bluuebunny/crossref_metadata_2025 huggingface dataset:
IMPACT OF GERIATRIC INTERPROFESSIONAL TRAINING ON ADVANCE CARE PLANNING IN GERIATRIC PRIMARY CARE
Authors: Barrientos Maureen E , Chodos Anna , Neumann Alicia , Troya Yvonne , Chen Pei
Published: November 2019

Currently, an important measure of Advance Care Planning (ACP), Advance Health Care Directives (AHCD) documentation rate, is at 33% for older adults in the United States. To address this disparity, geriatric faculty in an academic geriatric primary care practice aimed to train geriatrics fellows and other interprofessional (IP) learners to engage patients in ACP. As part of a Geriatric Workforce Enhancement Program funded by the Health Resources and Services Administration, geriatrics faculty and the Medical Legal Partnership for Seniors based at University of California Hastings College of Law provided ACP training to fellows and IP learners, including social work interns. In practice, the fellows and social work interns collaborated to incorporate ACP into patient visits and follow-up telephone calls. To monitor ACP progress, research staff reviewed patients’ electronic health records and performed descriptive analysis of the data. In 21 months, 4 geriatrics fellows built a panel of 59 patients who on average had 3 office visits and 7 telephone calls per person. Prior to clinic enrollment, 12 (20.3%) patients had preexisting AHCD, and 47 lacked AHCD documentation. After ACP intervention, 42 of 47 patients without AHCD documentation engaged in ACP discussion. Of those who engaged in ACP discussion, 24 completed AHCD, raising AHCD completion rate to 61%, or 36 patients in the panel of 59. ACP is a complex process that benefits from skilled communication among interprofessional providers and patients. Findings underscore the potential advantages of IP training and engaging patients in ACP discussion in an academic primary care setting.
THE IMPACT OF CULTURE CHANGE ON FINANCIAL PERFORMANCE OF HIGH MEDICAID NURSING HOMES
Authors: Lord Justin C , Davlyatov Ganisher K , Ghiasi Akbar , Weech-Maldonado Robert
Published: November 2019

This study examines the association between culture change artifacts and financial performance among under-resourced nursing homes (70% or higher Medicaid census). Culture change represents a transformational process to become person-centered, through staff and resident empowerment. Cultural artifacts represent the physical evidences that culture change is occurring. In this study, we focus on the workplace (nurse staffing consistent assignments) and leadership (residents engagement) artifacts to assess the relationship between culture change practices and performance. Survey data came from 387 nursing home directors from 2016- 2018, merged with secondary data from LTCFocus, Area Health Resource File, and Medicare Cost Reports. The dependent variable consisted of the total profit margin (%), while the independent variables comprised composite scores for leadership (0-25) and workplace artifacts (0-15). Control variables included organizational-level (ownership, chain affiliation, size, occupancy rate, and Medicare and Medicaid payer mix), and county-level factors (Medicare Advantage penetration, per capita income, educational level, unemployment rate, poverty level and competition). Multivariate regression was used to model the relationship between cultural change artifacts and financial performance. Workplace artifacts in nursing homes were found to be associated with significantly higher profit margin (β = 0.30, p < 0.05), while leadership artifacts were not. Culture change practices aimed at improving nursing staff consistent assignments are associated with better financial performance. Given increasing nursing home market competition and declining resources for high Medicaid nursing homes, facilities with a greater emphasis on workplace culture may be able to perform better financially among these under-resourced facilities.
SOCIAL FUNCTIONING AS AN IMPORTANT CLINICAL TARGET DURING CARE TRANSITIONS FROM SKILLED NURSING FACILITIES
Authors: Simons Kelsey , Mills Whitney L , Bower Emily S , Gillespie Suzanne , Orden Kimberly Van
Published: November 2019

Care transitions from skilled nursing facilities (SNF) to home signify a period of medical risk for older adults. They also present opportunities for clinical interventions to reduce these risks and to enhance or maintain patients’ quality of life. A substantial body of research has been published on improving late life care transitions (CTs), including the development of standardized CT models for acute care. However, such models typically focus on improved coordination of medical services; overlook the need to address psychosocial well-being and social connectedness; and have rarely been implemented in SNFs. This poster will present a conceptual model of social functioning in older adults that draws on constructs from the World Health Organization’s World Report on Ageing and Health (2015). We propose that social functioning is a key part of overall functioning among older adults who use SNFs and is simultaneously influenced by physical, psychological, and cognitive functioning. To illustrate our model, we will present results of a qualitative study (n= 21) that describes declines in social functioning following care transitions to the community from VA SNFs. Implications for clinical practice include the need to better integrate social functioning in clinical assessments, goal setting, discharge planning, and coordination of care activities. The need for additional research on this topic will also be addressed. Our project is highly relevant to the overall conference theme “Harnessing the Power of Networks” as it presents a conceptual model and study findings related to social connectedness and social functioning in older adults who use SNFs.
FEDERAL POLICY SUPPORTS AND GAPS IN ADDRESSING RACIAL-ETHNIC HEALTH DISPARITIES IN U.S. LONG-TERM CARE FACILITIES
Authors: Mauldin Rebecca L , Lee Kathy , Williams Antwan
Published: November 2019

