bluuebunny/crossref_metadata_2025 huggingface dataset:
Benevolent Ageism: Exploring Its Boundary Conditions, Generalizability, and Correlates
Authors: Bisconti Toni , Sublett Jennifer , Chasteen Alison
Published: December 2020

Ageism is one of the few prejudices that is still socially condoned (Nelson, 2016). Given the aging population and the impact of internalizing ageist thoughts, this construct needs to be at the forefront for scientific examination. The long-term effects of ageism, particularly negative self-perceptions, lead to negative health and cognitive outcomes (Chasteen et al., 2015; Levy et al., 2002). One of the intricate components of ageism, however, is that it is often “benevolent”. Cuddy and colleagues developed the Stereotype Content Model (SCM) to describe how individuals are categorized based on varying degrees of warmth and competence. Unlike many devalued members of society who are viewed as low on both, older adults are viewed as having high warmth and low competence, leading to more overaccommodative treatment. The goal of the present symposium is to overview the ways in which researchers have dissected this more nuanced type of ageism. Specifically, two of the presenters will cover some of the boundary conditions of understanding age-based stereotypes and their malleability, examining them across ages and across genders. Additionally, one of our presenters will overview the validation of the Ambivalent Ageism Scale on a Chinese sample, lending support to its generalizability. Finally, our last presenter will overview the relationship between benevolent ageism and self-compassion to predict metamemory, given the pervasive stereotype that older adults suffer from severe cognitive decline. Themes and implications of these presentations will be discussed.
Changes in Social Networks as a Response to Loneliness Among Older Adults
Authors: Visaria Abhijit , Sung Pildoo , Chan Angelique W M
Published: December 2020

The expression of loneliness suggests perceived social isolation and the lack of meaningful, rewarding and desired social connections. In this paper we seek to estimate whether loneliness among older adults is related to subsequent changes in two attributes of their social networks, i.e. the size and frequency of contact with network members. We use the Panel on Health and Ageing of Singaporean Elderly, a nationally representative study of older adults aged 60 years and older, conducted in 2009 (N=4990) with two follow-up waves in 2011 and 2015, and measure loneliness in terms of relational connectedness, i.e. feeling a lack of companionship, and social connectedness, i.e. feeling left out. Our preliminary analysis shows that loneliness is associated with a subsequent reduction in the size but not strength of social networks. We further propose to assess the causal relationship using cross-lagged panel analysis, thereby accounting for the possibility of a reciprocal relationship.
Economic and Social Influences on Later-Life Well-Being: New Evidence From the NLSY79
Authors: Carr Deborah , Burge Stephanie
Published: December 2020

The National Longitudinal Survey of Youth 1979 (NLSY79) provides unprecedented opportunities for understanding how work, family, and socioeconomic characteristics over a 40-year period shape the well-being of older adults. The large sample enables explorations of race, gender, and socioeconomic differences in these processes. The five papers in this symposium exploit the rich life course data of NLSY79 to understand two key outcomes: health, and work/economic arrangements as adults approach their retirement years. Harrati and Heburn document the impacts of unemployment trajectories on physical and mental health, highlighting gender differences in these processes. Wolfe investigates the long-term health consequences of significant economic setbacks over the life course (shocks), taking into account those risk factors (selection) that render one vulnerable to such shocks. Jang and Tang document the negative impacts of informal caregiving on later-life physical health, yet their subgroup analyses detect positive impacts for African-Americans. Aughinbaugh delineates women’s time spent in caregiving over the life course, and discusses the implications for later-life economic well-being of both early life childcare and later-life coresidential caregiving. Walsemann, Fisk and Ailshire examine the role that parents and grandparents play in paying for their offspring’s college education, with careful attention to gender and socioeconomic differences in these patterns. Taken together, these papers underscore the importance of adopting an intersectional approach to understanding later-life well-being, and reveal the complex ways that paid work, unpaid work (caregiving), and inter-transfers (via tuition payment) bear on the health and financial stability of adults transitioning into their retirement years.
Who’s Hurt Most by Economic Shock? Exploring Heterogeneity in the Health-Related Effects of Wealth Loss
Authors: Wolfe Joseph
Published: December 2020

Prior research finds evidence of an effect of negative economic shocks on health, but this growing area has not fully investigated variation in this effect. A large number of people from diverse backgrounds experience a substantial financial setback of some type, and differences related to one’s gender, race/ethnicity, and socioeconomic status (SES) may influence the consequences of economic shocks on one’s life such that the health-related effects of shocks vary systematically in the U.S. population. Thus, this study aims to identify the effects of multiple economic shocks on health in middle adulthood, and whether the effects of shocks on health vary by one’s underlying propensity to experience the shock. The analysis uses newly developed statistical techniques from causal inference literature and over twenty-five years of biographical information from the NLSY-79. Results from the analysis help shed light on important variation in the association between negative economic shocks and health.
Parent and Child Factors That Predict Who Helps Young Adult Children Pay for College
Authors: Walsemann Katrina , Fisk Calley , Ailshire Jennifer
Published: December 2020

