bluuebunny/crossref_metadata_2025 huggingface dataset:
YOU HAVE TO BE STRONG TO GET OLD: MIDDLE-AGE CAREGIVING, WISDOM DEVELOPMENT, AND LIFE PLANNING AMONG OLDER ADULT WOMEN
Authors: Hartikka Kathryn
Published: November 2019

This study explores women’s development of wisdom in older adulthood resulting from caregiving of aging parents and spouses during their middle age years. As a way to grasp the complexity of middle age care work influencing wisdom development in older adulthood, this study used in-depth case analysis with in-depth interviews of three older adult women from the Silent Generation, ranging in birth years from 1933 to 1944. Women self-identified wisdom through themes such as compassion, knowledge attainment, and resilience resulting from their care work. This study also captured the significance of their caregiving in middle age as a turning point in their lives, marking their physical health and capabilities as notably stronger compared to their present selves in older adulthood. These women also illustrated increased awareness of their own mortality through caregiving. Jointly, these women self-identified their roles as caregivers as uniquely female roles. While all noted being confronted with care work as unexpected in their life path, these women believed in having a natural inclination to nurture and care, coupled with social pressures, leading to their ultimate caregiving. This study unearthed deeper meanings these women had for their lives resulting from caregiving, manifesting as knowledge gained about life, health, and aging. Thus, inspiring their own decision-making as they approach even older adulthood experiences such as dependency and death. This study ultimately illustrates the importance of caregiving on women’s lives: marking their middle age, increasing their wisdom development, and influencing their life planning as they age.
INFLUENCE OF HEALTH AND SOCIAL SUPPORTS ON OUTCOMES POST-REHABILITATION FOR HIP FRACTURE SURGERY: SYSTEMATIC REVIEW
Authors: McGilton Katherine , Vellani Shirin , Bayly Melanie , Tanjong-Ghogomu Elizabeth , Iaboni Andrea , Lapenskie Julie , Welch Vivian , Omar Abeer
Published: November 2019

Background: Older adults who sustain hip fractures encounter physical and functional decline after discharge from inpatient rehabilitation. Currently, a synthesis of literature is lacking on health and social supports that may impact outcomes in the community-dwelling older adults, post-discharge from rehabilitation. Methodology: We conducted a systematic review to a) evaluate how health and social supports influence outcomes for older adults and their caregivers following inpatient rehabilitation post-hip fracture surgery, and b) identify the factors that affect their impact on outcomes. We searched Medline, CINAHL, Embase, Emcare, Psychinfo, and Ageline for publications between 2000 and 2018. We followed Cochrane Handbook methods to screen titles and abstracts, appraise quality, collect data and synthesize results. Results: A total of 3364 articles were retrieved, and 34 studies were included for final synthesis, including 24 randomized control trials and 10 observational studies. Most studies excluded persons with moderate or severe cognitive impairment. Interventions can be broadly categorized as either comprehensive care delivered by interdisciplinary teams focusing on exercise, nutrition and fracture prevention; or exercise sessions delivered by health professionals, trained instructors or volunteers. Interventions involving interdisciplinary teams demonstrated moderate improvement of mobility and functional ability in the first 3 months. However, the longitudinal effects of interventions were not realized for all. Conclusion: This review provides evidence of the effectiveness of health and social supports provided to older adults post-hip fracture. We are uncertain of the applicability to people with cognitive decline due to exclusion from most studies. Implications for practice and research will be discussed.
THE IMPACT OF THE OPIOID EPIDEMIC ON OLDER ADULTS: FINDINGS FROM A NATIONAL SURVEY OF COMMUNITY-BASED ORGANIZATIONS
Authors: Cameron Kathleen A , Popham Lauren E , Herrera-Venson Angelica
Published: November 2019

The National Council on Aging (NCOA) conducted a national survey of community-based organizations (CBOs) in early 2019 to better understand how older adults, people with disabilities, and their caregivers are affected by the opioid epidemic and identify new resources and tools needed by CBOs to better serve their community needs. Specifically, the survey asked about the extent to which CBOs’ service delivery and level of effort has changed as a result of the opioid epidemic; unique issues reported by this population, directly or indirectly resulting from opioid misuse by them or loved ones; how organizations screen and refer older adults and individual with disabilities for support associated with opioid misuse; how organizations may be connecting with local or state initiatives addressing the opioid epidemic, or forming strategic partnerships to respond to emerging client needs; and pinpoint gaps in resources that may help organizations to more effectively respond to these issues. Over 200 organizations, representing urban, suburban and rural communities, responded to the survey and included senior centers, area agencies on aging, Senior Health Insurance Assistance Programs, as well as health care organizations. Seventy percent of organizations report spending more effort to address the needs of older adults/caregivers who are adversely affected by opioid misuse/abuse since 2 years ago. Common health and financial concerns, current strategies related to screening, partnership development, and educational programming as reported by CBOs will be presented. This session will include a discussion of opportunities to assist CBOs address the opioid-related needs of their older adult clients.
FAMILY CAREGIVER FACTORS AND HOSPITALIZATION IN DISABLED OLDER ADULTS WITH AND WITHOUT DEMENTIA
Authors: Amjad Halima , Mulcahy John , Kasper Judith D , Burgdorf Julia , Roth David L , Covinsky Kenneth , Wolff Jennifer L
Published: November 2019