Older adults from racial and ethnic minority groups face health inequities in long-term care facilities such as nursing homes and assisted living facilities just as they do in the United States as a whole. In spite of federal policy to support minority health and ensure the well-being of long-term care facility residents, disparities persist in residents’ quality of care and quality of life. This poster presents current federal policy in the United States to reduce racial and ethnic health disparities and to support long-term care facility residents’ health and well-being. It includes legislation enacted by the Patient Protection and Affordable Care Act of 2010 (ACA), regulations of the U.S. Department of Health and Human Services (DHHS) for health care facilities receiving Medicare or Medicare funds, and policies of the Long-term Care Ombudsman Program. Recommendations to address threats to or gaps in these policies include monitoring congressional efforts to revise portions of the ACA, revising DHHS requirements for long-term care facilities staff training and oversight, and amending requirements for the Long-term Care Ombudsman Program to mandate collection, analysis, and reporting of resident complaint data by race and ethnicity.
INTERGENERATIONAL OCCUPATIONAL THERAPY PROGRAMMING FOR COMMUNITY-DWELLING OLDER ADULTS AND SCHOOL-AGE CHILDREN
Authors: Chilton Robin L
Published: November 2019

Community Intergenerational Action (CIA) was a four-week pilot program designed to bring community dwelling older adults and fourth-grade students together to engage in meaningful activities within a supportive group context under the facilitation of Robin Chilton, MBA, OTR/L, and four Master of Occupational Therapy Students from Cleveland State University. A phenomenological, qualitative research design study was conducted to explore the impact and meaning of this intergenerational occupational therapy programming on the social and emotional well-being of older adults. Participant observation, journaling, and in-depth interviews were used to determine the meaning of the program to the participants. CIA was conducted using ten female elders, and fifteen children ages nine to ten years old. Each week a new theme was introduced to assist the participants in solving a mystery and included an occupation-based activity such as horticulture and crafts. The CIA program was developed in a way that would allow it to be replicated in other intergenerational settings. Students involved in this study identified helping and cooperating with the older adults throughout the program as very important to them. The students began to feel a sense of empathy and increased self-awareness after spending time with the older adults. The program allowed the older adults to reminisce about their past, and feel a sense of generativity, or contribution to the younger generation. Findings provide an opportunity for others to use similar programs to engage older adults and children in meaningful occupation that will contribute to their overall sense of social and emotional well-being.
EARLY INPATIENT REHABILITATION IN GERIATRIC PATIENTS: A SYSTEMATIC REVIEW OF OUTCOME MEASURES
Authors: Hauer Klaus , Heldmann Patrick , Werner Christian
Published: November 2019

Selecting appropriate outcome measures for multimorbid, acutely hospitalized geriatric patients poses specific challenges, which may have caused inconsistent findings of previous intervention trials on early inpatient rehabilitation. The objective of this review was to describe primary outcome measures used in randomized controlled trials (RCTs) on early rehabilitation in older hospital patients, to analyze their matching to intervention programs, and to evaluate the effects of matching on the main findings of these RCTs. A systematic literature search was conducted in PubMed, Cochrane CENTRAL, CINAHL, and PEDro databases. Inclusion criteria were: RCT, patients aged ≥ 65 years, admission to hospital, physical exercise intervention, and primary outcome measure during hospitalization. Two independent reviewers extracted the data, assessed the methodological quality, and analyzed the matching of primary outcome measures to the intervention, study sample, and setting. Main study findings were related to the results of the matching procedure. In 28 included articles, 33 different primary outcome measures were identified, which we grouped into six categories: functional status, mobility status, hospital outcomes, adverse clinical events, psychological status, and cognitive functioning. Outcome measures differed considerably within each category showing a large heterogeneity in their matching to the intervention, study sample, and setting. Outcome measures that specifically matched the intervention contents were more likely to document intervention-induced benefits. Mobility instruments seemed to be the most sensitive outcome measures to reveal such benefits. High specificity (optimized match) of outcome measures and intervention contents is a key factor to reveal benefits of early rehabilitation in acutely hospitalized geriatric patients.
THE INTERPLAY OF FUNCTIONAL PERFORMANCE AND COGNITION ON WALKING SPEED RESERVE
Authors: Dawson Nicole T , Trapuzzano Ashleigh
Published: November 2019