In recent decades, the cost of higher education has exceeded the pace of inflation while wages have stagnated or declined. As such, young adult children may increasingly look to their parents and other family members, including grandparents, to help them pay for college. We use data from the National Longitudinal Survey of Youth 1979 to determine who financially contributes to a young adult child’s college education, restricting our sample to mid-life parents with at least one biological child who attended a 2-year or 4-year college and completed the college expenditures module in 2014 (n=3,525). For each college-going child, parents reported who paid for the student’s tuition – student, parents, grandparents, other family members, or a combination of these. Using multinomial logistic regression, we will estimate who paid for college as a function of parents’ social and economic characteristics when the child was 16 and the child’s gender and birth order.
Economic Inequality Over the Life Course: Causes and Effects of Cumulative Dis/Advantage Processes
Authors: Kelley Jessica , Crystal Stephen , Kelley Jessica
Published: December 2020

Economic inequality has grown rapidly in all age groups in the past several decades. In each successive cohort, the wealth gap grows for young people and seems to accelerate faster over the life course. While rising inequality has taken its toll on Baby Boomers, we have become acutely aware of the increasing economic pressures across the entire life course (work precarity; student loans) that will manifest in the greatest degree of inequality in older adulthood seen to date. This session explores the forces that have shaped the degree of inequality among current older adults and are setting the stage for future cohorts of older adults. Presenters will explore several aspects of this issue: the growing state of the “risk retirement,” the impact of income inequality on later-life wealth and health, the structural racism written into economic policies intended to help Americans accumulate wealth and maintain health, and the market disadvantage for GED recipients compared to high school diploma recipients.
Health Professionals' Knowledge of how to Report a Missing Person With Dementia: A National Survey
Authors: MacAndrew Margaret , Beattie Elizabeth , Taylor Dubhglas , Whitehead Jim , Quinn John
Published: December 2020

In Australia one in five land searches conducted by Police involve a person with dementia. Over a third of these people go missing from a health care service and 15% are not found alive. Delays in commencing a specialised search for the missing person with dementia contributes to the risk of death. Delays in Police searching may result from ambiguity in current policies about how to report a missing patient/client. This study aimed to explore health professional’s knowledge about how to report a missing person with dementia and reasons for delayed reports to Police. 246 Australian health professionals completed an online survey. Most were registered nurses (n=124), allied health professionals (n=69) and medical practitioners (n=22) who worked in a range of settings including acute care (n=111), community care (n=59) and residential aged care (n=44). Over a third (n=81) did not know their care service policy for reporting a missing patient/client and did not know if their health service had a policy specific to reporting a missing person with dementia. 20% did not know how long they needed to wait before reporting a missing person to Police and fear of calling Police too soon or wasting their time were common reasons for delaying a report. These findings confirm a degree of misunderstanding about current policy and procedures for reporting a missing person with dementia. Addressing knowledge deficits and standardising approaches to reporting a missing person with dementia in Australia would be recommended as a step toward improving their health outcomes.
A Qualitative Analysis of the Relationship Between Older Adults’ Daily Lives and Life Outlook
Authors: Bouklas Isabella , Pasquini Giancarlo , Gilbert Renee , Bergeman Cindy , Scott Stacey
Published: December 2020

Leading theories of adult development suggest age-related changes in one’s life perspective and changes in one’s priorities are reflected in daily behavior. The present study explored how older adults understand their current lives through a qualitative study of midwestern Americans. Twenty-four participants (Mage= 69.53 years; age range=63-78 years) from the Notre Dame Study of Health & Well-Being (Whitehead & Bergeman, 2014) completed semi-structured interviews in which they were asked about turning points across their lives. Inductive analysis using the constant comparative method (Maykut & Morehouse, 1994) resulted in 10 life-domains based on common descriptions across participants. These domains represented the ways in which participants understood their identities over the course of their lives, as well as their organization and use of time and space in daily life. Participants’ descriptions of both general life outlook and daily life informed one another, revealing the dialectical relationship between micro-level behaviors and macro-level attitudes.
The Dynamics of Control: Investigating the Effect of Control Diversity on Subjective Well-Being in Later Life
Authors: Mann Ajit , Nakamura Jeanne
Published: December 2020

Recent advancements in research on control beliefs have enabled the assessment of inter-individual differences in its intra-individual variability via a measure of control diversity. However, past research has focused on control diversity in relation to daily stressors. Among a sample of prosocial exemplars, this experience sampling study investigates control diversity across general daily activities and explores its relationship with subjective well-being. Participants indicated the activity they were primarily involved in, the extent to which they felt in control over the situation, and levels of positive and negative affect each time they were signaled; satisfaction with life was measured using a one-time survey at the end of the study. Results from multilevel structural equation modeling suggested that control diversity did not significantly predict positive or negative affect, or satisfaction with life. The study points toward the lack of association between control diversity and subjective well-being and highlights future directions for research.
Adult Day Services as a Platform for Innovation: Moving Beyond Simply Attendance
Authors: Anderson Keith
Published: December 2020

