bluuebunny/crossref_metadata_2025 huggingface dataset:
ASSESSING STEREOTYPES OF OLDER ADULTS THROUGH DRAWING: IMPLICATIONS FOR PEDAGOGY IN UNDERGRADUATE AGING COURSES
Authors: Pate Melannie , Fugate-Whitlock Elizabeth
Published: December 2022

Negative stereotypes and ageism toward older adults remain an insidious problem in the United States. These harmful views of older adults can lead to disparities in health care, social isolation, and loss of functional ability. In order to supplement current research on the perceptions of older adults, the researchers focus on the views of undergraduate students before and after taking an aging course. The students included in this study are enrolled in an undergraduate health and aging course or an undergraduate introduction to gerontology course. Before beginning any coursework, students were asked to draw an older adult, using any combination of colored markers available and to write one sentence describing an older adult. At the end of the course, students were again given the same directive to draw an older adult, using any combination of colored markers, and write one sentence describing an older adult. Content analysis was used to analyze the drawings and the phrases. Colors used and depictions of activity in the drawings changed from the first day of class to the end of the course, showing a progression of their views. Drawings were chosen specifically to elicit honest responses and perceptions of older adults. The results of this study can be used to inform pedagogical choices made when teaching courses on aging to undergraduate students.
STANDING UP TO AGEISM: PERCEPTIONS OF SIXTY AND EIGHTY YEAR-OLD ADULTS WHO REJECT BENEVOLENT AGEISM
Authors: Chasteen Alison , Saleem Zainab , Horhota Michelle
Published: December 2022

Older people encounter ageism in a variety of daily contexts, yet the consequences of confronting ageist behavior by older targets are not well understood. The present study asked whether the age of the older target who accepts versus rejects an act of benevolent ageism results in different impressions of the older target. Young (N = 368) and older (N = 388) adults read a scenario in which either a 60 or 80 year-old individual accepted or rejected benevolent ageism in the form of unwanted help. Participants then evaluated the older target’s warmth, competence, and overall impression of the target. Consistent with pre-registered hypotheses, competence ratings increased but warmth and overall impression ratings decreased when the older target rejected benevolent ageism compared with accepting it. Also consistent with predictions, older participants rated the older target more positively on all measures compared with younger participants. Surprisingly, the 80 year-old target was rated as warmer and made a more positive overall impression than did the 60 year-old target. Target age did not moderate reactions to accepting or rejecting unwanted help, suggesting that perceivers did not distinguish between young-old and old-old targets when evaluating an older target that confronts benevolent ageism. Taken together, these findings are consistent with research on confronting prejudice in general, whereby such confrontations can result in both positive and negative outcomes. Although older adults may reaffirm their competence through rejecting benevolent ageism they will also face the social cost of being viewed as less warm.
DEVELOPMENT AND VALIDATION OF THE FAMILIAL AGEISM SCALE
Authors: Walker Ruth , Kinkade Emily , Zelin Alexandra
Published: December 2022

Researchers have found a tie between family relationships and the physical and mental health outcomes of older adults (Kelly et al., 2017; Silverstein & Giarrusso, 2010). Researchers have also established the negative impact of ageism on the physical and mental health of older adults (Chang et al., 2020; Lyons et al., 2018). However, studies studying the impact of ageism perpetuated by family members is relatively unexplored. This may be due to a lack of measures to assess ageism perpetuated by family members specifically. To address this gap, the goal of the current study was to design a tool to measure experiences with familial ageism. Scale items were created based on the review and analysis of qualitative data on this topic (Walker & Kinkade, in prep). Items were reviewed by scholars for content and clarity. Two studies were then conducted to develop and validate our measure to assess experiences with ageism within the family context. In the first study, 151 participants completed the familial ageism items. The factor structure, convergent and divergent validity of the items were examined. We found evidence of strong psychometric properties for five related, but unique, factors in the retained items: Benevolent Ageism, Technological Competency, Out of Touch, Aging Appearance, and General Competence. Construct, convergent, and divergent validity was supported with small to large correlations with scales measuring general ageism, depression, and ego integrity. A second study with 282 participants confirmed the five-factor structure. Implications and recommendations for scale utilization will be discussed.
KNEE OA AS A SYSTEMIC MODEL OF AGING
Authors: Lox Dennis
Published: December 2022

