bluuebunny/crossref_metadata_2025 huggingface dataset:
Creativity’s Impact on Aging and Health, 1970–2010
Authors: Miller Wendy
Published: December 2020

In the 1970, practitioners in the arts, aging, health, social work and allied therapeutic professions became pioneers in a newly formed movement of creative aging. Robert Butler’s “Why Survive? Growing Old in America” called for rethinking aging and the services needed to support the growing aging population. Barriers to restrictions and the lower expectations around how older people could live in their communities began to change. Opportunities for engagement in the humanities and the arts began to be tailored to support older people’s life style and to accommodate the sharing of their life experiences in new ways through partnerships with schools and senior centers. The rise of these practices promoted the first multi-year study of arts engagement impact on the health on older adults and a wave of publications and new research studies followed. These were the foundation for this strength-based initiative across the spectrum of aging.
EngAGE via Alexa for Older Adults and Caregivers: Design, Utilization, and Impact of Socially Motivated Exercise
Authors: Huisingh-Scheetz Megan , Nicholson Roscoe , Smith Chelsea , Shervani Saira , Montoya Yadira , Hawkley Louise
Published: December 2020

EngAGE is a technology-based program leveraging Alexa that encourages older adult (OA) activity and socialization from home while empowering caregivers to support them. EngAGE delivers daily, in-home, NIA Go4Life exercise routines with instructions, pictures and music via Alexa Echo Shows or Fire Tablets to OAs. Caregivers use EngAGE to view scheduled exercises, follow progress, and send encouraging messages that are read aloud to OAs by Alexa. We will discuss the strategic co-design of EngAGE with OAs and caregivers and the utilization and functional impact of EngAGE over a 12-week feasibility and usability study (n=10 OA + caregiver pairs). Preliminary analyses revealed improvement in upper (mean grip strength change = +1.3 kg, paired t-test p=0.34) and lower (5-repeated chair stand time change = -2.3 seconds, paired t-test p=0.02) body strength. Discussion of focus group data will cover themes of perceived benefits, user experience, drivers/barriers to usage and desired features for EngAGE.
Enhancing Health for the Growing Number of Older Cancer Survivors: Designing Innovative Behavioral Interventions
Authors: Derry Heather , Conley Claire , Trevino Kelly
Published: December 2020

By 2040, there will be an estimated 26.1 million cancer survivors in the United States, with 73% over age 65. Compared to younger survivors and those without cancer, older adult cancer survivors have an elevated comorbidity burden. Lifestyle interventions can play a key role in preventing and managing chronic health conditions and promoting quality of life during and after cancer treatment. Yet, behavioral interventions for maximizing health are under-utilized in older adults with cancer. At times, older adults may have unique needs that require tailoring to increase accessibility, optimization, and uptake of behavioral interventions.

This symposium will showcase innovative approaches for enhancing health among older adult cancer survivors during and after cancer treatment. Dr. Bluethmann will discuss design considerations for using geriatric assessment in an ongoing exercise trial to manage side effects of aromatase inhibitors. Dr. Gell will present data on older survivors’ preferences regarding text messaging to support physical activity maintenance from an intervention study. Dr. Leach will discuss the use of technology to facilitate lifestyle change in older cancer survivors, presenting data on older adults’ user preferences and benefits from an eHealth tool. The discussant, Dr. Trevino, will summarize how these interventions can be leveraged to promote engagement in managing older survivors’ health and to inform next steps in intervention development. Collectively, this multidisciplinary group of speakers will provide practical information and “lessons learned” from designing behavioral and technology-based interventions, and highlight the promise that these approaches hold for improving quality of life in aging cancer survivors. Cancer and Aging Interest Group Sponsored Symposium.
Where We Live Matters: Residential Influences on Health and Well-Being
Authors: Ng Yee To , Munoz Elizabeth , Schafer Markus
Published: December 2020

Growing evidence indicates that residential contexts are implicated in the health and well-being of older adults. Operationalization of these contexts varies and includes psychosocial, physical and socioeconomic neighborhoods, and more proximal contexts (e.g., home environment). We aim to bring together a diverse set of papers focused on the living environment to understand how contextual factors are associated with individual outcomes. Muñoz and colleagues applied a lifespan perspective by evaluating associations between current and childhood neighborhood perceptions on cognitive health. Their results indicated that the association between perceived neighborhoods and cognition in adulthood was moderated by childhood neighborhoods. García and Ailshire contextualized the types of neighborhoods in which older Latinos live and how these influenced diabetes risk. They identified neighborhood clusters characterized by racial/ethnic and socioeconomic compositions and found that predominantly Latino neighborhoods with low SES were more likely to have diabetes compared to other neighborhood clusters. This symposium will also focus on the more proximal environment. Lee and Ailshire examined the neighborhood and home environment and found that the home’s proximity to green space and level of clutter within the home was associated with increased fall risks in older adults. Fingerman and colleagues coded older adults’ living spaces and found that personality type was associated with room conditions. Altogether, the presentations highlight the relevance of context measured across multiple levels of analyses and dimensions of well-being outcomes in aging individuals. Dr. Markus Schafer will provide a discussion of these findings and address the challenges and opportunities for future research.
Double Consciousness: Explaining Racial Paradox in Later Life Psychological Well-Being
Authors: Goler Timothy , Bhatta Tirth
Published: December 2020