At the most basic level, adult day services (ADS) provide a congregate environment for participants and respite for caregivers. Researchers often evaluate the impact of ADS on participants and caregivers in terms of attendance; however, what happens in ADS (e.g., specific programs and interventions) may be equally or even more important than simply attendance. In this presentation, we review four recent innovative studies conducted in the ADS setting with participants: (a) a board game intervention to improve cognitive functioning; (b) a cognitive behavioral intervention to improve sleep; (c) an aromatherapy intervention to address behavioral issues; and (d) a dance and movement intervention to stimulate physical activity. While these interventions had varying levels of effectiveness, they do support a growing body of evidence that ADS can serve as a platform for innovation and suggest that attendance may be simply one facet of the overall ADS experience.
Life Employment Histories in Middle Age and Their Association With Health Outcomes in Later Life: A Sequence Analysis
Authors: Shin Oejin , Kim BoRin , Park Sojung , Kang JiYoung , Kwon Ilan , Ahn Seoyeon
Published: December 2020

Despite consistent evidence on the negative effect of precarious employment on health, little is known about the dynamic pattern of employment over the life course on later year health. Using the longitudinal data (1-18 waves) from the Korean Labor & Income Panel Study (KLIPS) (n=1,705), this study aimed to (1) identify long term change patterns of employment in two middle-age groups (early middle-aged: 40-49 / late middle-aged: 50-59), (2) examine the association between the patterns and self-rated health in old age. We apply sequence analysis with 18 years of working status and conducted regression health outcomes in the 18th wave. The result of sequence analysis found the differential employment patterns: among the early middle-aged, five patterns were identified consistently full-time, consistently not- working, transit to self-employed, mixed pattern, retired. Among the late middle-aged, five patterns were identified: consistently full time, mixed pattern, consistently retired, transit to not- working, consistently not working. Regression results indicated a negative association between precarious employment history and health in later years: Among the early middle-aged, members in the “consistently full-time” were likely to have better health compared to “transit to self-employed”. Among the later middle-aged, “retired” and “transit to not –working” were likely to have better health compared to “mixed pattern group”. The findings suggest the importance of employment history in middle age to predict the health outcome in later life. Policies to support experiencing precarious or self-employment are needed to prevent health disparity in later life.
Optimizing Physical Activity and Decreasing Care-Resistant Behaviors Among Nursing Home Residents With Dementia
Authors: Galik Elizabeth , Resnick Barbara , Vigne Erin , Holmes Sarah
Published: December 2020

The purpose of this study was to test the effectiveness of the Function and Behavior Focused Care (FBFC) intervention on function, physical activity and behavioral symptoms among nursing home residents with dementia. This study was a clustered, randomized controlled trial with a repeated measures design in 12 nursing homes. The participants (N=336) were 82.6 (SD=10.1) years of age, mostly female and were moderate to severely cognitively impaired (MMSE of 7.8, SD=5.1). There were a statistically significant improvements in time spent in light, moderate and overall physical activity based on actigraphy and a decrease in resistiveness to care at 4 months among participants in the treatment group. There was no change in mood, agitation, and the use of psychotropic medications. This study provides some support for the use of the FBFC intervention to increase time spent in physical activity and decrease resistive behaviors during care among nursing home residents with dementia. Part of a symposium sponsored by Nursing Care of Older Adults Interest Group.
Peers in Primary Care: How Peer Specialists Support Aging Veterans
Authors: Peeples Amanda , Muralidharan Anjana , Kuykendall Lorrianne , Goldberg Richard , Chinman Matthew
Published: December 2020

Most of the more than 1,100 peer specialists (“peers”) in the Veterans Health Administration (VHA) work in mental healthcare settings. These peers provide a variety of services to Veterans such as facilitating groups, teaching recovery and coping skills, connecting Veterans with VHA and community services, and helping Veterans navigate VHA care. In 2014 the White House issued an Executive Action mandating the reassignment of peers from mental health to primary care settings in 25 VHA locations nationwide. This paper presents qualitative findings from a mixed-methods study evaluating this implementation of peers in VHA primary care. We found that peers assisted aging Veterans in primary care through activities such as providing health coaching, facilitating health education groups, connecting Veterans with services, and providing general peer support. Findings are drawn from semi-structured interviews with 27 peers, 25 supervisors, and 10 Veterans who received services from the peers in primary care.
Older Peer-Delivered and Smartphone-Supported Integrated Medical and Psychiatric Self-Management Intervention
Authors: Fortuna Karen
Published: December 2020

