bluuebunny/crossref_metadata_2025 huggingface dataset:
GENTRIFICATION, AGING, AND HEALTH: A NARRATIVE REVIEW
Authors: Bailey Dionne
Published: December 2023

Multiple definitions of gentrification exist, and the lack of consensus about what constitutes gentrification has limited the efforts of this concept’s measurement/operationalization as well as an understanding of how gentrification influences outcomes, particularly for older adults. The objective of this literature review is to synthesize existing definitions and measurement approaches to gentrification in studies of older adults and their communities. Another objective is to summarize the health implications of gentrification for older adults. OVID Medline, CINAHL, Academic Search Premier, PsycINFO, and Scopus were searched in order to identify peer-reviewed articles that were published up to August 2022. ‘Gentrification’ and ‘Aging’ were the keywords utilized to search for peer-reviewed articles. Post abstract screening, each article was annotated to identify key study characteristics and tabulated to identify patterns and themes. Forty-nine articles were identified and extrapolated. The analysis revealed inconsistencies in the definition of gentrification, which lead to mixed findings related to the health effects of gentrification for older people. Specifically, it was found that there are both positive and negative effects of gentrification. The most consistent findings evident were that minorities were most at-risk during periods of gentrification, particularly Black older adults. It is imperative that a scientific consensus is reached when defining and subsequently operationalizing gentrification. Such refinements will result in more robust and rigorous quantitative and qualitative research that describes the health implications and/or lived experiences of gentrification for older adults.
LIVING FOREVERWELL IN RURAL AMERICA: RESULTS FROM A QUALITATIVE EVALUATION OF A YMCA HEALTHY AGING PROGRAM
Authors: Kappel Rachel , Bayne Alycia , Popat Shena , Frank Mabel , Hasson Seana , Mondick Lindsay
Published: December 2023

Older adults benefit from community programs that promote physical and mental health, reduce social isolation, and offer connections to community resources. However, older adults living in rural communities have access to fewer health and social services and experience barriers to participation such as access to transportation. Recognizing these challenges, the YMCA of the USA (Y-USA) expanded ForeverWell, a healthy aging model, to 17 YMCAs (“Ys”) serving adults aged 55+ living in rural areas. Developed by the YMCA of the North in Minnesota, ForeverWell is a flexible set of Y activities focused on five dimensions of healthy aging: mind, body, community, spirit, and nature. The goals of ForeverWell are to improve health and well-being, decrease social isolation, and increase community connections among older adults. NORC at the University of Chicago conducted a qualitative evaluation of ForeverWell’s expansion in 17 communities in Minnesota, North Dakota, and South Dakota. NORC conducted virtual interviews with 25 Y staff members and 24 program participants to identify facilitators, challenges, and outcomes. NORC transcribed interviews and conducted qualitative content analysis to identify themes. This session describes findings from the interviews. A key facilitator of success was the flexibility of the model. Challenges included staff and financial resources, outreach in rural areas, and transportation access. Ys developed and enhanced older adult programming and created new partnerships. Program participants reported improvements in physical and mental health and strong social connections. ForeverWell is a flexible, holistic healthy aging program that shows promise for older adults living in rural communities.
AGE DIFFERENCES AMONG WITHIN-PERSON INDICATORS OF STRESS AND DEPRESSION
Authors: Blaxton Jessica , Bergeman Cindy
Published: December 2023

Although older adults tend to regulate their emotions and resist stress better than midlife or younger adults (Charles & Carstensen, 2007), research suggests that when older adults do negatively react to stress they may have more difficulty recovering (Charles, 2010). Research reveals that various indicators of stress relate to greater depression – even suggesting that stress causes the depression (van Praag, 2004). Individual perceived stress (PS) as well as perceived stress reactivity (PSR) influence how stress impacts well-being (Folkman et al., 1986). Thus, we examined age differences in the within-person relationships among PS, PSR, and depression, and potential causal determinants of depression with a longitudinal mediation model. We used data from 572 participants in the Notre Dame Study of Health & Well-being (M(age) = 59.77; sd(age) = 14.22) who completed two to four waves of yearly assessments. Sequentially built multilevel models, in which year was nested within person, illustrated that only midlife adults experience an exacerbated effect of within-person fluctuations in PSR on the relationship between within-person PS and depressive levels (gamma41 = -0.004, p < .01). The longitudinal mediation model revealed that PSR at Time 2 mediated the relationship between PS at Time 1 and Depression at Time 3. Findings suggest that older adults illustrate successful emotion regulation strategies at the yearly level --resisting the negative ramifications of years of greater PS and PSR, whereas midlife adults who experience years of greater PSR would particularly benefit from stress management interventions and monitoring of depressive levels.
CONNECTING THE DOTS: COLLABORATIVE LEARNING AMONG OLDER ADULTS, STUDENTS, AND INSTRUCTORS
Authors: Reynolds Caitlin
Published: December 2023