A substantial number of studies have documented paradoxical findings when examining race differences in later life psychological well-being. Despite experiencing significant structural disadvantages, Black older adults have been found to report significantly higher overall life satisfaction and lower depressive symptoms than White adults. This study relies on double consciousness framework which allows us to understand why satisfaction with material conditions (e.g., domain-specific life satisfaction) among Black older adults could differ from their evaluation of overall well-being (e.g., overall life satisfaction). Based on a survey of successful aging (n=409 aged 60 years or older) conducted by the Elderly Care Research Center (ECRC) in Cleveland, Ohio, we examined race differences in coping resources, and their role in shaping overall life satisfaction, domain-specific life satisfaction, and depressive symptoms. Findings show that Blacks on average have a higher likelihood of experiencing recent negative life events than their White counterparts. Despite adverse life circumstances, Blacks older adults expressed significantly higher overall life satisfaction than Whites. They, however, reported significantly lower domain-specific life satisfaction than their White counterparts. The differences in depressive symptoms between Black and White older adults was not statistically significant. The race differences in overall life satisfaction was explained by religiosity, religious coping, and social support. Education, income, and adverse life events were found to contribute to such differences in domain-specific life satisfaction. Our findings underscore the need to consider the unique role of racialized life course circumstances and coping resources in shaping disparities in later life psychological well-being.
Religious Socialization and Moral Development: How Similar? How Different?
Authors: George Linda
Published: December 2020

Among Vern Bengtson’s contributions to research on aging, religion, and the family was the finding of strong patterns of intergenerational religious socialization within families. Professor Bengtson and colleagues published at least one book and a dozen journal articles documenting the strong evidence of intergenerational religious socialization, although they also documented specific variations of this general pattern. More recently, social scientists in the culture and cognition tradition have focused on moral development. Most of this research is based on studies of adolescents and emerging adults and concludes that families influence morality at these life stages, but that the effects of peers are even stronger. Some of this research explicitly links morality to religion; most does not. This paper compares research on religious socialization and morality, focusing on similarities and differences in findings, the potential of each tradition to inform and advance the other, and how that can be accomplished. Part of a symposium sponsored by the Religion, Spirituality and Aging Interest Group.
Self-Reported Health and Well-Being Across Heterogeneous Groups of Caregivers
Authors: Sheehan Orla , Huang Jin
Published: December 2020

Using the Caregiving Transitions Study (CTS) we compared the effects of caregiving on self-reported health and well-being in caregivers reporting providing dementia care, different levels of strain and amount of care provided. Caregivers (n-251) were 65% female, 36% African American and had a mean age of 71.8 years. A quarter of CGs reported being under a lot of strain and 47% provided care for persons with dementia. Dementia CGs (n=117) provided more hours of care per week (49.7 versus 37.7, p=0.001), more commonly reported high strain (36.8% versus 15.7%, p<0.03) and were more than twice as likely as non-dementia caregivers to report that caregiving interfered with taking care of their own health (33.9% versus 15.4%, p=0.003). Additional results will be reported on how these factors of dementia caregiving, level of strain, and hours of care affect well-being including perceived stress, treatment burden, depressive symptoms and health-related quality of life.
Gender Inequality and Late-Life Cognition
Authors: Lee Jinkook , Angrisani Marco , Jain Urvashi
Published: December 2020

Indian women’s disadvantage in cognition has been documented in several studies, additionally noting geographic variations. The gender gap in late-life cognition could be a manifestation of gender discrimination. Using national data from LASI-DAD together with information drawn from administrative data, we construct a state-level composite index of gender inequality, following the UNDP definition. We investigate and find strong evidence that cross-state differences in gender inequality are significantly associated with the gender gap in cognition. Women in the most discriminating state (Bihar) perform significantly worse than men (-0.21 s.d.), after controlling for key risk factors such as age and education. The gender gap in the least discriminating state (Kerala) is much smaller (-0.10 s.d.). We also find that gender inequality is strongly associated with education, early marriage, labor force participation, and social activities. This has important implications for public health policy aimed at reducing the risk of cognitive impairment and dementia.
Design and Methodology of the Longitudinal Aging Study in India—Diagnostic Assessment of Dementia
Authors: Lee Jinkook , Khobragade Pranali , Banerjee Joyita , Chien Sandy
Published: December 2020

