bluuebunny/crossref_metadata_2025 huggingface dataset:
REFRAMING (MY OWN) AGING: SCHOLARLY AND PERSONAL PERSPECTIVES ON PRODUCTIVE AGING
Authors: Morrow-Howell Nancy
Published: December 2023

Advocacy and scholarship grounded in the productive aging paradigm have evolved over 40 years. From an age-drain to an age-as-asset perspective, productive aging scholars have focused on programs and policies to optimize the vital engagement of older people in paid and unpaid work (working, volunteering, caregiving). I have contributed to this body of work and I have evolved with it. I have changed what I study, how I think about later life, and what I think is important for gerontologists to consider. In this presentation, I will review the development of productive aging literature, including tensions that have existed in the scholarship. Themes of ageism and diversity, equity and inclusion have gained prominence in this work; and I will suggest future directions. I will reflect on how my own aging and experiences have shaped my thinking on productive aging.
THE IMPACT OF INTERGENERATIONAL SOLIDARITY ON GRANDPARENT WELL-BEING
Authors: Scott Rachel , Nadorff Danielle
Published: December 2023

Bowen’s Family Systems theory provides a framework for examining how values and beliefs are transmitted between family members and the overall potential impact that transmission may have on the well-being of family members. While familial emotional closeness has been shown to predict well-being for older adults, there is still a lack of research investigating the influence of level of agreement on ideology among family members within this relation. Objective: This study examined the impact that level of agreement on religious and political values (consensual solidarity) has on the relation between emotional closeness in intergenerational relationships (affectual solidarity) and well-being in grandparents. Method: Using a sample from the Longitudinal Study of Generations, the current study examined grandparent-adult child (N = 336) and grandparent-grandchild (N = 239) dyads to assess the extent to which agreement on ideological beliefs moderates the relation between intergenerational emotional closeness and well-being in the grandparent generation.

Results: Affectual solidarity ratings among the three generations, as well as religious ideological differences between grandparents and grandchildren, were found to influence the well-being of grandparents. Additionally, model fit was found to be excellent for both moderation models between the three generations.

Discussion: These findings suggest that emotional closeness is a predominant factor in predicting well-being in grandparents that may not be as heavily influenced by the level of agreement on ideological beliefs as is often assumed.
THE ROLE OF SOCIAL DETERMINANTS OF HEALTH ON CANCER RISK BEHAVIORS AMONG OLDER NIGERIAN MEN
Authors: Esiaka Darlingtina , Nwakasi Candidus , Chidebe Runcie
Published: December 2023

Despite the growing cancer incidence and mortality rate in Nigeria, there exists prevalence of imminent and aggressive stage of cancer diagnosis among Nigerian men due to cancer risk behaviors and lack of cancer preventive behaviors such as early screening. This adds to the increasing rates of cancer disparities in Nigeria and Sub-Saharan Africa. Research links social determinants of health (SDOH) to myriad of cancer outcomes including cancer detection and prevention behaviors. To contribute to our understanding of the complexity of cancer risk behaviors, this cross-sectional study aimed to determine the relationship demographic (age, education, employment, income), health (cancer knowledge, cancer beliefs, illness attitudes) and social determinants of health (health insurance, public health infrastructure, rural vs. urban dwelling) have on cancer risk behaviors among older Nigerian men (N=411, age 50+). Results show a significant association between SDOH and cancer risk behaviors. Lack of insurance, absence of health infrastructures, and rural dwelling were correlates of cancer risk behaviors. Also, cancer beliefs, illness attitude, income, and employment had significant relationships with cancer risk behaviors. Our findings point to the detrimental effects of these factors on the fight against cancer disparities. Understanding the mechanisms by which older Nigerian men experience health, requires efforts in identifying constructs that influence their daily-lived experiences and their impact on health-related behaviors. Our data can inform global health actions to eliminate cancer disparities at the individual, organization, and government levels.
ESPO AND BEHAVIORAL AND SOCIAL SCIENCES SECTION SYMPOSIUM: BRIDGES TO ELDER JUSTICE: BUILDING COLLABORATIONS AND COALITIONS TO CATALYZE ELDER MISTREATMENT RESEARCH
Authors: Chang E-Shien , Hackett Sara
Published: December 2023

Elder mistreatment is a widespread public health problem, affecting 1 in 6 older persons every year. Despite its high frequency and severity, relatively little attention has been paid to ensuring that the findings of elder mistreatment research can be implemented in routine care and clinical practice. Forging meaningful partnerships with health care systems may hold promise to facilitate this translational process, and ultimately improve health outcomes for older persons. In this symposium, we will identify proven approaches and mechanisms to successfully build, maintain, and sustain elder mistreatment research-to-practice partnerships with various health care system stakeholders. Dr. Karl Pillemer will describe best approaches in forging researcher-practitioner collaboration with long-term care providers to implement and disseminate evidence-based resident-to-resident aggression intervention program. Dr. Lena Makaroun will examine lessons learned from four high-impact Veterans Health Administration-led collaborations to accelerate applied elder mistreatment research. Dr. Kristen Lees Haggerty will discuss strategies and successes in developing a novel elder mistreatment screening and response tool for emergency departments nationwide in partnership with the National Collaboratory to Address Elder Mistreatment. Finally, Dr. Zach Gassoumis will describe his experiences with conducting intervention and observational research as well as provide advice to early career scholars looking to build partnerships with health care systems. Taken together, these presentations will shed light on the practice, policy, and research implications in strengthening health care system partnerships to closing the discovery-delivery gap.
USING THE ELECTRONIC MEDICAL RECORD OF NURSING HOME RESIDENTS FOR IMPROVED MEASURE OF BEHAVIORAL SYMPTOMS
Authors: Yun Hyunkyung , McCreedy Ellen , Mor Vincent , Mitchell Susan
Published: December 2023