Although the aging process is a universal phenomenon, misconceptions regarding late adulthood are prevalent, such as loneliness and dependency, which often lead to negative stereotypes and poor developmental outcomes (Kotter-Grühn, 2015); thus, it is important to minimize these stereotypes in an educational platform. Intergenerational discussions have been shown to be a robust approach in reducing stereotypes (Canedo-García et al., 2017; Golenko et al., 2019); especially if it is used to dismantle “othering” the groups by creating community and collectivist perspectives (D’Antonio, 2020). My goal is to explore how intergenerational discussions can be used in the classroom to facilitate collaborative learning among older adults, students, and instructors. In the Fall 2022 and Spring 2023 semesters, I partnered with the Osher Lifelong Learning Institute (OLLI) to connect undergraduate students with older adults from the community. The course centered around the students’ social innovation project- address how current systems may not adequately support older adults and propose a creative solution. The students interviewed the OLLI members throughout the semester about course content (e.g., their awareness of age-related discrimination and barriers in their community). At the end of the semester, students used their accumulated information from both the OLLI members and the course material to propose their social innovation to the OLLI members. The OLLI members asked questions, made recommendations, and highlighted limitations in the students’ work. I observed collaborative thinking and sharing across both groups during these presentations. Overall, intergenerational discussions were a valuable tool in the classroom.
EMERITI PROFESSORS’ INTERGENERATIONAL CONNECTION: QUALITATIVE RESEARCH EXPLORING PERCEPTIONS AND SATISFACTION
Authors: Melillo Karen Devereaux , Gautam Ramraj , Abdallah Lisa , Wangwun Patcharee
Published: December 2023

UMass Lowell, designated an AFU in 2019, launched AFU Inventory and Climate Surveys in 2020; respondents identified “involving retired faculty in university activities’ (AFU Principle 9) as an area for improvement. A follow-up study, guided by the PEACE Model (Levey, 2018), was undertaken to reduce students’ negative stereotypes about older adults and promote positive experiences through active engagement with professor emeriti. One study objective was to explore the experiences of emeriti professors’ in engaging online with Intro to Gerontology students in a novel intergenerational classroom activity. Emeriti professors met twice for one hour each with a group of 4-5 students. Following the activity, emeriti professors were invited to participate in one-hour qualitative interviews. The purpose was to explore their perceptions of, and satisfaction with, the experience in having engaged online with students. Nine of the 12 emeriti professors agreed to participate. The Zoom interviews were conducted December 2022 and January 2023 by two researchers. Qualitative content analysis coding was carried out individually by four researchers, who then met in pairs of two, followed by all four reaching consensus on identified themes. The findings revealed six major themes: enriching the IGL experiences; passion for teaching and interacting with young people; transition to and life after retirement; impact of COVID on engagement; university role in connecting with and engaging emeriti; and satisfaction with values and ideas expressed in IGL activities. These themes offer guidance in promoting AFU principle 9 through a novel intergenerational activity that benefits emeriti professors, students and universities.
MIXED-METHOD PILOT STUDY OF BREAST AND PROSTATE CANCER TREATMENT DIFFERENCES BY COGNITIVE STATUS
Authors: Mullins Megan , Kabeto Mohammed , Abrahamse Paul , Hawley Sarah , Levine Deborah , Kobayashi Lindsay , Wallner Lauren
Published: December 2023

We evaluated the association of cognitive status with treatment for breast and prostate cancer in the US Health and Retirement Study (HRS) linked to Medicare claims (2000-2016), and surveyed physicians at an NCI designated comprehensive cancer center (N= 20, response rate 52%) to explore whether treatment recommendations differ by patient cognitive status. We evaluated the association between cognitive status and treatment receipt among Medicare-eligible HRS participants aged ≥65 whose first and only cancer was breast (n=334) or prostate (n=1,210). Multivariable logistic regression was used adjusting for race, marital status, year, age, activities of daily living, instrumental activities of daily living, education, and comorbid conditions. Physicians were randomized to clinical vignettes presenting a patient with mild cognitive impairment (MCI) or normal cognition and asked their treatment recommendations for early-stage cancer via survey. Women with dementia had 80% lower odds of receiving radiation therapy compared to cognitively normal women (aOR 0.17; 95% CI: 0.03-0.87). Oncologists were less likely to recommend chemotherapy for early-stage breast cancer patients with MCI (vs. normal cognition). Prostate cancer treatment receipt and recommendations did not vary by cognitive status. Notably, 25% of breast oncologists and 40% of urologic oncologists overestimated the risk of dementia among patients with MCI, and both groups were more likely to ascertain caregiver preferences for patients with MCI. These findings suggest there may be differences in cancer treatment recommendations and receipt among patients with MCI compared to those with normal cognition, which may be in part driven by physician overestimation of dementia risk.
PEPTIDOGLYCAN RECOGNITION PROTEIN-1 PREDICTS CHEMOTHERAPY-INDUCED CARDIOVASCULAR DYSFUNCTION
Authors: Todorova Valentina , Azhar Gohar , Wei Jeanne
Published: December 2023