Longitudinal Aging Study in India is a nationally representative survey of the health, economic, and social wellbeing of the Indian population aged 45 and older. LASI-DAD is an in-depth study of late-life cognition and dementia, drawing a sub-sample of over 4,000 LASI respondents aged 60 or older. Respondents underwent a battery of cognitive tests, while their informants were interviewed about their cognitive and health conditions. A common set of cognitive tests was selected to enable international comparisons, and additional cognitive tests suitable for illiterate and innumerate populations were also selected. Rich data on risk factors of dementia were collected through health examinations, venous blood assays, and genotyping. The response rate was 82.9%, varying across sex, education, and urbanicity. LASI-DAD provides an opportunity to study late-life cognition and dementia and their risk factors in the older population in India and to gain further insights through cross-country analysis.
Telehealth Psychological Interventions for Rural Caregivers: Improving Care to Persons With Dementia
Authors: Sussman Joleen , Banerjee Nikhil , Winslow James
Published: December 2020

Geropsychologists are well-suited to assess dementia, assist caregivers in understand the disease and associated behavioral changes and ways to cope with their loved one’s disease. However, majority of these services are offered during in-person clinic appointments in urban settings. This study aims to describe the utilization and potential benefits of providing dementia education telehealth services to Veterans and their families residing in rural mountain and plain areas of Colorado. Psychological intervention was provided via telehealth from the primary VA hospital to small community clinics or to Veterans homes via video mobile application. The present study provides demographics of participants who elect this service and discusses how these challenge ageism and other biases relate to technology use. Further, we examined how engagement in this intervention may impact utilization of geriatric and extended care services as well as use of primary care, emergency room visits, and use of anti-psychotic medications.
Integrating Caregiver Education and Support into Multidisciplinary Video Visits
Authors: Rossi Michelle , Jost Lauren , Engel Ina , Dolbee Carol , Ward Keisha
Published: December 2020

The TeleDementia Clinic is an interdisciplinary longitudinal telehealth dementia clinic providing care to rural Veterans in Western Pennsylvania with cognitive decline. The TeleDementia Caregiver Support group uses telehealth to provide caregiver support and education to those caregivers with the highest levels of caregiver burden in this population. The support group has caregivers participating in the session at different rural clinics while a multidisciplinary team of professional (geropsychologist, geriatrician, nurse practitioner and others) are located at an urban VA medical center. All can interact via video telehealth connection. Each session provides a short educational session on caregiving topics that then provides a springboard for caregiver discussion about their own experiences. The multidisciplinary clinician team lend their expertise to the education and support of caregivers. Both quantitative and qualitative analysis of effectiveness of this model will be discussed.
Achieving Health Equity for Older Adults Through State-of-the-Art Innovations
Authors: Fortuna Karen , Batsis John , Jimenez Daniel
Published: December 2020

As health indicators such as life expectancy have improved for many older adults, some older adults experience a disproportionate amount of preventable disease, death, and disability. The causes of health disparities among older adults are multidimensional in that disparities are due to multiple, interacting factors such as socioeconomic status, disability status, geographic location, and race/ethnicity. Achieving health equity in late-life requires innovative strategies to address interconnected environmental, sociocultural, behavioral and biological factors that impede opportunities to achieve optimal health and quality of life. This symposium will present state-of-the-art innovations and strategies employed among socially disadvantaged racial, ethnic, and other population groups, and communities. We will discuss innovations in the workforce enhancements with older adult peer support specialists and community health workers, community engagement techniques in program design, and digital solutions aimed at addressing multiple dimensions of health in older adults.
Cardiovascular Profiles for Phenotyping Cognitive Trajectories in the Irish Longitudinal Study on Ageing
Authors: De Looze Celine , Williamson Wilby , Demnitz Naiara , Kenny Rose Anne
Published: December 2020

Cardiovascular risk factors are increasingly recognized as modifiable risks for cognitive decline and dementia in later life. The Life’s Simple 7, an ideal CV health scoring system, has been recently put forward as a tool for the promotion of brain health. This study aims to evaluate the LS7 as risk prediction tool for cognitive decline trajectories (MMSE, immediate/delayed recall and verbal fluency) in 2,739 adults aged ≥50 years from TILDA. We investigate if indices of muscular strength (grip strength), mobility (Time Up and Go, walking speed) and physiological stress (e.g. orthostatic blood pressure and heart rate recovery) as add-ons to the LS7 improves prediction of cognitive trajectories; and, in a subcohort, we assess CV health score in association with multimodal brain measures. Identifying the factors that influence the onset and trajectory of cognitive decline in a multifactorial perspective is critical toward lowering dementia risks and developing adequate intervention and treatment.
Hierarchy of Loss in Functional Capability: Findings From a 15-Year Follow-Up in a Brazilian Aging Cohort
Authors: de Oliveira Cesar , Cadar Dorina , Biddulph Jane , Mambrini Juliana Vaz de Melo , de Andrad Fabiola Bof , Lima-Costa Maria
Published: December 2020

