bluuebunny/crossref_metadata_2025 huggingface dataset:
Where are all the men? A review of the barriers and facilitators to participation in health promotion interventions
Authors: Howell Britteny , Corbett Sage , Peterson Jennifer
Published: December 2021

Research shows that men in the U.S. experience significant morbidity and earlier mortality than women and are less likely to access, interpret, and apply health information to improve their outcomes. Although evidence-based health promotion programs have proven successful at increasing healthy lifestyle behaviors and reducing morbidity among older adults, older males are still significantly less likely to enroll and sustain participation in such health interventions. While studies have shown the barriers and facilitators to older adult participation in health programs in general, it is largely unknown why older male recruitment and participation in health promotion interventions remains so low. In this poster presentation, we conducted a thorough review of the last 20 years of existing research across a variety of academic search databases to outline the barriers, facilitators, and recommendations for increasing older male participation in health promotion programs. Of 1,194 initial search results, 383 article abstracts were thoroughly screened for inclusion, and 26 articles met all inclusion criteria. Included studies were coded and analyzed using Grounded Theory and reveal that masculine gender roles, as well as program scope, environment, and gender of the instructors and other participants, were important factors for male participation. Interventions should include men in all aspects of program planning and implementation, take into account men’s existing relationships and interests to create gender-sensitive programming, and clearly delineate the benefits to participation. Lastly, the field of public health would benefit by helping to normalize men’s participation in health promotion interventions.
Age, Period, and Cohort Effects on Literacy Skills across Life Stages
Authors: Yamashita Takashi , Smith Thomas , Cummins Phyllis
Published: December 2021

Literacy skills are essential adult competencies for economic, social, political and cultural participation, which are linked to higher quality of life. Literacy skills are known to be lower for older age groups. However, relatively little is known about cohort and period effects, which provide clues to the sociohistorical impacts on literacy, in addition to the well-known age effects, over the life course. This study analyzed three nationally representative cross-sectional survey data of the U.S. adults at five time points, from the 1994 International Adult Literacy Survey (IALS), 2003 Adult Literacy and Life Skills Survey (ALL), and the 2012/2014/2017 Program for International Assessment of Adult Competencies (PIAAC). The total analytic sample was 17,450 adults age between 18 and 65 years old. The literacy measures were re-scaled (0-500 points) to be comparable across the surveys. An age-period-cohort hierarchical linear model (i.e., cross-classified random effects model) was constructed using the Bayes estimator. Individuals were cross-classified based on 14 five-year birth cohort and 5 periods (survey years) information. Results showed that literacy skills improved [95% credibility-interval (CI) for linear effect of age = (0.31, 1.07), but the rate of improvement declined over time, faster rates of decline in later life stages [95% CI for quadratic effect of age = (-0.17, -0.09)]. Additionally, the notable variability across the cohorts and periods [95% CI variances = (5.34, 52.52) and (2.30, 172.01), respectively] were identified. Possible explanations for the identified age, period and cohort effects on literacy and implications for adult competencies in later life are evaluated.
Daily Steps Buffer the Impact of Daily Stress on Mood in Youth and Middle-aged/Older Adults
Authors: Fleming Daniel , Liu Yin , Maxey Myles , Fauth Elizabeth Braungart , Beckert Troy
Published: December 2021

Physical activity has known associations with lower stress and improved well-being. These studies often include samples from one developmental phase at a time, which is helpful for researchers in those developmental areas, but less informative for identifying predictors of health and well-being across the lifespan. The current study examined whether protective aspects of physical activity (steps) on stress and mood worked similarly in widely different age cohorts. We also examined these relationships at the daily level, as opposed to global/macro levels. Participants (n = 119, 67% female) were 44 adolescents between 13-18 years (Mage (SD) = 15.73 (1.48) years, 57% female) and 77 middle-aged/older adults between 55-76 years (Mage (4.97) = 59.67, 74% female). They self-reported global life satisfaction and demographic characteristics at baseline and completed ecological momentary assessments (three per day for three consecutive days, across six measurement bursts, each spaced two weeks apart) via smart phones, reporting on their mood, stressor exposures/types, and end-of-day pedometer step count. Multilevel models showed that daily steps had protective effects against social network stressors on both daily mood and life satisfaction, such that more steps weakened the negative relationship between network-related stressors, mood, and life satisfaction. This protective effect was uniform for both older and younger adults, and across boys/men and girls/women. Overall, the present study suggested the importance of physical activity, even that of general step count, on buffering daily stress on daily mood and general life satisfaction for participants at multiple phases of the lifespan.
Meaningful Assessment or Minimum Compliance: PASRR for Nursing Home Residents with Mental Illness
Authors: Bucy Taylor , Moeller Kelly , Bowblis John , Shippee Tetyana
Published: December 2021