Doxorubicin (DOX) is an effective anti-cancer agent but may induce cardiotoxicity and cognitive dysfunction through inflammatory mechanisms. Peptidoglycan recognition protein 1 (PGLYRP1), secreted by inflammatory cells such as neutrophils has been elevated in the circulation of patients with cardiovascular diseases such as myocardial infarction and atherosclerosis. We hypothesized that PGLYRP1 might be elevated in cancer patients receiving DOX and will correlate with cardiac or cognitive function. Gene expression of peripheral blood cells and plasma protein concentration of PGLYRP1 were determined by reverse transcription-quantitative polymerase chain reaction (RT-QPCR) and ELISA in 18 breast cancer patients with subclinical cardiotoxicity and in some of the cases with self-reported memory problems in comparison with 22 patients without cardiotoxicity. After adjusting for age and race using multivariate logistic regression, we found a positive correlation between PGLYRP1 log2 fold change of gene expression (0.878 versus 0.534, p=0.05) and protein expression (0.920 versus 0.534, p=0.08) in patients with DOX-induced cardiotoxicity, as evident by left ventricle ejection fraction (LVEF) reduction by >10% versus baseline. Reduced LVEF secondary to DOX, appeared to cause memory impairment similar to vascular cognitive decline. The results from this study suggest that PGLYRP1 could potentially be used as predictive biomarker for DOX-induced cardiotoxicity and Alzheimer’s disease related dementias (ADRD). The role of PGLYRP1 in DOX -associated cardiac and cognitive decline in older cancer patients needs further exploration in larger studies.
AGE DIFFERENCES IN SOCIAL DISCOUNTING AND CHARITABLE GIVING IN A US SAMPLE
Authors: Lu Yi , Löckenhoff Corinna
Published: December 2023

Social discounting describes the tendency to show less generosity to more socially distant recipients. With respect to age differences, prior studies (Pornpattananangkul et al., 2019; Lin & Zhang, 2020) found that older adults showed more generosity to distant others (i.e., lower social discounting rates) than younger adults. However, prior research relied on small samples, compared extreme age groups, and focused on Asian countries. To examine generalizability, this pre-registered study examined social discounting and charitable giving in a U.S. adult life-span sample (N = 426, age 18-96, Mage = 50.93, SDage = 19.51, 51% female, 61% non-Hispanic White). The social discounting measure was adapted from Jones and Rachlin (2006) and involved five social distances (1, 5, 10, 50, 100) on a 100-point scale (0 = closest, 100 = most distant). For each social distance, participants were asked how much of $100 they would allocate to themselves versus a person at that distance. They made the same decision for their favorite charity. Contrary to previous findings and our predictions, results revealed a significant positive association between age and social discounting rates (p< .01), such that older adults’ generosity declined more with increasing social distance. Age differences remained robust after controlling for demographics. There were no significant age differences in average giving across social distances and in charitable giving, but, regardless of age, charitable giving was higher among those with lower social discounting rates (p< .001). Findings suggest that age differences in social discounting may be sensitive to cultural context.
UNDERSTANDING THE DYNAMICS OF INTRINSIC HEALTH USING AGE-DEPENDENT QUANTILE GRAPHICAL MODELS
Authors: Khan Zain , Malinsky Daniel , Cohen Alan , Pei Sen , Berhane Kiros , Picard Martin , Belsky Daniel , Wei Ying
Published: December 2023

Human health is a complex and dynamic system. Individual components, such as clinical biomarkers, vary jointly as an ensemble, and appropriate models are needed to study them in the context of health. Network analysis is an effective way to assess and visualize cross-biomarker dependencies, where each node represents a biomarker, and each edge represents the conditional dependency between two biomarkers. We developed a new class of age-dependent quantile graphical models to fully capture the complexity of cross-biomarker dynamics. This model quantifies cross-biomarker dependencies at the boundary (i.e., when biomarkers approach or exceed normal ranges) and differentiates them from those within normal ranges. Further incorporation of age-dependency helps identify biological mechanisms by which humans maintain intrinsic health over their life course. Applying this analysis to the NHANES data (n=60,014), we discovered that cross-biomarker dependencies differed by age and across quantile levels. For participants under 20 years old, at the median quantile we found significant relationships between heart rate (HR) and all other biomarkers: cholesterol, hemoglobin, albumin, systolic blood pressure (SBP), and diastolic blood pressure (DBP) (all p-values < 0.001). However, elderly populations (60+) at the median quantile displayed cholesterol centrality instead—albumin, SBP, DBP, and HR were significantly associated with cholesterol (all p-values < 0.001) while HR was less connected to other biomarkers. At the 0.9 quantile, the <20 group resembled the older age groups in that cholesterol was the more central node. This demonstrates that association levels and centrality patterns varied across age groups and quantile levels.
ECONOMICS OF LONG-TERM SERVICES AND SUPPORTS: PRODUCTION, DEMAND, AND COSTS
Authors: Bishop Christine
Published: December 2023