Functional loss among older adults is known to follow a hierarchical sequence, but little is known about this in low-middle income countries. We examined longitudinally the hierarchy of loss in physical functioning in 1,602 older Brazilian adults (aged 60+) from the Bambui Cohort Study of Aging. Functional loss was ascertained using self-reported difficulties in six basic activities of daily living (BADL). The incidence for each BADL limitation was assessed using survival analysis while controlling for the competing risk of death. Over the 15-year follow-up, the incidence in BADL disability rate was highest for dressing, followed by getting out of bed, bathing/showering, walking across a room, using the toilet or eating. The findings from this 15-year follow-up Brazilian aging cohort support a hierarchical pattern of disability in activities of daily living based on both prevalence and incidence of disabilities over time, and they suggest gender differences in the incidence of disability.
Involuntary Treatment in Dementia Care at Home: Results From the Netherlands and Belgium
Authors: Moermans Vincent , Mengelers Angela , Bleijlevens Michel , Verbeek Hilde , Tan Frans , Capezuti Elizabeth , Milisen Koen , Hamers Jan
Published: December 2020

Most PwD remain living at home. Due to complex care needs this can result in an increased risk for care provided against the wishes of the client and/or to which the client resists, referred to as involuntary treatment. This study explores the use and factors associated with involuntary treatment in PwD receiving home care in the Netherlands and Belgium. A secondary data analysis of two cross-sectional surveys (n=844 persons) showed that more than half of the PwD (51%) living at home received involuntary treatment (Belgium 68% and the Netherlands 45%). Non-consensual care (83%) was the most common, followed by psychotropic medication (41%) and physical restraints (18%). Involuntary treatment was associated with living alone, greater ADL dependency, lower cognitive ability, higher family caregiver burden and receiving home care in Belgium versus the Netherlands. In order to provide person-centered care, it is important to study ways to prevent involuntary treatment in PwD. Part of a symposium sponsored by Systems Research in Long-Term Care Interest Group.
Addressing Older Adult Social Isolation in Various Settings With Unique Conflating Trajectories of Care Models
Authors: Bowland Sharon
Published: December 2020

No matter the age, social isolation is common among older adults due to a number of factors. In looking at social isolation through the framework of the International Classification of Functioning, Disability and Health (ICF) model, the biopsychosocial factors intersect. Care models will be explored that involve the ICF model multi-disciplinary concepts of body functions, activities, participation and environmental factors. Developing more programs to counter isolation is critical for the health of older persons. (1) The experience of vulnerability may be overcome by banding together through assisting others or building a peer support network. (2) A holistic perspective is needed in promoting interventions that support functionality. Regular programming with body awareness and cognitive reflection is enjoyed by institutionalized older adults. (3) The role of social action and social justice in reducing social isolation is part of training social work students about the importance of culture and advocacy. (4) Collected ethnographic data found that the practice of remembrance reduces social isolation regardless of the program. Gardening and storytelling were found to be opportunities to reduce social isolation. (5) With unexpected longevity in individuals with hemophilia due to scientific advances, researchers also found shame, fear, and coping through social isolation to avoid social assumptions of health status. Care models are being explored to support this cohort. To conclude, Dr. Sharon Bowland will summarize our abstracts and discuss how they revolve around the ICF model of care that can be applied to the important social determinant of health area of social isolation.
Experiences of Social Withdrawal: Why Aging Matters Among Individuals With Hemophilia Facing Unexpected Longevity
Authors: Perry Tam , Schwartz Sara , Francis Dana , Kaplan Charles
Published: December 2020

For the first time, individuals with hemophilia are living beyond their 30s and 40s. This cohort, many of whom had been dependent on donated blood and contracted HIV and hepatitis, face unique challenges as they age with hemophilia and other conditions. Little is known about the experiences and health needs of these adults over the age of 40. Scientific advances have changed the life course of individuals who received earlier treatment modalities. Today, a person with hemophilia who has received preventative synthetic treatment can look forward to a long, healthy and active life. Semi-structured telephone interviews (n=32) were conducted with long-term survivors, family members, and professionals who supported these families. Findings include shame, fear and coping through social withdrawal in order to hide their hemophilia to avoid assumptions of HIV status. Analyzing unexpected longevity and why age matters for this historically isolated cohort, we explore appropriate care models.
Home and Community Based Services for People With Dementia
Authors: Degenholtz Howard , Van Cleve Raymond
Published: December 2020