The Omnibus Budget Reconciliation Act (OBRA) of 1987 included provisions for the Preadmission Screening and Resident Review (PASRR) program, which requires states to create and maintain systems to assess persons with serious mental illness (SMI) seeking NH care. The prevalence of SMI in NHs is increasing, and little is known about the effectiveness of the PASRR program intervention. We conducted 20 interviews with state and national PASRR stakeholders, including assessors, hospital discharge planners, mental health advocates, geriatricians and geriatric psychiatrists. Interview data were triangulated with state provided materials on PASRR collection and implementation. Based on these interviews, we identified four themes: 1) variation in the implementation of federal PASRR legislation across states and jurisdictions, 2) the need for investment in professional development and workforce capacity, 3) lack of usefulness of PASRR in ongoing care planning, and 4) the need to consider the role of age, race/ethnicity, and stigma on quality of care for NH residents with SMI. Stakeholders agree that PASRR legislation was well intentioned, but also expressed concern regarding the completion of PASRR as an issue of compliance versus meaningful assessment. More work is needed to determine how best to develop and support the care needs of people with SMI, while being mindful of the original goals of deinstitutionalization that prompted OBRA passage. In order to assess the impact of the PASRR program on quality of care and mental health outcomes, further research should take an evaluative approach through meaningful use of PASRR data.
Direct Care Workers Employed as Medical Aides: Home Health Aides, Nursing Assistants, and Orderlies
Authors: Kelly Christopher , Deichert Jerome
Published: December 2021

Purpose: This study describes the differences among direct workers (DCWs) employed as medical aides in three occupations: home health aides, nursing assistants, and orderlies. Design and Methods: Data were from the 1% Public Use Microdata Sample (PUMS) of the 2019 American Community Survey (ACS). Logistic regression was used to compare demographic and employment characteristics of DCWs employed as medical aides in three occupations: home health aides, nursing assistants and orderlies. Results: Compared to orderlies and psychiatric aides, home health aides are more likely to be foreign born, more likely to be female, less likely to work in institutional settings, less likely to be under age 25, less likely to work year-round full-time, less likely to have more education, and less likely to receive insurance from their employers. Implications: Since 2018, the PUMS of the ACS separates nursing, psychiatric, and home health aides (previously one occupational category) into three: home health aides, nursing assistants, and orderlies. This affords researchers a more precise understanding of this part of the direct care workforce. Home health aides represented more than 2/3 of DCWs employed as medical aides in 2019. Further, these workers are distinct among medical aides. More than nursing assistants and orderlies, home health aides are older, female, underinsured, foreign-born, and with limited education. This reflects both the barriers home health aides face to other occupations and also the preferences of their employers (which include private households). These findings have implications for the recruitment and retention of medical aides across all three occupations.
The Preservation of Spousal and Partner Relationships Among Nursing Home Residents
Authors: Shaw Shanae , Csikai Ellen
Published: December 2021

The decision to seek placement in a nursing home may be especially difficult for spouses or partners of the potential nursing home residents. Disruption of the attachment relationship following placement may influence the psychosocial well-being of nursing home residents. Although the responsibility of nursing home staff is to ensure psychosocial well-being, including awareness of the influence that separation can have on a spousal or partner relationship, little is known about services offered for the maintenance of spousal and partner relationships. This study was conducted to identify nursing home practices that had preservation of spouse/partner relationships as the goal. A mixed methods approach utilized both an online survey (81 respondents) with nursing home social workers in four Southern states and ten telephone interviews (from among the respondents). Survey results revealed that 49% of respondents’ facilities had a written policy to preserve these relationships, however, only 22% reported having a specific formal program to carry this out. In the interviews, participants expanded on survey topics and shared that facilitating outings and encouraging participation in routine facility activities were commonly used to preserve relationships. Privacy was discussed as being important in maintaining relationships and also found to be a barrier to doing so. Nursing home social workers can utilize the results in the design and implementation of specific services to preserve relationships and maintain strong attachment between residents and their spouses/partners. These will be best carried out in a coordinated, collaborative manner among multiple disciplines within the nursing home setting.
When Advocates are Forced to go Virtual: The Long-Term Care Ombudsman Response to COVID 19
Authors: Nelson H Wayne , Netting F Ellen , Carter Mary W , Yang Bo Kyum
Published: December 2021

