate dementia were selected in an urban safety-net primary care clinic. Propensity - demographics and comorbidity was matched. Main outcomes were (A) number of hospitalization and 90-day rehospitalization rate, hospitalization-related healthcare cost estimates from the State Inpatient Dataset using the ICD-10 codes of principal diagnosis and hospital length of stay between January-December 2021. One-hundred twenty-two patients were cared by primary care providers who received the IPETC;122 patients were by those who did not have the IPETC; (2) CMS quality measures were compared between 2019 (baseline) and 2021 of patients cared by providers with IPETC. Number of hospitalization with IPETC was fewer than those without IPETC (0.72 vs. 1.38, p < .01). Number of 90-day rehospitalization with IPETC was fewer than those without IPETC (0.14 vs. 0.30, p < .01). An average cost-saving of $20,289 per patient was observed among those with IPETC than those without IPETC (p < .001). CMS quality measures improved from 15.6% to 51.0% in dementia caregiver education/referral; 10.2% to 24.7% in documented advance care plans.
THE HOSPITAL TO HOME TRANSITION: EFFECTS OF LIFE CHANCES AND LIFE CHOICES ON UNPLANNED HOSPITAL READMISSIONS
Authors: Yeatts Dale , Cready Cynthia
Published: December 2023

Roughly 18% of all patients discharged from hospitals in the United States experience an unplanned hospital readmission (UR) within 30 days which can be life-threatening to patients and extremely costly for the health care system. Medicare alone paid $900.8 billion in 2021, or 21 percent of total national hospital expenditures. A promising theory for adding to our understanding of the causes for URs is Health Lifestyle Theory (HLT). It proposes that structural factors (e.g., SES, hospital procedures) affect one’s life chances and that socialization and personal experiences affect one’s life choices and the two merge to produce a person’s health lifestyle. The purpose of our study was to consider the ability of HLT to explain why some patients recover after hospital discharge while others experience URs. To accomplish our purpose, we interviewed 37 patients in their homes who had been discharged from a regional hospital in north Texas roughly 30 days prior to being interviewed. All the patients had been admitted for various serious illnesses. Fourteen of the patients had experienced an UR. Qualitative analyses included open and focused coding. Data from those experiencing an UR and those avoiding an UR were analyzed separately. We found the HLT to provide sound reasons for patients experiencing recovery or URs. Those who experienced an UR were found to have similar life chances caused by structural factors and similar life choices based on their socialization and personal experiences. Specific structural factors and personal experiences associated with life chances and life choices are presented.
WHEN OLDER ADULTS GOT TRAUMATIC INJURY: EFFECTS OF CASE MANAGEMENT
Authors: Kao Hsueh-Fen , Jimenez Sarah
Published: December 2023

Case management can improve patient outcomes from the acute to rehabilitation phase after traumatic injury. However, a lack of evidence on effects of case management in older patients with traumatic injury makes it difficult to translate research findings into practice. The study was to examine the effects of a case management intervention on illness perception, coping strategies used, and quality of life in older patients with traumatic injury across a 9-month span after hospital discharge. A 4-wave longitudinal, experimental design was used in older patients with traumatic injury hospitalized at a regional hospital in Taiwan. Subjects were randomly assigned to case management (experimental) or usual care (control) group. The intervention started during hospitalization and ended with a phone follow-up two weeks post discharge. Illness perception and/or coping strategies used along with health-related quality of life were measured at baseline, 3, 6 and 9 months after discharge. Generalized estimating equations were used for analysis. Findings showed significant differences of illness perceptions at 3 and 6 months as well as coping strategies used at 6 and 9 months after discharge between the two groups. However, no significant difference on quality of life over time between the two groups was found. While case management appears to help older patients with traumatic injury decrease illness perception and better cope with their injury, it does not significantly improve their quality of life nine months after discharge. It is recommended that healthcare professionals develop a comprehensive long-term case management program for older patients with traumatic injury.
GERIATRIC WORKFORCE ENHANCEMENT PROGRAMS AS AAA AGE-FRIENDLY INITIATIVES PARTNER
Authors: Severance Jennifer , Edelman Linda , Gordon Barbara , Luk-Jones Susanna , Telonidis Jacqueline , Morgan Jennifer
Published: December 2023

The Health Resources and Services Administration funded 48 Geriatric Workforce Enhancement Programs (GWEPs) to partner with community-based organizations in addressing gaps in health care for older adults, promoting Age-Friendly ecosystems, and addressing social determinants of health. This paper discusses three GWEPs collaborative projects with Area Agencies on Aging (AAAs) that deliver community-based programs . The University of Utah’s GWEP, a rural AAA, the Alzheimer’s Association, and the Utah Department of Veterans and Military Affairs provided a hybrid Dementia Caregiver Conference to six counties, reaching 65 in-person attendees and 10 senior centers online. Attendees agreed the content met their educational needs, would positively influence care, and was motivation to form a caregiver coalition. The University of Louisville Trager Institute (Trager), AAA, and Kentucky Coalition for Healthy Communities provided focused regional training and sharing of community resources utilizing the Project ECHO training model for 11 AAA regions, reaching 412 home and community-based services professionals. The University of North Texas Health Science Center, AAA, and emergency management services expanded evidence-based programs in falls prevention, medication safety, and dementia caregiving, serving an additional 23 urban postal codes, rural counties, and over 1,900 individuals. These examples utilize unique community relationships and partnership strategies to identify local needs, maximize older adult and family caregiver engagement, measure outcomes, and achieve GWEP goals to educate diverse, underserved and rural communities.
IMPLEMENTATION AND RESULTS: THE ZESTFUL LIVING PROGRAM FOR OLDER ADULTS RESIDING IN CNY ASSISTED LIVING FACILITIES
Authors: Seo Minjung , Pagan Mary Theresa
Published: December 2023

Studies indicate that older adults experiencing more interactions with younger ones through health promotion programs perceive better health and life satisfaction than their counterparts. Positive attitudes toward aging and self-efficacy working with older adults are essential attributes for professionals entering gerontology fields. The aim of this study is two-fold, to examine the changes in attitude toward aging and self-efficacy to work with older adults among young adults and to investigate changes in perceived physical and mental health among older adults participating in the Zestful Living Health Promotion Program in an assisted living facility in Upstate New York. A mixed method design (questionnaire and interview) was used on seventy-five older adults (Male: 15, Female: 49) and eighty-two college students. The five-week program theoretical framework utilized tenets from social learning theory and the behavioral change model. This evidenced-based program included exercises, memory training, stress reduction activities, and interactive games using implementation strategies such as health communication, health information, behavioral modification, and positive reinforcement. Results indicate attitudes toward aging and self-efficacy to working with older adults significantly differed before and after program implementation (P <.004, P <.0001). The potential benefits of this approach include improved perceived mental and physical health among older adults during five weeks with low resource allocation as a university supported. Sustainable programs like the Zestful Living Program provide research and outreach opportunities within assisted living facilities.