Home and Community Based Services has grown as an alternative to nursing homes over the past 30 years. While there are extensive data on nursing home staffing, there is a dearth of similar information about Medicaid financed home care. We use data from 2014-2016 Pennsylvania Medicaid to examine personal care for elderly with and without dementia across the range of physical disability. One challenge is that even though physical function can be measured in terms of discrete tasks (i.e., limitation in bathing, dressing, toileting), analysis of the amount of care people receive has to take into account the combination of dementia and combinations of ADL limitations. We found that older adults with dementia receive one hour more of personal care per day at the lowest level of disability and 1.5 hours at the highest level. The increased need for caregiving hours should be incorporated into policies that guide HCBS programs.
Person-Centered Dementia Care: Workforce and Organizational Supports in Nursing Homes
Authors: Morgan Jennifer , Burgess Elisabeth , Chen Yun-Zih
Published: December 2020

Person-centered care that supports choice and autonomy of residents is foundational to implementing high quality care for long-term care residents including those living with dementia. Organizational change that supports person-centered approaches requires leadership engagement and a stable, well-qualified dementia-capable workforce. This paper uses survey data from a statewide probability sample of nursing homes and their staff (N=438) to identify barriers and facilitators to person-centered care. Findings show key barriers to delivering person-centered care, including a lack of staff empowerment practices and irregular use of consistent assignment. While most organizations are implementing some person-centered resident care practices, few have moved beyond predominantly institutional practices. Staff stability and retention also remain key barriers to person-centered care. Facilitators include adoption of evidence-based and inclusive quality improvement strategies. The paper will discuss implications for state, community and organizational strategies for improving staff empowerment, integrating dementia care competencies, promoting culture change and increasing leadership engagement.
Allegation Assessment and Outcome Differences Across Racial Groups From Standardized Adult Protective Services Data
Authors: Hass Zachary , Liu Pi-Ju (Marian) , Conrad Karen , Stratton Sara , Conrad Kendon
Published: December 2020

Objective assessment is an important tool for Adult Protective Services (APS) in supporting a diverse population. Out of the 1472 APS’ clients, aged 65 and over, assisted during the study period, 39% identified as a non-white race and 30% did not speak English. Providing services to this vulnerable population is made even more difficult by the need to provide culturally appropriate services. In this work, we present on differences in types of abuse alleged, abuse severity assessment, services provided, and preliminary outcomes across racial and language groups. For example, for this population, clients identifying as black race had the highest allegation rates of neglect (16%) and financial abuse (27%), Asians of physical (15%) and emotional abuse (24%), and other races of self-neglect (56%) and isolation (9%). Standardized data collection permits tracking such patterns and objective assessment tools help to avoid systemic bias in aiding this vulnerable population.
Discrimination and Protective Factors to Cognitive Health: Testing NIA’s Health Disparities Framework
Authors: Gonzales Ernest , Whetung Cliff , Lee Jane , Wang Yi
Published: December 2020

Cognitive impairment is a worldwide epidemic. Informed by NIA’s Health Disparities Framework, this study investigated interpersonal, behavioral, and sociocultural risk and protective factors associated with cognitive health trajectories. Mixed models examined factors associated with cognitive health with data from the Health and Retirement Study among Whites, Blacks, and Hispanics (2008-2014, N=4,511). A majority of respondents who experienced everyday discrimination attributed it to ageism among this racially and ethnically diverse sample. Stratified mixed models of everyday discrimination by attribution (racism or ageism) revealed worse cognitive functioning. Major lifetime discrimination was not statistically associated with cognitive functioning. Economic factors (education, income, assets) and religious activity protected cognitive functioning and were particularly salient for Blacks and Hispanics. Strategies that bolster individual resilience as well as social policies that address discrimination and structural inequities will likely reduce health disparities and improve population health.
Arts, Narrative, and Creativity: Enhancing Connection, Communication, and Health
Authors: Eaton Jacqueline
Published: December 2020

Older adults will comprise17% of the world’s population by2050. Meeting the unique challenges of an aging society requires innovative solutions to enhance the aging experience, reduce the pressures placed on the current infrastructure, and inspire future generations to see that aging matters. Shifts in multi and transdisciplinary approaches to research in aging have contributed to an increasing surge in the development and evaluation of arts-based strategies to find innovative solutions to the challenges associated with aging. This symposium examines the use of creative expression as a tool to enhance older adult health and quality of life through five different approaches targeting1) workforce training,2) mental health self-support,3) perceptions of peer loss and death in long-term care and,4) social activity for persons with dementia. Cox and Maguire enhance undergraduate gerontology courses with guided autobiography, portfolios, and creative collaging processes. Eaton et al. report findings from a study testing the use of arts-based caregiving techniques by certified nursing assistants to improve resident care. Fortuna and Brooks describe the use of narrative and storytelling to share lived experiences of aging with a mental health condition while promoting age-related self-management skills development. Olson presents findings from her work using expressive arts to explore perceptions of death and peer loss by residents in long-term care. Finally, Mittelman and Harris share outcomes from the program, A Place For Us, which provides creative expression opportunities for persons with dementia.
Healing With the Arts: Older Adult Recovery Narratives
Authors: Fortuna Karen , Brooks Jessica
Published: December 2020