This study explores strategies used by the nation’s Long-Term Care (LTC) Ombudsman Programs (LTCOP) to perform their grass roots, investigatory, sentinel defense advocacy during the near total COVID LTC lock out from March 13th 2020 through September 17th, when the “ban” was conditionally lifted. Our layered systematic searches by title, subject, and total text for unrestricted allusions to the LTCOP used the multi-disciplinary database Academic Search Ultimate that includes mass media. Selection criteria included print and broadcast news. Search keywords were “ombudsman” singly and with 10 other terms. This was augmented by reviewing the National LTC Ombudsman Resource Center (NORC) clearinghouse information website and by interviewing NORC staff. Resulting (172) media entries (92% print) were manually coded independently by a team of five, and iteratively reconciled according to a simple flat frame format to identify key words and associated themes. Four main LTCOP lock out strategies emerged: (1) virtual resident interventions (via phone, Skype, Zoom, in-facility allies); (2) public outreach (services provided, sharing COVID data and best practices, social isolation threats and mitigation efforts [window visits], need for volunteers); (3) systems advocacy (state/federal; CMS, legislative and other testimony about social isolation, CARES Act check problems, visitation issues; and (4) partnering with others (multi-agency planning groups, task forces, Zoom town halls, interstate information sharing). NORC interviews revealed that older LTCOP volunteers are seizing the COVID lock-out to retire undermining an already short-staffed network—so calls for volunteers were evident in about 25% of all stories regardless of any other focus.
When Is a Nursing Home Complaint Really a Complaint? Making Sense Out of Increased Complaints in U.S. Nursing Homes
Authors: Qiu Xiao , Straker Jane , Abbott Katherine
Published: December 2021

Official complaints are one tool for addressing nursing home quality concerns in a timely manner. Similar to trends nationwide, the Ohio Department of Health (ODH) has noticed a trend in increasing nursing home complaints and has partnered with the Scripps Gerontology Center to learn more about facilities that receive complaints. Greater understanding may lead to proactive approaches to addressing and preventing issues. This study relies on two years of statewide Ohio nursing home complaint data. Between 2018 and 2019, the average complaint rate per 100 residents went from 6.59 to 7.06, with more than 70% of complaints unsubstantiated. Complaint information from 629 Ohio nursing homes in 2018 was linked with Centers for Medicare and Medicaid Services Nursing Home Compare data, the Ohio Biennial Survey of Long-Term Care Facilities, and Ohio Nursing Home Resident and Family Satisfaction Surveys. Using ordered logistic regression analyses, we investigated nursing home providers' characteristics using different levels of complaints and substantiated complaints. Findings suggest that providers with higher complaint rates are located in urban areas, had administrator and/or director of nursing (DON) turnover in the previous 3 years, experienced decreased occupancy rates, had reduced nurse aide retention, and received lower family satisfaction scores. Additionally, providers with administrator and/or DON turnover, and low family satisfaction scores are more likely to have substantiated complaints. Because increasing numbers of complaints are accompanied by relatively low substantiation rates, policy interventions targeted to specific types of providers may improve the cost-effectiveness of complaint resolution, as well as the quality of care.
Perceptions and Impacts of COVID-19 on Family Caregivers
Authors: Balmuth Alexa
Published: December 2021

For many family caregivers, COVID-19 has presented new obstacles to providing elder-care while balancing additional responsibilities such as work or childcare. Three survey waves explored impacts over the course of the pandemic. Family caregivers demonstrated resilience, taking a variety of measures to care for and protect family; caregivers were also more confident in their ability to protect loved ones age 60+ from contracting COVID-19 than non-caregivers. However, COVID-19’s toll on caregivers was evident. Caregivers reported higher personal burnout than non-caregivers, and across all three survey waves, consistently reported greater degrees of worry in regards to COVID-19 in general, as well as its impacts on domains including the health and wellbeing of themselves and family members, and near and far term finances. This presentation will highlight how caregivers’ perceptions and impacts of COVID-19 have evolved over the course of the pandemic, and implications of these findings for life tomorrow.
Personal Care Aides in residential care and adult day centers: differences in training, benefits, and roles
Authors: Sengupta Manisha , Ejaz Farida
Published: December 2021

Personal care aides (PCAs), along with other direct care workers, provide the hands-on care, including help with activities of daily living for individuals receiving care in residential care communities (RCC) and adult day services centers (ADSC). Recruitment and retention of such workers is a challenge as low pay, inadequate training, unsatisfactory roles and lack of benefits contribute to turnover. Using data from the 2018 National Study of Long-Term Care Providers, the only nationally representative data about PCAs in RCCs and ADSCs, this study will assess differences in training hours, benefits, and work roles among PCAs in these settings. About 76% of RCCs and 66% of ADSCs employed aides. On average, PCAs received 32 hours and 51 hours of initial training in ADSCs and RCCs, respectively. Results from bivariate analyses (accounting for complex survey design), showed that benefits received by PCAs varied by sector. A higher percentage of PCAs in ADSCs than in RCCs received health insurance for employees (60% vs. 46%), and pension (51% vs. 40%). About 51% of ADSCs and 46% of RCCs reported that PCAs rarely or sometimes attended care plan meetings. Further, 11% of RCCs and 15% of ADSCs reported that aides rarely or sometimes worked with the same care recipient. This overview of PCA activities, training and benefits may provide insights into approaches to improve the retention of PCAs and subsequently the quality of care provided across sectors.
The Impacts of COVID-19 on Technology Use and Experience Across Generations
Authors: Lee Chaiwoo , FakhrHosseini Shabnam , Rudnik John
Published: December 2021