Older adults with disabilities commonly rely on family caregivers’ help, yet effects of caregiver factors on patient outcomes are poorly understood. Within this population, dementia is common. Our objective was to evaluate the association between caregiver factors and risk of hospitalization in disabled older adults with and without dementia. We examined 2,589 community-living older adults with mobility/self-care disability and their primary family caregiver in four waves of the National Long-Term Care Survey and National Health and Aging Trends Study. We used Cox proportional hazards models to examine risk of one-year, Medicare claims-derived, all-cause hospitalization as a function of caregiver factors, adjusting for older adult characteristics (sociodemographics, comorbidities, healthcare utilization) and survey year, considering dementia a characteristic of interest. Among disabled older adults, 38% were hospitalized over one year, and 31% had probable dementia. Hospitalization rates were similar for older adults with and without dementia (39.5% and 37.3% respectively); dementia was not associated with hospitalization risk (HR 1.09, 95% CI 0.95-1.26). Older adults demonstrated greater risk of hospitalization if their caregiver was male (HR 1.31, 95% CI 1.10-1.56), new to caregiving (HR 1.61, 95% CI 1.27-2.04 for < 1 year versus ≥ 4 years), or helped with healthcare tasks (HR 1.21, 95% CI 1.04-1.41). The association between most caregiving factors and hospitalization risk did not differ by dementia status. Results suggest that strategies to reduce hospitalization in older adults with disabilities could target select caregivers using similar strategies in populations with and without dementia.
IT’S THE LITTLE THINGS THAT COUNT: IMPLICATIONS OF DAILY EXPERIENCES FOR WELL-BEING AND BIOLOGICAL INDICATORS
Authors: Birditt Kira S
Published: November 2019

Middle-age and older adults vary widely in their physical health. This symposium describes studies that identify diverse daily experiences that account variation in health using multiple indicators of well-being (self-reported, biological). Fingerman et al. assessed daily TV viewing among older adults and found that more frequent television watching was associated with poorer physical health, worse health behaviors, and less energy expenditure (via actical watch). Leger et al., examined links between daily affect and sleep. Greater variability in daily positive affect is associated with fewer hours of sleep and greater morning tiredness even after adjusting for mean levels of affect. Luong et al. examined links between daily stress and affect. Interpersonal stressors were associated with greater affect reactivity than non-interpersonal stressors and links were reduced among older adults. Birditt et al. assessed links between daily social interactions and cardiovascular reactivity. More frequent social interactions and negative social interactions were associated with increased heart rate and links varied by gender and race. Polenick et al. examined links between daily social interactions and salivary DHEA-S (a marker of the stress response). Positive interactions predicted greater DHEA-S over the course of the day and links between negative interactions and DHEA-S varied by age group such that younger individuals appeared to be more reactive. These studies offer important clues regarding how daily experiences get under the skin to influence health and well-being.
AGE DIFFERENCES IN CONCORDANCE BETWEEN LAB AND DAILY LIFE STRESS RESPONSES
Authors: Luong Gloria , Arredondo Carla M
Published: November 2019

The literature is mixed with respect to how stress reactivity changes with age. Previous studies have overlooked contexts, ignoring whether stressors occurred in the laboratory or in daily life. The Health and Daily Experiences (HEADE) study includes 126 younger and older adults who completed both laboratory stressors and ecological momentary assessments (EMA) of affect and stressor experiences in daily life. We found that the laboratory stressor elicited the greatest levels of negative affect reactivity (i.e., larger increases in negative affect) and positive affect reactivity (i.e., larger reductions in positive affect) compared to the two types of daily life stressors. Interpersonal stressors were associated with greater negative and positive affect reactivity compared to non-interpersonal stressors in daily life. Younger adults exhibited greater stress reactivity than older adults. Together, these findings support age-related reductions in stress reactivity. Implications for understanding stressor-health links are discussed.
DAILY SOCIAL INTERACTIONS AND BIOLOGICAL STRESS REACTIVITY: ARE THERE AGE DIFFERENCES?
Authors: Polenick Courtney A , Zarit Steven H , Birditt Kira S
Published: November 2019

Older people experience fewer negative social interactions and report less anger and stress when faced with interpersonal tensions. Little is known, however, about age differences in biological responses to social interactions. We evaluated how salivary DHEA-S, a key indicator of stress reactivity, is associated with daily positive and negative social interactions among midlife and older adults. Participants were drawn from the Daily Health, Stress, and Relationship Study, which includes 93 adults age 40 to 95 who completed 14 days of daily diary interviews and provided saliva samples on four of those days. Multilevel models showed that people had higher DHEA-S on days in which they reported more positive interactions. Older respondents were less reactive to negative interactions relative to younger respondents. These findings indicate that positive social interactions may benefit biological stress reactivity regardless of age, whereas older adults are more resilient to the adverse effects of negative social interactions.
CULTURALLY COMPETENT CARE FOR OLDER SEXUAL MINORITY ADULTS: A SYSTEMATIC REVIEW FOR HEALTHCARE DELIVERY
Authors: Saliba Debra , MacCarthy Sarah , Darabidian Biayna , Elliott Marc N
Published: November 2019

