bluuebunny/crossref_metadata_2025 huggingface dataset:
In Sickness and in Health: Dyadic Perspectives on Health and Well-Being Among Older Couples
Authors: Polenick Courtney
Published: December 2020

This session will incorporate a variety of dyadic methods to explore the multifaceted ways that older spouses shape their own and their partners’ health and well-being. First, Dr. Karen Lyons will consider the roles of communication, collaborative decision-making, and social support in shaping the mental health of couples managing chronic pain. Her comparative dyadic analysis highlights the value of collaborative illness management in optimizing couples’ mental health. Dr. Courtney Polenick will then describe how chronic condition discordance (i.e., the extent to which two or more conditions have non-overlapping self-management requirements) within individuals and between spouses is linked to perceived control among couples over an8-year period. This study reveals that more complex patterns of chronic conditions within couples have particularly detrimental implications for women’s perceptions of control over their own health and other life domains. Next, Dr. Kira Birditt will examine the long-term effects of spouses’ similar drinking patterns (i.e., concordance). Although drinking concordance may enhance marital satisfaction, she will explain how it can have enduring negative consequences for cardiovascular health among middle-aged men. Dr. Joan Monin will then explain the short-term benefits of laughter for blood pressure among couples during lab-based spousal support interactions. Finally, Dr. Amy Rauer will discuss how spouses react to one another’s health-related support attempts using in-depth qualitative interviews conducted with both members of the couple. Taken together, these studies underscore the importance of evaluating dynamic short-term and long-term health-related influences among couples in middle and later life. Dyadic Research on Health and Illness Across the Adult Lifespan Interest Group Sponsored Symposium.
Individual-Level and Couple-Level Chronic Condition Discordance: Longitudinal Links to Perceived Control
Authors: Polenick Courtney , Birditt Kira , Turkelson Angela , Shattuck Sadie , Kales Helen
Published: December 2020

Chronic condition discordance (i.e., the extent that two or more conditions have non-overlapping self-management requirements) has adverse mental health implications but little is known about mechanisms accounting for these links. We considered how chronic condition discordance at the individual level and the couple level (i.e., between spouses) was associated with perceived control among 2,676 couples from three waves (2006, 2010, and 2014) of the Health and Retirement Study. Dyadic growth curve models revealed that when wives had greater individual-level discordance, they reported lower initial health-related control and personal mastery and steeper reductions in personal mastery. When husbands had greater individual-level discordance, they reported lower initial health-related control and faster declines in health-related control and personal mastery, and wives had faster declines in personal mastery. When there was greater couple-level discordance, wives reported lower initial health-related control. Targeting increases in perceived control among older couples managing complex conditions may be beneficial. Part of a symposium sponsored by Dyadic Research on Health and Illness Across the Adult Lifespan Interest Group.
Age-Related Engagement and Outcomes in a Cancer Survivor Self-Management eHealth Program
Authors: Leach Corinne , Hudson Shawna , Diefenbach Michael , Chantaprasopsuk Sicha , Alfano Catherine
Published: December 2020

While eHealth programs equip survivors with tools at where and when they need, their benefit to and engagement patterns among older adults are less known. Data come from the Springboard Beyond Cancer RCT, a cancer survivor self-management program (N=176; 88 control, 88 intervention arm) and the corresponding qualitative evaluation/user testing (N=40). Younger survivors, but not older, preferred socially interactive and personalized long-in features which enable greater tailoring of the program. However, the older survivors who did enroll in the RCT were equally as likely as their younger counterparts to engage with one or more aspects of program. Health self-efficacy improvement from baseline to 3 months was significant among younger participants in the intervention (p<.05) but not the control arm (p=.54) (d=.20) and marginally significant among older survivors (age 60+) in intervention (p=.06) but not the control arm (p=.58) (d=.28). Results suggest that the program may benefit survivors regardless of age. Part of a symposium sponsored by the Cancer and Aging Interest Group.
Positive Emodiversity Buffers the Association Between Stress and Depressive Symptoms
Authors: Benson Lizbeth , Ong Anthony
Published: December 2020

Intensive measurements of individuals’ experiences allow for identifying patterns of functioning that may be markers of resilience, and whether such patterns differ across the life span. Using 8 daily diary reports collected in the second burst of the National Study of Daily Experiences (NSDE, n=848, age 34-84; 55%female), we examined whether positive emodiversity (Shannon’s entropy) attenuated the association between cumulative stressor exposure and depressive symptoms, and age-related differences therein. Results indicated age moderated the extent to which positive emodiversity attenuated the association between stress and depressive symptoms (b=0.11, p < .05). The attenuated association was strongest for younger adults with higher positive emodiversity, compared to those with lower positive emodiversity. For older adults, the association between stress and depressive symptoms was relatively similar regardless of their positive emodiversity. Implications pertain to for whom and in what contexts specific types of dynamic emotion experiences may promote optimal functioning and resilience.
Familism and its Impact on Younger African-American Informal Family Caregiver Role Strain and Decision-Making
Authors: Alexander Ivana
Published: December 2020