Among its many downstream effects, the COVID-19 pandemic has influenced how people think about and interact with technology. With limitations and restrictions around in-person interactions and use of public spaces, people are increasingly relying on technology to support everyday activities including work, communication and care. Results from the survey series showed an increased adoption of and interest in home, health and communication technologies. The changes may be long-lived, with the majority of the new adopters saying that they will continue to use the technologies that they started using in response to the pandemic. A generational comparison showed that while baby boomers and the silent generation were less likely than younger adults to have made recent adoptions, the older generations did not significantly differ in terms of interest in using new technologies. This presentation will also report on how COVID-19-related changes in technology experience varied by other demographic and socio-economic characteristics.
Different Statistical Approaches to Develop a Guideline for Improvement of Caregiver’s Mental Health
Authors: Leggett Amanda , Koo Hyun Jung
Published: December 2021

Caregiver burden is common, and improvement of caregivers’ mental health could lead to better quality of care and well-being for both caregivers and care recipients. We investigate ways to develop a guideline to enhance caregiver’s mental well-being by applying and comparing regression tree and ensemble tree models. Data comes from the 2017 National Health and Aging Trends Study and National Study of Caregiving. Dementia caregivers’ (n=945) aspects of caregiving, care activities, support environment, and participation along with basic demographics and health are considered. First, insignificant predictors are preselected using linear regression with backward selection, which will not be included in the tree models. Using the predetermined predictors that are not excluded in the backward selection method, regression tree and ensemble tree models are generated to predict emotional difficulty of caregivers. The regression tree with the preselected predictors predicts caregivers with low to moderate levels of overload and high levels of joy being with their care recipient associated with the lowest level of emotional difficulty. On the other hand, if caregivers have high levels of overload and low to moderately high levels of positive affect, this is linked with the highest level of emotional difficulty. Ensemble tree models showed similar results with lower error measures. Using tree-based methods can help determine the most important predictors of caregiver mental health. Easily interpretable results with applicable decision rules can provide a guideline for intervention developers.
Sleep Health, Depression, Pain and Quality of Life among Older Adults during the First Months of the Covid-19 Pandemic
Authors: Lorenz Rebecca , Stallings Devita , Palmer Janice , Lach Helen
Published: December 2021

To slow the spread of Covid-19, many states instituted restrictions on group size for religious services, exercise, and social engagement. We are beginning to understand the effect of these mandates on older adults. The purpose of this study was to examine the relationships between sleep health, depression, pain, and quality of life (QOL) among older adults during the initial months of the Covid-19 pandemic. Older adults completed an anonymous online survey to collect data including personal characteristics, behaviors, and health conditions during May-September 2020. Sleep Health was assessed with a survey of satisfaction, timing, efficiency, and duration of sleep along with daytime alertness. Pearson correlations were used to explore relationships between age, education, socioeconomic status, pain, depression, and QOL. Participants (N=509) were primarily female (n=392, 77%), white (n=466; 92%), college educated (n=471, 93%) and with a mean age of 75.6 years (SD=5.0; range 63-93 years). Mean Sleep Health score was 7.4 (SD=2.1; range 0-10). Higher (better) Sleep Health scores were associated with education (r=.15, p<01) and socioeconomic status (r=.17, p<.01) and lower scores with depression (r= -.35, p<.01), pain (r= -.23, p<.01), and QOL (r= -.26, p<.01). Poorer Sleep Health among older adults during the initial months of the pandemic were associated with depression, pain, and reduced QOL. Sleep, depression, and pain have reciprocal relationships that may have lasting consequences on physical and mental health among older adults. These findings suggest that poor sleep health should be identified and treated to improve QOL among older adults.
The Interplay Between Retirement Transition Sequences and Mental Health: Focusing on Gender Differences
Authors: Shin Oejin , Park Sojung , Kim BoRin
Published: December 2021