Recent attention to culturally competent care has largely overlooked the needs of older LGB adults. To address this, we conducted a systematic literature review and make recommendations for how the healthcare workforce can reduce sexual-orientation-based disparities. We searched PubMed, PsycINFO & CINAHL for manuscripts 1/1/10-6/19/18 (n=799), deduplicating, dually-screening abstracts (n=80), reviewing full-text articles (n=44), and classifying relevant articles (n=27) into five domains of cultural competency and associated recommendations: 1) Physical environment: display pictures with older same-sex couples and LGB-identified symbols; 2) Education/staffing: expand to include older-specific LGB issues, especially for key conditions (e.g., cancer, dementia,) and hire LGB-identified administrative/clinical staff; 3) Inclusive language and communication: review terminology on forms, electronic health records, and used with patients to ensure a broad range of terms (e.g., partner/spouse) and note older LGB may have more limited understanding/comfort with terminologies (e.g., self-identify as ‘something else’ instead of ‘gay/lesbian’ or ‘bisexual’); 4) Patient histories: discuss how factors particular to their sexual orientation (e.g., level of outness) may affect their support networks; 5) Subgroup differences: consider specific health concerns by sexual minority subgroups (e.g., healthy weight for lesbian women, HIV for gay men, and negative health outcomes for bisexual adults related to their simultaneous isolation from sexual minority and heterosexual communities) and note additional challenges based on characteristics such as race/ethnicity and urbanicity. Cutting across these domains are the ways in which local and national policies affect healthcare access and surrogacy (e.g., legality of same-sex partners to obtain health insurance, participation in medical decision making/visitation).
IMPROVING HEALTH CARE OF LGBT OLDER ADULTS: INTERDISCIPLINARY PROJECT ENHANCES HEALTH OUTCOMES
Authors: Rowan Noell L , Smith Stephanie D , Arms Tamatha , Hohn Kris L
Published: November 2019

To date, there is a dearth of interdisciplinary simulation education and research that involves LGBT older adults within schools of social work and nursing. The purpose of this mixed method study was to examine the use of an intervention among social work and nursing students to determine if lecture and simulations impacted their health-related knowledge and cultural sensitivity/awareness of health provisions with LGBT older adults. Interprofessional faculty created lecture and interdisciplinary simulations with actual members of the older LGBT communities using simulation clinic/lab and health care scenarios. An adapted survey with permission from Grubb et al (2013) was used to include quantitative and qualitative measures of cultural awareness with LGBT populations. Pre-Post test data were analyzed using Generalized Linear Models in SAS software. Results indicated that the intervention positively changed perceptions and increased knowledge among (N=90; 32 social work; 58 nursing) allied health students. Statistically significant change experiences in their work with LGBT individuals were noted to positively alter their beliefs about sexuality, gender identity, and sexual development (Agree to Strongly Agree, X2(1)=26.51, p<0.001). Qualitative findings include four primary themes about how gender identity and sexual orientation influences health: (a) bias of health care providers, (b) access to quality care, (c) specific health care needs, and (d) health risks of LGBT older adults. As older adults continue to be the largest population needing health care, it is imperative that professionals are trained to give culturally sensitive health care and demonstrate this competency in their practice and interpersonal interactions with clients.
SOCIAL ISOLATION AMONG LGBT OLDER ADULTS: LESSONS LEARNED FROM A PILOT FRIENDLY-CALLER PROGRAM
Authors: Perone Angie , Ingersoll-Dayton Berit , Watkins-Dukhie Keisha
Published: November 2019

Lesbian, gay, bisexual, and transgender (LGBT) older adults face heightened risks of social isolation, given decades of discrimination. Research on telephone buddy programs with non-LGBT participants have proved predominantly unsuccessful at addressing social isolation and have found the greatest success with same-age matches. However, evidence suggests that LGBT adults may actually benefit from telephone buddy programs and in ways uniquely different from other groups. This article shares lessons learned from 30 participants across a 12-month pilot program that matched LGBT older adults to both LGBT and non-LGBT volunteer callers of various ages. One-third of participants identified as African American or Black. This project employed community-based participatory action research to identify, execute, and evaluate the program. Data includes information from questionnaires and telephone interviews prior to and during the program. In contrast to other research, data here revealed strong support for intergenerational matches. LGBT older adults of color especially benefited from program referrals and matches with/from LGBT adults of color, regardless of age. While the project aimed to capture two groups (LGBT older adults experiencing isolation and volunteer callers), the project revealed a third group: LGBT adults at risk of social isolation. This third group usually emerged among the “volunteer” callers but also identified concerns and risk factors for social isolation. The program also revealed unexpected benefits to both LGBT and non-LGBT volunteers, including less loneliness and a stronger sense of community. This article concludes with recommendations for developing similar programs to reduce social isolation in the LGBT community.
LONG-TERM CARE II EFFECTS OF A NEW VALUE-BASED REIMBURSEMENT SYSTEM ON EXPENDITURES AND CARE QUALITY IN MINNESOTA NURSING HOMES
Authors: Hass Zachary , Cooke Valerie , Arling Greg
Published: November 2019