Domains of functional performance (strength, balance) and cognition (executive function, processing speed) have been shown to independently predict both comfortable and gait speed. Walking speed reserve (WSR) reflects an individual’s ability to increase their walking speed when needed to adjust to environmental demands. Increasing speed requires a higher demand of neuromuscular control and cognitive resources. Few studies have investigated WSR; however, poorer cognitive status has been shown to be associated with a smaller WSR. Understanding mechanisms in WSR could help with intervention development. The purpose of this study was to investigate the interplay of functional performance and cognition on WSR. Sixty-seven community-dwelling older adults (mean age 80.57; 71% female) completed assessments including: global cognition (Mini Mental State Examination), leg strength (30 Second Chair Stand), balance (Functional Reach), executive function (Trail Making Test Part-B, clock-drawing test, Flanker Task), simple reaction time, processing speed (Digit Symbol Substitution Test), and gait speed (comfortable and fast) using the GAITRite® system. WSR (fast-comfortable gait speed) was the dependent variable. Independent variables in the regression model were selected using Pearson correlation values <0.05 (strength (r=.332, p=.006) and processing speed (r=.361, p=.003)). Linear regression revealed that the strength and processing speed explained 16.3% of the variance (adjusted r2) of WSR and were both unique predictors of WSR indicating individuals with greater strength (B=.79, p=0.036) and faster processing speed (B=.44, p=0.015) have a greater capacity to alter their gait speed. Further, the interdependence between cognition and physical performance emphasizes the importance of interprofessional care for older adults.
SOCIAL SUPPORT AND SOCIAL RESOURCES PREDICTING LIFE SATISFACTION AMONG CENTENARIANS AND OCTOGENARIANS
Authors: Arieli Rotem , Martin Peter , Poon Leonard
Published: November 2019

Although much research has assessed the relationship between social support and life satisfaction for older adults, there is little information on how social support predicts life satisfaction over and above social resources among very old people. The purpose of this research was to determine pathways from demographic variables, social resources, and social support to life satisfaction. Data from 208 cognitively-intact centenarians and octogenarians of the Georgia Centenarian Study (GCS) were analyzed using multiple regression analyses to evaluate pathways from social resources via social support to life satisfaction. Three different models were analyzed in the GCS sample: one with a combined group of octogenarians and centenarians, one with only octogenarians, and one with only centenarians. Path models included: demographic variables (gender, ethnicity, residential type, and age in years) to social resources to social provisions to life satisfaction. Results in the combined older adult group showed that residence type significantly predicted social resources, β = -.26, p < .01, social resources significantly predicted social provisions, β =.15, p < .05, and social provisions significantly predicted life satisfaction, β =.15, p < .05. Results in the centenarian sample showed that both residence type and age significantly predicted social resources, β =-.19, p < .05, and β = -.17, p = .05, respectively, and social resources significantly predicted social provisions, β = .18, p = .05. Overall, results indicate the uniqueness of the centenarian population and their paths to high life satisfaction through social resources and support.
DO OLDER ADULTS WITH HIV HAVE A SOCIAL NETWORK DEFICIT? EVIDENCE FROM AGINCOURT, SOUTH AFRICA
Authors: Schafer Markus H , Upenieks Laura , DeMaria Julia
Published: November 2019

HIV/AIDS has had a substantial social and economic impact on Sub-Saharan Africa, and research is only beginning to examine the prevalence and consequences of HIV infection among older adults in this region. Though informal social networks provide crucial resources for older people managing health problems, little is known about how the form and function of such networks differs by HIV status. Drawing from theories of health stigma and network mobilization, we use egocentric network data from HAALSI, the Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (N=5,059). HAALSI is a community-based study centered in Agincourt, South Africa, and focuses on adults ≥40 years of age. Approximately 12% of this sample is HIV positive. Results of multivariable logistic and Poisson regression reveal three main findings. First, relative to those without HIV, infected older adults have larger personal networks—including more kin and more non-kin network members. Second, HIV status has no discernible impact on whether people receive regular emotional support from those in their networks. Third, older adults who have disclosed their HIV status have a relatively high proportion of kin members in the close networks relative to those not infected with HIV and to those with HIV who have not disclosed their disease. Our findings point to the need for further research on the implications of social networks for outcomes such as well-being and health care delivery among older AIDS patients in the Global South.
A COMPARATIVE ANALYSIS OF THE SOCIAL SUPPORT IN SOLITARY SENIORS WHO ATTEND CLUB ACTIVITY OR GO OUT TO SEE FRIENDS
Authors: Takase Mai , Ogino Ryogo , Goto Jun , Okata Junichiro
Published: November 2019

The Toyoshiki-dai housing complex, constructed in 1960s, is located in one of the commuter towns in a metropolitan area of Japan. Those who moved to this area as youngsters are now aged over 75 and many live a solitary life; making social support vital to prevent social frailty. The municipalities and universities have been hosting interventions, e.g. club activities, to make social connection but the effects remain unclear. In this study, the relationship between activity participation and the size of social support was explored to develop an effective method to increase social connections. A cross-sectional study was conducted in October 2018 and 200 questionnaires were distributed at a lunch event at the housing complex. The participants were solitary and independent seniors over the age of 70 (M:F=14.4:67.5). The frequency of going out to participate in club activity, see friends, and the geriatric social support scale were used for analysis. As a result, compared to seniors who went out to see their friends, the size of social support was smaller in groups that remained isolated (N = 161, odds ratio = 0.26, 95% CI=0.11-0.60). On the contrary, seniors who joined club activities had similar size of social support despite the frequency of participation. Clubs in Japan are often closed groups with limited membership, which may have restricted the addition of new social connection. Future intervention researches should focus on modifying the membership system of clubs and opening of a public space where seniors can casually access and talk to acquaintances.
DEVELOPING AGE-FRIENDLY COMMUNITIES: EVIDENCE FROM MULTIPLE CASE STUDIES
Authors: Oh Patricia A
Published: November 2019

