bluuebunny/crossref_metadata_2025 huggingface dataset:
USING SERIAL TRICHOTOMIZATION WITH NEUROPSYCH MEASURES TO INFORM DECISIONS ON FITNESS TO DRIVE AMONG OLDER ADULTS
Authors: Yamin Stephanie , Ranger Valerie , Stinchcombe Arne , Knoefel Frank , Bédard Michel
Published: November 2019

Older adults report that driving provides a sense of independence and wellbeing. For some older adults, driving cessation becomes necessary due to their health status having an impact on their ability to drive safely. Decisions related to driving cessation are difficult and often left to the clinical judgement of primary care physicians. There is an interest in developing a method that could help assist physicians in making that determination. To date, there is no neuropsychological test that produces an acceptable level of sensitivity and specificity allowing for the determination of an individual’s fitness to drive. Serial trichotomization involves classifying drivers as either pass, fail or indeterminate based on cut-points that leads to 100% sensitivity and specificity. The purpose of this study was to examine the serial trichotomization method using four common neuropsychological tests (i.e., 3MS, Trails A & B, clock drawing). Sensitivity and specificity for each test were established using a medical expert’s clinical judgement. Charts of 105 patients at a tertiary memory disorders clinic were reviewed and data related to neuropsychological test scores and clinical judgement around fitness to drive were abstracted. After applying the trichotomization, 38.1% of the sample were classified as unfit to drive, 36.1% were classified as indeterminate, and 25.8% were classified as fit to drive. This study adds to the growing body of literature supporting the use of serial trichotomization to streamline decision-making about fitness to drive.
THE NATIONAL COLLABORATORY TO ADDRESS ELDER MISTREATMENT: A COLLECTIVE IMPACT APPROACH
Authors: Stoeckle Rebecca Jackson , Lees-Haggerty Kristin , Dash Kim , Lachs Mark , Mosqueda Laura , Bonner Alice , Dyer Carmel
Published: November 2019

The National Collaboratory to Address Elder Mistreatment is a team of experts who have come together to develop, test, and disseminate a care model for addressing elder mistreatment in emergency departments. In this presentation we will demonstrate how a collective impact approach, including a centralized infrastructure, dedicated staff, and structured process allowed the Collaboratory to develop and test the Elder Mistreatment Emergency Department Care Model. The model consists of four core elements: 1) The Elder Mistreatment Emergency Department Assessment Profile, 2) staff training modules, 3) brief screening and response tools adapted from a validated measure, and 4) a roadmap for leveraging community resources to support referral and follow up. We will explore the applicability of this approach for harnessing and integrating multidisciplinary expertise to develop, test, and disseminate innovative solutions to complex health care challenges.
BE GENERATIVE TO ACCEPT DEATH: ROLE OF MEANING IN LIFE MODERATED BY AGE AND PERCEIVED IMPACT
Authors: Fung Nicole Long Ki , Chu Steven Tsun-wai , Fung Helene Hoi-lam
Published: November 2019

Meaning-management theory (MMT) suggests living a meaningful life leads to higher death acceptance. This paper investigates how generativity, i.e. the intention to bring benefits to the next generation, can affect death acceptance through achieving meaning in life (MIL). 343 participants in Hong Kong (aged 18-90) filled in a questionnaire as part of “Age(ing) as Future” project. Generativity positively correlates with death acceptance. MIL fully mediates the effect of generativity on death acceptance (r(343)=.132, p=.014). The effect of generativity on MIL might differ by age and perceived influences of generative acts. As speculated, the mediation is moderated by Age and Transformational Future Time Perspective (TFTP; generative impact that expands future time perspective). In older adults with lower TFTP, generativity no longer predicts MIL and the mediation was nonsignificant. The results provide empirical support to MMT and emphasise the importance of perceived impact and the needs in different developmental stage.
VARIATION IN BIOLOGICAL RISK AMONG OLDER COLOMBIANS BY AGE, GENDER, AND EDUCATIONAL ATTAINMENT
Authors: Ailshire Jennifer A , Osuna Margarita
Published: November 2019

Recent rapid aging in Colombia raises questions about the health status of older adults, but there has been very little research in this population. This study examines variation in biological risk by age, gender, and educational attainment using data from the 2015 SABE-Colombia, a nationally representative survey of Colombians ages 60 and older. Levels of cholesterol (total, HDL, and LDL), triglycerides, glucose, and hemoglobin were measured from whole blood and clinical cut-points were used to determine high-risk on each indicator. The five metabolic indicators were summed to create a total risk score; 58% of older adults had a score of 1 or more. Those ages 80 and older and women had lower risk, as did those with at least primary education. These patterns were also observed for high-risk on hemoglobin (13% prevalence), an indicator of anemia. Most older Colombians have some biological risk, but this varies by key subgroups.
USING CHRONIC DISEASE SELF-MANAGEMENT TO ENHANCE PATIENT-PROVIDER PARTNERSHIPS
Authors: Case Brea , Zell Angela M , Ilardo Joan
Published: November 2019