Although several states have implemented Value Based Reimbursement (VBR) systems in long-term care; little is known of their impact. In 2016, Minnesota passed new VBR legislation to tie payment to quality with increased funding earmarked for nursing and other care-related services. We evaluated the effect of the policy change on care-related expenditures and measures of care quality. Data sources were cost reports and quality measures for the years 2013-2017 from 348 Minnesota nursing homes. Analysis consisted of descriptive tables, time plots, and linear growth curve modeling. We found increased expenditures for nursing and care-related services, particularly nursing assistants, during the first year; while quality metrics did not appear to be impacted by the policy change. Some differentiation was seen across facilities in their response to the policy change based on occupancy rate, rural-urban continuum code, attachment to a hospital, and resident acuity. The lack of an improvement in care quality might be attributable to VBR design as the quality incentive affected very few facilities. Additionally, there is the challenge of improving quality metrics even with additional resources. The legislature is currently considering changes to VBR policies in response to the report from this study.
HUMAN RESOURCE MANAGEMENT PRACTICES, ORGANIZATIONAL CULTURE, AND NURSE STAFFING TURNOVER
Authors: Weech-Maldonado Robert , Ghiasi Akbar , Davlyatov Ganisher K , Lord Justin C , Rondeau Kent
Published: November 2019

This study examines whether nursing homes’ (NHs) human resource management (HRM) practices and organizational culture are associated with nursing staff turnover. HRM practices are classified into traditional (employment selection tests, formal performance appraisal systems, and realistic job previews); employee-centered (flexible work hours and job sharing); and high involvement (incentive based/merit pay and self-managing teams). Organizational culture consists of four types: clan culture (friendly working environment); adhocracy culture (dynamic/creative working environment); market culture (results-based organization); and hierarchy culture (formalized/structured work environment). This study used facility survey data from approximately 324 NH administrators (30% response rate) from 2017- 2018, merged with secondary data from LTCFocus, Area Health Resource File, and Medicare Cost Reports. The dependent variables consisted of RN, LPN, and CNA turnover rates (% voluntarily quit), while the independent variables comprised HRM practices and type of organizational culture. Control variables consisted of organizational (ownership, chain affiliation, size, occupancy rate, and payer mix) and county-level factors (Medicare Advantage penetration, income, education, unemployment rate, poverty, and competition). Generalized linear model results show that every unit increase in high-involvement HRM practices is associated with a reduction of 6%, 4%, and 2% in RN, LPN, and CNA turnover rates, respectively. Also compared to hierarchical cultures, nursing homes with a clan culture are associated with a reduction of 62%, 49%, and 33% in RN, LPN, and CNA turnover rates, respectively. HRM practices and organizational cultures that promote employee participation, engagement, and empowerment have the potential to reduce nurse staffing turnover rates among underresourced nursing homes.
NOT JUST HOW MANY BUT WHO IS ON SHIFT: THE IMPACT OF WORKPLACE INCIVILITY AND BULLYING AMONG RCAS ON RESIDENT CARE
Authors: Cooke Heather A , Murray Kaitlin , Baumbusch Jennifer
Published: November 2019

Much of the literature examining the link between care quality and staffing in long-term residential care focuses on staffing ratios and staffing mix; that is, how many staff are on shift. Far less attention has been devoted to exploring the impact of staff members’ workplace relationships, or who is on shift, on care quality. Of increasing concern is the potential for peer incivility and bullying to disrupt the respectful, collaborative and effective working relationships considered key to residential care aides’ (RCAs) care provision. This paper draws on data collected from a critical ethnography examining workplace incivility and bullying in a rural, not-for-profit care home. To date, more than 50 hours of participant observation, and 20 in-depth interviews with RCAs, licensed practical nurses, support staff, management and residents have been conducted. Thematic analyses identified three key themes: impact on resident safety; cutting corners; and impact on resident agitation and anxiety. Impact on resident safety highlights how incivility and bullying can result in non-adherence to two-person lift policies and procedures. Cutting corners outlines how RCAs’ relationships with their co-workers dictates to what extent they provide the requisite care to a resident for whom another RCA is responsible. Impact on resident agitation and anxiety focuses on residents’ reactions to the tensions that emerge between RCAs as a result of incivility and bullying. Findings highlight how peer incivility and bullying may indirectly influence certain quality indicators (e.g., pressure sores, psychotropic medication use) thereby offering additional insight into the staffing-care quality link.
INTEREST GROUP SESSION—GEROSCIENCE: METHODS FROM BENCH TO POPULATION SCIENCE TO INFORM CONSTRUCTION OF GEROSCIENCE CLINICAL TRIALS
Authors: Sanders Jason L , Newman Anne B
Published: November 2019