Economic analysis of the production, demand, and utilization of long-term services and supports (LTSS) can generate insights for public policy. This symposium presents a range of economics approaches to LTSS, with policy implications. The first paper considers in-home care as a production process, estimating the impact of various mixes of informal care and paid formal care on health outcomes. The two types of care, and their combination, contribute to different aspects of self-reported health. Paper Two uses the disruption of the pandemic to examine the productivity of an understudied resource in nursing home care provision: informal care by visiting family and friends. The finding that continuing resident interaction with informal caregivers reduced mortality should inspire future research on this valuable and understudied input into nursing home care. A third paper tracks rising wages for nursing staff wages and increasing use of contract nursing, fueled by workforce shortfalls. These trends have consequences for quality, worker attachment, and costs. An exogenous policy change raising the out-of-pocket price to some consumers of nursing home services in Germany enables the fourth paper to estimate elasticity of demand. Individuals with lower levels of need were more sensitive to rising prices than those with greater needs and fewer alternatives. The fifth paper examines the relationship of an Alzheimer’s diagnosis to individual health expenditures in Mexico and for persons of Mexican origin in the US. Cross-national comparisons and urban-rural differences suggest insights into how LTSS for cognitive disabilities may combine with health services in the two countries.
HOME-BASED CARE AND PATIENT OUTCOMES: DOES THE DELIVERY TEAM MATTER?
Authors: Coe Norma , Sun Chuxuan , Van Houtven Courtney , Basu Anirban , Konetzka R Tamara
Published: December 2023

A major challenge facing the U.S. is how to best to meet the growing demand for person-centered, high-quality long-term care in the least restrictive setting possible for community-dwelling older adults who need assistance with daily activities. This paper asks whether who is providing home care impacts patient outcomes. The relative benefits to the care recipient of informal care, formal care, or a combination of the two is largely unknown. A systematic review (Coe et al. 2021) found informal care, either solo or in concert with formal care, tends to lead to improvements in health and well-being of the care recipient compared to formal care alone. However, little of that research can show causation, and most is not based in the U.S. Recipients’ utilization of formal and informal care is affected by factors that also may affect outcomes, complicating the estimation of any causal relationship. Using the 2002-2018 Health and Retirement Study (HRS), we use family structure variables as instruments for both formal care and the combination of formal and informal care to estimate the causal impact of the home health care team on self-reported mental and physical health outcomes. Once the endogeneity of the care team is accounted for, having both formal and informal care leads to higher self-reported health and having only formal care leads to worse mental health outcomes, such as higher depression and lower positive affect, compared to informal care alone. Mobility measures seem unaffected by the type of home care provider.
EFFECTS OF ESSENTIAL CAREGIVER POLICIES ON COVID-19 AND NON-COVID-19 DEATHS IN NURSING HOMES
Authors: Konetzka R Tamara , Ghazali Nadia , Qi Mingyu
Published: December 2023

Balancing the safety of nursing home residents with their need for social interaction has emerged as a key challenge from the COVID-19 pandemic. Strict bans on nursing home visitation eventually led to growing concern that physical isolation may have unintended harms on nursing home residents. To address this concern, at staggered times between June 2020 and January 2021, 17 states implemented Essential Caregiver policies allowing nursing home visitation by designated family members or friends under controlled circumstances. Using the Nursing Home COVID-19 Public File and other relevant data, we analyze the effects of Essential Caregiver policies on COVID-19 and non-COVID-19 deaths for nursing home residents. To estimate plausibly causal effects, we employ recent innovations in difference-in-differences and event-study estimation. We find that on average, Essential Caregiver policies prevent 0.44 non-COVID-19 deaths, 0.42 COVID-19 deaths, and 0.86 total deaths per 1,000 residents in a two-week period, representing 8 percent, 17 percent, and 11 percent of the sample mean for the three outcomes, respectively. The effects are mainly driven by state policies that are mandatory or implemented without restrictions and are larger for high-quality facilities and highly staffed facilities. Our results suggest that nursing home residents derive substantial benefit from regular social interaction with family members and friends and from the additional care they provide. Our findings support the use and expansion of Essential Caregiver policies to balance resident safety and the need for social interaction for future infectious disease outbreaks.
CHANGES IN ACCELEROMETER MEASURED MOVEMENT BEHAVIORS OVER RETIREMENT: A COMPOSITIONAL DATA APPROACH
Authors: Sacco Lawrence , Westerlund Hugo
Published: December 2023