The age-friendly community movement is gaining momentum in the United States. More than 325 communities have joined the AARP Network of Age-Friendly States and Communities or the WHO Global Network of Age-Friendly States and Communities. The purpose of this multiple case study was to explore what influences municipal decision-making about joining a network and how communities mobilize the resources at their disposal to make age-friendly changes after joining. The conceptual model that guided this exploratory study incorporated Kingdon’s policy change model to explore municipal decision-making about joining a formal age-friendly network and resource mobilization theory to explore factors that influence implementation of age-friendly changes after a community joins an age-friendly network. Data was gathered in three in-depth case studies of age-friendly communities in New England-- Brookline, Massachusetts; Newport, Vermont; and Ellsworth Maine. In these three cases, the policy entrepreneur was key to municipal decision-making. Kingdon posits that a single problem definition increases the likelihood that a policy is adopted. However, in these cases, the policy entrepreneur used selective framing to advocate with local organizations and municipal government, a departure from Kingdon’s model. Implications for age-friendly policy adoption will be discussed. Resource mobilization theory posits that implementation of change is dependent on resources and collaborations. Each case had access to different resources, but partnerships were key to moving the work forward (with or without collaborations). The primary resources utilized were relational and ideological. Material resources were less likely to move the work forward. Implications will be discussed.
USING PHOTOVOICE TO EXPLORE THE SALIENCY OF NEIGHBORHOOD LANDMARKS FOR PERSONS LIVING WITH DEMENTIA
Authors: Seetharaman Kishore , Shepley Mardelle
Published: November 2019

This study demonstrates the potential of Photovoice, a participatory action research method involving participant-generated photo-elicitation, to explore how persons living with dementia (PLWDs) perceive neighborhood landmarks. Previous research has highlighted the role of well-designed, stable geographical landmarks in improving the navigability of neighborhoods for PLWDs. However, the specific attributes that render landmarks salient have not yet been sufficiently explored, resulting in inadequate evidence-based environmental design guidelines for dementia-friendly communities (DFCs). To address this gap, a Photovoice study was conducted with five community-dwelling PLWDs and their care partners, as part of a dementia-friendly neighborhood walking program in the city of Seattle, USA. Photovoice facilitated the exploration of saliency of neighborhood landmarks from an emic perspective by empowering PLWDs to identify and take photos of salient landmarks during the group walk and interpret and reflect on attributes that contributed to saliency using the photos as visual aids in a focus group discussion and survey questionnaire. PLWDs associated the saliency of landmarks not only with objective physical attributes, e.g., size, shape, color, texture, but also with subjective factors linked to their past, passions, hobbies, and emotions related to having dementia. Findings suggest that the design of outdoor landmarks should satisfy universal design principles, as well as aspects of familiarity, recognizability, and memorability, to ensure that the neighborhood physical environment provides navigational support to PLWDs. The study proposes using Photovoice to facilitate community engagement in the planning and design of DFCs and mobilize people’s lived experience to generate more robust dementia-friendly environmental design guidelines.
CAREGIVING AND SERVICE USE: CULTURAL INFLUENCES, REGIONAL BARRIERS, AND FAMILY RELATIONS
Authors: Savla Jyoti , Roberto Karen A , Blieszner Rosemary
Published: November 2019

Elder care in rural Appalachia is challenging due to poor socioeconomic conditions, geographical isolation, and lack of services and transportation. Certain aspects of Appalachian culture, namely self-reliance, traditionalism, and strong family ties, also create unique barriers for using services to help care for persons with dementia (PwD). Quantitative and qualitative data from 85 caregivers of PWD with moderate to high care needs were explored to examine caregivers’ use of personal care services, identification with their community, attitudes towards service use, and geographical distance from the nearest service location. Results suggest that although services such as adult day centers, food banks, meal delivery, and support groups are widely dispersed throughout rural Appalachian counties, use or nonuse of services was driven by lack of economic resources, care preferences of the PwD, and dissatisfaction with previous service use. Discussion focuses on suggestions for uptake of services by caregivers of PwD in rural Appalachia.
EXPANDING RELATIONAL BOUNDARIES OF DEMENTIA CARE
Authors: Roberto Karen A , Savla J Tina
Published: November 2019