We are on the cusp of a revolution in aging science. It has matured to the point where geroscience trials will test interventions in humans which alter aging mechanisms to lengthen healthspan and possibly lifespan. This goal is unprecedented in clinical trial design, and it requires retooling the clinical trial toolbox. Traditionally, trials are constructed around a single disease; interventions target a narrow part of a defined biological pathway involving only one molecule, tissue, or organ; events are well known intermediate endpoints and clinically-defined hard outcomes; and follow up may be short and historically informed based on prior trials. Geroscience trials by design target aging mechanisms which, when altered, are likely to have pleiotropic effects that modify several biologic pathways; efficacy and safety signals may require integration across multiple levels of biologic organization; intermediate endpoints are not agreed upon; and follow up timelines are undefined. In this symposium, we provide guidance on the design of geroscience trials using examples that span from bench to population science. Dr. LeBrasseur will discuss screening senolytic compounds across models of age-associated decline and advancing their candidacy as interventions. Dr. Justice will detail a framework for biomarker selection in geroscience trials, focusing on a trial of metformin as an example. Dr. Sanders will illustrate how observational data can inform phenotype use in clinical trials. Dr. Levine will explain translating omics data for use in geroscience trials, focusing on epigenomics. We expect additional discussion to hasten development of well-designed geroscience trials.
DEVELOPMENT OF EPIGENETIC MEASURES FOR GEROSCIENCE CLINICAL TRIALS
Authors: Levine Morgan E
Published: November 2019

One of the major goals of the NIA is to oversee development of biomarkers of aging. In recent years, DNA methylation has emerged as a promising avenue from which to quantify biological age. We and others have shown that these measures track age across various tissues and cells, and further deviations between chronological and “epigenetic age” have been shown to confer risk for various aging outcomes. However, the usefulness of these measures will depend on both their modifiability and ability to capture known targetable hallmarks of aging. Using DNA methylation data from cell line experiments, we have recently generated epigenetic predictors of cellular senescence for both human and mouse that when assessed in vivo from bulk samples, show age-related increases and are associated with aging outcomes. In moving forward, measures such as these may serve as promising surrogate endpoints for assessing efficacy of senolytic drugs and/or other anti-aging therapeutics.
A FREEZE IN TIME: PERCEPTION AND EXPERIENCE OF AMERICAN AND HONG KONG CHINESE OLDER ADULTS
Authors: Ho Tinky Oi Ting , Fung Helene Hoi-Lam , Tsang Vivian Hiu Ling , Li Angel Yee-lam , Ekerdt David J , Kim Hansol
Published: November 2019

According to self-continuity model, older adults are less likely to distinguish between the present and future, relative to younger adults. This mixed method design study aims at examining whether older adults perceive future as an infinite extension of present (i.e. “time freeze”) and investigating whether it is associated with life satisfaction, perceived control and perceived changes in future. 30 older adults from the US (aged 60-85, M = 78.4) and Hong Kong (aged 60-85, M =71.4) completed a structured interview and a survey. Findings revealed that 43% of Americans and 83% of Hong Kongers were experiencing ‘time freeze’. Individuals with a lower level of time freeze held more vivid and positive images of the future, and were achieving life goals actively, whereas individuals with a higher level of time freeze had comparatively more vague and neutral future views, and focused more on maintaining the current lifestyle.
PRETTY GOOD PRACTICES: GERIATRICS WORKFORCE ENHANCEMENT PROGRAMS AND LIFELONG DISABILITIES
Authors: Taylor Catherine , Munly Kelly
Published: November 2019

Growing old with lifelong disabilities is a recent reality that is catching healthcare providers unprepared. While there’s little extant federal or state public policy on aging with lifelong disabilities, and aging, disability, and healthcare systems lack a history of intersystem collaboration, Geriatrics Workforce Enhancement Programs (GWEPs) can lead the way in developing curricula, training, policy, and standards to respond. The GWEPs can intervene to create meaningful intersystem knowledge and skills and better prepare providers. Two GWEPs are filling the best practices void, operationalizing de facto public policy and “pretty good” practices to improve care for individuals with lifelong disabilities. In metro Richmond, VA, the GWEP at the Virginia Geriatric Education Center (VGEC) has built on the successful Area Planning and Services Committee on Lifelong Disabilities (APSC) intersystem partnership to provide this expertise. In Rhode Island, the RI Geriatric Education Center (RIGEC) has aligned its GWEP Alzheimer’s disease supplemental funding with other federally funded programs to build dementia capability into the systems that support adults with intellectual or developmental disabilities (I/DD). RIGEC incorporated expertise previously gained through the University of Rhode Island’s CMS-funded LivingRIte Innovation, which established pilot centers to support individuals with I/DD living with dementia and other chronic conditions, through novel person-centered approaches. This symposium examines how the two GWEPs expanded upon a foundation of previous efforts to serve older adults with lifelong disabilities, the methods by which they built and fostered effective networks, the resulting system improvements, and suggested strategies to move from “pretty good” to best practices.
COMMUNITY PARTNERSHIPS: A MODEL FOR LIFELONG DISABILITIES AND DEMENTIA CARE
Authors: Helm Faith , Taylor Catherine , Clark Phillip G
Published: November 2019