Informal family caregivers of older adults are the life’s blood of the long-term services and supports (LTSS) system in the United States, providing an estimated $470 billion in unpaid care each year. This care is disproportionately provided by racial and ethnic minority families, where systemic economic disparities make it impossible to afford formal care in many cases. Adding to this are the cultural expectations or familism values that often influence attitudes and beliefs about caregiving. These expectations and values contribute to the emotional, psychological, financial, and professional strain experienced by caregivers. They also impact the caregiver-healthcare provider dyad as well as the caregiver-patient-healthcare provider triad, where shared decision-making is an essential component of providing LTSS for family members. This presentation applies an auto-enthographic lens to the author’s personal experiences as a younger African-American female caregiver of an elderly, terminally ill family member and as a medical social worker to highlight the gaps that exist between familism values, the shifting reality of family caregiving, and available resources and addresses related implications for the future of long-term care in a family-centered context.
Challenges Using Technology in a Health Coaching Intervention, Early Lessons Learned
Authors: Riegel Barbara , Hirschman Karen , Thomas Gladys , Shepard Brooke , Walser Tracie , Stawnychy Michael , Bowles Kathryn , Garcia Lydia
Published: December 2020

Technology provides opportunities to engage with those who are too busy, overwhelmed, or distant for face-to-face interventions, such as lay caregivers of adults with heart failure. While testing the efficacy of virtual health coaching for caregivers on stress and self-care we have encountered challenges in implementing the intervention and learned early lessons. Caregivers (n=250) enrolled into a randomized controlled trial receive a Samsung Galaxy tablet with Internet access. Half receive health information by tablet (control) and half receive 10 live virtual health coaching sessions plus health information all by tablet (intervention). Tablets are configured to allow access to preselected websites and a Vidyo conference room for the intervention group. Completing the first 6 months of enrollment, 36 caregivers have enrolled (34% black, all female, 74% spouses, mean age 56.4 years, 40% employed full-time, mean 9.3 hours spent caregiving daily), with 18 randomized to intervention. Only 2 of the 79 assessed for eligibility reported discomfort with technology. Yet, one early challenge is difficulty connecting with the health coach via Vidyo. Another is the uncertain nature of the patient’s condition, which frequently precludes the caregivers’ attendance at prescheduled sessions. Although tablets were anticipated to facilitate the intervention, in some cases, these two challenges interact to further accentuate caregiver stress. Alternatives such as FaceTime and plain old telephone contact suffice. We found that flexibility in intervention delivery is essential for such a real-world intervention. Contributing factors and implications of these challenges for future caregiving research and practice will be discussed.
AI-Assisted Hiring Process and Older Workers: An Exploratory Study
Authors: Choi Moon
Published: December 2020

An increasing number of companies have adopted an artificial intelligence (AI) hiring system such as resume screening and/or AI-powered video interview. This study explored older adults’ attitudes toward AI and their intentions to apply for jobs based on AI-assisted hiring process. Data came from an online survey in South Korea (N=123). Results showed an acceptable reliability of the scale of attitudes toward AI (Cronbach’s a = 0.72) and indicated no statistically significant differences in the attitudes toward AI across age groups (F(4,118) = 0.41, p = .80). However, a one-year increase in age was associated with a 5.8% decrease in the likelihood of decisions to apply for jobs based on AI-assisted hiring process after accounting for attitudes toward AI as well as socioeconomic status. The findings raise a concern about older workers’ constraints in job mobility as well as early retirement due to technological change in the hiring process.
Early Differences in Cognition Associated With Familial Longevity and ApoE Genotype Using Digital Technology
Authors: Andersen Stacy , Du Mengtian , Roth Nicole , Wojczynski Mary , Thyagarajan Bharat , Perls Thomas , Cosentino Stephanie , Sebastiani Paola
Published: December 2020

Merging digital technologies with neuropsychological testing allows for collection of novel metrics that may reveal early, subtle differences in cognitive functioning. We examined whether digital pen metrics from the Clock Drawing Test (CDT) differentiate healthy agers (i.e., individuals with familial longevity) from spouses and individuals by APOE genotype. We used generalized estimating equations adjusted for sociodemographics, familial longevity, and APOE genotype. Among 1974 participants with correct clocks (mean age 71±10 years), familial longevity was associated with better cognitive processing (i.e., shorter latencies/thinking time before cognitively demanding components) whereas the e4 allele was associated with smaller clock diameter and longer latencies. The e2 allele was negatively associated with total time and latencies. Therefore, digital metrics captured differences in cognitive processing among individuals with correct clocks and thus may be more sensitive than traditional scores. Additionally, familial longevity may confer cognitive advantages that are distinct from the risk/protection afforded by APOE genotype.
Church and Family Informal Social Support Networks of African Americans
Authors: Taylor Robert , Chatters Linda
Published: December 2020