Rapid changes in family structures have expanded caregiving boundaries beyond the level of lineal kin to include extended and fictive kin. Guided by stress process and health behavior models, we analyzed semi-structured interviews with 120 family caregivers of persons with dementia (PWD) in rural Appalachia to explore personal/family circumstances that influence the responsibilities nonlineal kin assumed to meet the needs of PwD. Compared to spouse and adult children caregivers, nonlineal caregivers reported that PWD had similar behavioral problems, but greater ADL limitations. They also expressed greater burden, overload and role captivity; yet, they reported higher personal mastery, and perseverance. Although sisters and nieces did not report using any paid services to care for PwD, grandchildren and fictive kin used paid services such as meal delivery, personal care, and respite services. Findings provide new insights into a more elaborated conception of caregiving that considers the transformations occurring in family life today.
CAREGIVING SURVEILLANCE AT THE CDC: PAST, PRESENT, AND FUTURE
Authors: Edwards Valerie J , Whiting C Grace
Published: November 2019

As the U.S. population ages, caregiving has emerged as an important public health issue affecting an increasing proportion of American families. In 2015, an estimated 17.7 million people provided assistance to family members and friends. Although caregiving can have positive aspects, many studies have found that caregivers report more health difficulties than non-caregivers. The importance of population-based information is central to public health’s ability to respond effectively to this growing public health problem. The Alzheimer’s Disease and Healthy Aging Program at the Centers for Disease Control and Prevention (CDC) has made surveillance of caregivers a priority area. To this end, the development and use of a caregiving module for the Behavioral Risk Factor Surveillance System (BRFSS) was undertaken. The BRFSS is one of the largest telephone-based health surveillance system in the world, and collects information from the public across a broad range of health topics. This platform therefore provides a unique opportunity to capture health status data from caregivers as well as the option of comparing caregivers to non-caregivers. The Caregiver Module consists of 9 questions that address the characteristics of care and the type of assistance provided. The objective of this symposium is to describe the development of the current caregiving module (Dr. Bouldin), present relevant findings from the previous three years of surveillance data (Drs. Edwards and Taylor), and to discuss future directions for caregiver surveillance and CDC-developed resources to facilitate date utilization (Dr. McGuire). The discussant will describe the impact and status of national-level surveillance data
CLARK TIBBITTS AWARD AND HIRAM J. FRIEDSAM MENTORSHIP AWARD LECTURES
Authors: Hancock Cynthia
Published: November 2019

AGHE’s Clark Tibbits Award was established in 1980 and named for an architect of the field of gerontological education. The award is given each year to an individual or organization that has made an outstanding contribution to the advancement of gerontology and geriatrics education. The Clark Tibbits Award lecture will feature an address by the 2019 award recipient, David Burdick, PhD, of Stockton University. Hiram J. Friedsam was the professor, co-founder, and director of the Center for Studies in Aging and dean of the School of Community Service at the University of North Texas. Dr. Friedsam was an outstanding teacher, researcher, colleague, and mentor to students, faculty, and administrators, as well as a past president of AGHE. The purpose of this award is to recognize those who emulate Dr. Friedsam’s excellence in mentorship. The Hiram J. Friedsam Award lecture will feature an address by the 2019 award recipient, Bradley Fisher, PhD, of Missouri State University.
INTEREST GROUP SESSION—CANCER AND AGING: CURRENT CHALLENGES IN CANCER SCREENING AMONG OLDER MINORITY POPULATIONS
Authors: Li Chien-Ching , Liu Darren
Published: November 2019

Cancer is an important public issue around the world. Among types of cancer, lung and colorectal cancer are the most common in men while breast and cervical cancer are the most common in women. Detection of early stage cancer via screening can significantly reduce the mortality and prolong life. Although cancer prevention and control has been served as the national priority, individual’s utilization of cancer screening services is low due to limited knowledge of cancer screening and ineffective patient-provider commutation, especially in minority populations. In this symposium, we will examine three scenarios that highlight the challenges of cancer screenings in minority populations. First, we will share the results from a mixed method study that investigate the knowledge and attitudes towards Low Dose Computed Tomography lung cancer (LDCT) screening and assess the smoking cessation needs for African Americans who receive LDCT screening in an effort to reduce the health burden of lung cancer. The next study will discuss how the characteristics of older Chinese adults from the United States and Taiwan are associated cancer screening communication with physicians (i.e., whether doctor recommended screenings and whether communicated screenings with doctor). Lastly, we will share the results from a cross-sectional study that analyzed 10 years data of National Health Interview Survey to examine the difference in LDCT screening eligibility among Asian American (i.e., Chinese, Filipino, and other Asian) smokers. The discussant will summarize with an overview of the topic, and comment on the disparities of cancer screening in older minority populations.
KNOWLEDGE AND ATTITUDES TOWARD LDCT LUNG CANCER SCREENING AND SMOKING AMONG AFRICAN AMERICANS: A MIXED METHODS STUDY
Authors: Tseng Tung-Sung
Published: November 2019