In 2015 the Rhode Island Geriatric Education Center (RIGEC) was one of 44 organizations funded by HRSA to implement the Geriatrics Workforce Enhancement Program (GWEP). A primary objective was to develop and deliver Alzheimer’s Disease and Related Dementias (ADRD) education to patients, families, caregivers, and health professionals, with a focus on special populations. Concurrently, Seven Hills Rhode Island, a nonprofit agency that serves people with disabilities, received a grant from the Administration for Community Living (ACL) to provide education and resources to health professionals and caregivers of people with I/DD. As goals for both projects aligned closely, they worked together, fostering a strong partnership, amplifying the opportunity to offer high-quality educational programs and reach target audiences. Lessons learned from this networked approach are critical to informing sustained improvements to the I/DD and health care systems in subsequent GWEP projects.
RAISING OUR VOICES: THE BENEFITS OF AN INTERGENERATIONAL CHOIR FOR PEOPLE WITH DEMENTIA AND THEIR CARE PARTNERS
Authors: Sheets Debra J , Allison Theresa A
Published: November 2019

This interdisciplinary symposium focuses on the Voices in Motion (ViM) choir, a novel social intervention to address issues of stigma and social isolation among older adults with dementia and their caregivers. ViM is an intergenerational choir for community-dwelling older adults with dementia (PwD) and their caregivers. Local high school students participated in the choir and added to the lively social interactions. Two professionally directed ViM choirs were fully implemented in 2018-2019 with a public performance in the Fall and Spring seasons. This symposium brings together multiple methodologies to investigate the effects of choir participation on cognition, social connections, stigma, and quality of life for the dyads. Results in the individual papers demonstrate the positive impact of choir participation on dyads (n=26) for measures that includecognition (MacDonald), well-being and quality of life (Sheets), and social connections (Smith). Taken as a whole, the papers indicate that this social intervention offers an effective non- pharmacological alternative approach for older adults with dementia. Choir participation has important and significant impacts on psycho-social well-being and quality of life. The body of evidence presented points to the importance of intergenerational programs that are dementia-friendly and that support meaningful participation by older adults with dementia in the broader community. Discussion focuses on implications for social policy with attention on the replication and sustainability of the program.
NOTEWORTHY: THE IMPACT OF A CHOIR FOR OLDER ADULTS WITH DEMENTIA ON THE WELL-BEING AND QUALITY OF LIFE OF CAREGIVERS
Authors: Sheets Debra J , MacDonald Stuart W , Smith Andre , Kennedy Mary
Published: November 2019

Informal caregivers provide 80% of the care needed to support community-dwelling older adults with dementia. Over time caregivers often face adverse effects on their health, quality of life and well-being; particularly those caring for someone with dementia. This study examines the impact of participation in the Voices in Motion (ViM) choir on caregiver burden, mood and quality of life. A measurement burst approach was used to investigate intraindividual variability on key psychosocial and health indicators. Results indicate that choir participation significantly improves caregiver well-being (e.g. mood, burden) and quality of life. Findings suggest that choirs offer significant caregiver support and respite. The discussion focuses the public policy and on the potential economic implications which suggests a shift is needed in the services available to older adults with dementia and their caregivers.
PAIN-RELATED BRAIN STRUCTURE AND PAIN CATASTROPHIZING IN BLACKS AND WHITES WITH KNEE OSTEOARTHRITIS
Authors: Terry Ellen , Terry Ellen L , Cardoso Josue S , Sibille Kimberly T , Tanner Jared J , Goodin Burel R , Price Catherine C , Fillingim Roger B
Published: November 2019

Pain catastrophizing is a cognitive-affective response during painful experiences and is implicated in the facilitation of pain processing. Non-Hispanic blacks (NHB) more often engage in catastrophizing as a coping strategy compared to non-Hispanic whites (NHW). Hence, pain catastrophizing may contribute to poorer pain-related outcomes and greater disability in NHBs. Functional neuroimaging studies have linked high levels of catastrophizing with increased cerebral responses to pain in the insula and primary somatosensory cortex [S1], but associations between brain structure and catastrophizing remain largely unexplored. Moreover, no neuroimaging studies have investigated whether catastrophizing is differentially associated with pain-related brain structure across racial/ethnic groups. We examined the association between race/ethnicity, catastrophizing, and pain-related brain structure (insula, S1) among 176 participants with and without knee pain. Findings provide evidence for differing associations of catastrophizing with pain-related brain structures in NHBs and NHWs. It is therefore important to develop culturally-relevant, neural-mediated interventions targeting catastrophizing for NHBs.
RESILIENCE, COPING, AND HEALTH IN MIDDLE TO LATE LIFE
Authors: Thorpe Roland J , Whitfield Keith E
Published: November 2019