Recovery narratives are an effective healing art medium that support individual development by virtue of the shared human experience transmitted through each story. Older adult recovery narratives are unique as they share their experiences of aging with a mental health conditions to support others with similar difficulties. Older adult recovery narratives offer encouragement of self-determination in late life, share lived experience of aging with a mental health condition, and promote age-related self-management skills development. The RecoverYdia smartphone app provides an online community for older adults with a lived experience of a mental health condition. RecoverYdia subscribers can search through hundreds of relevant videos and find the storyteller who tells the viewer’s story, prompts them to reach out for help, and eventually inspires them to help others. This presentation will discuss the state of evidence regarding the evidence for recovery narratives across the globe and offer a RecoverYdia technology demonstration.
Getting Involved With Policy as a Graduate Student
Authors: Gallo Haley
Published: December 2020

The third speaker is University of Southern California PhD candidate Haley Gallo. Haley will discuss strategies for connecting research to policy as a graduate student, as well as aging-policy internship opportunities for graduate students, including the GSA’s Greg O’Neill Policy Internship. Haley’s research focuses on policies that promote the goals of the Age-Friendly Cities and Communities initiative. She is passionate about including older adults—particularly those from groups who are traditionally left out—in the development of research and policy that affects people of all ages.
Partnerships to Connect Aging Research to Policy
Authors: Thomas Kali
Published: December 2020

The fifth speaker is Dr. Kali Thomas. Dr. Thomas will discuss her experience working in partnership with government and non-profit organizational stakeholders to conduct aging research that informs policy and practice. Dr. Thomas is an Associate Professor at the Brown School of Public Health and research health science specialist at the Providence VA Medical Center, where her research focuses on identifying ways to improve the quality of life of older adults needing long-term services and supports (LTSS) through applied health services research.
Do Age-Friendly Community Initiatives Form a Biopolitical Paradigm?
Authors: Yeh Jarmin , Fox Pat , Vlahov David , Pinderhughes Howard
Published: December 2020

Biopolitical paradigms are frameworks that specify how concerns about health and the body are made the simultaneous focus of biomedicine and state policy (Foucault 1984; Rose 2007). As aging and urbanization trends converge, developing “age-friendly community initiatives” (AFCIs) has become a global movement and important policy area. To prompt critical questioning, situational analysis was used as a theory-methods package to compare AFCI conceptual frames with perspectives of thirteen AFCI experts and seventeen older San Franciscans. Preliminary analysis suggests AFCIs form a biopolitical paradigm because they not only seek to rework boundaries between bodies and environments, they operate as modes of individual and population governance for the sake of health; yet, struggle to find ways to preserve the inclusion of older people in the ongoing social system. Understanding how AFCIs place social and physical environments squarely in view within the biomedical arena of the gerontological gaze has theoretical and policy implications.
Financial Security at Older Ages
Authors: Mudrazija Stipica , Butrica Barbara
Published: December 2020

As Americans have become increasingly indebted over time, understanding the factors influencing indebtedness is increasingly important and can help policymakers design policies that discourage debt, thus enhancing private retirement savings so that retirees become less dependent on Social Security benefits. The paper uses data from a major credit bureau of a nationally representative 2 percent random sample from more than 250 million consumer records to examine the financial health and indebtedness of older adults. The data cover the years 2010 through 2018 and follow the same consumers over time. They are supplemented with the zip-code level information from the American Community Survey on neighborhood characteristics, including racial and ethnic composition, education, median income, and poverty. Our preliminary findings suggest that, while the proportion of older adults in serious financial distress is not substantial, their indebtedness is increasing and the growth of unsecured debt (e.g., student debt) has been especially fast. Part of a symposium sponsored by the Economics of Aging Interest Group.
The Financial Presentation of Alzheimer’s Disease and Related Dementias
Authors: Nicholas Lauren
Published: December 2020

Dementia, a currently incurable degenerative cognitive disease, represents a major threat to financial stability. Early signs of dementia can include difficulties managing money and forgetting to pay bills, raising concerns about the implications of pre-clinical disease for financial well-being. We linked Medicare claims data to 20 years of consumer credit data for more than 80,000 older Americans living in single households to study the financial presentation of Alzheimer’s Disease and Related Dementias. Using non-parametric regression models, we find elevated rates of payment delinquency, subprime credit, and withdrawal from use of credit products up to 6 years before dementia is clinically diagnosed. Similar patterns did not appear with a number of placebo acute and chronic health conditions, suggesting that the adverse financial events are unique to dementia and do not occur with other acute or chronic illnesses. Part of a symposium sponsored by the Economics of Aging Interest Group.
Family Spillovers and Long-Term Care Insurance
Authors: Coe Norma , Van Houtven Courtney , Goda Gopi
Published: December 2020