The purpose of this study is to investigate knowledge, attitudes, and smoking cessation needs for African Americans who receive Low Dose Computed Tomography (LDCT) in an effort to reduce the health burden of lung cancer. A mixed method study was conducted among African Americans who received LDCT. The sample size for both the quantitative and qualitative approach was fifteen. The results showed that 73% of participants were male, the mean age was 61.8(SD=4.6) years old. Smoking history was long but 64% of the patients had a low nicotine dependence. Participants had a moderate/lower knowledge score (Mean=4.3 SD=2.6), and most had a positive attitude. Similar findings were also observed in the qualitative analysis. Understanding the factors associated with smoking cessation among at-risk African American smokers will help reduce disparities in lung cancer burden, and is important to improve health for medically underserved minority populations.
DISCRIMINATION, STRESS, AND HEALTH ACROSS THE LIFE COURSE
Authors: Thorpe Roland J , Hill Carl V
Published: November 2019

There is a paucity of research that seeks to understand why race disparities in health across the life course remain elusive. Two such explanations that have been garnering attention is stress and discrimination. This symposium contains papers seeking to address the impact of discrimination or stress on health or health disparities across the life course. First, Brown and colleagues examine black-white differences in the number of reported chronic stressors across five domains their appraised stressfulness, and their varying associations with anxiety and depression among a diverse sample of older adults using data from 6,019 adults ages 52+ from the 2006 HRS. Race and appraisal interactions show that blacks and whites report similar increases in anxiety and depressive symptoms with appraisal. Second, Tobin and colleagues investigate the impact of early life racial discrimination (ELRD) on mental health among Black adults. Using data from 618 participants in the Nashville Stress and Health Study, these investigators found that childhood and adolescent ELRD were positively associated with adult distress. Also, individuals who experienced childhood ERLD had 88% lower odds of adult MDD than individuals with no ELRD. Cobb and colleagues examine the cross-sectional association between everyday discrimination and kidney function among older adults in HRS. The authors report that after adjusting for demographic characteristics, everyday discrimination was associated with lower mean eGFR. The relationship between everyday discrimination and kidney function was not explained by biospsychosocial factors. This collection of papers provides insights into how discrimination or stress impacts health in middle to late life.
BLACK-WHITE DIFFERENCES IN CHRONIC STRESS: DOES APPRAISAL MATTER FOR ANXIETY AND DEPRESSIVE SYMPTOMS?
Authors: Brown Lauren , Abrams Leah , Mitchell Uchechi , Ailshire Jennifer
Published: November 2019

Prior research has suggested that exposure to objectively stressful events contributes to mental health disparities in older adulthood. Yet, in order to understand the extent to which some groups bear a disproportionate stress and mental health burden, we consider black-white differences in not only stress exposure, but also stress appraisal—how upsetting the exposures are perceived to be across five domains (health, financial, residential, relationship and caregiving). Data come from 6,019 adults ages 52+ from the 2006 Health and Retirement Study. Fully adjusted models show stress exposure and appraisal significantly and independently predicted anxiety and depressive symptoms. Race and stress exposure interactions show that exposure differently predicts anxiety and depressive symptoms while race and appraisal interactions show blacks and whites report similar increases in anxiety and depressive symptoms. Findings suggest stress exposure has varying consequences for mental health of whites and blacks, while stress appraisals have similar consequences across groups.
DOES EARLY-LIFE RACIAL DISCRIMINATION EXPLAIN A MENTAL HEALTH PARADOX AMONG BLACK ADULTS?
Authors: Thomas Tobin Courtney S , Moody Myles D
Published: November 2019

To evaluate the impact of early life racial discrimination (ELRD) on mental health among Black adults. Data were from the Nashville Stress and Health Study (n=618). OLS regression models examined the relationship between ELRD and adult psychological distress; logistic regression estimated the probability of past-year major depressive disorder (MDD). We also assessed whether ELRD moderated the relationship between adult discrimination and mental health. Childhood (b=1.07, SE=0.51, p=0.04) and adolescent ELRD (b=1.32, SE=0.42, p=0.002) were associated with adult distress. Individuals who experienced childhood ERLD had 88% lower odds of adult MDD than individuals with no ELRD. Significant interaction analyses showed that ELRD was generally protective against adult discrimination. While ELRD importantly shapes distress and MDD among Black adults, patterns vary by outcome. Results indicate that adult distress and MDD develop through cumulative adversity processes that are further influenced by sensitive periods in the life course.
GLOBAL PUBLISHING OPPORTUNITIES IN GERONTOLOGY: A VIEW FROM THE EDITORS' DESKS
Authors: Miller Edward A , Simpson Elizabeth , Gusmano Michael
Published: November 2019