Retirement is a significant life transition where individuals change their daily patterns of movement behaviors (i.e. physical activity and sedentary behavior). However, evidence accounting for how individuals re-allocate time from one type of activity to another is lacking, considering that engagement in different activities is co-dependent as time not spent in a given type of activity will be spent in another one. The objective of this paper is to evaluate how relative time spent in movement behaviors (light physical activity, moderate-vigorous physical activity and sedentariness) and sleep change over the retirement transition. Furthermore, the aim is to assess how movement behaviors change differently between genders, manual Vs non-manual work and weekend Vs weekdays. Data was collected from 114 participants (47 men and 67 women; ages: 60 to 73) from the Swedish Retirement Study (SRS) at three timepoints: 6 months before retirement and, 6 and 18 months after retirement. Time-use data on movement behaviors and sleep was collected over a week-long period through thigh-worn accelerometers and wrist-worn actigraphs. Compositional data analysis (CoDA) was used to account for the compositional and finite nature of 24 hour time-use data. Results indicate that small changes in allocation of time between movement behaviors occur during retirement. Changes indicate that after retirement weekdays shows patterns of activity that resemble more patterns typical of pre-retirement weekends. Findings are discussed in relation to implications for physical activity guidelines and the influence of retirement on health.
AGEING WELL WITH AUTISM
Authors: Brown Laura , Aitken Rebecca , Berry Katherine , Gowen Emma
Published: December 2023

Autism is characterized by patterns of neurological development that can cause differences in social interactions and sensory processing; restricted and repetitive patterns of behavior; and difficulties in identifying and describing feelings. The highly sociable and unpredictable environments typical of most societies are poorly suited to autistic people*, leading to disadvantage and exclusion. Despite increasing numbers of people aging with autism, little is known about the needs and experiences of middle-aged and older autistic adults. This is important given that autistic people experience higher rates of health and functional difficulties, and express a need for appropriate, accessible forms of support as they age. In this study, we interviewed seventeen autistic adults, aged from 46-72 years, about their views and experiences of aging, and how services could better support them to age well. The transcribed interviews were analyzed using inductive thematic analysis. The findings revealed several potential ways that autism affected people’s ability to age well. This included difficulties in accessing formal and informal supports; interactions between autism and health conditions; and negative attitudes and low understanding about autism encountered within services and society. Recommendations for supporting autistic adults to age well included involving autistic people in the design of services, and introducing specialized advocate/coordinator roles or ‘one-stop-shop’ hubs that could help autistic people navigate services more easily. * Our use of the terms ‘autistic people/adults’ is in-line with evidence-based guidance for writing about autism research, and is preferred by autistic people to ‘person-first’ terms like ‘person with autism’ (https://journals.sagepub.com/pb-assets/cmscontent/AUT/Autism-terminology-guidance-2021-1626860796.pdf)
PRACTICE AND THEORY: THE SIGNIFICANCE OF PARTICIPATING IN CULTURALLY-RELEVANT CRAFTS FOR DIVERSE OLDER ADULTS
Authors: Adams-Price Carolyn
Published: December 2023

In the last 25 years, there has been a great increase in interest in the benefits of creative activities for older adults, especially for dementia patients. More recent research (Adams-Price et al., 2018) has identified specific benefits that healthy older adults get from participating in arts activities. However, little research has featured the benefits of traditional craft activities, especially those prominent in different ethnic groups. The focus of this symposium will be on the benefits of traditional crafts for older adults, especially when those crafts are traditional to one’s culture and have benefits for identity. The proposed symposium will include papers by Chen and Alcantar on the impact of craft participation on diverse older adults. Kaori Otera Chen will be discussing older women weavers in New York State, and the psychological growth they experience from learning and practicing skills associated with weaving, and from creating beautiful pieces. Sandy Alcantar will be discussing a program that she runs for older Hispanic immigrants that promotes participation in traditional crafts to provide income and connect the immigrants to their culture of origin. Adams-Price will be discussing life-span developmental psychology and the sociocultural theory of creativity from Vlad Glaveanu, and their implications of the theory for discussing the significance of long-term participating in culturally-relevant crafts in later life, singly and in groups. She will tie in examples from diverse cultures, including older rural African American women who quilt.
POSITIVE ASPECTS OF DEMENTIA CAREGIVING EVOLVE FROM AN INTEGRATIVE STRESS COPING AND EXISTENTIALISM PARADIGMS
Authors: Yu Doris S F , Cheng Sheung Tak
Published: December 2023

Family caregiving is the crucial informal care resource to buffer the associated disease burden. Research in this field has focused on promoting effective adaptation of family caregivers of persons with dementia (PWD) by ameliorating their caregiving burden. Little attention is placed on positive aspects of caregiving (PAC). PAC refers to the extent to which caregiving experience is appraised as enriching to one’s life, and promoting uplift, personal growth and gratification. This mixed-method study investigated how PAC evolved from the encounter of the family caregivers of PWD. Based on the research evidence about how PAC is shaped, an integrated theoretical model combining the stress coping and existential paradigms were hypothesized to explain the evolvement of PAC. A mixed-method longitudinal study was conducted, and 403 family caregivers of PWD were invited to respond on validated measure for active dementia management strategies, self-efficacy, social support, meaning-making, motivation to care and religiosity. PAC was measured at baseline and 6 months thereafter. Path analysis indicated that PAC was evolved from the self-efficacy derived from active coping with the caregiving experience, with a social support as a significant moderator for such relationship. The use of meaning-focus coping especially in a religious context also optimize this favorable caregiving attribute. The qualitative findings converge with this model, and further elaborate how performance success, self-affirmation, spiritual growth, and relationship solidarity consolidate perceived positivity on the caregiving experience. This study provides important insights on how to advance caregiving supportive care by adding an existential paradigm.
A MODEL FOR DISSEMINATING EVIDENCE-BASED RESIDENT-TO-RESIDENT AGGRESSION INTERVENTION PROGRAMS
Authors: Pillemer Karl , Luebke Matthew
Published: December 2023