PeerTECH is older peer-delivered and technology-support integrated medical and psychiatric self-management intervention developed by older adult peer support specialists. Older adult peer support specialists are older adults with a lived experience of a mental health condition, who are trained and accredited to provide support services to others with similar conditions. A pre/post trial by our group has shown PeerTECH is associated with statistically significant improvements in self-efficacy for managing chronic disease and psychiatric self-management skills. This presentation will discuss the feasibility and potential effectiveness of a 3-month pre/post study with older adults with SMI. We will discuss the potential effectiveness of PeerTECH with older adults with SMI related to loneliness, distress, and medical and psychiatric self-management. in conclusion, we will discuss the main and interactive effects of loneliness and factors linked to mortality.
Trends in the Receipt of Consistent Hospice Professional Visits at the End of Life and Ratings of Hospice Care Quality
Authors: Christian Thomas , Teno Joan , Cobb Kyle , Galantowicz Sara , Levitt Alan , Massuda Cindy
Published: December 2020

Caregivers have identified consistent visits by professional hospice staff at the end of life as positively affecting experiences of care quality. Little is known about the prevalence of such visits. Using 100% Medicare hospice claims with discharge dates in Federal Fiscal Year 2018, we identified the rates of providing skilled nurse or social worker visits to hospice beneficiaries in at least two of the last three days of life and compared these rates to percentages of caregivers indicating they would “definitely” recommend the hospice and caregivers rating the hospice a 9 or 10 on a 10-scale from CAHPS Hospice scores. Among our analytic cohort of 762,238 hospice discharges, 509,585 individuals (66.9%) were visited by a nurse or social worker in at least two of the last three days of life. Beneficiaries lacking these visits were more likely to be black (black 39.6% vs. white 32.2%; AOR 1.32 95% CI 1.29-1.34) or resided in a nursing facility (nursing facility 37.7% vs. patient’s home 32.1%, AOR 1.39 95% CI 1.36-1.40). The mean hospice-level score for achieving these visits was 64.8% (median 70.2%; IQF 53.0%-80.9%). The Pearson’s correlation coefficients between hospice-level rates of visits at the end of life and the caregiver percentages for “definitely” recommending the hospice was 0.2418 and for rating the hospice a 9 or 10 on a 10-scale was 0.2587. These findings demonstrate significant variability across hospice providers and signal a positive correlation with caregivers’ quality ratings. Future work is needed to monitor the provision of these visits.
What Is Important at the End of Life? Perspectives From Experienced Home Care Workers
Authors: Tsui Emma , Franzosa Emily , Boerner Kathrin
Published: December 2020

Home care workers (HCWs) make up a large and rapidly growing sector of the American health care workforce serving older adults. This study focuses on a common but understudied feature of home care labor: workers’ thoughts around what makes a "good" or "bad" patient death. While researchers have investigated patients’, families’, physicians’, and other care providers’ perspectives on this issue, the perspectives of HCWs, who contribute substantially to home-based care at the end of life, have yet to be explored. We conducted 40 in-depth interviews with HCWs in New York City on their experiences with and reflections on patient death. We used a inductive, iterative approach to analyze data on what HCWs believe is important for dying patients. HCWs described EOL values that align well with the views held in common by patients, families, and other care providers, like the importance of not being alone when dying and being physically comfortable (not in pain and not suffering). In particular, HCWs conceptualized a detailed role for themselves when providing EOL care near the time of death. HCWs’ sustained presence and relationships with patients may uniquely position them to assist in the attainment of patients’ EOL goals, particularly when HCWs understand what these goals are. HCWs’ potential for playing this role, however, is jeopardized by a lack of training in EOL care and by the limited information they receive about a patient’s health status.
An Exploration of Learning Results and Curricula Gaps Within an Online Grandfamilies Certificate Program
Authors: Crittenden Jennifer
Published: December 2020

Professionals who work with grandparents raising grandchildren have cross-cutting training needs that span content in gerontology, social services, child welfare and program development. To address these needs, a unique, asynchronous, online continuing education program was launched by the UMaine Center on Aging. To-date the program has 177 individual program completers with learners from across the U.S. and Hong Kong that are affiliated with a diverse set of organizations and perform a wide range of professional and lay functions. Participant data indicate that the program has appealed to a wide variety of learners including participants who serve caregivers generally (60.8%) and grandparents raising grandchildren specifically (81%). A small majority (55.6%) of the agency-based learners reported serving, on average, more than 40 grandfamilies annually. Self-reported learning levels were notable ranging from a mean low of 3.46 out of 4 points (N = 157, SD = 0.59) for the volunteer recruitment and mentorship programming module to a mean high of 3.79 (N = 167 ,SD = 0.45) for the caregiver self-care module. Evaluation results from the first seven learner cohorts underscore the efficacy of program content as well as the utility of performing an initial program needs assessment to guide curriculum development. Practice implications for future continuing education efforts targeting grandfamilies professionals and lay leaders include: the need for easily accessible online education in combination with supplemental training opportunities addressing topics such as the long-term impact of substance use disorder and trauma combined with locally relevant content on grandfamilies and legal resources.
Barriers and Challenges Faced by Social Workers Caring for Dementia Patients in Acute Care Settings
Authors: Dunkle Ruth , Cavagnini Katherine , Cho Joonyoung , Sutherland Laura , Kales Helen , Connell Cathleen , Leggett Amanda
Published: December 2020