The Partners in Aging Strategies and Training (PAST) project employed a bilateral approach to educate both healthcare professionals and consumers. Our theory is that improved health outcomes are attained by teaching healthcare providers and consumers how to engage better with each other, especially when consumers use the skills learned in community-based programs, such as self-management and healthy lifestyle choices. PAST activities provided an integrated educational program for healthcare providers and older adult patients, their families and caregivers to learn skills that enhance their ability to form productive patient-provider partnerships. We used three types of training: 1) multi-disciplinary health professions and primary care provider continuing-education face-to-face workshops and webinars; 2) older adult patient and caregiver workshops, resource materials; and 3) reverse marketing comprised of sending information to physicians whose patients attended a workshop that included the topics covered in the workshops and the patients’ three- to six-month action goals. We found that physicians who attended the grand rounds presentations were very receptive to the ‘nuts and bolts’ approach to things like doing a quick mobility assessment, effectively communicating with patients, health literacy, and referring patients to community-based non-medical services and supports. We conducted seven types of evidence-based workshops. Over 90% of participants gave permission to send a letter to their physician to tell them they attended the workshop. We used pre-post confidence scales based on each workshop’s learning objectives to measure changes in workshop participants’ self-management confidence. There was positive change in confidence for all seven workshops.
CARE MANAGEMENT CHALLENGES AND PROGNOSTIC TOOLS FOR HEART FAILURE PATIENTS IN HOSPICE
Authors: Creber Ruth Masterson , Jordan Lizeyka , Baik Dawon , Russell David
Published: November 2019

Heart failure (HF) patients enroll in hospice at lower rates despite their worse prognosis. This multi-method study explores the characteristics and challenges associated with caring for HF patients. Data from qualitative interviews with hospice providers (n=32) and quantitative records (N=1,114) were used to identify care management issues and prognostic tools. Hospice providers described HF patients unique and often unpredictable symptomatology, their limited understanding and discordant hospice expectations, and difficulties managing symptoms at home. Providers also highlighted HF patients use of assistive medical devices and complex medication regimens. Palliative Performance Scale (PPSv2) scores at hospice enrollment were found to be strongly associated with hospice survival (AUC: 7 days=0.80; 14 days=0.77) and live discharge risk (PPSv2 50-70% AOR=5.68 [CI=3.66-8.79]). Findings underscore the need for specially-tailored trainings and protocols for providers to prevent unplanned discharges and support HF patients at end-of-life.
THE IMPACT OF MEANINGFUL VOLUNTEER ENGAGEMENT IN AGING ADULTS: THE BALTIMORE EXPERIENCE CORPS TRIAL
Authors: Carlson Michelle C , Rebok George
Published: November 2019

Experience Corps was designed to embed cognitive, social, and physical activity into volunteer service by training older adults to serve in neighborhood elementary schools as mentors of children in Kindergarten-3 for 15 hours a week over two academic years. We incorporated cognitive activities through the intentional design of a variety of roles in reading, math, library support, and positive communication. Socially, volunteers engage with other volunteers, teachers, and children, and functional walking 3-4 days/week to and from as well as within the schools. The Baltimore Experience Corps Trial (BECT) is the largest randomized controlled trial (N = 702) examining the impact of volunteer engagement on cognitive functions in cognitively intact older adults, over sampling African Americans (91%) who have twice the risk of Alzheimer’s disease as whites. Findings will be summarized and demonstrate the dose-dependent cognitive, psychosocial, lifestyle activity, and brain benefits of volunteering for up to two years.
HOME CARE AIDE-LED RESISTANCE EXERCISE FOR MEDICAID HOME AND COMMUNITY-BASED SERVICES CLIENTS
Authors: Danilovich Margaret , Diaz Laura , Ciolino Jody , Healey William , Huber Gail , Corcos Daniel
Published: November 2019

Home Care Aides (HCAs) assistance is the most common care provision to help clients with activities of daily living, but exercise is not currently provided, despite well-established health benefits. We developed a resistance exercise intervention using a stakeholder panel of physical therapists, HCAs, and clients. Stakeholders suggested a mobile application that played exercise videos. We then enrolled 128 HCA-client dyads (93% african american & 79% female) and randomized home care aides to lead the intervention with their clients in addition to usual care for 6 months or continue usual care. Our aims were to 1) evaluate the feasibility of the intervention and 2) determine the effects of the intervention on client physical performance, frailty classification, self-reported health, and strength. 96% of HCAs reported the training session successfully prepared them to lead exercise and we had no adverse events. There was high attrition rates among dyads (28.13%) at 6 months which was worse among HCAs (55%). We found no statistically significant differences between study arms. However, the range of completed sessions was 1-34 out of 52 possible sessions. Program evaluation indicated high satisfaction among clients and HCAs (8.9 & 8.6/10). HCA attrition limited client participation, technology did not facilitate exercise completion, and client motivation was a barrier to adherence. Results show it is feasible to train HCAs to lead exercise, however, given high turnover in the HCA profession, alternative implementation models should be studied. While the app use was an innovative way to engage older adults in exercise, technology challenged HCAs.
LONG-TERM COSTS OF GRANDPARENT CAREGIVING: RESULTS FROM THREE WAVES OF THE MIDLIFE IN THE UNITED STATES STUDY (MIDUS)
Authors: Rickenbach Elizabeth , Rickenbach Elizabeth H , Huang Chih-Chien , Allen Jessica Y , Cichy Kelly E
Published: November 2019