Although retirement has been given a substantial amount of attention, there are gaps in the literature on 1) the various forms of retirement (nature= voluntary/involuntary, timing= early/ late, type= full/ partial) using with previous employment history, and 2) gender differences in retirement transition. Drawing on the life course perspective, this study examined the gender differences in retirement transition sequences using the labor participation history and various forms of retirement. Data are from the 2004 to 2016 HRS with 1,653 older workers. Sequence analysis was used to answer how individuals experienced retirement in the extended time frame. OLS regression analysis was used to estimate the relationship between retirement transition sequences and depression. For both genders, eight clusters of retirement transition sequences were identified. However, the most prevalent group for males was those who experience voluntary retirement transition from full-time work in mid-time point (19%), while the most prevalent group was a gradual involuntary retirement (21%) for females. Regarding the association with depression, those who experienced voluntary retirement after full-time work in all different time points (early, mid, late) and those who retired from self-employment were less likely to have depressive symptoms for males. For females, only those who experienced voluntary retirement from full-time work in mid-time point were less likely to have depressive symptoms. This result contributes to identifying the heterogeneity of retirement transition sequences and their association with depression. The result suggests important implications of gender-specified intervention programs to prevent involuntary retirement and mental health support program for involuntary retirees.
Exploring the Impact of Alcohol and Other Drug Use on HIV Care Among African American Older Adults Living with HIV/AIDS
Authors: Harris Lesley , Silverstein Sydney , Crawford Timothy , Kerr Jelani , Ball Diana
Published: December 2021

For people living with HIV, there are multiple barriers to engagement with care. This study qualitatively examines the role of use of alcohol and other drugs (AOD) on the health and management of Human Immunodeficiency Virus (HIV) disease among older African Americans (≥50 years). It draws on interviews conducted with twenty-seven older African Americans living with HIV in the Louisville, Kentucky area. Interviews were transcribed verbatim and then analyzed using constructivist grounded theory analytic techniques. Participants’ understandings of their AOD use fell on a continuum of problematic use to use for self-care. Regardless of where participants fell on this continuum, they faced a) environmental impacts of AOD use and b) current or historic discrimination from the health care system. The analysis focused on gaining a deeper understanding of the intersection of AOD use and engagement in the HIV care continuum. This revealed six major phases, which occurred at various stages of the continuum: (1) Linking AOD use as the cause of HIV diagnosis (2) Having AOD use facilitate denial of HIV, (3) Experiencing problematic use, (4) “Testing the Waters,” (5) Relying on AIDS Service Organizations (ASO) and medical providers and (6) Maintaining health and/or using AOD for self-care. We discuss the ways that stigma along the lines of race, gender, and age intersect with co-occurring conditions such as substance use disorders in complex and multifaceted ways. Recommendations include assessing a patients’ AOD use in relationship to the HIV care continuum to assess patients’ experiences and barriers within systems of care.
Motivation to Learn at the Intersections of Age, Gender, and Race
Authors: Yamashita Takashi , Smith Thomas , Sahoo Shalini , Cummins Phyllis
Published: December 2021

Continuing adult education and training, or lifelong learning, has become increasingly important to fully engage in rapidly changing technology and information-rich societies. However, without motivation to learn (MtL), lifelong learning participation is unlikely to occur. Although previous research has identified lifelong learning gaps by various demographic characteristics, including age, gender, and race/ethnicity, little is known about the intersectionality or differences in MtL across specific sub-groups (e.g., older Black women vs. older Black men) at the national level. The current study analyzed U.S. data from the 2012/2014/2017 Program for International Assessment of Adult Competencies (PIAAC) to examine MtL at the intersections of age (five 10-year age groups), gender (women vs. men), and race (White vs. Black). The previously established 4-item latent MtL construct was evaluated for twenty sub-groups using the alignment optimization method, which is a machine learning algorithm for latent mean estimation and simultaneous multiple group comparisons. Results showed that the latent MtL construct was validly measured across the sub-groups, and the estimated sub-group means were then used to develop a national MtL profile. Overall, older adults tended to have lower MtL than younger age groups. Notably, compared to than older Black men age 66+ years, older White men aged 55-65 and 66+ years old had lower MtL (latent mean differences of -0.29 and -0.41, respectively, p < .05). Additionally, older Black women had significantly lower MtL than older Black men (latent mean difference = -0.50, p < .05). The national MtL profiles, the intersectionality and policy implications were discussed.
The Relationship Between Metabolic Health and Mortality Among Older Hispanics in the US and Mexico
Authors: Carabello Maria
Published: December 2021

Studies consistently show that Hispanics, especially first-generation Mexican immigrants, face lower mortality risks in mid-to-late life than US-born non-Hispanic whites. This extended lifespan defies expectations given Hispanics’ disadvantaged socioeconomic status relative to whites and thus is referred to as the Hispanic paradox. However, it remains an open question as to whether the Hispanic paradox in mortality mirrors a lower chronic disease burden. To address this gap, this study will combine and leverage two harmonized longitudinal population-based data sources of late-middle-aged and older adults in the United States and Mexico; the Health and Retirement Study and the Mexican Health and Aging Study. First, I evaluate differences in the association between metabolic syndrome (MetS) and mortality risk for older adults living in Mexico, first-generation Mexican immigrants to the US, US-born Mexican Americans, and US-born whites. Second, I explore the extent to which the proportion of deaths attributable to MetS in each of these groups can be explained by differences in socioeconomic and health/behavioral characteristics. This study uses Cox proportional hazards models to estimate the mortality risks of MetS across groups, as well as the associated population attributable fractions (PAFs) to investigate potential differences within a decomposition framework. Developing this detailed understanding of metabolic health and the associated mortality risks across multiple generations of older Mexican immigrants may help us identify modifiable lifestyle and behavioral factors to better manage these conditions and alleviate possible complications as current and future generations of Mexican immigrants age in the US.
Barriers that Contribute to the Digital Divide Among Older Community Dwelling Adults in Later Life
Authors: Wang Haowei , Yang Mai See , Choi Yong Kyung
Published: December 2021