Behavioral symptoms as study outcomes are measured by routinely collected data such as the Minimum Data Set (MDS), the standardized assessment of nursing home (NH) residents. However, MDS under-detects neuropsychiatric symptoms in people with dementia, and better identification in this outcome measurement is needed. This work aims to determine if the electronic medical record (EMR) NH data, the Interventions to Reduce Acute Care Transfers (eINTERACT) form, could improve the identification of agitated behaviors (behaviors). 77,936 assessments of the MDS and the EMR of 19,705 long-stay residents with dementia from 322 NHs, conducted between January 2020 and August 2022, were used. MDS behaviors were defined as any verbal or physical behaviors directed at others, resistance to care, or other behaviors (e.g., pacing). eINTERACT behaviors were defined as any general agitation or verbal or physical aggression. 96% of NHs used eINTERACT forms for at least half of their residents. On average, 14.8% (SD 35.6) of residents with a qualifying assessment in a given month had an MDS-documented behavior, and 2.4% (SD 15.2) had an eINTERACT-documented behavior. 1.4% (SD 11.7) had behaviors documented only on the eINTERACT form representing about a 10% increase in detectable behaviors in a given month over MDS alone. Results were robust to stratification by NH-level prevalence of MDS behaviors. Using the eINTERACT forms in addition to the MDS behavioral items increased in detection among long-stay residents with ADRD. There is some indication that greater use of eINTERACT is associated with greater increases in behavior identification.
THE UNEVEN LATER WORK COURSE: INTERSECTIONAL GENDER, AGE, RACE, AND CLASS DISPARITIES
Authors: Moen Phyllis , Flood Sarah , Wang Janet
Published: December 2023

We document patterned continuity and change in monthly work attachments and analyze the intersecting effects of age, gender, education, and race/ethnicity. We utilize 16-month panel data from Current Population Survey (2008-2016) to code monthly states: working full-time, long hours, part-time; being self-employed or unemployed; not working due to disability or family care, or retired. Analyses of 346,488 American women and men aged 50–75 years reveal patterned elasticity in the timing and nature of work attachments in the form of six distinctive pathways. Analyses illustrate divergences and disparities: advantages for educated White men, disadvantages for low-educated Black men and women through their early 60s, and intersecting effects of gender, education, and race/ethnicity during the later work course across age groups. We find convergence across social markers by the 70s. This research highlights the importance of intersectional analysis, recasting the gendered work course in later adulthood to reflect its complexities.
EARLY-LIFE WAR EXPOSURE AND LATER-LIFE FRAILTY AMONG OLDER ADULTS IN VIETNAM: DOES WAR HASTEN AGING?
Authors: Zimmer Zachary , Korinek Kim , Young Yvette , Teerawichitchainan Bussarawan , Toan Tran Khanh
Published: December 2023

We aimed to assess the nature and degree of association between exposure to potentially traumatic wartime experiences in early life and later-life frailty. The Vietnam Health and Aging Study included war survivors in Vietnam, age 60+. Latent class analysis (LCA) is used to construct classes exposed to similar numbers and types of wartime experiences. Frailty is measured using a deficit accumulation approach that approximates biological aging. LCA yields 9 unique wartime exposure classes, ranging from extreme exposure to non-exposed. Higher frailty levels among those with heavy/severe exposures certain combinations of experiences, including intense bombing, witnessing death firsthand, having experienced sleep disruptions during wartime, and having feared for one’s life during war. The difference in frailty-associated aging between the most and least affected individuals is more than 18 years. War trauma hastens aging and warrants greater attention toward long-term implications of war on health among vast post-conflict populations across the globe.
ACTIVITIES OF DAILY LIVING (ADL) NEGLECT IN INDIVIDUALS WITH DEMENTIA
Authors: Hancock David , Czaja Sara
Published: December 2023