Social support networks are an integral component of an individual’s life. This presentation investigates the complementary roles of family and church members as sources of informal social support among African Americans. The analysis utilizes the African American sub-sample of the National Survey of American Life. A pattern variable was constructed that describes four types of church and family networks: 1) received support from both family and church members, 2) received support from family members only, 3) received support from church members only, and 4) never received support from family nor church members. Overall the findings indicated 1) the majority of African Americans received support from both groups, 2) a small group of respondents were socially isolated in that they did not receive assistance from either family or church members, 3) for some African Americans who were estranged from their family members, church members were an alternative source of social support. Part of a symposium sponsored by the Religion, Spirituality and Aging Interest Group.
Changes in Social Engagement for Incident Caregivers Compared to Controls
Authors: Liu Chelsea , Blinka Marcela , Fabius Chanee , Howard Virginia
Published: December 2020

Maintaining social engagement is important for the health and well-being of older adults who become caregivers. We assessed the association between incident caregiving and leisure satisfaction as well as the 10-year change in social network size among 245 incident caregivers and 248 matched controls. Multiple linear regression analyses were used to adjust for age, gender, race, education level, income, and geographic region. Compared to controls, incident caregivers had significantly lower levels of leisure satisfaction (p<0.01) and greater declines in total social network size (p<0.01). Incident caregivers and controls did not differ on the change in the number of social network members contacted monthly. Among incident caregivers, dementia caregivers and spouse caregivers had lower leisure satisfaction compared to non-dementia caregivers and non-spouse caregivers, respectively, but no differences were found on social network measures. Future studies should further examine social engagement among caregivers and its influence on their health outcomes.
Advance Care Planning for Care-Dependent Older Persons Living at Home: A Cluster-Randomized Controlled Trial
Authors: Köpke Sascha , Silies Katharina , Schnakenberg Rieke , Kirchner Änne , Köberlein-Neu Juliane , Meyer Gabriele , Hoffmann Falk
Published: December 2020

Advance Care Planning (ACP) for care-dependent older persons living at home is an important part of care, but remains difficult to implement, mostly due to access barriers. The aim of this trial is to increase patient activation, family communication and surrogate designation through an ACP-intervention delivered by trained nurses to care-dependent clients in their homes. The intervention is evaluated in a cluster-randomised controlled trial in Germany (DRKS00016886). Primary outcome is patient activation (PAM-13); secondary outcomes cover institutionalisation, ACP-engagement and prevalence of ACP-documents. 28 home care services (HCS) with 20 trained nurses and about 340 participants have been included. First results show that patients and caregivers judged the topic and the discussion with trusted persons as important and seized the opportunity for communication. In conclusion, established relationships can be built upon to ensure access to ACP and thus to avoid involuntary treatment in situations of decisional incapacity. Part of a symposium sponsored by Systems Research in Long-Term Care Interest Group.
Racial and Ethnic Disparities in Quality Measures for People With Alzheimer’s Disease and Related Dementias
Authors: Rivera-Hernandez Maricruz , Kumar Amit
Published: December 2020

Over 50% of nursing home residents have ADRD. Prior research has shown strong evidence that, compare to non-Hispanic White, African-Americans are more likely to admitted in low performing nursing homes characterized by severe deficiencies understaffing and poor care. However, it is unknown whether these experiences are similar for Hispanics with ADRD. We conducted a cross-sectional study using 2016 data from Medicare- certified providers. Our cohort included 1,425,220 short- (30%) and long-term (70%) beneficiaries with ADRD. Approximately 81% of residents were White, 13% African Americans, and 6% Hispanics. African Americans and Hispanics have lower rates of seasonal influenza vaccination (IV). However, they were also less likely to report pain, pressure ulcers and antipsychotic use compared to white residents. After including the facility fixed-effects in the model, it appears that these disparities are mostly due to between-facility level differences.
Addressing the Needs of Persons Living With Dementia Across Care Settings (A Collaborative Symposium between the Assisted Living and Research in Quality Care Interest Groups)
Authors: Degenholtz Howard , Kemp Candace , Pace Doug
Published: December 2020