In elder mistreatment research, a key problem is the failure to disseminate interventions to broad audiences. This gap prevents most interventions from benefitting victims and improving their quality of life. Interventions are often not disseminated because of a lack funding, staffing, and support from provider organizations. We report on a novel, low-cost dissemination model to circumvent these barriers and expand program reach. The program, Improving Resident Relationships in Long Term Care (IRRL), trains staff to recognize resident-to-resident aggression (RRA) and to learn how to manage it. The training consists of two sessions, (1) recognition and (2) management. A dissemination model was created that included systematic marketing, outreach, and organizational sponsorship. We describe the model, which is replicable for a variety of dissemination efforts: 1) creating an easily accessible manual, supporting documents, and evaluation materials; 2) designing a user-friendly website for distribution; 3) identifying provider associations for program marketing; 4) developing partnerships with LTC organizations for dissemination; 5) providing national informational webinars; 6) offering webinar participants subsequent train-the-trainer sessions and coaching. This plan is feasible with limited expenditures and can be accomplished via the use of student research assistants. Using this model, the IRRL program has gained organizational support and has employed web-based training to reach over 300 providers. The dissemination of the IRRL program offers a potential method for intervention delivery with limited funding. Implications for future dissemination research are discussed.
LEADING ADVANCE CARE CONVERSATIONS: DEVELOPMENT OF AN INTERVENTION PLATFORM
Authors: Dassel Kara , Aruscavage Nancy , Nachtweih Emily , Supiano Katherine , Utz Rebecca , Iacob Eli , Clayton Jordana
Published: December 2023

The LEAD Guide (Life-Planning in Early Alzheimer’s and Other Dementias) is an advance care planning guide designed specifically for people with dementia and their care partner. It addresses changes in cognition and goals of care, including values and preferences, for end-of-life care and support across the disease continuum. The goal of using the guide is to create a shared understanding of the care recipient’s end-of-life care preferences. We developed an interactive web-based format of the LEAD Guide, an enhanced extension of the original paper guide, for a pilot behavioral intervention. The LEAD Intervention guided community-based Alzheimer’s disease and related dementias (ADRD) dyads (N=60 dyads; persons concerned, at risk, or with a dementia diagnosis and their care partners) through advance care planning (ACP) conversations and documentation. The intervention model included the LEAD Guide, interactive instructions, and educational material about ACP in the context of dementia. We developed the LEAD Intervention using an interactive design and beta testing process (including surveys and focus groups) with our community advisory board members. The board members included professional dementia experts, community partners, and ADRD dyads. Board members were enthusiastic about the LEAD Intervention and provided suggested revisions in three areas; technology (navigation of web-based documents, webpage design), personalization (the need to personalize emails and surveys to individual participants), and evaluation (creating simple scaled and open-text questions to obtain feedback on the intervention activities). Creating a feasible, acceptable, and efficacious intervention requires a multi-faceted approach that incorporates input from end users using community-based participatory research methods.
COHORT DIFFERENCES IN PTSD SYMPTOMS AMONG VIETNAM, PERSIAN GULF, AND POST-9/11 COMBAT VETERANS
Authors: Kurth Maria , Witzel Dakota , Segerstrom Suzanne , Choun Soyoung , Aldwin Carolyn
Published: December 2023

Research examining long-term effects of military service often focuses on help-seeking Veterans who served in Vietnam, Korea, and WWII. Less is known about Veterans from more recent conflicts or community-dwelling Veterans. We administered online surveys to community-dwelling combat Veterans (N=167; Mage=57.96; 31% women) to examine cohort differences in service appraisals, post-service experiences, and predictors of PTSD symptoms. Chi-square and hierarchical regression were used to test differences in demographics, appraisals of service, post-service experiences, and PTSD symptoms. Among Veterans from Vietnam (n=60), Persian Gulf (n=68), and Post-9/11 cohorts (n=39), only age and educational attainment varied. Vietnam Veterans were older, and Persian Gulf War Veterans more likely to have a college education compared with other eras. There were no cohort differences for military appraisals or post-service experiences. In step one of hierarchical regression, men and those with lower income reported more PTSD symptoms. In step two, including cohort, Vietnam Veterans had more PTSD symptoms than the two younger cohorts, despite age now being inversely correlated with symptoms. In step three, including military and post-service experiences, demographics and cohort were no longer significantly associated with PTSD symptoms. Combat severity, undesirable appraisals, and social support were positively associated with PTSD symptoms, while desirable appraisals were inversely associated with PTSD symptoms. Cohort and demographics may be less important for Veteran mental health than service-related experiences. As Veterans of all eras move through adulthood and into later life, the importance of their miliary experiences must be considered, as it might be a ‘hidden’ variable of aging.
CAREGIVER AND VETERAN PERCEPTIONS OF THE REFINING ELDER CARE IN AMERICA PROGRAM (RECAP)
Authors: Haverhals Leah , Magid Kate , Nunnery Mary , Manheim Chelsea , Young Jessica , Levy Cari
Published: December 2023