The nature of dementia care provided by social workers across various hospital settings is unexplored. This study utilized the “rigorous and accelerated data reduction” (RADaR) qualitative analysis technique to explore the process of care among social workers for persons with dementia (PWDs) across a Midwestern tertiary care system with two aims: 1) to identify environmental barriers and supports to quality dementia care in two hospital settings (medical and psychiatric emergency departments (ED), and the main inpatient hospital (IP)), and 2) to identify existing strengths and challenges to high quality social work dementia care within these settings. Twelve qualitative interviews were conducted with a purposive, snowball sample of social workers in dementia care in a large, academic health care system in 2016. Results identify environmental barriers in both settings (physical space design, patient-environment interactions, safety, and discharge disposition). Environmental aspects that promote quality care include supportive staff and family in the patient environment in the IP and ED hospital sections while the discharge disposition is more relevant in the IP. While there are some areas of social work involvement (discharge, psycho-social needs, treatment/management issues) that promote quality of care across locales, the pattern of performing roles varied, e.g. there is more focus on discharge planning and less management of competing demands in the IP than in the ED. Also, social workers were more involved in the diagnosis of dementia in the ED than other settings. We offer policy and practice recommendations to improve care for PWDs in academic hospital settings.
Leveraging Novel Label Design to Improve Older Consumers' Use of Medications
Authors: Harben Alyssa , Nathan Andrew , Anderson Kaitlin , Kashy Deborah , Bix Laura , Becker Mark
Published: December 2020

Over-the-counter (OTC) medication is a convenient, affordable way for older adults to treat a variety of conditions; older consumers use more OTCs per capita than other people for varied reasons. As with any medication, OTCs carry risks. Because the labels of OTCs are frequently the only information accessed by consumers, labels designed to communicate safety information are paramount for these products. Yet, available studies suggest that consumers do not regularly access the comprehensive information in the Drug Facts Label (DFL) when making purchase or use decisions, tending to rely on information found on the front of the package. Herein, we evaluate how four OTC label formats (standard; standard/highlight; critical warnings on front/highlighted; critical warnings on front not highlighted) affect how aging participants attend to critical information. Sixty-eight participants (65+) engaged a computer-based task answering yes/no questions that required use of labeling information about the warnings or active ingredients (AI). Results indicate that AI information is found accurately and relatively quickly compared to warning information and highlighting and placement on the front of the package had little effect. By contrast, warning information was found slowly and with low accuracy with the standard label, and highlighting and front of pack placement both significantly improved performance. These results suggest that novel labelling strategies could result in more effective, safer use of OTC medicines among older consumers and provide insights that could be used by regulators as they work to improve policy focused on improving mandates for OTC labeling.
Effects of Nurse Staffing, Work Environment, Education on Adverse Events in Nursing Homes
Authors: Choi Seonhwa , Cho Eunhee , Kim Eunkyo , Lee Kyoungeun , Chang Soo Jung
Published: December 2020

This study examined the effect of registered nurse (RN) staffing level, work environment, and education on adverse events experienced by residents in nursing homes. A cross-sectional study was conducted with 216 RNs working in nursing homes who were selected using random stratified sampling by location and bed size. Self-reported questionnaires regarding staffing level, work environment, education level, adverse events, and nurse characteristics were administered. Data from the National Health Insurance Service were used to describe nursing home characteristics. Both multiple and multinomial logistic regressions were used to control for the characteristics of nurses and nursing homes, and investigate the effects of nursing staffing level (number of older adults assigned to a nurse), work environment (Practice Environment Scale of the Nursing Working Index), and level of nursing education on the adverse events experienced by residents. An increase of one resident per RN was significantly associated with a higher incidence of pressure ulcers (OR= 1.019, 95% CI=1.004-1.035). Poor work environment increased the incidence of adverse events such as pressure ulcers (OR= 3.732, 95% CI=1.155-12.056) and sepsis (OR=3.871, 95%CI=1.086-13.800). Compared to RNs with a baccalaureate or higher, RNs with diplomas reported increased incidence rates of pressure ulcers (OR=2.772, 95%CI= 1.173-6.549). RN staffing, work environment, and education level affect the incidence of pressure ulcers, and the work environment affects the incidence of sepsis among residents in nursing homes. Policy-wise, improving the level of nurse staffing, nursing work environment, and nursing education will improve health outcomes of residents.
Stakeholder Perspectives on Reducing Hospitalizations Among Nursing Home Residents
Authors: Tyler Denise , Kordomenos Cleanthe , Ingber Melvin
Published: December 2020