Knee osteoarthritis (OA) and aging, may be viewed differently by various patients and health care providers. Aging is now considered as a systemic interplay of molecular, cellular, tissue, hormonal, and body dysfunctions. Important drivers of these factors lead to osteoarthritis, coronary artery disease, cancer and dementia. An understanding of each as its progresses can alter morbidity. The proposed theories of aging hold true for knee OA. A simple joint compartment model, such as the knee, may help this understanding. A degenerative knee OA joint is a progressive disorder, just like aging. Knee OA may be accelerated by trauma, aging, decreased autophagy, cellular changes, cytokine production, disruption of the matrix, and cellular senescence. The associated SASP leads to the progressive cascade of degenerative changes. Understanding how to mitigate these affects provides a framework for a longer healthspan. Obesity, and it’s adipokines exacerbate the inflammation, and compound weigh bearing stress. Promotion of longevity pathways, stimulate repair via Sirt, AMPK, FOXO and decreased stimulation of MTor, and FOXO4- P53 coupling. The resulting changes can altering the nature of the accelerated nature of progressive knee OA. Joint conservation, unregulated IL-4, IL-10, IRAP, and down regulation of NF-kB, and the ensuing cascade of HMBG1, and DAMP. Hippocrates wrote walking is man’s best medicine, however, with knee OA this may need amendment, to encourage proper medical guidance for appropriate exercise and diet. It is time to merge knee OA and aging models to work in harmony for prolonged health span.
STABILIZING ROLE OF HCN CHANNELS ON POST-CAMP MECHANISMS OF DETRUSOR MYOCYTE CONTROL
Authors: Ramasamy Ramalakshmi , AlObaidi Alya , Smith Phillip
Published: December 2022

Aging is associated with an increased incidence of co-morbidities, including detrusor underactivity (DU). DU is defined as the failure to create sufficient and durable expulsive force to adequately empty the urinary bladder during a normal voiding timespan. DU is prevalent in older adults, as evidenced by its prevalence in nearly two-thirds of nursing home residents. Current treatments are mostly palliative or come with many side effects. β-adrenoceptor-mediated relaxation is the primary mechanism of detrusor relaxation, and Hyperpolarization-activated Cyclic Nucleotide-gated (HCN) channels have previously been identified by us and others as a very important mediator of this relaxation, however the role of HCN in detrusor relaxation has not been elucidated. Hence, we seek to characterize its role in adrenergic relaxation mechanisms and spontaneous myocyte activity. Male and female 10–12-month-old C57Bl/6 mice were used for this study. Pharmacomyography studies were performed to assess the effect of different drugs that act at various steps along the adrenergic relaxation pathway, +/- CsCl, an HCN blockade at [5mM]. As expected, we saw that increasing HCN opening probability by isoproterenol or forskolin (adenylyl cyclase/cAMP-agonist) or lamotrigine (HCN-activator) resulted in decreases in tonic tension, but were diminished in the presence of CsCl. Mechanisms modulated by H89 (PKA-inhibitor) and NS1619 (BK-channel-agonist) show no change in tonic tension, however spontaneous phasic activity significantly increases. These data support increased cAMP, not hyperpolarization, as the key inductor of HCN in adrenergic relaxation.
HOW DO INTERPERSONAL FACTORS AFFECT GRIEF AMONG BLACK MIDDLE- TO OLDER-AGED ADULTS?
Authors: McDuffie Danielle
Published: December 2022