Caregiver (CG) neglect, a form of elder mistreatment, is often measured by examining unmet care needs. A common way to measure unmet needs is to examine if a care recipient has needs for Activities of Daily Living (ADL) or Instrumental Activities of Daily Living (IADL) care needs, and if so, whether those needs are being met. The current study, using data from the Caring for the Caregiver Network Study, describes unmet ADL care needs among persons with dementia. Specifically, we examine how many needs there are, which needs are most common, how bothersome the caregiver finds attending to those needs, and how often those needs go unmet by the caregiver or other family members or friends. Overall, 1 in 10 care recipients experienced neglect as defined by unmet ADL needs. On average, caregivers (n=244) indicated care recipients needed help with 4 ADL care needs (range 0-7). The most common ADL need was needed help bathing, followed by getting dressed, and toileting. Moreover, the CGs generally found these tasks to bother or upset them between “not at all” and “a little.” Toileting and bathing were ranked as the most bothersome tasks. Additionally, 10% of the caregivers identified ADL needs which were not being met by either themselves or other family members or friends. The most common unmet need was help with bathing, followed by toileting. Needs were most bothersome and most likely unmet for intimate acts such as bathing and toileting, suggesting possible targets for skill-based intervention development.
DEVELOPING A SCALE TO MEASURE NEGLECT SEVERITY: THE HEALTH-RELATED SEVERITY IN ELDER NEGLECT SCALE
Authors: Rosen Tony , Pillemer Karl , Burnes David , Fulmer Terry , Teresi Jeanne , Safford Monika , Czaja Sara , Lachs Mark
Published: December 2023

Caregiver neglect in older persons can vary dramatically in severity, with differential impact on an older adult’s health. Assessing severity is critical for research and clinical practice but has received focus until recently. To address this gap, we developed a scale to describe the health-related severity of elder neglect using an expert consensus method. In development, the experts conceptualized severity as: (1) the level of risk that neglectful behaviors would cause morbidity or mortality and (2) related timeframe. Additionally, the experts recommended that the scale identify risk for future neglect. The scale was designed iteratively, and, after finalization, we assessed face and construct validity. The final scale was found to have validity. It has 5 levels: not present, not present / potential risk, present / mild, present / moderate, present / severe. Each level has a description to guide assessment. For example, present / mild is described as: “caregiving behaviors not optimal, with potential to create morbidity, but low concern for immediate danger,” present / moderate is: “caregiving behaviors with significant potential to create morbidity within the next 4 weeks,” and present / severe is “caregiving behaviors creating immediate danger of morbidity or mortality -- insufficient access to shelter, food, medication – with alternative living situation or ED visit / hospitalization recommended.” The description of not present / potential risk is: “though neglect not currently occurring, factors present that raise concern for future neglect risk.” Assessing neglect severity using this scale may improve understanding of the phenomenon and inform intervention.
DEMENTIA DIAGNOSES PREDICT CAREGIVER EDUCATION DISCREPANCIES IN HOSPITAL SETTING
Authors: Medlin Austin , Still Catherine , Werner Nicole , Fields Beth
Published: December 2023

Many family caregivers report feeling unprepared to provide care for persons living with dementia (PLWD) after their hospital stay. Consequently, PLWD may experience poorer health outcomes and higher service utilization rates. Health systems can provide education to patients and their family caregivers, increasing preparedness, but these practices are less understood. This retrospective data analysis of electronic health records examines the role of diagnostic billing codes in predicting amount of education received by patients and their family caregivers. Our dataset includes 419 unique encounters of hospitalized older adult patients with a documented dementia diagnosis and a listed family caregiver between 1/1/2019 and 8/1/2022. Dementia-related ICD-10 billing codes determined unique patient diagnoses. Encounters were given designations of receiving more vs. less education if the amount of education received was above or below the sample median. Logistic regressions then determined the relationship between diagnostic billing codes and education received while controlling for demographic and contextual characteristics. We found that encounters with diagnostic codes “other degenerative disease of nervous system” and “Alzheimer’s disease” were 2.8 and 3.3 times as likely to receive more education, respectively (95% confidence interval = [1.051, 7.347], p = .0394; [1.175, 9.461], p = .0236). Conversely, encounters with the code “other frontotemporal dementia” were 3.3 times as likely to receive less education ([1.150, 9.684], p = .0266). Findings demonstrate certain dementia-related diagnoses predict differences in how likely caregivers are to receive education. Health systems should evaluate for these differences and incorporate new methods to increase caregiving preparedness.
DEVELOPING A CONCEPTUAL MODEL TO ASSESS ACTIVE ENGAGEMENT WITHIN A DEMENTIA CAREGIVER INTERVENTION
Authors: Neller Sarah , Cajavilca Moroni Fernandez , Johnson Julene , Ellington Lee , Eaton Jacqueline
Published: December 2023

Active engagement is identified as an effective component of psychoeducational interventions for caregivers of persons living with dementia. There are many approaches to active engagement; however, limited assessment of this component within interventions reduces optimization and standardization. To fill this gap and increase transparency, we aimed to strengthen active engagement by developing Enhancing Active Caregiver Training (EnACT), an arts-based intervention designed to help caregivers address the behavioral symptoms of dementia. The intervention uses multi-sensory activities, including interacting with caregiver-informed vignettes, to foster engagement and process caregiving experiences. We partnered with caregivers of persons living with dementia (n=9) to iteratively refine EnACT through six focus groups. The purpose of this presentation is to report the process we took to identify how intervention participants actively engaged with EnACT. Focus group data were analyzed using process coding to identify the patterns of participant engagement with 17 intervention activities. The process codes were mapped to create a diagram of participant engagement for each activity. These diagrams were used to develop the EnACT Cycle of Engagement, a conceptual model illustrating how participants engaged with the intervention. The three-step model illustrates that: 1) antecedents (personal and intervention) contribute to 2) interaction with EnACT through participation, contribution, and application, which leads to 3) EnACT’s hypothesized proximal outcomes (capacity to adapt and appraisal of caregiving demands) and distal outcomes (perceived stress and caregiver well-being). The EnACT engagement model will be tested in the forthcoming randomized control trial assessing feasibility and acceptability.
INFLUENCE OF PERSON AND ENVIRONMENTAL FACTORS ON OLDER ADULT ENGAGEMENT IN VIDEO TELEHEALTH
Authors: Gately Megan , Waller Dylan , Maynard Matthew , Moo Lauren
Published: December 2023