Cross-sectional studies reveal the health burden of grandparent caregiving. Still, longitudinal, research is needed to understand how grandparent caregiving compromises grandparents’ long-term health. Using three waves of data from the Midlife in the United States Study (MIDUS), we examined sociodemographic factors, health and well-being outcomes between caregiving (CG) and non-caregiving (NCG) grandparents. By wave 3, 12.8% (n = 234) were CG. CG were younger, more likely female, and had lower income and education. MANCOVA adjusted for age, gender, education, and number of children revealed CG reported poorer physical and emotional well-being (e.g. higher depression, anxiety, lower life satisfaction, greater morbidity); CG were consistently less healthy than NCG across all three waves. Lower income and less healthy older adults are more likely to become grandparents, and they remain less healthy over time. Policies and resources to assist grandparents, particularly low-income and vulnerable older adults who are caring for grandchildren, are needed.
A NATIONAL PROFILE OF FRAIL OLDER ADULTS WITH INSUFFICIENT CARE AND MISMATCHED SUPPORT
Authors: Savla Jyoti , Roberto Karen A , Sands Laura
Published: November 2019

Older adults differ widely both in the care they require and who they rely upon for care. We use data from the National Health and Aging Trends Study (2011; N=3,265; MAge [SD] = 77 [7.74] years, 62% women) to classify community-living older adults based on their care needs and the various informal and formal providers of care. We also examine the type of care they receive, predictors of this care, and its implications on their health. Older adults with a co-residing caregiver were more likely to report that their needs were not being met (OR = 1.67; 95% CI=1.15–2.42), compared to those who received informal care and paid support. Moreover, older adults who needed help with self-care activities, but received help with household activities were more likely to report unmet needs (OR = 1.55; 95% CI=1.13–2.12). Results are discussed in light of sociodemographic factors differences and mismatched support.
GOOD HEALTH AND WELL-BEING: ESSENTIAL TO ACHIEVING SDGS
Authors: Stohrer Hans
Published: November 2019

The importance of good health for older persons is a human right, good public policy, and practical. We argue that it is fundamental to achieving the UNs SDGs. Older people can be important assets in the achievement of SDGs but need to be in good health so as to be valuable, productive and contributing members of society. This includes functional health, cognitive health and capacity, mental health, sustainable long term care for non-communicable diseases, and quality palliative care provided in the home at the end of life. This means not only access to health care services and access to safe and effective medicines and vaccines, but also access to rehabilitation and physical therapy, mental health care, long term care, and hospice and palliative care. In conclusion, to achieve the United Nations SDG on Health, it is important to consider explicitly the health of older persons, including the public policy needs.
NEW FINDINGS ON WORK AND FAMILY USING IPUMS DATA
Authors: Moen Phyllis , Raymo James
Published: November 2019

The IPUMS Data in Aging Research symposium will showcase aging research that is possible using freely available population-level data accessible via IPUMS. This session will feature papers that use IPUMS data in novel ways to examine aging-related topics including living arrangements, widowhood and divorce, paths toward retirement, intergenerational effects of interventions on later life outcomes, and time use of caregivers. In addition to the common threads of work and family, these papers all represent innovative contributions to aging research based on census and nationally-representative survey data. The potential value of these types of data for studying aging may not be immediately apparent to all researchers. By combining papers on an array of topics from a variety of data sources, this symposium highlights exemplar papers that demonstrate the types of novel research possible using public use census and survey data.
THE INTERGENERATIONAL EFFECTS OF THE NEW DEAL WORK RELIEF PROGRAMS ON LATE-LIFE OUTCOMES: AN 80-PLUS-YEAR FOLLOW-UP STUDY
Authors: Modrek Sepideh
Published: November 2019

Evidence from multiple disciplines suggests that early-life conditions and environments affect outcomes across the life course. However, less is known about the effects of policy interventions targeted to adults and communities that may have intergenerational consequences on exposed children. In this study, we undertake novel data linkages to examine the effects of the New Deal work–relief programs on long-term health, disability and mortality outcomes of children born between 1920-1940. We first link the American Manufacturing Cohort (AMC) workforce backward to their childhood census records to capture parental and community exposure to New Deal work-relief programs. We then test the hypothesis that employment in New Deal work-relief programs is associated with lower levels of chronic disease, lower rates of disability and delayed mortality for both the children in benefitting households and children in non-benefit households living in areas that received greater amounts of New Deal funding.
‘TIL DEATH DO US PART? DECLINING WIDOWHOOD AND RISING GRAY DIVORCE, 1980-2017
Authors: Brown Susan L , Lin I-Fen
Published: November 2019