This talk will explore: 1) the conceptual importance of select interpersonal factors inherent to Black culture and bereavement, and 2) the impact of these factors on grief in a Black bereaved sample. 103 Black adults aged 45+ were administered items assessing cultural (communalism, experienced racial violence) and bereavement-specific (expectancy and suddenness of loss, closeness to the deceased, anger) factors. Using linear regressions, closeness (p<.001), suddenness (p=.020), anger (p<.001), and communalism (p<.001) predicted reported levels of grief. This study identifies factors which substantially dictate the experienced levels of grief of bereaved Black adults in the latter half of life. With cultural factors notably impacting the Black bereavement experience, individuals seeking to work with this population must adopt strategies to keep bereaved Black adults connected to their communities throughout their loss. Resources to support Black adults in maintaining healthy continuing bonds with the deceased through abrupt or unsettling losses also appear paramount.
RETURNED MISSING PERSONS WITH DEMENTIA: WHAT ROLE CAN FIRST RESPONDERS AND SERVICE PROVIDERS PLAY?
Authors: Daum Christine , McLennan Lauren , Letts Elyse , Conway Cathy , Liu Lili
Published: December 2022

The number of people living with dementia that wander and go missing is increasing. First responders and service providers play a role in the return of a missing person living with dementia. In the United Kingdom (UK), “return home interviews” are discussions between police and returned missing persons that offer support to the returned missing person to prevent repeat incidents. This study aims to explore and understand the role of first responders and service providers who follow-up with returned missing persons living with dementia. Eight service providers (e.g., social workers) and seven first responders (e.g., police officers) from Canada and the UK participated in online semi-structured interviews. Data were concurrently collected and analyzed using conventional content analysis. In the UK, police conduct “return home interviews” within 72 hours of the missing person’s return. Some charities conduct interviews with vulnerable populations to prevent repeat missing incidents by understanding the circumstances of the missing incident and connecting the person to community supports. In Canada, although follow-up with returned missing persons is not routine, some police units offer support to returned missing older adults. Government and community support organizations also offer supports to returned missing older adults such as referrals for in-home support, technologies, and vulnerable person registries. Service providers and first responders have an important role to play in the prevention of repeat missing incidents. Findings will contribute to the development of a Canadian practice guide for conducting interviews with returned missing persons living with dementia.
THE EFFECTS OF LIFETIME EXPERIENCES OF HOMELESSNESS AND INCARCERATION ON COGNITIVE AGING
Authors: Hanes Douglas , Clousten Sean
Published: December 2022

Alzheimer’s disease and related dementias (ADRD) remain a pressing health concern in the U.S., and this burden and access to care are unequally distributed across the population. The U.S. has one of the highest incarceration rates globally, which is also unequally distributed; and groups like veterans, formerly incarcerated people, and sexual and gender minorities (SGM) face high risk of homelessness. Homelessness and incarceration are potentially traumatic experiences in themselves. Both experiences are more likely among people with less formal education, less economic security, and racialized groups, even as they reduce educational and economic opportunities. Using data from the Health and Retirement Study (HRS; 1998–2016), we investigate whether self-reported lifetime experiences of homelessness and incarceration (including time spent incarcerated) are associated with cognitive functioning and risk of possible dementia. Multilevel modeling adjusted for age, education, and other demographic covariates revealed that lifetime experiences of homelessness and incarceration are associated with lower cognition (Homelessness: β=-1.231, p< .001; Incarceration: β=-0.929; p < .001), but slower aging-related declines (Homelessness-slopes: β=0.044, p<.001; Incarceration-slope β=0.041; p<.001), and homelessness moderated the impact of prior incarceration (β=-1.789; p<.001), but less-steep declines (β=0.092; p <.001). Homelessness and incarceration, independent of their other risk factors and associated harms, have associations with ADRD risk.
EXPLORING THE EFFICACY OF MOCA SCORE CORRECTIONS IN REDUCING THE INFLUENCE OF RACE/ETHNICITY
Authors: McCray Rachel , Bubu Omonigho , Blanc Judite , Seixas Azizi , Jean-Louis Girardin , Turner Arlener
Published: December 2022