Rural patients at Veterans Health Administration (VHA) are older and have more complex chronic conditions than Veterans receiving care outside VHA. Rural patients face challenges accessing care, particularly specialty services which are often in urban areas. Though video telehealth can increase access to care by older patients, video was underutilized by this group even during the rapid increase in use of video in response to COVID. The unequal uptake of video telehealth by older patients during a time when there were limited options suggests a gap in our understanding of the factors involved with older adults’ utilization of video telehealth. To explore these factors, we interviewed occupational therapy practitioners who were high users of video telehealth (N=27) about their experiences with video telehealth. According to interviews, successful utilization of video telehealth involves consideration of complex factors operating at the person (i.e., patient and clinician) and environmental levels. Person-level factors for the patient and/or family caregiver include technological literacy, sensory impairments, and stress tolerance. Clinician person-level factors include confidence with technology, attitudes towards video (including perceived benefits for clinical care), and specific skills like communication and flexibility. Environmental level factors include the physical setting (e.g., whether the patient/clinician are in a private space), availability of technical assistance for patients and clinicians, caregiver assistance on the patient side, and presence of a device and adequate broadband for patients. Elucidating the network of factors involved with video telehealth may enable sustained integration of video telehealth by rural patients most in need of care.
UNTANGLING THE MODEL MINORITY STEREOTYPE: PROMOTING HEALTH EQUITY AMONG ASIAN AMERICAN OLDER ADULTS
Authors: Wu Bei , Jang Yuri
Published: December 2023

The “model minority” stereotype portrays Asian Americans (AAs) as a monolithic group with common traits, e.g., high levels of education and income, and better health status. Five studies in this symposium used multiple data sources and provided rich information to untangling this stereotype. The first study highlighted racial/ethnic disparities in help-seeking behaviors among Americans with subjective cognitive decline, revealing that AAPIs exhibit the lowest likelihood of seeking help for cognitive problems. The second study examined the degree to which socioeconomic disparity contributes to functional impairment among older AAs relative to other racial/ethnic groups, revealing that AAs fare worst in the burden of functional impairment due to education disparity. The third paper explored the cultural adaptation of the NYUCI for Chinese and Korean dementia caregivers, showing that cultural beliefs have a profound effect on caregivers’ views of dementia and caregiving, their use of social and family support, and their understanding of self-care and counseling services. The fourth study assessed factors linked to depressive symptoms among older Southeast AAs, revealing that Vietnamese Americans have significantly more depressive symptoms than Indonesian and Filipino Americans. Resilience and age are negatively related to depressive symptoms, while greater family conflict and inability to speak English fluently are positively associated with depressive symptoms. The fifth study used a large longitudinal survey on older Chinese Americans and demonstrated that higher acculturation levels are associated with a more rapid decline in depression and a slower decline in activities of daily living but are not related to long-term cognitive changes.
CLIMATE CHANGE AND AGING: FROM VULNERABILITY TO ACTION
Authors: Ayalon Liat , Pillemer Karl
Published: December 2023

Older people are particularly susceptible to extreme climate change events. This is attributable to physiological susceptibility, but also to factors such as social isolation, digital exclusion, ageism, and living arrangement. Unfortunately, older people are often not considered in mitigation and adaptation climate change policies contributing to their heightened susceptibility in the face of extreme climate events. Compounding this challenge, it is younger people who are seen as the face of the climate change movement, at times, blaming older people for their (in)action, which has contributed to the current climate situation. Nevertheless, research has shown that older people engage in pro-environmental behaviors and can highly benefit from taking part in climate change activism. The present symposium aims to tackle this topic by discussing the challenges pertaining to older populations occasioned by climate change, and how older populations can engage in being part of mitigation solutions.. The first presentation by Carr and colleagues addresses global population aging and heat exposure with a particular focus on implications for wellbeing and social policy. Delving into the country level, Cherry and colleagues discuss findings concerning long term mental health effects of exposure to a single versus two extreme weather events. Moving to possibly mitigation and adaptation measures, Nikitin and Rupprecht address opportunities associated with exposure to nature, whereas Kohon and colleagues discuss the role that aging and old age capture in climate change policies. The symposium concludes with a theoretical conceptualization by Diehl which reframes aging in the context of climate change. This is a Climate Change and Aging Interest Group Sponsored Symposium.
CLIMATE CHANGE POLICIES AND OLDER ADULTS: AN ANALYSIS OF STATES’ CLIMATE ADAPTATION PLANS
Authors: Kohon Jacklyn , Carlson Bryant , Carder Paula , Himes Dani , Toda Eiji , Tanaka Katsuya
Published: December 2023