Roughly one-third of dissolutions among married persons aged 50 and older occur through divorce rather than widowhood, reflecting the rising gray divorce rate and lengthening life expectancies. We use data from the 1980 Vital Statistics and the 2017 American Community Survey (ACS) to estimate the divorce and widowhood rates among married individuals (aged 50+) in 1980 and 2017 to track how much the widowhood rate has declined and the divorce rate has risen. In 1980, women’s widowhood rates exceeded their divorce rates at all ages. For men, the rate of divorce outpaced the rate of widowhood through ages 50-54. By 2017, divorce rates were higher for women through ages 55-59 and for men through ages 60-64, coinciding with the growth in gray divorce. We also examine subgroup variation in the 2017 patterns and the sociodemographic correlates of having experienced divorce versus widowhood during the past year using the ACS data.
NOVEL DATA AND APPROACHES TO THE STUDY OF HEALTH AND AGING IN NSHAP
Authors: Waite Linda J
Published: November 2019

The National Social Life, Health, and Aging Project (NSHAP) is a longitudinal, population-based study that seeks to improve an understanding of the well-being of older, community-dwelling Americans. It accomplishes this by affording researchers a wide range of high quality measures that enable examining interactions among physical health and illness, medication use, cognitive function, emotional health, sensory function, health behaviors, social connectedness, sexuality, and relationship quality. The panelists in this symposium use NSHAP data to shed light on previously un- or underexplored aspects of health during aging. Kaufman et al. use interviewer ratings of respondents’ skin shade along with respondents’ individual experiences of discrimination, neighborhood racial composition, and other factors to characterize heterogeneity in the racial experience and how heterogeneity relates to health inequities. Riley integrates information on respondents’ residential region at birth and in older age to show that older adults who left the South are less healthy than those who stay in the South, and that social embeddedness helps to explain the health benefits for those who stay. Huang et al. take advantage of rich structural and functional social connectedness data to show that self-reported hearing impairment is associated with depth but not breadth of social connections. Huisingh-Scheetz et al. capitalizes on performance measures of gait speed and chair stands obtained at each wave to examine whether repeated measures improve the ability to predict loss of independence in activities of daily living. Discussant will discuss the importance, strengths, and weaknesses of these papers, and consider implications for future research.
PARTNERING IN GERIATRICS WORKFORCE ENHANCEMENT PROGRAMS: MODELS TO ENHANCE COLLABORATION AND ENGAGEMENT
Authors: Waters Leland , Tumosa Nina
Published: November 2019

To achieve their healthcare system transformational goals to improve care for older adults, Geriatrics Workforce Enhancement Programs (GWEPs) facilitate the building of strong relationships among academia, community-based organizations, and primary care networks. Each GWEP develops strategies to formalize collaborations and build sustainable networks to meet program goals while addressing partner needs. Unique models from four GWEPs addressing stakeholder engagement are described, and factors facilitating collaboration are explored. One GWEP achieves mutual goals by collaborating with statewide coalitions that have a history of successful partnerships. Another GWEP achieves programmatic goals through an “all-in” interprofessional model called the Plenary. A third GWEP has capitalized on a shared complex outcome that requires multi-level stakeholder engagement to support aging in place. The final GWEP has coopted the resource exchange model as a conceptual foundation in order to enhance collaboration. Themes emerging from these four models include: (1) the enhancement of interpersonal relationships through communication, trust, and engagement; (2) the importance of commitment to the overall partnership itself; (3) the critical component of resource sharing and synergy across projects; and (4) strategies for sustainability in the face of changes and challenges across healthcare systems. Given the complex nature of person-centered interventions in geriatrics, it truly takes a village to develop and provide services for a heterogeneous, targeted population. This symposium emphasizes key elements of the structures and processes of these transformational GWEP villages.
THE ROLE OF GERONTOLOGISTS IN ACHIEVING THE UN’S SUSTAINABLE DEVELOPMENT GOALS
Authors: Cox Carole , Cox Carole B
Published: November 2019

The Sustainable Development Goals (SDG’s) developed by the United Nations in 2015 are global benchmarks for all countries to meet by 2030 to ensure well-being and prosperity while protecting and promoting human rights and freedoms. The underlying pledge is that no one will be left behind Globally, older adults are one of the most vulnerable populations, suffering from poverty and poor health and little social protection. Social workers can play key roles in assuring that the concerns and interests and rights of older adults are recognized in the SDGs and in the policies developed to meet them. This paper focuses on 6 of the SDG’s that are most pertinent to the status and inclusion of older people and the implications they have for specific social work involvement.
SHINGLES VACCINE UPTAKE AMONG OLDER ADULTS: IDENTIFYING EARLY, LATE, AND NON-ADOPTERS
Authors: Kang Hyewon , Crimmins Eileen , Ailshire Jennifer A
Published: November 2019