We examine how the presence of long-term care insurance (LTCI) spills over to family outcomes, including informal care, co-residence, and labor supply of adult children. We instrument for long-term care insurance with changes in state tax policies to address the endogeneity of LTCI coverage. We find that for tax-filing families in the top third of the income distribution, LTCI coverage leads to a 50 percent reduction the parents’ perceptions of the willingness of people to care for them in the future, including their adult children. We also find that LTCI causes changes in the residential decisions of adult children, with lower co-residence rates and higher likelihood of living within 10 miles of the parent. We also find small decreases in part-time work among adult children. Our findings provide empirical support for the presence of family spillovers of LTCI on the economic behaviors of family members. Part of a symposium sponsored by the Economics of Aging Interest Group.
Enriching Future Research: The Power of Qualitative Methods in Cancer-Related Health Services Research
Authors: Halpin Sean
Published: December 2020

The ever-changing landscape of cancer care for older adults—with novel treatments, increasing survival rates, and growing population diversity—makes effective cancer care delivery increasingly complex. Qualitative research is uniquely poised to make sense of this complexity and shape potential interventions and their implementation. While the potential power of qualitative methods in cancer-related health services research and implementation science is great, as recognized in a recent National Cancer Institute report, the range of qualitative methods can make identifying and applying the most appropriate method(s) challenging. To meet this challenge, this symposium will bring together researchers across disciplines to report on three qualitative techniques and how each was applied in cancer research with older adults. Halpin will present on the use of applied conversation analysis to study medical education delivery to patients with multiple myeloma. The method is particularly well-suited to investigate health education and communicative efficacy. Carrion will discuss in-depth qualitative interviews that were conducted to understand the cancer beliefs and attitudes of older Latinx adults. The interviews, conducted in Spanish, offer an opportunity to consider how qualitative methods are key to illuminating the experiences of underrepresented populations. Seaman will report on the multiple qualitative methods used, including questionnaires, interviews, and site observations, to document survivorship care practices among head and neck cancer programs. The triangulation of qualitative methods allowed for an unparalleled understanding of guideline implementation and program variation. Exploring a range of methods, the presentations make a powerful argument for qualitative methods in cancer-related health services research.
The Implementation of Birdsong: A Non-Pharmacological Intervention for Persons With Dementia
Authors: Tompkins Catherine , Thomas Joan , Cole Christina , Qiu Mei
Published: December 2020

Birdsong is a person-centered, nonpharmacological intervention for people with dementia. Using a touch-screen tablet, residents with dementia are stimulated with content customized based on individual interests such as sports, videos, music or brain games. The increased stimulation is expected to redirect negative behaviors, decrease the use of anti-psychotic medications and increase positive emotions. Birdsong is being implemented in a 100% Medicaid funded, long-term care facility. Two 10-week experimental design studies were implemented with 39 residents. Preliminary findings suggest a lack of independence with the tablets among the residents, but positive stimulation of emotions and redirection of negative behaviors with assistance of staff or volunteers. A team of practitioners, faculty and student researchers continue to examine the intervention, its implementation and effects on this population by examining the Minimum Data Set (MDS data) and observations of the residents as they utilize Birdsong.
In the Red: Debt, Financial Well-Being, and Retirement Preparedness Among Older Adults
Authors: Miller Julie , Miller Julie
Published: December 2020

Over the past twenty years, total debt for Americans ages 70 and over has increased more relative to all other ages group- by 543% according to the Federal Reserve Bank of New York (2019). Higher rates of debt among older adults have been attributed to a range of factors including expanded access to consumer credit, the capability for people to borrow from 401(k) plans, increases in costs of living, and limited financial literacy, among others. Related research of adults nearing retirement age who carry debt points to delayed retirement timing, lower levels of retirement savings, and higher risk and rates of bankruptcy. This symposium introduces timely investigations of retirement planning and economic security among older adults with debt. The first presentation will provide an overview of the impact of financial hardship on health among older adults in the United States over a recent ten-year period. The second presentation will focus on over-indebtedness among pre-retirees. The third presentation will examine the role of safety net services and borrowing from retirement plans among older adults with debt, particularly among older adults of color. The fourth and final presentation will focus on student loan debt as a hurdle to near-term and long-term financial security for older women in particular. A discussant will comment on how, together, the aforementioned papers contribute to our understanding of economic wellbeing and retirement preparedness in this era of increasing longevity. The session will integrate policy and programming implications for gerontological professionals.
Nurses Working in and With Adult Protective Services: Agency Characteristics and Job Responsibilities
Authors: Liu Pi-Ju , Chilatra Jessica Hernandez
Published: December 2020