Global aging has proceeded at an unprecedented and accelerating rate. The aging of the population creates both opportunities and challenges for elders, their families, and society in general. Importantly, there is substantial variation in the effects of and response to global aging both within and across nations depending, in part, on prevailing cultural expectations and values, political and economic imperatives, and social and demographic characteristics. Thus, while some regions and countries have responded with innovative policies and programs to better enable the growing cohort of older adults to remain active and engaged in the community, other regions and countries have struggled with their response or barely begun to plan for the rising population of elders. This symposium assembles editors at five leading gerontological journals to demonstrate the role that peer-reviewed scholarship can play in disseminating knowledge that informs gerontological research, policy, and practice internationally. Editors include: Jeffrey Burr, PhD, Research on Aging; Deborah Carr, PhD, Journal of Gerontology: Social Sciences; Edward Alan Miller, PhD, Journal of Aging & Social Policy; Julie Hicks Patrick, PhD, International Journal of Aging & Human Development; and Julie Robison, PhD, The Journal of Applied Gerontology. Each presenter will review the scope, content, and focus of their journals and the role and opportunities for international scholarship. Michael Gusmano, PhD, a leading expert on the economic, political, and social consequences of global aging and International Editor of the Journal of Aging & Social Policy, will serve as discussant.
MAXWELL A. POLLACK AWARD LECTURE
Authors: Harootyan Robert
Published: November 2019

The Maxwell A. Pollack Award for Productive Aging recognizes instances of practice informed by research and analysis, research that directly improved policy or practice, and distinction in bridging the worlds of research and practice. The award lecture will be presented by the 2018 recipient, Karen Fredriksen-Goldsen, PhD, University of Washington. This award is generously funded by The New York Community Trust.
FAMILY CAREGIVER CONTRIBUTIONS TO HOME HEALTH FOR OLDER ADULTS: PREDICTORS OF ADEQUATE SUPPORT
Authors: Burgdorf Julia , Burgdorf Julia , Kasper Judith D , Wolff Jennifer L
Published: November 2019

Family caregivers play a crucial role in supporting older adults through home health (HH) episodes; yet no prior research examines factors affecting the adequacy of caregiver support during HH. We use a novel dataset linking nationally-representative survey data with HH assessment data for community-dwelling older adults (n=2,128) to identify older adult characteristics associated with adequate caregiver support in four task categories (Activities of Daily Living, medication management, medical tasks, and safety/oversight) during a subsequent HH episode. Weighted, multivariable logistic regression is used to model the likelihood of adequate caregiver support in each category. Multiple older adult characteristics prior to the HH episode were associated with greater likelihood of adequate caregiver support during HH, including: prior caregiver assistance with mobility, self-care, and health care tasks, living with others, and cognitive impairment. These findings reveal new risk factors for consideration in risk assessment and payment adjustments related to social determinants of health.
QUALITY OF COMMUNICATION WITH THE HEALTH CARE TEAM FOR CARE PARTNERS OF PERSONS WITH COGNITIVE IMPAIRMENT
Authors: Houtven Courtney H Van , Lippmann Steven , Belanger Emmanuelle , Smith Valerie A , James Hailey , Shepherd-Banigan Megan , Plassman Brenda
Published: November 2019

The CAregiver Perceptions About CommunIcaTion with Clinical Team members (CAPACITY) instrument measures perceived quality of communication with the health care team and the extent to which caregivers believe that the health care team considers their capacity and preferences in decision-making. A higher score reflects higher perceived quality. This presentation highlights features of CAPACITY scores in a national survey of care partners of persons with unexplained cognitive impairment who sought an Amyloid PET scan. A positive scan (presence of amyloid) indicates probably Alzheimer’s (n=1746). In addition to presenting its psychometric properties in this new sample, discussion focuses on the relationship between CAPACITY scores and a process measure of care that matters – accurate reporting of a new diagnosis. The CAPACITY score reflects an important domain of care quality that could be used more broadly to reflect the caregiver-centeredness of health care experiences and to predict patient outcomes.
COGNITIVE TRAINING ATTENUATES AGE-RELATED DECLINE IN PHYSICAL FUNCTION ACROSS 10 YEARS
Authors: Sprague Briana N , Phillips Christine B , Ross Lesley A
Published: November 2019

Poor physical function is associated with negative health and cognitive outcomes. Although nine studies demonstrate that cognitive training reduces age-related declines in physical function, only one has examined effects beyond immediate posttest changes. The current study assessed the impact of three cognitive training programs on physical function measures across 10 years. Using data from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) trial, older adults randomized to a no-contact control condition (n = 698) were compared to those randomized to processing speed (n = 702), memory (n = 703), or reasoning (n = 694) training. Intention-to-treat and treatment-received analyses were conducted for grip strength, Digit Symbol Copy, and Turn 360. There were no significant effects of being assigned to processing speed, memory, or reasoning training to any physical function outcome (p > .05). Treatment-received models indicated that processing speed training attenuated age-related declines in Digit Symbol Copy (b = -.005, p < .01) and Turn 360 (b = -.011, p < .001), memory training attenuated age-related declines in Digit Symbol Copy (b = -.009, p < .001) and Turn 360 (b = -.011, p < .001), and reasoning training attenuated age-related declines in Digit Symbol Copy (b = -.012, p < .001) and Turn 360 (b = -.012, p < .001). There was no significant transfer to grip strength. This is the first study to demonstrate beneficial effects of cognitive training to some physical functions across 10 years. Future work should examine moderators and mediators of transfer effects.
BEYOND FUNCTIONAL SUPPORT: PAID CAREGIVERS AND THE HEALTH OF OLDER ADULTS
Authors: Reckrey Jennifer M , Bowers Barbara
Published: November 2019