Understanding the needs of persons living with dementia is critical to promoting quality of life and care. Co-sponsored by the Assisted Living (AL) and Research in Quality Care Interest Groups, this symposium includes four papers that present new ways to use claims data, qualitative data, benchmarking data, and intervention data to promote well-being for persons living with dementia. First, Degenholtz and Van Cleve use Pennsylvania Medicaid data from 2014-2016 to examine the provision of personal care to persons with and without dementia. They find that those living with dementia received more personal care per day across levels of physical disability and discuss implications for home and community based services policy. Next, Kemp et al. investigate meaningful engagement among assisted living residents with dementia using qualitative data collected over a one-year period in four diverse care communities. Findings show a range of engagement experiences and point to the influence of key resident, care partner, and care community influences. Third, Morgan et al. use data from a statewide probability sample of nursing home staff (n=438) to identify barriers and facilitators to person-centered care. Findings show key barriers to delivering person-centered care, including a lack of staff empowerment practices and low use of consistent assignment. Last, Zimmerman et al. present an evidence-based program, “Mouth Care Without a Battle” developed in nursing homes. Using data from over 2,000 assisted living stakeholders, they situate their findings within implementation science and the NIH Stage Model and make their findings transferable regardless of focus or setting.
Perceptions of Workplace Fairness in the Context of Age and Intersectionality
Authors: Halvorsen Cal , Pitt-Catsouphes Marcie , Saran Indrani
Published: December 2020

While scholars have focused on workplace fairness (often called organizational justice) for quite some time, the context of diversity—in its many forms—has rarely been included in this conversation. This presentation will review concepts related to workplace fairness, describing how the context of diversity may influence perceptions of it. We then will present the results of a recent survey of 609 respondents aged 18 to 70 with a focus on how holding diverse attributes (e.g., age, gender, and their intersectionality) may shape perceptions of workplace fairness and diversity. Overall, we found that the perceptions of workplace fairness and diversity are similar by age and gender, with a few notable differences (e.g., older respondents value interpersonal justice the most, such as their opinions being considered, and younger respondents see workplace diversity the most positively). These results can inform scholarship and discussions on human resource practices and environmental change in organizations.
Assisted Living Care for Special Populations
Authors: Sloane Philip , Zimmerman Sheryl
Published: December 2020

Assisted living (AL) is a notable provider of residential long-term care for older adults; there are almost twice as many AL communities as nursing homes, and they provide care to more than 800,000 older adults. As AL has evolved, it has come to serve more individuals with cognitive, mental, and health care needs. For example, 70% of residents have sleep disturbances, 42% have moderate/severe dementia, and mortality rates average 14% annually. Care needs include those for behaviors such as agitation, serious mental illness, and at the end-of-life. However, not all AL communities provide similar care. This symposium will use national data and data from a seven state study of 250 AL communities to focus on four populations receiving care in AL: persons with dementia, serious mental illness, sleep disturbances, and on hospice. The first speaker will discuss how AL staff conceive of and respond to behavioral expressions of persons with dementia; the second will focus on the use of psychosocial/environmental practices for persons with dementia in AL. The third speaker will discuss the growing proportion of persons with serious mental illness in AL and related implications for care. The fourth presenter will address the high use of melatonin in AL, as well as resident- and community-level correlates of melatonin prescribing. The final speaker will examine hospice use in AL and how it varies based on community characteristics. These findings related to care and care needs for four key populations have important implications for practice, policy, and future research.
Which Assisted Living Communities Provide Hospice?
Authors: Prizer Lindsay , Zimmerman Sheryl , Wretman Christopher , Preisser John , Thomas Kali , Sloane Philip
Published: December 2020

Assisted living (AL) communities have become a common site for end-of-life and hospice care. However, AL is highly variable, meaning that hospice use is likely to be variable as well. This study explored the association between AL community characteristics and their residents’ use of hospice. A stratified random sample of 250 AL communities in seven states was recruited. Community-level data were obtained from interviews with AL administrators, and resident-level case-mix data were abstracted from charts. Survey-weighted regressions examined the relationship between community characteristics and hospice use. Having residents on hospice was associated with being for-profit (86% vs. 51%), larger (48 vs. 31 beds), newer (16 vs. 37 years), having weekly primary care provider visits (44% vs. 26%), having more residents with dementia (50% vs. 35%) and fewer on Medicaid (4% vs. 11%), and having more lenient discharge policies. Data suggest there may be some disparity in hospice provision in AL.
Bane or Boon? The Role of Spirituality, Religion, and Well-Being in Later Life Across Diverse Older Populations
Authors: Nelson-Becker Holly
Published: December 2020

Older adults tend to be religiously-affiliated to a greater extent than any other generational cohort (ARDA,2018; Koenig, King & Carson,2012; George et al.,2013; Nelson-Becker,2018). However, their level of engagement varies across cultural and national contexts. Complex life course trajectories related to spirituality and religion mean that these domains often interface with both challenges and a search for well-being. Individuals may align with spiritual and/or religious values to a greater or lesser extent at different periods in their lives becoming more spiritual/religious, less spiritual/religious, or differently so. These papers address diverse perspectives on spirituality, religion, and well-being using samples primarily from the UK, Europe, the US, and Canada. The first paper by Christina Victor sets context by comparing the role of religion, and spirituality in well-being across three separate older adult data sets, touching on loneliness and dementia. Holly Nelson-Becker discusses results from an online international survey of older persons who walked the ancient Camino de Santiago pilgrimage regarding their motivations and learning from the experience. Michael Thomas considers the complex role of spirituality and sexuality for older LGB couples who may choose to remain in or leave their religious faith as they integrate expanding views. Keith Anderson explores perceptions of belief changes among religious and spiritual older adults across the life course. Together, these papers will address benefit and harm from formal religious practice and the advancing roles of spirituality as well as nonspirituality (the “nones”) in global societies.
Is It What You Have or What You Do With It? Staffing, Human Resource Management, and Knowledge Management Practices
Authors: Hearld Larry , Ghiasi Akbar , Davlyatov Ganisher , Weech-Maldonado Robert
Published: December 2020