Stress and resilience are two factors that are receiving attention as key determinants that can provide insights that underlie the deleterious effects on the overall health and well-being of individuals by influencing behavioral and biological processes. This symposium contains a collection of papers seeking to address the influence of resilience and coping on health outcomes in middle to late life adults. Tobin and Thorpe identified profiles of psychosocial resilience and examined their association with allostatic load (AL) among 283 Black men in the Nashville Stress and Health Study. Using Latent class analysis (LCA), individuals in the high resilience class had the greatest odds of high AL; high resilience worsened physical health for older but not younger Black men. Tan and colleagues explored satisfaction across life domains and correlates of satisfaction across domains in 93 Black adults. The authors report that higher satisfaction was associated with less education, less financial strain, lower depressive symptoms, and better self-rated physical health. Nguyen examined the association between everyday discrimination and generalized anxiety disorder (GAD) and whether church-based relationships buffer the negative effects of everyday discrimination on GAD among older African Americans. Using data from 670 African American respondents age 55 and older from the NSAL, the author reports, that significant interactions indicated that frequent contact with church members and high levels of subjective closeness to church members buffered against the negative effects of discrimination on GAD. These presentations collectively will bolster our knowledge of how stress and resilience impacts health disparities.
CORRELATES OF LIFE SATISFACTION AMONG MIDDLE-AGED AND OLDER BLACK ADULTS
Authors: Tan Shyuan Ching , Gamaldo Alyssa , Sardina Angie L , Andel Ross
Published: November 2019

This study explored satisfaction across life domains (e.g., family, daily life, health, finances, city of residence) and correlates of satisfaction across domains. Black adults (n=93, age range=55-80) completed the domains of life satisfaction scale and measures of sociodemographic factors, personality, and mental/physical health. Participants’ satisfaction was highest for home condition, but lowest for health. Univariate analyses of variance demonstrated better life satisfaction in the oldest-old (80+) than the youngest-old (55-64; p<.05), particularly in the domains of daily life/leisure, current financial situation, and total household income. Linear regression models suggested that higher satisfaction was associated with less education, less financial strain, lower depressive symptoms, and better self-rated physical health, although the pattern of results varied by domain. Satisfaction may increase with advancing old age, at least in some life domains. It can also vary across life domains and unique factors likely relate to satisfaction in each life domain.
CHANGES IN SOCIAL SUPPORT AND THE INFLUENCE OF DRIVING CESSATION
Authors: King Brittany M
Published: November 2019

Driving cessation has been shown to be a potentially isolating transition in life, with important implications for mental health, social isolation, and social support. Older adults who live alone are vulnerable to social isolation in the context of driving cessation. Although some research has examined the association between driving cessation and certain kinds of social engagement activities, no research has specifically examined changes in social support, particularly among older adults most vulnerable to social isolation – those who live alone . The present study addresses this gap, using data drawn from the 2006-2014 waves of the Health and Retirement Study (HRS) to examine how social support changes in the context of driving cessation among older adults who live alone (N=412). This study specifically focuses on instrumental and emotional social support, and how different sources of the support (children, friends, and other family) are influenced by loss of driving. I use a series of ordinary least squares regression (OLS) to examine four-year changes in various forms of social support among those who live alone, comparing those who lose the ability to drive relative to their continuously driving counterparts. Preliminary results indicate that driving cessation is associated with decline in perceived instrumental support of friends (-0.984, p<01) for older adults who live alone. However, these effects did not extend to children or other family members. These results suggest that loss of driving may perpetuate vulnerabilities facing individuals who live alone by leading to lower levels of perceived support from non-family members.
Supporting Older Homeless Persons’ Positive Relocations to Long-Term Care: Service Provider Views
Authors: Sussman Tamara , Barken Rachel , Grenier Amanda
Published: November 2019

Background and Objectives

This study sought to explore the challenges and opportunities associated with supporting older homeless persons’ relocations to long-term care (LTC) from the perspective of service providers. It aims to inform how to improve relocation processes for this vulnerable and growing subpopulation of older persons.

Research Design and Methods

This cross-sectional qualitative study employed semistructured face-to-face interviews with service providers from two Health and Social Service Centres in Montreal, Quebec. All interviews were audio-recorded, transcribed verbatim, and thematically analyzed in five stages.

Results

A total of eight service providers reported on their experiences supporting over 40 relocations of older homeless persons (50+) in the last year. According to participants, older homeless persons’ trajectories into LTC typically included a series of neglected medical issues followed by hospitalization and eventual relocation to LTC. Systemic barriers such as limited-time for proper planning, insufficient housing options for persons with minor functional limitations, disregard for preferred geographic location, multiple moves, and staff prejudices worked together to expedite premature relocation and challenge relocation processes.