In 2021, the Veterans Health Administration (VHA) piloted the Redefining Elder Care in America Program (RECAP) at two Department of Veterans Affairs (VA) health care centers. RECAP identifies Veterans at risk for nursing home placement, and coordinators conduct a phone assessment with Veterans or their caregivers to link Veterans to VA services. To identify benefits and challenges of RECAP from Veterans’ and caregivers’ perspectives, we conducted phone interviews (N=32) from October 2021- May 2022. We analyzed data using a thematic approach, finding that participants appreciated the proactive nature of RECAP, felt supported by RECAP coordinators, and felt the VA cared about them. Caregivers cited RECAP’s benefits, such as learning about VA services and having the RECAP coordinator as a point of contact to help them navigate the VA. Caregivers of Veterans who received services reported improvements in caregiver mental health, decreases in caregiver burden, and improvements in Veterans’ abilities to remain at home. A few caregivers were uncertain if they could trust the RECAP phone assessment, thinking it was a scam, and two reported challenges contacting the coordinator after the assessment. Several caregivers expressed uncertainty about the timeline for service delivery and next steps to obtain services following the assessment. Caregivers described challenges related to receiving services including Veterans not being eligible for the chosen service and receiving fewer hours of home health care than desired. Overall, participants were satisfied with RECAP. Challenges identified should be addressed to best meet the needs of Veterans and Caregivers.
FUNCTIONAL LIMITATIONS AND ABSENCE OF CARE AMONG OLDER ADULTS LIVING WITH DEMENTIA IN CHINA, ENGLAND, THE EUROPEAN UNION, AND THE UNITED STATES
Authors: Lin Zhuoer , Qian Yuting , Gill Thomas , Hou Xiaohui , Chen Shanquan , Chen Xi
Published: December 2023

Assistance with daily living is essential for people living with dementia (PLWD) who also have functional limitations. Despite the growing demands for caregiving, the absence of care for PLWD with functional limitations can be large and concerning. Using harmonized longitudinal survey data (2012-2018) on community-dwelling adults aged 50+ from the US, England, Europe (covering 28 countries), and China, we provided the first comparative evidence on the global trends in functional limitations and absence of caregiving for PLWD. We demonstrated three alarming facts in both developing and developed countries: there was an overall increasing trend in the extent of functional limitations defined as difficulty with basic or instrumental activities of daily living (ADL/IADL) among PLWD; besides, about 1 in 5 PLWD received no care for their ADL/IADL limitations; and most importantly, the above absence of care has not improved over time in all studied countries, regardless of the stages of development. The patterns were evident for both ADL and IADL limitations and for informal and formal care. Our subgroup analysis showed consistency of these three facts, but also highlighted more worrying situations that about 2 in 5 PLWD received no care for their ADL limitations and at least 3 in 5 PLWD received no formal care. We also reported the greater absence of care for more vulnerable populations with less education and living alone. Our estimates highlight the urgency to ensure basic provision of care for PLWD with functional limitations, especially among those who are less educated or live alone.
MULTIPLE CHRONIC CONDITIONS AND DISABILITY IN VIETNAMESE OLDER ADULTS IN THE UNITED STATES
Authors: Miyawaki Christina , Garcia Joshua , Nguyen Kim , Park Van , Markides Kyriakos
Published: December 2023

Asian Americans recorded the highest life expectancy in the U.S. possibly due to selective migration as 86% of them are immigrants. However, the health of refugees such as older Vietnamese has been understudied. Using data from the Vietnamese Aging and Care Survey (VACS) collected in Houston, Texas, the 2nd-largest Vietnamese-populated metropolitan area in the nation, we assessed their chronic conditions, disability, depressive symptoms, and cognitive impairment, and examined the associations between their chronic conditions and disability by comorbidity clusters. Multivariable logistic regression models were used to answer the research questions. The respondents (N=177) were 76 years old (mean), married (62%), and female (58%). They lived in the U.S. for 24 years (mean) and spoke Vietnamese only (92%) in multi-generation (88%) low-income households (90% ≤$25K). They were in fair/poor health (84%) with 2 ADL/4 IADL disability (mean) and ≥3 chronic conditions (60%). Hypertension (79%) and arthritis (54%) were the most common chronic diseases. Respondents with ≥3 chronic conditions had significantly higher ADL (OR=2.77)/IADL (OR=2.33) disability and cognitive impairment (50%). However, cognitive impairment had the most significant impact on their disability (ADL:2.94-3.75; IADL:5.41-5.79) when combined with most common chronic conditions. Healthcare providers should pay special attention to older Vietnamese’ cognitive impairment due to their high prevalence and negative impact on their disability. Culturally and linguistically tailored healthcare services created by policymakers, healthcare professionals, and local social service agencies are recommended for the well-being of refugees who could not come as selected immigrants but migrated to the U.S. for a better life.
WHAT MATTERS MOST? REACTIONS TO THE RAISE ADVISORY COUNCIL’S NATIONAL STRATEGY TO SUPPORT FAMILY CAREGIVERS
Authors: Nadash Pamela , Tell Eileen , Qu Shan , Pallis Maryssa
Published: December 2023