As climate change drives more frequent and intense weather events, older adults face disproportionate impacts, including having the highest mortality rates from storms, wildfires, flooding, and heat waves. State governments are critical in deploying local resources to help address climate change impacts. This policy study analyzes states’ climate adaptation plans to assess the methods through which they address the impact of climate change on older adults. This study uses content analysis to analyze available climate change adaptation plans for all U.S. states for strategies designed to increase resilience of older adults to impacts of climate change. Nineteen states have climate adaptation plans, of which 18 describe older adults as a population group with specific health impacts and risks factors. Four categories of adaptation strategies for older adults include communications, transportation, housing and emergency services. State plans vary in terms of the risk factors and adaptation strategies included. To varying degrees, states’ climate change adaptation planning address health, social and economic risks specific to older adults, as well as strategies for mitigating those risks. As global warming continues, collaborations between public and private sectors and across regions will be needed to prevent negative outcomes such as forced relocation and other social and economic disruptions as well as disparate morbidity and mortality.
CONCURRENT VISION AND HEARING IMPAIRMENTS, SOCIAL ISOLATION, DEPRESSION, AND ANXIETY: FINDINGS FROM THE NHATS
Authors: Xu Shu , Huang Alison , Zhou Yunshu , Ehrlich Joshua
Published: December 2023

Sensory impairments are contributors to poor health for older adults, and the likelihood of having more than one sensory impairment increases with age. There has been little research on population-level associations of visual and hearing function with social and mental health. This study examined the associations between objectively measured hearing and vision impairment, social isolation, depression, and anxiety among older US adults. Using nationally representative data from the 2021 National Health and Aging Trends Study, we conducted cross-sectional analysis among adults aged >70 (n=2,520). Visual impairment (VI) was defined as distance (<20/40), near (<20/40), and/or contrast sensitivity (>1SD below mean) impairment. Hearing impairment (HI) was defined as a better ear pure-tone average >25 decibel hearing level. Respondents with VI and HI were identified as having dual sensory impairment (DSI). Social isolation was assessed by living arrangement, core network size, religious attendance, and social participation. Depressive and anxiety symptoms were measured with the PHQ-2 and GAD-2, respectively. Weighted sample characteristics showed that 25.53% of older adults had DSI. Logistic regression analyses revealed that, compared to those without HI or VI, older adults with DSI were more likely to report social isolation (OR=1.71, 95% CI=1.12-2.60), have depression (OR=4.57, 95% CI=2.34-8.92), and anxiety (OR=2.65, 95% CI=1.36-5.17). Associations with DSI were stronger than for single impairments. All models controlled for age, gender, education, race/ethnicity, marital status, number of chronic conditions. Findings suggested that older adults experiencing DSI are at greater risk of having social isolation and emotional distress.
PATTERNS OF SELF-EMPLOYMENT AND HEALTH TRAJECTORIES IN LATER LIFE: EVIDENCE FROM CHINA
Authors: Chen Yu-Chih
Published: December 2023

Self-employment is a major form of work among older adults, yet most research has focused on its antecedents, with a focus on developed countries. Additionally, the impact of self-employment on health and well-being remains understudied. This study extends the current literature by investigating self-employment in China, a country with a unique self-employment landscape encompassing both agricultural and non-agricultural types. Using data from the 2011-2018 China Health and Retirement Longitudinal Study, this study investigated the impacts of self-employment on physical, mental, and cognitive health among 5,492 older adults. Latent class analysis was used to identify self-employment patterns. Multilevel models were employed to assess the associations between self-employment patterns and health outcomes, adjusting for baseline health conditions. Results showed that three patterns of self-employment were identified: consistently self-employed, wage worker, and switchers who transitioned between self-employment and wage work. Compared to wage workers, self-employed individuals and switchers have lower self-rated health and life satisfaction. No significant differences were found in depressive symptoms and cognitive scores. Notably, such effects were stronger for agriculture self-employment than the non-agriculture self-employment. The study highlights that most older Chinese are pushed into self-employment, which can adversely affect their health outcomes. Structural efforts to support older adults to stay engaged at work, such as age-friendly job redesign, anti-ageism measures in the workplace, or pension reform, would promote health and economic well-being among older adults in China.
GSA JOURNAL EDITORS PANEL: WHAT HAPPENS AFTER I PRESS SUBMIT? UNDERSTANDING THE JOURNEY OF A MANUSCRIPT
Authors: Kelley Jessica
Published: December 2023

You have finished your great manuscript. Formatted it. Wrote the cover letter. But what happens after you press the “Submit” button? This moderated panel of Editors-in-Chief of five of the GSA journals will talk about all aspects of the review process that lead to a final decision. We will cover topics such as how reviewers are selected, top reasons a manuscript may be rejected without review, and review timetables. We will discuss how Editors use the reviews to make a decision, including how they deal with reviewers who may disagree with each other, or a case where an Editor may disagree with a reviewer. Following the moderated discussion, we will have plenty of time for audience questions.
INTERDISCIPLINARY WELLNESS CLINIC SERVICES PROVIDED TO RESIDENTS IN LOW-INCOME SENIOR HOUSING
Authors: Klinedinst Jennifer , Resnick Barbara , Holmes Sarah , Brandt Nicole
Published: December 2023