Although a shingles vaccine (Zostavax) has been available since 2006, vaccination uptake has been slow. As a newly approved shingles vaccine (Shingrix) became available in 2018, understanding factors affecting acceptance and timing of the original vaccine would be useful in establishing effective strategies for greater immunization. Using the Health and Retirement study, we examined individual-level and area-level characteristics of early and late vaccine adopters, and those who were not vaccinated between 2006 and 2016. Early adopters were those who got vaccinated during the four year window after the approval of the vaccine; late vaccine adopters were those who got vaccinated from 2010 to 2016. Early adopters (13.5%) and late adopters (18.5%) comprised 32% of the sample, leaving two-thirds unvaccinated. Regression results suggest that those who received the vaccine were more likely to be socioeconomically advantaged, covered by insurance, socially active, healthy, to use other preventive vaccines, and to live in a region with more vaccinated people. Early adopters were more likely to be highly educated, affluent, and more conscientious compared to late adopters. Utilization of influenza vaccine and living in the region with the highest level of vaccination were found to be significant factors predicting early vaccine uptake. Our findings highlight the importance of outreach efforts and health care access in increasing vaccination rates.
MODEL-BASED CLUSTER ANALYSES OF COGNITION FOR UNPACKING SUBGROUP DIFFERENCES IN PSYCHOSOCIAL OUTCOMES
Authors: Roque Nelson A , Sliwinski Martin J
Published: November 2019

We forward a methodological approach, using model-based cluster analyses, and ambulatory assessments of cognition (2 indicators from each task), to derive subgroups of interest for tailored clinical follow-up in a longitudinal framework. Community dwelling adults were asked to complete 14 consecutive days of ecological momentary assessments (EMAs) using smartphones, including measures of cognitive performance, and self-reported physical and mental health outcomes (e.g., stress, memory complaints, depression, pain). A stable four-cluster solution emerged, labelled as: (1) a high-risk cognitive group (13%; most memory complaints, slowest performing, more memory errors); (2) subjective risk group (42%; highest levels of somatic and cognitive complaints); (3) normative aging (28%; intermediate cognitive performance -- speed/accuracy); (4) super-cognitive agers (17%; fastest speed, best memory). In conclusion, these findings highlight the potential of a cluster-based approach for risk classification, uncovering different profiles of poor performance that may represent different etiologies.
MOTIVATION AS A MECHANISM: THE LONGITUDINAL RELATIONSHIP BETWEEN PERSONAL RESOURCES AND ACTIVITY ENGAGEMENT
Authors: Lothary Allura F , Queen Tara L , Hess Thomas M
Published: November 2019

Past research has demonstrated an association between health and cognitive resources, intrinsic motivation, and activity participation in older adulthood, both cross-sectionally and from a daily perspective (e.g., Queen & Hess, 2018; Hess et al., 2018). This highlights the potential importance of motivation as a mediator of the impact of changing personal resources on engagement in cognitively beneficial activities. This study expanded on prior research by examining these relationships longitudinally in a large representative sample of adults over 50. Specifically, we used data from the Health and Retirement Survey (N = 5600) to create two 4-year longitudinal assessments, with multi-level structural equation modeling used to test the mediating role of motivation on everyday activity engagement. Consistent with expectations from Selective Engagement Theory (Hess, 2014), motivation served as a partial mediator of the impact of changing resources on engagement, with the effect being selective based on the cognitive demands of the activity.
THE ASSOCIATION BETWEEN SENSE OF PURPOSE IN LIFE AND REPEATED MEASURES OF HEALTH BEHAVIORS OVER TIME
Authors: Kim Eric S , Shiba Koichiro , Kubzansky Laura
Published: November 2019

Although a stronger sense of purpose in life has been associated with reduced risk of chronic conditions and mortality, potential pathways underlying these associations remain understudied. In the present study, we tested if a higher baseline sense of purpose in life was associated with maintenance of recommended levels of five health behaviors. Prospective data included 13,771 adults from the Health and Retirement Study, who were assessed up to six times across an average of 9 years. In mixed models that adjusted for sociodemographic factors, those in the highest quartile of purpose, compared to those in the lowest quartile, had a higher likelihood of not smoking (RR=1.04; 95% CI: 1.03–1.06), remaining physically active (RR=1.42; 95% CI: 1.33–1.51), drinking moderate amounts of alcohol (RR=1.21; 95% CI: 1.13–1.29), not suffering from sleep problems (RR=1.29; 95% CI: 1.24–1.34), and maintaining healthy BMI (RR=1.09; 95% CI: 1.06–1.11) over follow-up.
COGNITIVE AGING IN OLDER MINORITY POPULATIONS: LONGITUDINAL EVIDENCE FROM U.S. CHINESE OLDER ADULTS
Authors: Dong XinQi , Simon Melissa
Published: November 2019