As studies have highlighted significant differences in test score distributions between ethnicities, we chose to examine if the MoCA corrections for education curb racial differences. Therefore, we use data from the NIA Alzheimer's Disease Research Center (ADRC) program to explore the efficacy of score corrections in reducing the influence of race/ethnicity. This study utilized the NACC dataset to analyze data covering UDS visits from September 2005 to February 2021. Participants included in the analyses (n= 11987, 64.9% women, 12.3 % Black/African American, mean age 73□9.460; 16□4.98 years of education) were all cognitively normal. The analyses uses the Montreal Cognitive Assessment (MoCA) with and without correction for education (addition of one point for less than 12 years of education), via cut off score derived cognitive status categories. A 2x3 contingency table revealed a statistically significant association between participants’ race (black vs white) and performance on the uncorrected MoCA, X22,n=5291=188.971, p<.001, and the corrected MoCA X22,n=5282=167.073, p<.001. Additionally, a One-way ANCOVA analysis comparing the correlation of education and uncorrected MoCA score for Black/African American (r=.425, p<.001) and White participants (r=.198, p<.001) shows a significant difference between the two groups F1,5288=167.992, p<.001. Specifically, in Black/African American participants, the correlation is much stronger suggesting that years of education is a greater determinant of cognitive status. These results demonstrate that regardless of controlling for education via adding buffer points significant racial disparities in global cognition scores were still present. Alternative corrections for race and education should be considered for future test adaptations.
EXPERIENTIAL ASSESSMENT OF AN INNOVATIVE DEMENTIA CARE TRAINING SEQUENCE FOR HEALTH AND HUMAN SERVICES WORKERS
Authors: Wehry Susan , Wihry David
Published: December 2022

This poster presents results of an assessment of an interdisciplinary dementia care training titled Dementia Reconsidered (DR). In contrast to disease and deficit-focused training curricula, DR incorporates and emphasizes the strengths and humanity of people living with dementia and focuses on person-directed support for, and care of, persons living with dementia. For example, DR makes the case for an approach to shared and supported decision-making that optimizes the individual’s— and significant others’—abilities. The on-line lectures were chunked to accommodate cognitive load and active learning; 20-30 second stretch breaks were interspersed to facilitate attention. This may account for the higher retention and utilization rates of DR than are often found in one-off trainings. A retrospective pre-post survey administered at the conclusion of DR sessions measured participant learning outcomes. Participants in DR sessions were representative of the fields of social work (42%), nursing (21%), and a significant “other” category (28%), mostly long-term care administrators. Among post-training survey respondents (N=36), 77% improved their knowledge of the key principles of person-directed dementia care; 73% (N=37) showed improved comfort in supporting residents with dementia during the CoVID-19 pandemic; 83% (N=24) showed improvement in ability to distinguish capacity and competency; and 83% (N=23) reported increased comfort in supporting people with dementia in making decisions in the face of diminished capacity. At six month follow-up, 63% (N=33) had used a skill gained from their training (17% no, 20% not sure). Implications for training in dementia care practices will be discussed.
DIRECT CARE WORKFORCE IN THE US BEFORE AND DURING COVID-19
Authors: Kelly Christopher , Deichert Jerome , Holley Lyn
Published: December 2022

Purpose

This study describes the changes in the direct care workforce between 2019 and 2020. Design and

Methods

Data were from the 1% Public Use Microdata Sample (PUMS) of the 2019 and 2020 American Community Survey (ACS). Logistic regression was used to compare demographic and employment characteristics of direct care workers (DCWs) in 2019 and 2020.