To date a total of 15 visits have been made to the four senior housing communities participating in the Interdisciplinary Wellness Clinic program. Flyers are sent to the housing property managers and posted on a community bulletin board so that residents can sign up for services as they want. In addition, residents are free to walk in to the clinic during the hours we are present. At this point in time, a total of 190 residents have been evaluated, averaging about 15 residents per clinic which runs from 1 to 4pm. The majority of residents have been seen once, but 4 have been seen twice, 8 were seen 3 times, and 3 were seen 4 times. The average age of the residents attending the clinics is 77 years old, and the majority are women (91%) and nearly one-third were people of color (30%). During the visits, we have provided blood pressure checks, immunizations (flu, COVID-19 booster, Shingrix), completed Medical Orders for Life Sustaining Treatment, reviewed overall health status and health behaviors (e.g., smoking, exercise, immunizations), completed medication reviews, evaluated hearing and removed cerumen, and evaluated and addressed foot care (skin and nails) and completed Annual Wellness Visits for the residents. A number of emergency home visits and evaluations have also been provided to determine the appropriateness for an emergency room transfer or a need to intervene and call the individual’s outside primary care provider.
PREVENTING ELDER MISTREATMENT THROUGH A CAREGIVER-FOCUSED INTERVENTION: THE COACH PROGRAM
Authors: Wilber Kathleen , Rowan Julia , Yonashiro-Cho Jeanine , Mosqueda Laura , Hou Anthony , Gassoumis Zach
Published: December 2023

Elder mistreatment has negative implications for individuals, families, communities, and society as a whole, yet little research exists on interventions or prevention approaches. This study reports on the results from the pilot test of an elder mistreatment prevention program. The Comprehensive Older Adult Caregiving Supports (COACH) program was developed as a strengths-based person-centered caregiver support intervention, built on evidence-based prevention approaches used in other types of family violence. In a double-blind randomized controlled trial, family caregivers (n=80) of older adults aged 65 and older who were members of Kaiser Permanente completed surveys at baseline, post-test, and three-month follow-up. The primary outcome was elder mistreatment; additional proximal outcomes were caregiver burden, quality-of-life, anxiety, and depression. All analyses were conducted using nonparametric tests. The treatment group had no mistreatment at 3-month follow-up, a significantly lower rate than the control group (treatment=0%, control=23.08%, p=0.010). Among the proximal outcomes, a significant difference in social quality-of-life was seen at post-test but did not persist to the 3-month follow-up. No further proximal outcome effects were detected. This pilot program offers a promising model to reduce elder mistreatment and its resultant impacts on the health and well-being of both caregivers and the older adults they care for. In helping to ameliorate mistreatment, COACH supports individuals providing crucial care to older adults with chronic health conditions and reduces the burden of addressing this complex condition for an already strained geriatric health and social service delivery system.
IS HOME HOSPICE THE “GREAT EQUALIZER?”—ADDRESSING EQUALITY AND EQUITY DURING THE COVID-19 PANDEMIC
Authors: Moreines Laura , Boafo Jonelle , Franzosa Emily , Kim Patricia , Schulman-Green Dena , Aldridge Melissa , Brody Abraham , David Daniel
Published: December 2023

COVID-19 illuminated many of the inequities that exist in the current healthcare system, especially for those who are most vulnerable and facing the end of life. Social determinants of health (SDOH) directly and indirectly influence access to the quality of care received by patients enrolled on the hospice benefit. We interviewed 20 interdisciplinary providers (nurses, managers, administrators, physicians, medical directors, social workers, and clergy) between September 2022 and January 2023 from three healthcare organizations that provided hospice care to older adults and their caregivers in NYC regarding their perceptions of the impact of SDOH on the delivery of hospice care during the pandemic. We then conducted rapid analysis of their responses. Findings emerged around three salient themes: 1. “I provide equal care to everyone” (Some providers recognize SDOH result in inequities within hospice, whereas others perceive hospice as an equalizer of care); 2. “They’re going to kill us” (Describing barriers that challenge hospice enrollment and continued access to care); and 3. “We’ve got to do better” (Addressing inequity through organizational and community programs that address barriers and improve access to hospice). Overall, we learned that SDOH must be addressed in a proactive rather than a reactive way to ensure hospice access. Systemic, rather than individual approaches were needed to overcome existing barriers exacerbated by the pandemic. To this end we will discuss lessons learned and strategies for program development and equitable delivery of home hospice care.
ASSOCIATIONS OF VISUAL IMPAIRMENTS AND OCULAR DISEASE WITH BRAIN VOLUMES AND DEMENTIA IN UK BIOBANK
Authors: Ferguson Erin , Buto Peter , Thoma Jingxuan Wang Mary , Casaletto Shea Andrews Kaitlin , Choquet Tom Hoffmann Helene , Yaffe Kristine , Glymour M Maria , Brenowitz Willa
Published: December 2023