The increasing diversity in the aging population warrants systematic investigations regarding ethnic differences related to cognitive aging and ethnicity-unique risk factors. However, due to the great paucity of population-based longitudinal data on cognitive aging in racial/ethnic minority populations, our knowledge in this area remain limited. The purpose of this symposium is, therefore, to examine various psychological, socio-cultural, and physical factors associated with cognitive aging among U.S. Chinese older adults, representing one of the biggest and fastest growing older minority populations nationally. Using longitudinal data from a population-based prospective cohort study, namely The Population Study of ChINese Elderly in Chicago (PINE) with a sample size of 3,157, this symposium presents findings from five research projects. Session 1 investigates the relationship between psychological well-being and change of cognitive function over four years. Session 2 and 3 examine the relationships between two socio-cultural factors and cognitive function. Specifically, session 2 investigates the associations between immigration-related factors and the incidence of cognitive impairment. Session 3 explores the relationship between cognitive function and Tai-Chi practice. Session 4 and 5 examine the relationships between two physical health indicators and cognitive aging. Specifically, session 4 examines the relationship between physical function and change of cognitive function over two years. Session 5 explores the association between body mass index and cognitive function decline over two years. Taken together, this symposium aims to further our knowledge of cognitive aging among ethnically/culturally diverse populations. The research findings will identify unique factors related to cognitive aging in older minority populations.
EFFECTS OF SOCIAL SUPPORT ON PERSONS’ NEUROLOGICAL WELL-BEING:IMPLICATIONS FROM CROSS-CULTURAL STUDIES
Authors: Jiang Nan , Wang Jing
Published: November 2019

The impact of social determinants on health is well documented. Among them, social support has emerged as one of the most important old ideas being revisited from a new perspective. Social support refers to perceived supportive resources from an individual’s social engagement or social network. Recently, the concept of social support has become the subject of intense discussion, as it represents a mechanism by which interventions lead to health improvement. Neuropsychological disorders, on the other hand, represent a large burden on worldwide health. Research has shown that older adults with neurological conditions are embedded in social structures that may affect their outcomes, but not enough attention has been paid to the potential effect of social support on many neurological conditions. Using data collected from studies across cultures that have sought to understand neurological well-being worldwide, this symposium will present evidence of the relationship between social support and neurological conditions among older adults and explore how these mechanisms of social support extend the understanding of health disparities in old-age neurological wellbeing. A discussant will draw out common themes from these papers and connect them with the broader literature on the effect of social support on neurological well-being. We propose that social support constitutes an integral part of medical care for older adults with neurological conditions. This symposium will generate insights to help clinical practitioners more effectively design their social support interventions.
RISK AND RESILIENCY IN THE RELATIONSHIP BETWEEN WIDOWHOOD AND DEPRESSIVE SYMPTOMS AMONG OLDER MEXICAN AMERICANS
Authors: Cong Zhen , Pei Yaolin , Wu Bei
Published: November 2019

This study investigated the association between widowhood and depressive symptoms and the extent to which the association is contingent upon immigration status, functional limitations, financial strains, and intergenerational support, among older Mexican Americans. A sample of 344 parent-child dyads reported by 83 older adults in a city of West Taxes completed the measures for socioeconomic status and depressive symptoms. Clustered regression analysis showed that widowhood elevated the risk of depressive symptoms. Living with functional limitations, having more children and residing in the same city with children exacerbated the adverse effects of widowhood on depressive symptoms. Residing in the same city with children increased the detrimental effects of widowhood on the depressive symptoms among men, whereas this pattern did not appear among women. The findings highlight the heterogeneity of depressive symptoms among the widowed Mexican American older adults.
RACE-ETHNICITY, GENDER, AND DISABILITY: A TEST OF STRESS DISABLEMENT PROCESS MODEL AND INTERSECTIONALITY THEORY
Authors: Wray Linda A , Wray Linda A , Thierry Amy D
Published: November 2019

Decades of studies demonstrate that: physical disability differs widely by race/ethnicity, sex, and achieved social status in midlife and older adults; health conditions explain part or all of the differences by race/ethnicity and/or sex; but disparities by race/ethnicity and/or sex often persist beyond controls for health conditions. Using longitudinal HRS data on 16,280 adults and sequential logistic regression models, Wray and Thierry test if those links are additive or interactive and if achieved social status attenuates remaining disparities. Initial models support past studies indicating that impairments in strength, mobility, and ADLs are greater for females and race/ethnic minority adults. Fully adjusted models, including terms for the intersection of race/ethnicity, sex, and health conditions and controlling for other health and social status factors, reveal differential impacts on reported impairments; and that achieved social status only partly attenuates the disparities. More research is warranted to understand underlying mechanisms that produce health disparities.
HEALTH BEHAVIORS AND PSYCHOLOGICAL WELL-BEING ALLEVIATE DIABETES-RELATED DISABILITY DETERIORATION
Authors: Tsai Yi-Hsuan , Chiu Ching-Ju
Published: November 2019