Results

While the total number of DCWs increased by 0.08% and the number employed in home care increased by 3.45%, the number of DCWs employed in hospitals decreased by 3.73% and the number employed in residential care facilities decreased by 4.01% from 2019 to 2020. Compared to 2019, DCWs in 2020 were more likely to be nonmedical aides, under 25, over 65, non-white, to purchase health insurance directly, and to receive health insurance from Medicaid. DCWs in 2020 were less likely to be widowed, to be recently married, to be non-English speaking, to work year-round and full-time, to have moved in the last year, and to be below poverty than they were in the previous year. Implications: By the end of 2020, the early effects of the COVID-19 pandemic on the direct care workforce could be seen. While the total number of DCWs increased slightly, this was due to the accelerated growth of DCWs in home care, as the decline in the number of DCWs in hospitals and residential care facilities also accelerated. The direct care workforce in 2020 was more nonmedical, part-time, entry-level or exit-level and non-white than in the previous year.
OLDER ADULTS LEAVING THE WORKFORCE: SENSORY LOSS, RETIREMENT, AND DISABILITY
Authors: Morales Emmanuel Garcia , Assi Lama , Reed Nicholas
Published: December 2022

Hearing loss (HL), vision loss (VL), and their combination (dual sensory loss, DSL) are common among older adults. Sensory loss impacts labor productivity which might result in departures from the workforce. Whether older adults leave due to retirement or a disability, and how these responses are associated with sensory loss remains unexplored. Using the 2004-2018 rounds of the Health and Retirement Study, self-reported sensory loss (No Impairment/HL/VL/DSL) at baseline, and reason for leaving the workforce (retirement or disability) were observed. Competing risk models models for departures from the workforce treating retirement or disability as a competing risk were estimated. Among 5,201 adults employed at baseline, ages 50-94, 3,436 reported retirement, and 4254 reported a disability as a reason for not working. In Fine-Gray models, treating retirement as a competing risk and adjusting for sociodemographic and clinical characteristics, we found that compared to older adults without impairments, DSL was associated with a 50% increase in the rate of departures from the labor force due to disability among adults in the in the risk group (SHR=1.51; 95% CI=1.09,2.11). In contrast, when treating disability as the competing risk, HL was associated with a 22% increase in the rate of departures labor force due to retirement (SHR=1.22; 95% CI=1.10,1.36) among adults in the risk group when compared to those without impairments. In sample of older adults, we provide evidence that the presence of sensory impairments is associated with departures from the workforce. Our results highlight differences in the type of departures by sensory loss.
URBANIZATION, FINANCIAL SOURCE, AND PLACE OF DEATH AMONG CHINESE LONGEVITY OLDER ADULTS
Authors: Zhou Rui , Wang Shuangshuang , Yao Nengliang
Published: December 2022

The research on place of death among Chinese oldest adults is scare. This study explored the associations of urbanization and financial source on the places of death among Chinese longevity older adults. The sample consists of 21,920 decedents (female=60%, died at home=89%, mean age at death=95) from 2000-2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS), conducted by Peking University. Places of death were divided into two categories: home and other sites (including hospitals, institutions and others). Urbanization was measured by residential areas: rural or city. Financial source consisted of family financial support and retirement wage. Chi-square test showed that older adults living in rural areas and getting family finance support were more likely to die at home. Results from binary regression models show that controlling for covariates, decedents living in cities were 6.2 times more likely to die in other places than at home and those received retirement wage were 3.1 times respectively. Notably, older adults who lived in cities and also had retirement wage were 17.7 times more likely to die in other places comparing to those living in rural areas with only family finance support. Findings suggest that more older adults will choose to die at hospitals or institutions as the process of urbanization and the development of social pension system in China, which will put enormous pressure to the hospital-centered healthcare system. Improving the quality of healthcare in grassroots areas might be a feasible attempt to relive the pressure of hospital-centered healthcare system in cities.
PALLIATIVE AND END-OF-LIFE CARE INTERVENTIONS FOR INDIVIDUALS EXPERIENCING HOMELESSNESS: A SCOPING REVIEW
Authors: Ingle Pilar
Published: December 2022