This presentation reports on feedback from advocates and researchers, those working in organizations serving family caregivers, and family caregivers themselves regarding the 2022 National Strategy to Support Family Caregivers. The Strategy was issued by the RAISE Family Caregiving Advisory Council, created under the Recognize, Assist, Include, Support, and Engage (RAISE) Family Caregivers Act (2018). A Request for Information (RFI) published in the Federal Register garnered nearly 600 responses from a wide range of individuals and organizations, providing feedback about top priorities for action, topics or populations that were not adequately addressed, and recommendations for actions that could help meet stated objectives; these comments will prove critical in implementing the National Strategy, as well as in updating and revising it. This presentation sets the progress of the National Strategy in context, reports on the RFI analysis, and describes next steps, highlighting key areas of focus for the federal government, states, and other entities. Priorities included expanding the direct care workforce and increasing access to caregiver training and supports, particularly respite. Other top comments pertained to financial and workplace security for family caregivers - encouraging caregiver-friendly workplaces, paying family members to provide care, and strengthening the Family and Medical Leave Act. Respondents broadly endorsed the Strategy and noted the need for campaigns promoting greater awareness of family caregiving. The findings suggest that there is strong consensus among caregiver advocates regarding the most critical areas for action and the most favored strategies to achieve caregivers’ priority goals.
LGBTQ-RELATED DISCRIMINATION REDUCES SLEEP QUALITY IN OLDER ADULTS: EVIDENCE FROM VUSNAPS AND UCNETS
Authors: McKay Tara , Tran Nathaniel , Trautman Lana , Clark Kirsty
Published: December 2023

Sleep is a critical protective factor for health outcomes with low-quality sleep linked to increased risk of diabetes, cardiovascular disease, and cognitive decline. Theoretical work proposes that minority stress may negatively affect sleep quality for LGBTQ and other minoritized populations. We examine differences in sleep quality across sexual orientation and gender identity and test the relationship between minority stress and sleep quality for LGBTQ adults. Data come from 1) UC Berkeley Social Networks Study (UCNets), a panel study of 50–70-year-olds with an oversample of older LGBTQ adults and 2) the Vanderbilt University Social Networks, Aging, and Policy Study (VUSNAPS), a panel study of older LGBTQ adults aged 50-76. LGBTQ identity includes participants who are transgender and/or gay, lesbian, bisexual, or something else. We estimate Poisson models predicting sleep quality as a function of LGBTQ identity and exposure to LGBTQ-related discrimination. Sleep quality is measured using three items available in both studies: 1) the number of nights per week trouble falling asleep, 2) number of nights per week trouble staying asleep, and 3) number of mornings per week waking well rested. Experiences of LGBTQ-related discrimination in the last year were measured using the Daily Heterosexist Experiences Questionnaire. We find that LGBTQ identity is significantly associated with poorer sleep quality compared to non-LGBTQ peers. Among LGBTQ adults, sleep quality declines as the number and intensity of recent experiences of LGBTQ-related discrimination increases. Poorer sleep quality may be an underlying mechanism exacerbating health disparities across sexual orientation and gender identity.
NEIGHBORHOOD SOCIAL TIES AND LONELINESS IN RETIRED AND CURRENTLY WORKING OLDER ADULTS
Authors: Keenoy Jaclyn , Ermer Ashley
Published: December 2023

Peripheral social ties such as coworkers and neighbors have been identified as helpful to protect against loneliness, considering their convenient geographic proximity and ability to contribute diversity into one’s social network (Sandstrom & Dunn, 2014). However, the importance of neighborhood social ties for older adults has rarely been investigated by employment status. We anticipated that with an absence of coworkers to serve as peripheral social ties, retirees will rely more heavily on neighborhood social ties to alleviate feelings of loneliness. Using Wave 3 of the National Social Life, Health, and Aging Project, 1,088 currently working and 1,594 retired older adults were compared using path modeling in Mplus (v. 8). We first ran an overall model and found that there was a significant negative association between neighborhood social ties and loneliness among all participants (p=.000). Next, we ran a multigroup model between working and retired older adults. In this model, neighborhood social ties and loneliness were negatively associated for both retired (p=.000) and working (p=.047) respondents. A Wald test revealed that these groups were not significantly different (p=.100). Our results suggest that neighborhood social ties help to alleviate loneliness similarly in both working and retired older adults. This is despite those currently working likely having a network of coworkers as peripheral social ties from their workplaces. These findings contribute to the broader literature on social networks, and particularly advance the social convoy model’s understanding of the importance of peripheral social ties, even in older age (Huxhold et al., 2020).