Research demonstrates that race and health literacy contribute to the digital divide, which is a major public health concern for older adults in the U.S. However, we still lack information about what types of barriers older adults have through a comprehensive examination using population -based data. This study focuses specifically on barriers to technology use among older adults. We use data from the Health and Retirement study 2012 Module “Technology Use: Barriers and Benefits” (N = 1,416). About 42% of participatnts did not use any technology (e.g., emails, social media, smart phone) (n = 501). The mean age for this non-user group was 72 years old (SD 10.3). 13% were foreign born, over half were female (56%), and the majory were somewhat educated (72% with a high school education or lower). About 23% of non-users were self-reported black, 16% Hispanic, 3% other race, and 58% non-Hispanic white. Barriers for adopting the use of technology included too difficult to keep up with the changes in technology (78%), too complicated (69%), not interested (65%), too much time required to learn (53%), too hard to learn (52%), expensive (43%), not easily available (24%), and opposed to using new technologies (27%). Results suggest that barriers were significantly correlated with more depressive symptoms among older adults who did not use technology. Compared to users, non-users were also more likely to have health conditions (e.g., hypertension, diabetes, lung disease, stroke, and arthritis). Findings of this study provide directions to address digital divide among older adults.
Digital Mobility Assessment for Regulatory and Clinical Endorsement in Hip Fracture Patients
Authors: Jansen Carl-Philipp , Taraldsen Kristin , Blain Hubert , Becker Clemens
Published: December 2021

Hip fracture is the most frequent non-intentional injury of older persons leading to hospital admission in Europe and North America. Until recently, in regulatory submissions no attention was given to patients’ mobility after sustaining/recovering from a hip fracture. To better evaluate efficacy and effectiveness of new drugs and treatments, it is necessary to develop mobility biomarkers since failure to recover and regain pre-fracture mobility is considered the single most important disability symptom experienced by hip fracture patients, often leading to care home admission. However, regularly used measures of mobility capacity are not representative of individuals’ performance in real life, intermittent in nature, and require visiting study centers. Digital technology has the potential to revolutionize mobility assessment in a real-life setting. With this presentation we build a case for a valid solution for real-world digital mobility assessment in hip fracture patients as carried out in the “Mobilise-D” clinical validation study.
Unpacking Data From Adult Day Centers in Order to Realize Their Untapped Potential in Dementia Care
Authors: Sadarangani Tina , Parker Lauren
Published: December 2021

Adult day centers (ADCs) in the United States represent a vital, but commonly overlooked, resource for dementia care among community-dwelling older adults. However, the severity of dementia in ADC users, their medical complexity, the supports offered to them, and health outcomes associated with adult day services among persons living with dementia is poorly understood. This is in part due to a lack of standardized data collection in this industry. In this symposium, we present the most current research on these issues, as well as strategies to improve data collection across ADCs to strengthen care. The symposium begins with analysis of data from the state of California that identifies patterns of chronic conditions in ADC users with dementia that are associated with emergency department visits and hospitalizations. We then examine data from the Centers for Disease Control, comparing dementia specialized ADCs and their participants to non-specializing ADCs. We compare the extent to which states with ADC programs require collection of patient centered reported outcomes on persons with dementia. Finally, we explore an innovative collaboration between researchers and community partners to simplify data collection in these centers. Our findings suggest that persons with dementia in ADCs are an extremely complex population and that some ADCs are better suited than others to meet their extensive needs. Additional patient-centered data collection can be supported with widely available software, and has the potential to demonstrate the effectiveness of ADCs, aid in program development, and help leverage funding opportunities.
Relationship Between Clusters of Chronic Conditions and Disability Trajectories
Authors: Klinedinst Tara , Terhorst Lauren , Rodakowski Juleen
Published: December 2021