Research in the nursing home industry shows more robust knowledge management activities are associated with the adoption of patient-centered, culture change initiatives among high Medicaid nursing homes. These findings are notable because they highlight the important role that knowledge management activities may play for improving quality of care in under-resourced nursing homes. They also raise important questions about the conditions that may support or hinder the use of these activities. Using survey responses from 393 nursing home administrators, we empirically examined whether two components of human resources – staffing levels and HRM practices – are associated with the level of knowledge management activities in high Medicaid census nursing homes. More robust HRM practices were associated with greater levels of knowledge management activities, as well as three separate domains of knowledge management (acquisition, dissemination, and responsiveness). Staffing levels, in contrast, were not significantly associated with the level of knowledge management activities.
Political Impediments to Aging in Place: The Example of Informal Caregiving Policy
Authors: Chattopadhyay Jacqueline
Published: December 2020

Most Americans prefer to “age-in-place” as long as possible, but to do so often need overlapping resources—one of which is help from “formal” or “informal” caregivers (family and friends). Family and friends often want to provide care for as long as safely possible. However, informal caregiving can pose financial and physical risks to the caregiver that—as many scholars have noted—public policy in the U.S. does relatively little to mitigate. This policy shortfall also hurts care recipients since the risks that informal caregivers face can prematurely curtail their ability to provide care. Why does policy in the U.S. not better support informal caregivers? By synthesizing family caregiving research and political science research that has addressed long-term care, this paper surveys nine factors in the political system that may help answer this question. Four emanate from policy history. Three concern the mass public. Two vary at the policy level.
The 2020 Portrait of American Caregivers
Authors: Shih Regina
Published: December 2020

The prevalence of caregiving for an adult or child with special needs has increased significantly in the past five years (from 18.2% to over 21.3%), driven by an increase in the prevalence of caring for a family member or friend aged 50 and older. At the same time, care recipients have greater health and functional needs that necessitate care from others in comparison to 2015. These new 2020 data from the Caregiving in the US Survey by the National Alliance for Caregiving suggests that not only are more American adults taking on the role of caregiver, but they are doing so for increasingly complex care situations. This paper addresses the prevalence of caregiving including the demographics of family caregivers, relationship between the caregiver and the care recipient, health conditions of the care recipient, and living situations of care recipients and their caregivers.
Caregiver Health and Well-Being, and Financial Strain
Authors: Reinhard Susan , Feinberg Lynn
Published: December 2020

Family caregivers often face key challenges when caring for a relative or close friend with health or functional needs. This paper presents findings from Caregiving in the U.S. 2020 on the impact of caregiving on the physical health and well-being of family caregivers and the financial impacts of family care. The data suggest that the caregiver’s own health has declined, with 1 in 5 (21%) saying they are in fair to poor health themselves, up from 17 percent in 2015. Nearly 1 in 4 (23%) feel caregiving has made their health worse. Nearly 4 in 10 (38%) family caregivers of adults experience a moderate to a high degree of financial strain from providing care. Forty-five percent have experienced at least one financial impact (e.g., stopped savings, debt, ability to pay bills, and ability to afford necessary expenses, like food). These findings reveal that because family caregiving today is more complex, costly, and stressful than in the past, action is needed to recognize and support family caregivers in the U.S adequately.
Policy-Relevant Research and Media Communication
Authors: Herd Pamela
Published: December 2020

The second speaker is Dr. Pamela Herd, Professor of Public Policy at Georgetown University. Dr. Herd will discuss her approach to conducting innovative and impactful policy-relevant research, as well as her experience communicating research to policymakers and the public through op-eds and other forms of media. Dr. Herd’s research focuses on inequality and how it intersects with health, aging, and policy. She also has expertise in survey methods and administration. Her most recent book, Administrative Burden, was reviewed in the New York Review of Books. She has also published editorials in venues such as the New York Times and the Washington Post, as well as podcasts, including the Weeds, produced by Vox media.
Shining Light and Creating Solutions: Health and Social Needs of Older Affordable Housing Residents
Authors: Simon-Rusinowitz Lori , Mullins C Daniel , Morales Karen , Elliott Rodney , Raab Constance
Published: December 2020