This symposium will explore role that paid caregivers (e.g. home health aides, personal care attendants, and other direct care workers) play in the health and team-based healthcare of older adults living in the community. The large and growing workforce of paid caregivers witness the changes in health status, chronic health needs, and psychosocial stressors of the older adults they care for. Yet existing research on paid caregivers has largely been limited to workforce issues such as recruitment, retention, and job satisfaction. The unique potential of paid caregivers to impact the health of their clients remains largely unstudied. The first presenter will describe results from qualitative interviews with seriously ill older adults and their long-time paid caregivers that found that paid caregivers perform a wide variety of health-related tasks in the course of their routine care. The second presenter will describe results from focus groups with paid caregivers that found that though not a part of the official care plan, paid caregivers provided deliberate cognitive, emotional, and social care that sought to improve their clients’ “total” health. The third presenter will outline the rationale for and development of an educational intervention aiming to improve paid caregiver’s ability to provide care to patients with heart failure. Finally, the fourth presenter will discuss the limited role paid caregivers currently play in the healthcare team. She will then highlight key policy, educational, and clinical recommendations to promote further paid caregiver integration in the healthcare team.
YOU’RE THE ONLY PERSON THERE FOR THEM: LEVERAGING HOME HEALTH AIDES’ EXPERTISE TO SUPPORT TOTAL CLIENT HEALTH
Authors: Franzosa Emily C
Published: November 2019

Formally, home health aides provide physical, non-clinical care to support the health and safety of older and disabled individuals. But in practice, both workers and clients report that the often unrecognized relational care aides provide is also central to clients’ well-being. In focus groups with New York City-based home health aides, aides described their conception and delivery of “total” care, which included specific and deliberate cognitive, emotional and social strategies to support clients’ mental and physical well-being. However, since this work was not included in formal care plans and invisible to those outside the care team, aides felt unprepared and unsupported in performing it. Realigning the definition of home care to address “total” care and better integrating aides into the care team has the potential to both improve job satisfaction and patient care.
HEART-FAILURE TRAINING FOR HOME CARE WORKERS IN NEW YORK CITY
Authors: Sterling Madeline , Leung Peggy
Published: November 2019

Home care workers (HCWs), which include home health aides and personal care aides, are increasingly being used by community dwelling adults with heart failure (HF) for long-term assistance and post-acute care. Findings from our prior research suggest that HCWs are deeply involved in many aspects of HF patients’ self-care, including HF maintenance and management, but the majority have not received any HF training or HF-specific resources. Due to this, many HCWs do not feel confident caring for their clients with HF. In this symposium, we will present the findings of a qualitative study that used a nominal group technique to elicit the educational needs of 40 English and Spanish speaking agency-employed HCWs caring for HF patients in New York City. We will also present an overview of the HF training course that was developed from this data and its effect on HCWs’ HF knowledge and caregiving self-efficacy.
AWARENESS OF HEALTH RISKS OF CAREGIVING AMONG PRIMARY PHYSICIANS AND THE CAREGIVERS THEMSELVES
Authors: Carmel Sara , Bachner Yaacov , Biderman Aya
Published: November 2019

Literature indicates that family primary caregivers (FPC) to severely-ill patients are at high risk to incidence of physical and mental morbidity, especially if they are old themselves. The purpose of these studies was to examine the FPC’s awareness to their own health risks, and primary physicians’ awareness to the importance of locating, following and providing preventive treatment to FPC in their clinic. Participants included 202 FPC older spouses with average age 70.7 (SD=8.33), and 68% women, and primary physicians (N=201) with average age of 48.5 (SD=11.22) and 53.5% women. Among the FPC, awareness to the health risks of caregiving was higher the greater was the caregiving burden, the worse was their self-rated health, the severer was the patient’s disease, as well as the lower was the number of children and among women and spouses. Awareness to importance of medical surveillance was low. Among physicians, awareness to the risks of caregiving was highest among physicians who received their diploma in Israeli universities, and to specialists in family medicine. Their awareness was higher to the FPC’s susceptibility to mental risks rather than to physical risks. Physician’s awareness to the efficiency of medical surveillance of the FPC was high but their actual performance of it was low. This finding is in accordance with the FPC’s report about a low level of interest in their own health among their primary physicians. The importance of awareness to location, surveillance and preventive treatment of FPC should be promoted in medical education, and primary medical services.