Recent evidence shows that more complex clusters of chronic conditions are associated with poorer health outcomes. Less clear is the extent to which these clusters are associated with different types of disability (basic and instrumental activities of daily living (ADL, IADL) and functional mobility (FM)) over time. This was a longitudinal analysis using the National Health and Aging Trends Study (NHATS) (n = 6,179). Using latent class analysis, we determined the optimal clusters of chronic conditions, then assigned each person to a best-fit class. Next, we used mixed-effects models with repeated measures to examine the effects of group (best-fit class), time (years from baseline), and the group by time interaction on each of the outcomes in separate models over 4 years. We identified 5 chronic condition clusters: “multisystem morbidity” (13.9% of the sample), “diabetes” (39.5%), “osteoporosis” (24.9%), “cardio/stroke/cancer” (4.5%), and “minimal disease” (17.3%). Group by time interaction was not significant for any outcome. For ADL outcome, only time was significant (F3,16249 = 224.72, p < .001). For IADL, both group (F4,5403 = 6.62, p < .001) and time (F3,22622 = 3.87, p = .009) were significant. For FM, both group (F4,5920 = 2.96, p = .02) and time were significant (F3,16381 = 213.41, p < .001). We did not find evidence that any cluster experienced greater increases in disability over time, but all clusters containing multiple chronic conditions had risk of IADL and FM disability. Increased screening for IADL and FM disability could identify early disability and prevent decline.
Utility of the Late Life Function and Disability Instrument (LLFDI) in rehabilitation services for older adults
Authors: Toto Pamela , Stankiewicz Anne
Published: December 2021

Introduction: The Late Life Function and Disability Instrument (LLFDI) is a valid self-report tool that quantifies disability based on activity limitations and participation restrictions in everyday life. Both the original longer tool (LLFDI) and the shorter computer adaptive version (LLFDI-CAT) offer practitioners a method for measuring function independent or in conjunction with performance-based assessment. Objectives: Examine scores of the LLFDI and LLFDI-CAT for measuring disability in older adults who are receiving rehabilitation services in community and institution settings. Method: A secondary data analysis was conducted comparing scores from occupational therapy evaluations with older adults from 3 groups: 1) older adults in primary care using the LLFDI; 2) older adults in primary care using the LLFDI-CAT; older adults in a skilled nursing facility (SNF) using the LLFDI-CAT. Results: Mean scores for Activity Limitation and Participation Restriction were lowest for older adults in a SNF indicating greater disability. A one-way Analysis of variance on ranks showed a main effect for Activity Limitation, χ2 (2) = 22.267, p < 0.001, and Participation Restriction, χ2 (2) = 60.372, p < 0.001. Post-hoc analyses revealed significant differences between groups based on tool (i.e. LLFDI vs. LLFDI-CAT) for Activity Limitations and setting (i.e. primary care vs. SNF) for Participation Restriction. Conclusion: The LLFDI-CAT may be the preferred instrument to measure disability in older adults across treatment settings. Additional research is warranted to understand how personal and environmental factors influence LLFDI-CAT outcomes.
Listening to Older Adults: A Qualitative Analysis of Advice Given During COVID-19
Authors: Van Vleet Bryce , Fuller Heather , Huseth-Zosel Andrea
Published: December 2021

The life experience of older adults offers a unique perspective of coping through historical crises. Specific advice offered by older adults is generally underrepresented in the literature. This qualitative study explores advice offered by older adults to others on how to cope through the COVID-19 pandemic as well as advice for the community about the needs of older adults. A Midwestern sample of 67 older adults aged 70-97 completed one phone interview in June of 2020 as part of a larger study about their experiences with social distancing and isolation. Participants were asked what advice they would give to others during the pandemic and what advice they would give to communities and families about the needs of older adults during the pandemic. Transcripts of these conversations were coded using in vivo and holistic coding as first-cycle methods. These codes were then analyzed using pattern coding as a second-cycle method. Results indicated older adults offered advice along three domains: fostering physical and mental wellbeing, promoting positive life perspectives, and maintaining connections. Advice to communities regarding the needs of older adults included having a selfless attitude and taking intentional actions like grocery shopping and writing letters. However, older adults also recommended avoiding extremes to allow them to maintain their independence and preserve physical distance for safety. Older adults utilized their life perspective and their own coping strategies when offering advice. Future research should evaluate the effectiveness of the advice given and how likely that the advice will be utilized by others.
Native American Elders’ Experiences during the COVID-19 Pandemic: Case Studies
Authors: Xie Bo , Shiroma Kristina , Lowe John , De Main Atami , Davis Nathan
Published: December 2021