Aging within a community requires access to health and social services. This project lays the groundwork for an innovative, three-part health and social services intervention intended to improve the health and well-being of older affordable housing residents in a low-income, vulnerable Baltimore neighborhood. We will report on the first part, an assessment of residents’ unmet health and social service needs and their ideas for meeting these needs. With guidance from a community advisory group of older residents (a key program component), we are conducting structured interviews with 50 elders to identify residents’ needs and interests. These findings will inform the next project segments: Part 2- exploring how the Village model (in which neighbors identify and offer needed services to help their neighbors age within a community) can be adapted for an affordable housing setting, and Part 3- adapting an evidence-based housing-plus-services model to meet older residents’ unmet needs.
Developing a Volunteer Education Initiative for Older Adults’ Health
Authors: Seidel Liz , Cortes Tara , John Cinnamon St
Published: December 2020

Older adults need sufficient information to make healthy decisions and be active participants in their healthcare. Yet there is often a lack of information available. The Bronx Health Corps (BHC) was created to meet this need by providing older adults with usable knowledge on managing health conditions and promoting healthy behaviors in community-based settings. The BHC trained 175 volunteers, educated 2,065 older adults, with a total attendance of >5,000. Steps of creating a volunteer education initiative will be presented with qualitative and quantitative data utilization in implementation of the program. Focus groups with older adults noted challenges in addressing community health needs and the importance of reaching outside of healthcare settings to address the health of the community. Focus groups with Spanish speaking older adults and caregivers expanded knowledge on their attitudes toward the 4Ms and their ability to use that knowledge in interacting with their providers.
Triangulating Qualitative Methods to Evaluate Survivorship Care
Authors: Seaman Aaron , Saeidzadeh Seyedehtanaz , Chasco Emily , Lee Sangil , Kendell Nicholas , Reisinger Heather , Pagedar Nitin
Published: December 2020

With 16.9 million survivors in the US, survivorship is an increasingly important aspect of oncologic care. As the number increases, we need to provide evidence-based, standardized survivorship care, yet the evidence base is lacking and guidelines are variably implemented. This multi-sited study documented the survivorship care practices of five head and neck cancer (HNC) programs in order to identify survivorship care practices, provider preferences, practice variability, and the facilitators and barriers to effective survivorship care implementation. To ensure rich, contextual data, the study utilized multiple qualitative methods: 1) program characteristics questionnaire; 2) semi-structured interviews with providers involved in treatment and survivorship care, 3) on-site observation and clinic workflow mapping, and 4) collection of survivorship materials. Triangulating data collection provided evidence of potentially promising HNC survivorship care practices, aligned with the vision of comprehensive survivorship care, that can be used to evaluate practices and develop interventions on a larger scale.
Barriers and Facilitators to Integrating Family Caregivers Into the Healthcare Team
Authors: Friedman Esther , Tong Patricia
Published: December 2020

Recent changes in health care practices - shorter hospital stays, increased complexity of disease management, and greater management of chronic illnesses at home - have left family members increasingly responsible for medical tasks. Although these family caregivers represent the vital front line of care, they remain mostly excluded from the formal health care team. Based on interviews with multi-sector stakeholders representing patients/caregivers, providers, and payers, we identified several barriers to fully incorporating family caregivers into the health care team. They fall under five key themes: identification of caregivers; communication and information; time and resources; trust and cultural barriers; and Medicaid coverage. We discuss these barriers and potential solutions that could be undertaken by different stakeholder groups to improve family caregiver integration into the care team.
Implementing Non-Pharmacologic Interventions for People Living with Dementia in Long-Term Care Settings
Authors: Ihara Emily
Published: December 2020

Person-centered dementia care is a best practice recommendation by the Alzheimer’s Association, and non-pharmacologic interventions that emphasize well-being and quality of life as defined by the individual are important to preserve personhood. Non-pharmacologic, person-centered interventions have been shown to effectively address various neuropsychiatric symptoms, commonly known as behavioral and psychological symptoms in dementia (BPSD), which include a wide range of behaviors such as verbal or physical aggression, agitation, wandering, and pacing. Interventions that are focused on an individual’s holistic needs and preferences can stimulate positive emotions and behavior regardless of the stage of dementia. Person-centered care emphasizes a social model of care, rather than a medical model, by focusing on an individual’s emotional needs and care preferences that are consistent with their previous lifestyle. This symposium explores four different non-pharmacologic interventions for individuals living with dementia and discusses challenges and best practices for implementation in long-term care settings. For example, a best practice includes “buy-in” from facility staff who ultimately are responsible for implementing interventions that follow a social care model. A challenge found includes creating consistency and adherence to non-pharmacologic interventions so they are sustained over time, potentially replacing additional doses of medication. Symposium presenters will discuss the Mason Music & Memory Initiative (M3I), the Alzheimer’s Poetry Project, Birdsong, and TimeSlips, which are all interventions that are relatively low-cost and easy to implement by non-specialists. Strategies for intergenerational programming and adaptability of these programs to different contexts will also be discussed.
Evacuation or Shelter in Place in Assisted Living: Adherence to Emergency Evacuation Orders for Hurricane Dorian
Authors: Peterson Lindsay , June Joseph , Sakib Nazmus , Hyer Kathryn
Published: December 2020