Organizations in seven states have been participating in the Center for Medicare and Medicaid Innovation (CMMI) initiative aimed at reducing potentially avoidable hospitalizations among long-stay nursing home (NH) residents. The purpose of this study was to identify market and policy factors that may have affected the initiative in those states. Forty-seven interviews were conducted with key stakeholders in the seven states (e.g., representatives from state departments of health, state Medicaid offices, and nursing, hospital and nursing home associations) and qualitatively analyzed to identify themes across states. Few policies or programs were found that may have affected the initiative; only New York (NY) was found to have state policies or programs specifically aimed at reducing hospitalizations. Market pressures reported in most states were similar. For example, stakeholders reported that the increased availability of home and community-based services and the growing presence of managed care are contributing to higher acuity among both long and short stay residents and that reimbursement rates and staffing have not kept up. Stakeholders suggested greater presence of physicians and nurse practitioners in NHs, better training around behavioral health issues for frontline staff, and more advance care planning and education of families about end of life may help further reduce NH hospitalizations. We also found that all states, except NY, had regional coalitions of health care related organizations focused on improving some aspect of care, such as reducing hospital readmissions. These coalitions may suggest ways that organizations can work together to reduce hospitalizations among NH residents.
The Effects of Old Age Care Services and Long-Term Care Insurance: Evidence From Korea
Authors: Kim Hoolda , Mitra Sophie
Published: December 2020

Along with a rapidly aging population globally, the need for homecare is on the rise. Such care can be a heavy financial burden on older people and their households. To address this issue, the Korean government initiated two programs: care services for low-income individuals and voluntary long-term care insurance for people age 65+. Although it has been a decade since the implementation of the programs, there is limited evidence on how they affect the economic lives of older people, with and without disabilities. We use the 2008-2018 Korean Longitudinal Study of Aging (KLoSa) that provides detailed information about healthcare and homecare utilization and out of pocket costs for people aged 45 or older. We investigate the economic effects of old age public assistance programs using multivariate linear regression models and a dynamic panel model. The preliminary results indicate that older people with disabilities are more likely to utilize homecare services but do not experience any significant extra costs associated with homecare, implying that old age public assistance programs mitigate the financial burden of homecare for older people.
Denials, Surprise Charges, Starting Over: How Medicare Recipients Navigate the Medicare Mental Health Coverage Gap
Authors: Fullen Matthew , Dolbin-MacNab Megan , Brossoie Nancy , Wiley Jonathan , Lawson Gerard
Published: December 2020

Medicare is the primary insurance provider for approximately 51 million older adults, including those who seek mental health care. Medicare provider eligibility was last updated in 1989, and approximately one-third of the graduate-level mental health workforce (i.e., Licensed Professional Counselors and Licensed Marriage and Family Therapists) is excluded from Medicare, despite these professionals participating in Medicaid, TRICARE, the Veterans Administration, and private insurance plans. This Medicare mental health coverage gap (MMHCG) raises concerns about older adults’ access to mental health care, resulting in a policy misalignment between Medicare’s provider regulations and a growing number of older adults seeking mental health care. However, little is known about the precise impact of the MMHCG. To better understand how the MMHCG impacts older adults, we interviewed 17 Medicare-insured individuals about their experiences accessing mental health services. Using a phenomenological framework to analyze our data, we found that Medicare recipients described several consequences, such as: 1) a detrimental impact on their mental health and well-being; 2) concerns about having to start over with new providers due to commencing mental health treatment only to have services interrupted once the provider is no longer Medicare-reimbursable; and 3) relying on pro bono services from Medicare-excluded providers with uncertainty about the long-term sustainability of these arrangements. The presenters will describe how these findings fit within the current Medicare mental health service context, including the direct impact on older adults’ mental health. Discussion will also focus on policy implications of the findings and possible solutions for addressing the MMHCG.
Mental Health of Homebound Older Adults in China: The Moderating Effect of Loneliness
Authors: Chen Tao , Wang Shuangshuang , Yao Nengliang (Aaron)
Published: December 2020

Homebound older adults are confined to their homes due to physical, mental, or social limitations, which contributes to elevated levels of depression. However, the mental health status of the homebound population in China is relatively overlooked. This study compares mental health status between homebound and non-homebound older adults, and examines the moderation effect of loneliness. The sample consists of 1,301 older adults aged 60 and over (39% homebound, 49% females, mean age = 69) from Shandong Aging and Health Survey, conducted by Shandong Provincial Government in 2019. Mental health status was measured by feelings of depression, not cheerful, bored, not calm or peaceful, and not happy. Compared to non-homebound older adults, homebound older adults tend to be older, lower educated, live in rural areas, and in worse health conditions. Results from generalized linear regression models show that controlling for demographic and physical health status, homebound population were more likely to have worse mental health status than other Chinese older adults. Feeling lonely, isolated, or lack of companionship intensifies the adverse effects of being homebound on older adults’ mental health. Findings from this study suggest that homebound older adults in China had both physical and psychological sufferings. Social programs and interventions may be designed to improve homebound older adults’ mental health. As the number of homebound older adults increases in China, medical care models may be tailored to improve the accessibility of healthcare services among people who are confined to their homes.
Statistical Estimation of Accelerated Biological Brain Aging After Mild Traumatic Brain Injury in Older Adults
Authors: Irimia Andrei , Kim Jun , Wang Shania , Lee Hyung Jun , Ngo Van , Mahoney Sean , Robles David
Published: December 2020