Despite the benefits of palliative and end-of-life (PEOL) care for individuals with life-limiting illness, barriers to accessing this care persist among older adults experiencing homelessness. A number of studies have identified barriers to PEOL care from the perspectives of unhoused individuals and other relevant stakeholders; however, few empirically studied interventions exist to support evidence-based guidelines for PEOL care for this population. This scoping review aimed to identify PEOL interventions for adults experiencing homelessness. The search was conducted in May 2021 and yielded 480 results, from which 50 full-text articles were closely reviewed for inclusion. Sources were included if they reported findings of original, empirical research or quality improvement projects evaluating PEOL services tailored for individuals experiencing homelessness. A total of 13 articles representing 12 studies published between 2006-2021 were included in the review. Over half (n = 7) of the studies described interventions to promote advance care planning documentation, five described interventions embedding PEOL services within homeless shelters, and one described a community outreach program to increase access to PEOL services. Nearly all studies reported positive outcomes on participant perspectives, advanced directive completion rates, or cost analysis. None of the studies included clinical palliative care outcomes. Although most studies reported promising results, service and healthcare providers expressed concerns about continuing challenges and longevity of the programs. The body of literature encompassing PEOL interventions for people experiencing homelessness is limited but growing. Future research may benefit from the inclusion of clinical outcomes and efforts to reduce structural barriers to providing care.
RECRUITING PATIENT-CAREGIVER DYADS IN A PANDEMIC: CHALLENGES AND OPPORTUNITIES IN HOSPICE AND PALLIATIVE RESEARCH
Authors: Wallace Cara L , Washington Karla , Coccia Kathryn , Ferguson Verna , Wingo Anna , Hinyard Leslie , Berg-Weger Marla , Wladkowski Stephanie P
Published: December 2022

Hospice and palliative care (HAPC) research has shown participation in research benefits both patients and caregivers. However, recruiting participants for HAPC research can be difficult and requires flexible, adaptive, and creative strategies. This presentation will review ongoing efforts for recruitment and subsequent alterations for an active NIH study of patients and their caregivers who have been discharged alive from hospice. A live discharge occurs when a hospice patient medically stabilizes, no longer meeting policy’s prognosis eligibility criteria. In 2019, hospices in the United States served more than 1.6 million people, and 17.4% were discharged alive from hospice care, with 6.5% due to being ‘no longer terminally ill’ (NHPCO, 2021). Currently, there is not an explicit discharge process available to guide practitioners in transitioning patients and caregivers out of hospice care, creating challenges and opportunities for collaborative research.Despite existing relationships with hospice networks, our initial recruitment strategy of recruiting patients and caregivers through direct referrals has been insufficient. Incorporating creative solutions to boost recruitment efforts appears to be effective. First, we developed partnerships with hospital/health systems for identification of eligible partnerships using existing information available in Electronic Medical Records (EMRs), yielding an initial 80% increase in referrals. Additional recruitment efforts include using brief informational videos on social media platforms, such as YouTube, Twitter, and TikTok. Promising recruitment strategies for hard-to-reach populations such as HAPC patients and their caregivers, including identification and outreach using existing EMRs, expanding eligibility to include retrospective data, and integrating efforts across social media platforms.
AWARENESS OF PARTNER PREFERENCES FOR END-OF-LIFE ASPECTS AND TREATMENTS IN OLDER ADULT COUPLES
Authors: Vilpert Sarah , Meier Clément , Jox Ralf J , Borasio Gian Domenico , Maurer Jürgen
Published: December 2022