Hurricane Dorian devastated parts of the Bahamas in 2019 with 185-mph winds. As it moved toward Florida, the state went on alert. This paper examines whether assisted living communities (ALCs) in affected counties evacuated or sheltered in place in the context of emergency management communications concerning evacuation. In 16 coastal counties, 66 ALCs were under mandatory evacuation orders, but 12 sheltered in place. Of 603 ALCs not under orders, 17 evacuated. Seven ALCs evacuated contrary to orders in one county, which issued a mandatory order Sept. 1, delayed it to Sept. 2 as Dorian weakened, and lifted it Sept. 4. Interviews with ALC administrators and emergency managers will be used to understand more about their decisions. Given prior findings that evacuation (versus sheltering in place) increases the mortality and morbidity risk of long-term care (LTC) residents, this research suggests a need for clearer LTC evacuation standards and communication. Part of a symposium sponsored by Disasters and Older Adults Interest Group.
Emerging Retirement Crisis: When Social Security Is Not Enough
Authors: Miller David
Published: December 2020

Evidence suggests a growing retirement crisis in the United States among older adults placing many of them at risk of falling into poverty. While Social Security provides income assistance to retirees, the average monthly benefit is $1,300. Among older adults nearing or in retirement, the use of public assistance programs is increasing. Using data collected by the Associated Press-NORC Center for Public Affairs Research we examine retirement preparedness, borrowing from retirement plans, and use of social welfare programs. Findings indicate increased borrowing from retirement plans due to debt, significant differences in racial and gender groups accessing and receiving services among those 75 and older. Increasing rates of unpreparedness for retirement exist among older Americans, particularly among adults of color. An increase in the use of safety net services among older adults is occurring concurrently with severe funding reductions in social welfare programming.
A Direct Reporting Platform for Financial Exploitation: From Banks to APS
Authors: Burnett Jason , Reisch Sally , Rogers Geoffrey
Published: December 2020

Despite encouraging changes in regulations and practices, opportunities remain to strengthen the collaboration between Financial Services Institutions (FSI) and Financial Exploitation (FE) investigative agencies such as Adult Protective Services (APS). A major barrier to these collaborations is timely and effective information exchange, between the agencies, for maximizing client protection. Often times, the need for more information from the agencies involved delays or mitigates the provision of financial protection to the client/victim. Through the U.S. Office for Victims of Crime, funding has been provided to develop a single reporting platform for enhancing communication and collaboration between FSI and APS. The helpful platform provides an innovative conduit for providing timely and effective information exchange between FSI and APS agencies to better serve and protect older adults against FE. This presentation will discuss the platform development, the lessons learned, preliminary data and future research. Part of a symposium sponsored by Abuse, Neglect and Exploitation of Elderly People Interest Group.
Cognitive Function in Sexual and Gender Minority Older Adults
Authors: Flatt Jason , John Samantha , Frew Paula
Published: December 2020

Nearly 3.5 million sexual and gender minority (SGM) adults aged 60+ in the U.S. identify as lesbian, gay, bisexual, transgender, and/or queer. We recruited over 50 diverse SGM older adults from the community to better understand correlates of their cognitive function. The Telephone Interview for Cognitive Status, an 11-item screening test of global cognition was used over the phone or in-person. We will describe relationships among cognition and several sociodemographic and health variables (age, sex assigned at birth, SGM identities, race/ethnicity, and health). Past research has highlighted higher rates of perceived memory problems among lesbian, bisexual and transgender adults compared to both gay men and heterosexual men and women. These rates were also higher among those who identify as women. We highlight implications for researching gender identity and cognition in late life, such as the influence of gender roles on cognition and the assessment of gender expression and related constructs.
Learning While Doing: Community-Engaged Action Research With Age-Friendly Community Leaders
Authors: Pestine-Stevens Althea , Greenfield Emily , Firestone Stephanie
Published: December 2020