The COVID-19 pandemic has affected community-dwelling elder adults’ experiences during the COVID-19 pandemic. We report 4 case studies of Native American elders’ pandemic experience. Participants were recruited from community-dwelling older adults in Central Texas. Data collection took place via in-depth, semi-structured telephone interviews during June-August 2020. Four of the participants self-identified as Native American. Three of them were male; between the ages of 74 and 75; had at least some college education. The fourth Native American elder was a 68 year-old female with some college education. All four participants were coping well with everyday life during the pandemic. Connectedness emerged as the overarching theme among the 4 cases. Regular communication with their families was expressed as most important. A variety of communication technology was used to maintain contact with family members such as phone calls, texting, email, and video chat services particularly Zoom, FaceTime, and Facebook Video Chat. Challenges with using these technologies were also frequently reported. The participants expressed they did not feel a sense of increased loneliness or loss of being connected. Another theme emerged related to surviving the impact of the pandemic. Having the vaccine accessible along with financial resources necessary to sustain essential needs were most frequently expressed by the participants. These findings have implications for community interventions and policies that support the provision of mechanisms for Native American elders to maintain a sense of connectedness, including the adoption and use of communication technology, during times of crises such as pandemics and natural disasters.
Medical Complexity, Mortality Among High-Cost Medicare Advantage Enrollees: Palliative, Hospice Implications
Authors: Amodeo Samuel , Kowalkowski Henrik , Bangerter Lauren , Brantley Halley , Cook David , Jones Nicholas
Published: December 2021

Older adults with high medical spend require tailored interventions and care delivery to meet their complex needs. Palliative is a high-value solution for high-cost patients because it provides relief from the symptoms, pain, and stress associated with multiple conditions. Likewise, other high-cost patients may be closer to end-of-life and therefore benefit from hospice care. For Accountable Care Organizations (ACOs) and hospitals to implement palliative care, these programs must identify and target the high-need patient populations. This study explored patterns of spending and mortality across 4 years (2016-2019) using claims from 1,701,647 patients continuously enrolled in UnitedHealth Group Medicare Advantage (mean age=73.7; S.E.=0.01). Patients with healthcare spend in the top decile were segmented into three subgroups based on health conditions and spend patterns. Analyses identified a subgroup of patients (mean age=76.6; S.E.=0.04), with the highest rate of mortality, and significantly more chronic conditions and frailty, indicating their cost and mortality was driven by medical complexity. Odds ratios from a multinomial logistic model tie blood formulation drugs (OR XX), medicative procedures (OR XX), and nonhospital-based care (OR XX) to members of this subgroup may be connected to short-term mortality. There is a critical need to identify patients who stand to benefit from palliative and end of life care, this is particularly true for high-cost high-need patients. Our study suggests that patterns of medical complexity and morality within high-cost patient subpopulations can be used to identify high-cost patients who would benefit from palliative or hospice care.
Documenting the Need for Patient-Centered Relevant Outcomes in Adult Day Services
Authors: Boafo Jonelle , Anderson Keith , Brody Abraham , Sadarangani Tina
Published: December 2021

ADCs are not uniformly regulated at the federal or state level, resulting in the absence of uniform data collection. The lack of large-scale data has resulted in a dearth of evidence on the role ADC services play in the health and well-being of their clients, particularly persons living with dementia (PLWD). The purpose of this study was to compare data being collected across states and evaluate the degree to which patient centered relevant outcomes (PCROs) are being collected. A review of ADC regulations in 50 states found that <10 states, required standardized reporting on ADC participants. Regulatory forms relied on clinical judgment as opposed to validated tools, and focused on eligibility for services as opposed to independence, engagement, or clinical interventions in the ADC. Emphasizing collection of PCROs in ADCs, beginning at the state level, is an essential step in documenting the value and effectiveness of ADCs, particularly for PLWD.
Qualitative Document Analysis of Patient’s Healthcare Trajectory With and Without Palliative Care
Authors: Steffen Melissa , Steffensmeier Kenda Stewart , Alexander Bruce , Berry-Stoelzle Maresi
Published: December 2021

Palliative care is important to the care of seriously ill patients to support the patient and family. Palliative care is often timely in the inpatient setting, but delayed in outpatient care, leading to missed opportunities. Identifying when to engage patients with palliative care in outpatient settings has been challenging. As part of a larger quality improvement project to increase access to palliative care, a qualitative sub-study was completed to identify missed palliative care engagement opportunities in patient’s healthcare trajectories. A document analysis of patients notes from a convenience sample of 20 recently deceased patients who received care within the Veteran Affairs healthcare system (VAHCS) was completed. Patients were sorted into four categories that emerged from initial analysis: cancer/palliative, non-cancer/palliative, cancer/non-palliative, and non-cancer/non-palliative. Two qualitative analysts reviewed the notes, paying particular attention to notes preceding or following seminal healthcare events. Patients in the cancer/non-palliative category were more likely to decline preventive care, engage less with the VAHCS health care or only interacted with the VAHCS for specific needs (e.g., determine VA health benefits). Similarly, non-cancer/non-palliative care patients were more likely to use a mix of VAHCS and outside healthcare, with inpatient care occurring outside of the VAHCS. For non-palliative care patients, seminal healthcare events were less likely to occur in the VAHCS. Thus, identifying opportunities to engage patients with palliative outside of seminal healthcare events may be important to increasing patient access within the VAHCS.