Visual impairments and ocular diseases are emerging potentially modifiable risk factors for dementia, however, causal relationships are poorly understood and vision impairment may also impact dementia evaluations. Few studies have examined associations of multiple measures of visual impairments with markers of neurodegeneration. We investigated associations of visual acuity and history of ocular diseases with dementia and brain MRI outcomes. UK Biobank participants aged 40-70 without dementia at assessment (n=496,938) self-reported history of cataract, glaucoma, age-related macular degeneration Subsets had visual acuity exams and refractive error measured by autorefractor (n=117,163) and brain MRIs (n=33,923). In cox proportional-hazard models adjusted for demographics and other health conditions, history of cataracts was associated with higher risk of all-cause dementia (HR:1.19: 95%CI: 1.09-1.31) but other eye conditions were not associated. History of cataract was associated with significantly smaller total gray matter volume (β=-2483 mm3, 95% CI: -4225 to -741) but not an AD brain signature based on cortical thickness. Worse than 20/40 visual acuity was associated with dementia (HR = 1.40, 95% CI: 1.11-1.77) but myopia defined based on refractive error was not, and neither were associated with total or regional volumes on brain MRI. History of cataract and binary 20/40 vision are associated with dementia risk. Our results suggest that cataract, but not myopia, may increase risk of neurodegeneration independent of typical AD, but more investigation is needed.
MEETING THE CHALLENGE OF AGE-INCLUSIVE EDUCATION: FOCUS GROUP PERSPECTIVES
Authors: Whitbourne Susan
Published: December 2023

Through a series of 16 virtual focus groups involving a national sample of 78 faculty, staff, and students, a set of challenges and related strategies for meeting those challenges were identified based on the ICCS responses from campus constituent groups of faculty, staff, and students. Qualitative analysis of focus group transcripts in the areas of teaching/learning, personnel, and student affairs produced 969 strategy statements that were then collapsed into thematic groupings based on the challenges they were intended to address. Major challenges and their relevant areas included the following: Long-term employees often feel undervalued (personnel), non-traditional age and older students often feel that career services do not meet their needs, and non-traditional age and older students often feel excluded or disregarded in the post-secondary classroom. Focus group members suggested strategies in the area of personnel that included greater recognition of accomplishments of long-term employees. In student affairs, they suggested such strategies as providing more resources for advising and career services. Teaching and learning strategies included incentivizing faculty to develop age-inclusive practices and promoting age-friendly classroom and course offerings. These findings suggest ways for campuses to enhance age-inclusive practices through specific actions, but their feasibility and impact remain necessary to evaluate.
GROWING OLD IN CHINA: SYSTEMATIC REVIEW OF LONG-TERM CARE INSURANCE PILOT STUDIES
Authors: Lobanov-Rostovsky Sophia , He Qianyu , Chen Yuntao , Curry Natasha , Brunner Eric , Liao Jing , Hemmings Nina , Venkatraman Tishya
Published: December 2023

Between 1970 and 2020, there was a three-fold increase in China’s ≥65 population, compared to less than a doubling in UK. This rapid-ageing demographic has led to a rise in age-related disabilities. At the same time, internal migration and declining fertility have shaken traditional models of care. An important policy response is to pilot differing long-term care insurance (LTCI) systems, with the aim of establishing equitable care for all. Strengths and limitations of the first set of pilot studies have been identified. In 2020, a second set of 34 pilot studies was introduced. Following PRISMA guidelines, we undertook a systematic review of literature published since introduction of the second pilot phase, to answer the question: ‘what are the key challenges to China achieving an equitable nationwide long-term care system for older people?’. Records were eligible for inclusion if published between June 2020 and June 2022 in Mandarin or English. 42 studies (n=16 Mandarin) were included. Four themes emerged: poor quality of service provision, widespread preference for family care, inequitable distribution of cost burden, and varying LTCI eligibility. Key recommendations included increasing salaries to attract and retain staff, mandatory financial contributions from employees and a unified standard of disability with regular assessment. Strengthening support for family caregivers and improving smart care capacity can support preferences to age at home. Our systematic review highlighted significant challenges in provision of equitable care which suits preferences of its users. China’s LTCI pilots will provide useful lessons for other middle-income countries with rapidly ageing populations.
SLEEP DISTURBANCES IN RACIAL/ETHNIC DIVERSE MIDDLE-AGED AND OLDER ADULTS: FACTORS RELATED TO SLEEP DISTURBANCES
Authors: Gamaldo Alyssa , Sardina Angie , Mogle Jacqueline
Published: December 2023