Estimating biological brain age (BA) has the potential of identifying individuals at relatively high risk for accelerated neurodegeneration. This study compares the brain’s chronological age (CA) to its BA and reveals the BA rate of change after mild traumatic brain injury (mTBI) in an aging cohort. Using T1-weighted magnetic resonance imaging (MRI) volumes and cortical thickness, volume, surface area, and Gaussian curvature obtained using FreeSurfer software; we formulated a multivariate linear regression to determine the rate of BA increase associated with mTBI. 95 TBI patients (age in years (y): μ = 41 y, σ = 17 y; range = 18 to 83) were compared to 462 healthy controls (HCs) (age: μ = 69 y, σ = 18 y; range = 25 to 95) over a 6-month time period following mTBI. Across the initial ~6 months following injury, patients’ BAs increased by ~3.0 ± 1.2 years due to their mTBIs alone, i.e., above and beyond typical brain aging. The superior temporal and parahippocampal gyri, two structures involved in memory formation and retrieval, exhibited the fastest rates of TBI-related BA. In both hemispheres, the volume of the hippocampus decreased (left: μ=0.28%, σ=4.40%; right: μ=0.12%, σ=4.84%). These findings illustrate BA estimation techniques’ potential to identify TBI patients with accelerated neurodegeneration, whose rate is strongly associated with the risk for dementia and other aging-related neurological conditions.
Reasons for Refusing Home-based Palliative Care: A Qualitative Study of Patients and Caregivers
Authors: Cardenas Valeria , Zhu YuJun , Rahman Anna , Enguidanos Susan
Published: December 2020

Despite some insurance plans now paying for home-based palliative care, recent reports have suggested that coverage for palliative care may be insufficient to expanding patient access to home-based palliative care. Research has yet to explore palliative care barriers from the perspective of palliative care-eligible patients and their caregivers. To identify patients and caregivers’ perceived barriers to home-based palliative care and their recommendations for overcoming these barriers, we conducted a qualitative study using semi-structured individual interviews. Participants (patients, proxies, and their caregivers) who were eligible for a randomized controlled trial of home-based palliative care were interviewed via telephone. Our interview protocol elicited participants’ perspectives on home-based palliative care services; positive and negative aspects of the program explanation; and suggestions for improving messaging around home-based palliative care. Researchers used grounded theory to identify the themes within the transcripts. Two researchers independently coded the transcripts and then met to compare coding and reconciled discrepancies until 100% consensus was reached. Identified themes related to home-based palliative care referral barriers included reluctance to have home visits, timing, lack of palliative care knowledge, misconceptions of palliative care, and patients’ self-perceived health condition (not sick enough for palliative care). Themes related to recommendations for overcoming these barriers included preferring a palliative care referral from healthcare providers or from insurance company and clearer presentation of palliative care service. Findings reinforce the need for additional palliative care education among patients with serious illness and the importance of delivering the information from a trusted source.
Sequential Dependencies in Solid and Fluid Intake in Nursing Home Residents with Dementia: A Multistate Model
Authors: Liu Wen , Williams Kristine , Chen Yong
Published: December 2020

Nursing home (NH) residents with dementia commonly experience low food intake leading to negative consequences. While multilevel factors influence intake, evidence is lacking on how intake is sequentially associated. This study examined the temporal association between previous and current solid and fluid intake in NH residents with dementia. We analyzed 160 mealtime videos involving 27 residents and 36 staff (53 dyads) in 9 NHs. The dependent variable was the current intake state (fluid, solid, no-intake). Independent variables included the prior intake state, technique of current intake state (resident-initiated, staff-facilitated), duration between previous and current intakes. Covariates included resident and staff characteristics. Two-way interactions of duration and technique with the prior intake state, and resident comorbidity and dementia severity were examined using Multinomial Logit Models. Interactions were significant for technique by comorbidity, technique by dementia severity, technique by prior fluid and solid intake, and duration by prior fluid intake. Successful previous intake increased odds of current solid and fluid intake. Staff-facilitation (vs. resident-initiation) reduced odds of solid and fluid intake for residents with moderately severe (vs. severe) dementia. Higher morbidity decreased odds of solid intake (vs. no-intake) for staff-facilitated intake. Resident with severe dementia had smaller odds of solid and fluid intake for resident-initiated intake. Longer duration increased odds of transition from liquid to solid intake. Findings supported strong sequential dependencies in intake, indicating the promise of intervening behaviorally to modify transitions to successful intake during mealtime. Findings inform the development and implementation of innovative mealtime assistance programs to promote intake.
A Pilot Study of an Innovative Model of Care Delivery: Service Robot for Older People with Dementia in a Rural Community
Authors: Wang Kuan-Yuan , Chen Cheng-Sheng , Chen Hui-Mei , Chen I-Te
Published: December 2020