Diabetes is known to increase the risk of disability, which may be buffered by health behaviors and psychological factors. However, few existing studies examine how these factors affect disability in diabetic patients over time. The present study assessed the extent to which diabetes affected disability with age and how that effects differed by health behaviors and psychological well-being in older Taiwanese. The data of 5131 adults aged 50 and older were drawn from the 1996-2007 Taiwan Longitudinal Study on Aging. A cohort sequential multilevel modeling was employed to explore the effects of sociodemographic, comorbidities, lifestyle, and psychosocial factors in mediating and moderating the link between diabetes and disability. Disability was measured by mobility limitation in 1999, 2003, and 2007, while health behaviors and psychological factors were measured in 1996, 1999, and 2003 to be lagged time-varying covariates in random effect model analyses. Our results showed that adults with diabetes had more mobility limitation (β(diabetes) =3.031, P<.001) and progressed each year with ageing (β(diabetes*age) =0.061, P<.005). Exercising more than four times a week reduced the risk of disability by 51 % in diabetic patients (β(diabetes*exercise≥4 times) =-1.220, P<0.05). Social participation (β(social participation)=-0.631, P<.005), stress (β(stress)=0.651, P<.001) and depression (β(depression)=0.144, P<.001) had independent effects on the risk of disability in adults, but the interaction with diabetes was not significant. To conclude, exercise is the most powerful factor to alleviate the risk of disability in diabetic patients.
PROBLEMS AND PROSPECTS FOR CURRENT POLICIES TO EXTEND WORKING LIVES
Authors: Street Debra A , Street Debra A
Published: November 2019

Current policy debates fluctuate between “extending working life” and “delaying retirement”—assuming policies that reflect different conceptual approaches are identical. This presentation uses a different analytic strategy, conceptualizing later life work policies as representing distinctive approaches to consideration of work conditions/income security for older workers. Using data from over 30 countries, I discuss main trends in extended working life policies (mainly in the EU) and the gender and health implications for current and future workers. We find that policies committed to “extending working life”—supporting adequate/meaningful employment for later life work—are enacted rarely, but with potentially positive effects for the health and wellbeing of older workers of either gender. However, “delaying retirement” policies, which dominate the political landscapes of most of the country-specific policies we consider, reproduce or exacerbate gender inequalities and health risks for vulnerable older workers.
NEIGHBORHOOD AND HEALTH AMONG CHINESE ADULTS: BEYOND THE URBAN AND RURAL DICHOTOMY
Authors: Li Yuekang , Wang Yi
Published: November 2019

The associations between physical frailty and depressive symptoms among older individuals were established in existing literature. Taking the person-environment perspective, we argue that neighborhood environment could either buffer the stress derived from being physically vulnerable or worsen it by adding another layer of stressors in the environmental context when physical health declined. The objectives of this study are to explore 1) to what extent the neighborhood-level characteristics moderate the relationship between physical frailty and depressive symptoms, 2) if there were rural-urban differences in the moderation effects, and 3) whether some of the environmental factors worked beyond the contextual influences of the rural-urban scope. Using the China Health and Retirement Longitudinal Study 2011 wave, 6,246 individuals ages 60 years and older were included for analyses. Multilevel mixed-effects models were fitted to examine the moderating effects of urbanicity and neighborhood-level socio-economic status (SES) on the relationship between frailty and depressive symptoms among older adults, controlling for individual-level characteristics. Results showed a stronger relationship between deterioration in physical health and depressive symptoms in rural neighborhoods and neighborhoods with lower SES, after controlling for individual-level SES. Also, the moderating effects of the neighborhood-level socioeconomic factors remained after controlling for urbanicity, indicating that neighborhood SES works beyond the rural-urban contexts. Findings from this study demonstrate the important roles of neighborhood socioeconomic characteristics in reshaping and the need to redefining China’s rural-urban dichotomy. The findings also identified neighborhoods with low SES as potential targets for policy and practice to reduce the stress associated with health decline.
CHANGES IN FUNCTIONAL DISABILITY AND SUICIDAL IDEATION ASSOCIATED WITH PSYCHOTHERAPY FOR DEPRESSION
Authors: Lutz Julie , Beaudreau Sherry , Morin Ruth , Bickford David , Nelson J Craig , Mackin Scott
Published: November 2019

Given the association between functional disability and suicidal ideation (SI) in late life (Lutz & Fiske, 2017), this study examined associations between functional disability and SI among older adults receiving problem solving therapy (PST) for depression. PST is a promising intervention for SI (e.g., Gustavson et al., 2016) and has been shown to be effective in reducing functional disability among older adults with depression (e.g., Choi et al., 2014). Regression analyses with adults age 65-91 (n=65) found that level of SI (Geriatric Suicide Ideation Scale) at baseline was not significantly associated with change in SI from pre- to post-treatment. However, lower baseline disability (WHODAS-II; ΔR2=.08, p=.022) and greater reduction in disability (ΔR2=.12, p=.004) were significantly associated with greater reduction in SI after controlling for age and baseline SI. These results suggest that treatments that decrease disability may be particularly advantageous for reducing SI in older depressed adults.
DEVELOPING EVIDENCE-BASED INSTRUMENTS TO TALK ABOUT LONELINESS
Authors: Schoenmakers Eric
Published: November 2019