Discussion and Implications

Older homeless persons appear to be at heightened risk of premature and challenging relocation processes. Expanding housing stock for persons with functional limitations, strengthening intersectoral collaborations, providing education and training to staff, and ensuring flexibility around rules and regulations in receiving LTC homes would both improve access to aging in place for this marginalized group of older persons and ensure conditions are in place to support positive relocations to LTC for those who require it.
Service firm performance and foreign ownership
Authors: Choi Jieun
Published: November 2019

Little is known about the performance of service firms and its relations with foreign direct investment (FDI), in part due to methodological and conceptual challenges in measuring service performance. This article suggests two possible measures of service firm performance: total factor productivity (TFP) and markups, with modification needed to improve those measures for the service sector. Using these measures, it examines service firm performance from 1997 to 2007 in Tunisia, where the service sector accounts for 60% of GDP but faces high protection and complex entry barriers. Then, it investigates whether variations in performance can be explained by FDI. It finds that FDI firms have higher TFP but lower markups than local firms, with significant variations across sub-service sectors.
Short Time Regularity of Navier–Stokes Flows with Locally L3 Initial Data and Applications
Authors: Kang Kyungkeun , Miura Hideyuki , Tsai Tai-Peng
Published: November 2019

We prove short time regularity of suitable weak solutions of 3D incompressible Navier–Stokes equations near a point where the initial data is locally in $L^3$. The result is applied to the regularity problems of solutions with uniformly small local $L^3$ norms and of forward discretely self-similar solutions.
Conformal Invariance of CLEΚ on the Riemann Sphere for Κ ∈(4,8)
Authors: Gwynne Ewain , Miller Jason , Qian Wei
Published: November 2019

The conformal loop ensemble (${\textrm{CLE}}$) is the canonical conformally invariant probability measure on non-crossing loops in a simply connected domain in $\mathbbm{C}$ and is indexed by a parameter $\kappa \in (8/3,8)$. We consider ${\textrm{CLE}}_\kappa $ on the whole-plane in the regime in which the loops are self-intersecting ($\kappa \in (4,8)$) and show that it is invariant under the inversion map $z \mapsto 1/z$. This shows that whole-plane ${\textrm{CLE}}_\kappa $ for $\kappa \in (4,8)$ defines a conformally invariant measure on loops on the Riemann sphere. The analogous statement in the regime in which the loops are simple ($\kappa \in (8/3,4]$) was proven by Kemppainen and Werner and together with the present work covers the entire range $\kappa \in (8/3,8)$ for which ${\textrm{CLE}}_\kappa $ is defined. As an intermediate step in the proof, we show that ${\textrm{CLE}}_\kappa $ for $\kappa \in (4,8)$ on an annulus, with any specified number of inner-boundary-surrounding loops, is well defined and conformally invariant.
Deep learning in clinical natural language processing: a methodical review
Authors: Wu Stephen , Roberts Kirk , Datta Surabhi , Du Jingcheng , Ji Zongcheng , Si Yuqi , Soni Sarvesh , Wang Qiong , Wei Qiang , Xiang Yang , Zhao Bo , Xu Hua
Published: November 2019

Objective

This article methodically reviews the literature on deep learning (DL) for natural language processing (NLP) in the clinical domain, providing quantitative analysis to answer 3 research questions concerning methods, scope, and context of current research.

Materials and Methods

We searched MEDLINE, EMBASE, Scopus, the Association for Computing Machinery Digital Library, and the Association for Computational Linguistics Anthology for articles using DL-based approaches to NLP problems in electronic health records. After screening 1,737 articles, we collected data on 25 variables across 212 papers.

Results

DL in clinical NLP publications more than doubled each year, through 2018. Recurrent neural networks (60.8%) and word2vec embeddings (74.1%) were the most popular methods; the information extraction tasks of text classification, named entity recognition, and relation extraction were dominant (89.2%). However, there was a “long tail” of other methods and specific tasks. Most contributions were methodological variants or applications, but 20.8% were new methods of some kind. The earliest adopters were in the NLP community, but the medical informatics community was the most prolific.

Discussion

Our analysis shows growing acceptance of deep learning as a baseline for NLP research, and of DL-based NLP in the medical community. A number of common associations were substantiated (eg, the preference of recurrent neural networks for sequence-labeling named entity recognition), while others were surprisingly nuanced (eg, the scarcity of French language clinical NLP with deep learning).

Conclusion

Deep learning has not yet fully penetrated clinical NLP and is growing rapidly. This review highlighted both the popular and unique trends in this active field.
Implementation of the Non-Punishment Principle in England: Why Are Victims of Trafficking Not Benefiting from the Protection from Prosecution Provided by International Law?
Authors: Ofer Nogah
Published: November 2019

This study examines the prosecution of victims of trafficking for illegal activities they were compelled to carry out due to slavery or exploitation. The legal principle of ‘non-punishment’ protects victims from criminalization and was adopted in European law in 2005 and United Kingdom (UK) law in 2015. Despite this, prosecutions continue in the UK to date, with trafficking victims sometimes spending lengthy periods in custody. This research asks why that is the case. It adopts a micro-level analysis of two pathways: the first follows the processes within the criminal justice system from arrest to trial, and the second the progression between the state’s adoption of law and/or policy and its application by state agents. This study finds that at almost every stage the state fails to take sufficient proactive steps to elicit change, so that business as usual often prevails on the front line. The study also considers two alternative hypotheses: that prosecutions are the result of victims’ lack of disclosure, or a result of the need for the courts to establish in each case whether protection is warranted. It concludes that although these factors have some limited effect, state failings are the primary cause of prosecutions which breach the non-punishment principle. This research falls within the wider question of the effectiveness of international human rights law and I hope that it may contribute to the understanding and enhancement of human rights implementation.