Background: The telehealth approach offers enhanced service delivery for older patients living in rural areas. Purpose: We conducted a pilot study to evaluate the feasibility of using the Zenbo robot to improve the quality of care of elderly individuals with dementia. Methodology: In this study, we developed a digital solution on service robots and smart devices, which can leverage the capacity of the user-friendly interactive interface and digital dialog system. A group of eleven volunteered older adults was selected for this study. To assess the likability and acceptance of the Zenbo, we conducted a one-on-one (robot vs human) pilot study in our long-term care stations. Each participant engaged in conversational interactions for five consecutive days and completed a survey of 12 questions about the experiences they had with the Zenbo, at the beginning and the end of the study respectively. Results: Subjects with lower GDS-15 scores have more positive attitudes toward the robot before the intervention. 27% of older adults had an increase in positive attitudes toward the interaction with the Zenbo robot. With the aid of teleoperated mobile robotic systems at home, the innovative service model can be achieved through telecommunication between primary health professionals or caregivers at remote locations and psychiatrists at the medical center to make the seamless care environment real. Conclusion: The IoT technologies can be used to assist physicians in switching from a hospital-centered model of care to a home-based service for older people with dementia. It merits more future clinical trials and usability tests.
Age Differences in the Consumption and Avoidance of COVID-19 Information
Authors: Deng Stephanie , Nolte Julia , Loeckenhoff Corinna
Published: December 2020

Staying informed about COVID-19 is crucial to maintaining public health. Although older adults are at increased risk of complications, recent data (Global Web Index, 2020) suggest that they are less likely to seek out information about COVID-19. This is consistent with prior evidence indicating that information seeking is negatively associated with age (Mata & Nunes, 2010). However, it remains unclear whether older adults merely fail to seek information or intentionally avoid information. In response, we examined whether age is associated with general information seeking and deliberate information avoidance in the wake of the COVID-19 pandemic. Based on previous work indicating age-related shifts in motivational priorities (Carstensen, 2006) we also examined whether avoidance motives differ by age. In a pre-registered online study, an adult lifespan sample (N=500, Mage=49.90, 51% female, 67% non-Hispanic White) completed self-report measures of media consumption, information avoidance, and avoidance motives with respect to the COVID-19 pandemic. In addition, we measured behavioral information avoidance by allowing participants to opt out of receiving valid COVID-19 information. As predicted, age was associated with decreased media consumption (p<.001) and higher information avoidance about COVID-19 on the behavioral measure (p<.01). Self-reported information avoidance, in contrast, was highest among younger adults (p<.05). Further, with the exception of concerns about trustworthiness, older adults were less likely than younger adults to endorse various information avoidance motives (ps<.05). Thus, although information seeking is lower and behavioral information avoidance about COVID-19 is higher in later life, this cannot be traced to explicit intentions or select motives.
Changes in Family Caregiver Roles and Interactions During the COVID-19 Pandemic
Authors: Moone Rajean , Suleiman Elizabeth Lightfoot Kamal Abdi , Kutzler Courtney , Otis Jacob , Turck Kenneth , Yun Heejung
Published: December 2020

Family caregivers provide the majority of support for older adults and people with disabilities in the U.S. The onset of the COVID-19 pandemic forced radical changes in duties and relationships between family caregivers and care recipients. These changes can be attributed to fears of virus transmission as well as federal, state and local government mitigation strategies resulting in social distancing and quarantining limiting caregiving interactions. This qualitative investigation conducted 55 Zoom interviews over summer 2020 with family caregivers to explore their changing roles and duties during the pandemic. Researchers utilized a semi-structured interview guide to explore caregiver experiences with COVID-19. The average age of the caregiver participants was 59 and the average age of the care recipients for whom they provided care was 74. All participants provided unpaid care for family members. Interviews were conducted in English (n=40), Spanish (n=5), Somali (n=5) and Korean (n=5). Care recipients resided in a facility (nursing home, memory care, ICF-DD, or other assisted living) (70%) with the caregiver (20%), and in a separate independent setting (10%). Data from each interview were coded into themes by two researchers. Themes that emerged from the analyses included concerns about care recipient mental and physical health deterioration, lack of communication from formal providers, change in relationships with other family members, and future concerns. Implications for additional research and practice are included.