The majority of Adult Protective Services (APS) workforce is staffed by social workers, though some agencies have recognized the need to address clients’ medical needs such as wounds, injuries, nutrition issues, hydration issues, premature death and more. Using survey data from the National Adult Protective Services Association (NAPSA), we analyzed 99 nurses’ responses on their role in working in/with APS to help abused, neglect, and exploited adults. Out of the 99 nurses, 65 were direct employees of APS, and 61 did not report directly to a nurse supervisor. Forty-nine nurses carry a caseload like social workers, and 27 carry a caseload in conjunction with social workers. The most common services nurses provide are home visits, evaluations of clients and their medications, and client education. Qualitative data revealed the benefits of having nurses on staff, including assessing medical needs, preventing medical emergencies, providing holistic care, and navigating the healthcare system. Part of a symposium sponsored by Abuse, Neglect and Exploitation of Elderly People Interest Group.
The Process of Developing a WHO Dementia-Friendly Community Global Toolkit: Input From Multiple Stakeholders
Authors: Sun Fei , Seeher Katrin , Fréel Stéfanie , Dua Tarun
Published: December 2020

This study examined the process that the Department of Mental Health and Substance Abuse of WHO used to develop a global toolkit for dementia friendly initiatives (DFI). Data were collected through a mix-method approach consisting of individual interviews of 20 DFI leaders, four focus group interviews of persons living with dementia (PWD), three group interviews of professionals, and an online survey of 129 participants from 46 countries. Data from multiple sources were examined. The meaning of DFIs centered on the needs of PWD, multi-sector collaboration, and physical and social environmental changes. Over 70% participants in the survey reported their DFIs targeted PWD and included PWD as important partners. The EASTT model can be used to summarize DFI strategies including Education, Advocacy, Support, Training and Transforming environment. Countries advanced in DFI tended to focus on enhancing professional capacity and environmental adaptation, while countries launching DFI appeared to prioritize dementia awareness campaigns.
The Association of Nursing Home Staffing Levels With Consumer Complaints
Authors: Peterson Lindsay , Bowblis John , Jester Dylan , Hyer Kathryn
Published: December 2020

Nursing homes (NH) are inspected annually, however, residents and others can file complaints any time. Complaints are critical to NH oversight. Another important quality factor is staffing. Our objective was to examine the association of complaints and staffing levels in a 2017 sample of 14,194 freestanding NHs. We used federal data on NH complaints, quality, staffing, and other characteristics. The outcomes were having received at least one complaint (or not) and numbers of complaints. Using logit and negative binomial regression, controlling for facility and resident characteristics, we found greater registered nurse, nursing assistant, and social services staffing were associated with fewer complaints. Interestingly, licensed practical nurse (LPN) staffing was associated with a higher likelihood of receiving a complaint. Results are consistent with literature on nurse staffing and quality. LPN results raise questions about substituting LPNs for RNs. The social services results show social services staffing may be important for quality.
Pathways to and Consequences of Surrogate Decision-Making for Older Adults
Authors: Teaster Pamela , Bolkan Cory , Meyers Shawn
Published: December 2020

With a burgeoning aging population, there is a growing need for surrogate decision makers, yet oversight of and guidance for them remains inadequate. People needing surrogate decision makers are an especially vulnerable population because they rely on others for care and/or are unable to advocate for themselves. Their vulnerability leaves them susceptible to elder abuse (e.g., physical, sexual, psychological abuse; active and passive neglect; financial exploitation), which affects approximately five million older Americans each year. Personal, financial, and societal impacts can be devastating and are estimated to cost billions annually. The issue of abuse, neglect and exploitation by surrogates has been highly visible nationally, evidence indicates that some surrogate decision makers perpetrate abuse. One purpose of this symposium is to discuss ways in which surrogates do and do not make decisions for older adults. Ramsey-Klawsnik and Burnett present data at the systemic level to illustrate how self-neglect sequelae can result in placement under surrogate decision-making authority of either well-intended or opportunistic others. Bolkan, Teaster, Ramsey-Klawsnik, and Gerow present findings from a six-state study on surrogate decision maker victims and perpetrators who were substantiated in Adult Protective Services cases. Zhao, Katz, and Teaster show, using a survey of M-Turk participants, how a general population makes and is comfortable with surrogate decisions. Discussant Shawn Meyers will pull together the findings by exploring their translation to judicial best practices for making determinations regarding surrogate decision makers and the effects of their decisions on the surrogate as well as collaterals.