Complaints of poor sleep health is a prevailing U.S. public health issue. Although complaints of sleep disturbances is common in U.S. adults, prior research has indicated rates of sleep disturbances tend to vary across racial/ethnic groups. These cross-racial/ethnic comparison approaches may be limited, however, in identifying specific and unique sociodemographic and health factors related to sleep disturbances within racial/ethnic groups. The current study explored two specific aims. The first aim was to explore racial differences in self-reported sleep disturbances. The second aim was to explore sociodemographic and health factors related to sleep disturbances within racial/ethnic groups. A sample of U.S. adults (N=521; age range=40-92) were surveyed via Qualtrics Software (December 2022). Sleep disturbances was measured by the Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaire. Surveys were also collected on sociodemographic (e.g., age, monthly household income, education years, food insecurity, income changes due to COVID-19) and health (e.g., cognitive function, depressive symptoms, well-being, physical functioning, bodily pain, physical health conditions, and loneliness) factors. A univariate analysis of variance revealed non-significant racial/ethnic group differences in sleep disturbances (p > .05). However, bivariate correlations stratified by racial/ethnic groups suggested unique sociodemographic and health factors related to sleep disturbances within each racial/ethnic group. These findings contradict prior research of significant racial/ethnic group differences in sleep disturbances. Conversely, the findings support further investigating unique biopsychosocial factors associated with sleep health within racial/ethnic groups, which may provide meaningful information that may not be detected with cross-racial/ethnic comparison approaches.
ASSOCIATIONS OF PLASMA GDF15 WITH PHYSICAL PERFORMANCE AND COGNITIVE FUNCTIONS IN OLDER ADULTS
Authors: He Lingxiao , de Barreto Philipe Souto , Sánchez Juan Sánchez , Rolland Yves , Guyonnet Sophie , Parini Angelo , Lucas Alexandre , Vellas Bruno
Published: December 2023

Background

Growth differentiation factor 15 (GDF15) has been associated with several age-related disorders, but its associations with functional abilities in community-dwelling older adults are not well studied.

Methods

The study was a secondary analysis on 1096 community-dwelling older adults (aged 69 to 94 years) recruited from the Multidomain Alzheimer’s Preventive Trial. Plasma GDF15 was measured one year after participants’ enrolment. Annual data of physical performance (grip strength and short physical performance battery [SPPB]) and global cognitive functions (mini-mental state examination [MMSE] and a composite cognitive score) were measured for four years. Adjusted mixed-effects linear models were performed for cross-sectional and longitudinal association analyses.

Results

A higher GDF15 was cross-sectionally associated with a weaker grip strength (β = -1.1E-03, 95%CI [-2.0E-03, -1.5E-04]), a lower SPPB score (β = -3.1E-04, 95%CI [-5.4E-04, -9.0E-05]) and worse cognitive functions (β = -2.4E-04, 95%CI [-3.3E-04, -1.6E-04] for composite cognitive score; β = -4.0E-04, 95%CI [-6.4E-04, -1.6E-04] for MMSE). Participants with higher baseline GDF15 demonstrated greater longitudinal declines in SPPB (β = -1.0E-04, 95%CI [-1.7E-04, -2.0E-05]) and composite cognitive score (β = -2.0E-05, 95%CI [-4.0E-05, -3.6E-06]). The optimal initial GDF15 cutoff values for identifying participants with minimal clinically significant decline after one year were 2189 pg/mL for SPPB (AUC: 0.580) and 2330 pg/mL for composite cognitive score (AUC: 0.587).

Conclusions

Plasma GDF15 is cross-sectionally and longitudinally associated with lower-limb physical performance and global cognitive function in older adults. Circulating GDF15 alone has limited capacity of discriminating older adults who will develop clinically significant functional declines.
ATTITUDES TOWARD ADVANCE DIRECTIVES AMONG OLDER SOUTHEAST ASIAN AMERICANS
Authors: Wang Kaipeng , De Fries Carson , To My Ngoc , Sun Fei , Wu Bei , Levkoff Sue
Published: December 2023

Advance directives (ADs) are legal documents that enable individuals to communicate their end-of-life care preferences in advance. AD completion is associated with decreased likelihood of unwanted medical interventions, healthcare costs, and decisional burden for family members. Compared to older Americans in general, older Asian Americans are less likely to complete ADs. While research focusing on ADs among Asian Americans has grown, few have investigated attitudes toward ADs among older Southeast Asian Americans (SEAAs). The study addresses that gap by examining factors associated with attitude toward ADs among older SEAAs. Using convenience sampling from 12 community partners and snowball sampling, we recruited 251 participants aged 55 and older who self-identified as Vietnamese (n=113), Filipino (n=100), or Indonesian (n=38) Americans. Through online or in-person questionnaires, participants completed the Nolan and Bruder’s Advance Directive Attitude Survey, which measures attitudes toward ADs. Responses are rated on a 4-point Likert scale, with higher scores indicating more positive attitudes. In general, Indonesian (mean=3.40, SD=0.55) and Filipino (mean=3.40, SD=0.68) Americans expressed significantly more positive attitude toward ADs than Vietnamese (mean=3.15, SD=0.56) Americans. Results of ordinary least squares regression showed that family cohesion, expectation of intergenerational support, depression, and resilience were positively associated with attitude toward ADs, whereas death anxiety was negatively associated with attitude toward ADs. By enhancing understanding of SEAAs’ attitudes towards ADs, these results can inform culturally appropriate interventions to improve AD implementation among SEAAs and contribute to broader awareness of and access to end-of-life care services in this population.