Age-Friendly Community Initiatives (AFCIs) are expanding throughout the United States to make social and built environments within local communities more responsive to population aging. With over 450 initiatives affiliated with the AARP Network of Age-Friendly Communities, Cities, and States (125 of which began in 2019-early 2020), rapid growth on the ground necessitates that theory and research develop alongside practice innovations. This symposium showcases the intersection of cutting-edge scholarship with community-based efforts to generate knowledge of community change processes that is immediately actionable by community leaders. Collectively, these papers emphasize the benefits of action research and developmental evaluation in community gerontology towards building the theories of age-friendly change that will set the stage for outcomes research. The first paper will present on work with 83 AFCIs in rural Maine involving interviews with organizational leaders to inform which types of supports could stimulate age-friendly changes to communities’ built and social environments. The second paper will share a mixed-methods approach used to develop a global toolkit for dementia-friendly communities. The third presenter will describe the collaborative development and utilization of social network analysis to help age-friendly leaders plan their work, while simultaneously advancing research on variation in AFCI implementation. The final paper will present an evaluative framework that identifies roles and outcome measures for collective impact at the intersection of public health and age-friendly communities.
Building Sustainable Rural Age-Friendly Communities: Grassroots Perspectives
Authors: Oh Patricia
Published: December 2020

Joining the AARP Network of Age-Friendly States and Communities does not make a community age-friendly; the age-friendly team must cultivate community engagement, develop collaborations with diverse stakeholders, mobilize resources, and document achievements. Little research describes the tools age-friendly rural communities use to effect change and develop sustainability. Thematic content analysis of 67 interviews conducted between December 09, 2018 and January 24, 2020 with age-friendly leaders in rural Maine communities suggested that peer-to-peer networking, privileging local knowledge, engaging local and regional partners, technical advice from a trusted source, and fun were among the tools used to move age-friendly rural work forward.
Evaluating Collective Impact for Healthy Aging at the Intersection of Public Health and Age-Friendly Communities
Authors: Black Kathy , Hyer Kathryn
Published: December 2020

There is mounting interest in promoting - and evaluating efforts that improve healthy aging in age-friendly communities. Additionally, there is increasing recognition that multi-sectoral engagement beyond the aging network is needed to maximize impact and sustainability. Within the context of collective impact, this paper reviews a framework that explicates public health activities in collaboration across a range of stakeholders in age-friendly communities. Metrics demonstrating evidence of five categorical roles, processes and outcomes will be presented including: 1) Connecting and Convening; 2) Coordinating; 3) Collecting and Disseminating Data; 4) Communicating; and 5) Complementing and Supplementing. Examples that illustrate evidence vis-à-vis the components and phases of collective impact will be presented.
Let’s Stop Spinning Our Wheels: Strengthening the Case for Community-Engaged Transportation Solutions
Authors: Dabelko-Schoeny Holly , Fields Noelle , Silverstein Nina
Published: December 2020

On average in the United States, older adults outlive their ability to drive by seven years. Having safe, affordable and accessible alternative transportation options is critical to supporting the well-being of older adults and their ability to age in community. This symposium will provide evidence for utilizing community-engaged research strategies with diverse populations to identify the opportunities and barriers for the development and utilization of alternative transportation. The presentations will include up-to-date examples of innovative alternative transportation solutions and evaluation data. The first presentation will illustrate how community-based participatory research (CBPR) strategies were used to develop, use and evaluate alternative transportation options including walking, biking, fixed route busing, senior circulator, ride sharing and transit training in an age-friendly community. Data were collected through mapping the built environment, an electronic daily transportation diary app called “MyAmble” on tablets, walk audits and focus groups. The second presentation uses an environmental justice (EJ) framework to present the findings of a qualitative interpretive meta-synthesis (QIMS) about older adults’ experiences with outdoor spaces and buildings and transportation as part of the World Health Organization’s age-friendly network assessment. The third paper explores the barriers and facilitators of transportation among diverse older adults (English, Nepali, Khmer, Somali, Russian and Mandarin Chinese) using Rapid and Rigorous Qualitative Data Analysis (RADaR) technique. The final paper examines the challenges of rural transportation services supported by senior centers. The symposium will conclude with a critical reflection on the empirical contributions needed to advance scholarship on alternative transportation for older adults.
Using Community-Based Research Strategies in Age-Friendly Communities to Solve Mobility Challenges
Authors: Dabelko-Schoeny Holly , Fields Noelle , White Katie , Sheldon Marisa , Robinson Sarah , Murphy Ian , Jennings Claire
Published: December 2020

Aging is linked to an increased risk of disability. Disabilities that limit major life activities such as seeing, walking, and motor skills impact a person’s ability to drive a car. Low utilization of alternative transportation by older adults may put them at risk for social isolation. The purpose of this paper is to illustrate how community-based participatory research (CBPR) was used to engage older residents in the development of alternative transportation options in a metropolitan county in the Midwestern U.S. Older residents worked as co-investigators to develop, use and evaluate alternative transportation options including walking, biking, fixed route busing, senior circulator, ride sharing, and transit training. Data were collected through mapping the built environment, an electronic daily transportation diary app called “MyAmble” on tablets, walk audits and focus groups. CBPR approaches led by interdisciplinary teams resulted in community engagement and more equitable strategies for transportation planning and utilization.