People, professionals and non-professionals, lonely and non-lonely, experience difficulties in talking about loneliness. Yet, talking about loneliness is important. Without conversation about loneliness, it is impossible to identify lonely persons and to assist them in a tailor-made way. The aim of this research project is to create evidence-based instruments to make talking about loneliness easier. From 2016 to 2019 (ongoing) six researchers held about 60-70 interviews with lonely persons, discussing feelings of loneliness and coping behavior. After the first 23 interviews with lonely older adults, a qualitative analysis on how to discuss loneliness was performed, resulting in a format for talking about loneliness and a topic list to help in conversations. These instruments were tested in the remaining interviews with lonely older adults and students, after which the format and topic list were updated. The format for talking about loneliness discusses guidelines for the inter human relationship, how to bring up the topic of loneliness, and what to discuss, e.g. feelings, timing, coping, consequences and taboo. ‘What to discuss’ is also addressed in the topic list. It is important to not be eager to help. Often, lonely people have felt so for a long time and considered many coping options. This illustrates complexity. Trying to ‘solve’ loneliness with oversimplified suggestions makes people feel that their situation is not taken seriously. These instruments emphasize the importance of true listening. The instruments can be used to train professionals and volunteers who want to discuss loneliness with lonely people.
THE IMPACT OF MANDATED COGNITIVE ASSESSMENTS ON ALZHEIMER’S DISEASE AND RELATED DEMENTIA DIAGNOSIS RATES
Authors: Thunell Johanna , Zissimopoulos Julie
Published: November 2019

Although no cure for Alzheimer’s disease exists, early diagnosis allows clinicians to detect reversible causes of memory loss, inform pharmacologic treatment options that may delay cognitive decline, and inform patients about clinical trial opportunities. It allows patients to communicate medical, legal, financial, living, and end-of-life desires. Barriers to diagnosis include low public awareness of early symptoms, stigma and misconceptions about the disease that delay seeking medical assistance. Provider-related barriers include low recognition of cognitive impairment and/or insufficient training in dementia diagnosis, and reimbursement issues. The new annual wellness visit (AWV) benefit available to Medicare Part B beneficiaries may reduce some of these barriers. The Patient Protection and Affordable Care Act of 2010 mandated an AWV that, along with routine preventive services, included for the first time, a cognitive screen at each visit. In this study, we analyze the effect of the introduction of the AWV benefit on Alzheimer’s disease and related dementias (ADRD) diagnoses rates, average age at diagnosis and geographic dispersion of diagnoses. We use the 100% sample of Medicare claims and regression discontinuity to estimate the impact of the legislation enactment. Preliminary analyses show immediate and increasing take-up in AWV visits after the policy went into effect. The total number of preventative exams claims went from about 2,500 to 27,000 immediately after the policy and continued to grow in subsequent months. We also observe an increase in ADRD incidence in the months immediately following ACA, from about 14,000 claims in December 2010 to about 16,000 in January 2011.
SUCCESSFUL AGING A SELF-RELIANT UMBRELLA: DEFINING SUCCESSFUL AGING AMONG THE OLD-OLD (80+) IN SHANGHAI
Authors: Chen Lin , Ye Minzhi , Kahana Eva
Published: November 2019

The Chinese old-old (80+) population has steadily increased in recent years; however, limited studies have examined how they age. The purpose of this study is to explore how the old-old in urban China define successful aging. Guided by grounded theory, community-dwelling old-old individuals participated in semi-structured, in-depth interviews (N= 97). Participants identified self-reliance as the goal of successful aging, which was supported by four proactive behaviors, including physical activity, financial security, community connectedness, and willing acceptance of reality. These four proactive behaviors were conceptualized to constitute the ribs of an umbrella model offering a canopy to protect the pole of self-reliant successful aging. This study offers new insight in understanding dynamic and nuanced ways that the old-old in urban China age successfully and their valiant efforts to maintain an ideal status.
KNOWLEDGE OF AGEISM AND ATTITUDES ABOUT AGING AS A CORE COMPETENCY FOR HEALTH PROFESSIONALS
Authors: Marrs Sarah , Gendron Tracey , Waters Leland , Inker Jenny , McIntyre Maddie
Published: November 2019

Senior mentoring programs have been established that provide medical students exposure to a community-dwelling older adult mentor with whom they meet multiple times throughout the program. The goal of these programs is to expose students to healthy older adults, increase knowledge of geriatrics, and prepare them to care for an aging population. However, even while participating in a senior mentoring program, health professions students still demonstrate some discriminatory language towards older adults (e.g., Gendron, Inker, & Welleford, 2018). In fact, research suggests ageist practices occur, intentionally or not, among health professions in disciplines such as medicine, nursing, and social work and even within assisted and long-term care facilities (e.g., Bowling, 1999; Dobbs et al., 2008; Kane & Kane, 2005). We evaluated a senior mentoring program to gauge the impact of a new pedagogical approach and to gain a deeper understanding of the learning gained in relation to ageism and elderhood. This qualitative content analysis explored first-year medical students’ opinions of their own aging and attitudes towards caring for older adults. Students (n = 216) participating in a brief curriculum model of a senior mentoring program responded to the following open-ended prompts before and after the program: 1) How do you feel about your own aging?; 2) How do you feel about working with older adult patients after you complete your medical training? Responses suggest that students’ views of their own aging and views towards towards working with older patients are positively impacted by their experiences in the senior mentoring program.