Surrogate medical decision-making at the end of life is common and the patient’s partner is often the person who must make these critical decisions. The challenge of surrogate medical decision-making is to make decisions that best fit the patient's wishes. This study investigates how accurately older adult couples assess each other’s preferences for eleven end-of-life aspects and three medical treatments in a nationally representative sample of adults aged 58 and over living in Switzerland (N=573). The contribution of factors including end-of-life (EOL) discussion and care planning, self-rated knowledge of partner preferences, and EOL preferences homogamy in scoring higher in accurately assessing partner’s preferences for the end of life is examined. Weighted proportions, assessment accuracy scores and ordinary least squares regressions controlled for individuals’ characteristics are calculated. Results show that 44% of respondents accurately assessed their partners’ preferences for aspects related to medical, psychosocial, anticipatory and burden concerns at end of life, and 62% correctly predicted the preferences for cardiopulmonary resuscitation, life-prolonging measures, and palliative sedation. Respondents whose partner discussed their EOL preferences with them, completed an advance directive, designated them as their healthcare proxy, as well as respondents reporting very/rather good knowledge of their partners’ EOL preferences were more likely to have a higher accuracy score for their partners’ EOL preferences. Being a couple is not enough to assess one’s partner’s EOL preferences correctly. Communication about EOL wishes among the couple and individual EOL care planning should be encouraged, as both improve the assessment accuracy of partners’ EOL preferences.
UCHINANCHU AMERICAN OLDER ADULTS’ INFORMATION PREFERENCES AND BEHAVIORS IN END-OF-LIFE DECISION-MAKING
Authors: Shiroma Kristina , Xie Bo
Published: December 2022

End-of-life (EOL) decisions are unique and sensitive, requiring nuanced health information. Careful examination of ethnic minority older adults’ information preferences and behaviors in EOL decision making from a cultural perspective is increasingly necessary as the national and global population grows older and more diverse. Little is known about the information preferences and behaviors of Asian American older adults in EOL decision-making, especially for underrepresented ethnic minorities such as Uchinanchu American older adults. This pilot study examined Uchinanchu American older adult’s information preferences and behaviors in EOL decision making. In November 2019, I interviewed 4 Uchinanchu American older adults (age range: 67-85 years; Mean: 76 years; SD: 8.04) recruited from personal contacts and through Uchinanchu cultural groups in Texas and Hawaii. The interviews took place in-person and via phone. Each interview lasted approximately 90 minutes. Interviews were transcribed verbatim and analyzed using inductive thematic analysis. I identified three themes from the data: (1) EOL decision-making information not coming from healthcare professionals; (2) Funeral planning easier to talk about than advance EOL medical decision making; and (3) Cultural traditions may exclude people (women; non-first born children) from EOL decision making. My findings suggest possible misalignments of EOL communication between medical professionals and Asian ethnic minority older adults. These findings may inform the development of culturally competent interventions to enhance EOL decision making.
INFLUENCE OF TOTAL KNEE REPLACEMENT ON LEAN MASS MEASUREMENTS USING DUAL-ENERGY X-RAY ABSORPTIOMETRY
Authors: Jang Jae Young , Kim Miji , Lee Daehyun , Shin Hyung Eun , Won Chang Won
Published: December 2022

Sarcopenia and osteoarthritis often occur together. Many sarcopenic patients with osteoarthritis are managed by total knee replacement (TKR). The prevalence of TKR is increasing in older adults; however, metal implants can lead to the overestimation of lean mass (LM) in dual-energy X-ray absorptiometry (DXA). However, studies considering metal implants in DXA measurement of LM are scarce. Comparisons without and with automatic metal detection (AMD) are important for accurately measuring LM. Therefore, this study examined the effects of TKR on LM. Twenty-four subjects (mean age: 76.4±4.0 years) who underwent TKR were selected from the Korean Frailty and Aging Cohort Study. A GE Lunar iDXA (GE Healthcare Lunar, Madison, WI, USA) system was applied twice (with and without AMD). Leg LM was significantly overestimated in the right and left legs with TKR. The LMs with and without AMD were 6017.1±199.3 g and 5493.7±171.3 g, respectively (p< 0.001), in the right leg, and 5657.1±220.1 g vs. 5173.7±201.8 g, respectively (p< 0.001) in the left leg. The appendicular lean mass index (ALMI) without and with AMD was 6.5±0.6 kg/m2, 6.1±0.6 kg/m2 (p< 0.001). In addition, only one subject was classified as having low muscle mass without AMD, which increased to four based on AMD according to the Asian Working Group of Sarcopenia 2019 guidelines. The overestimated leg LM in subjects after TKR decreased with AMD. Furthermore, LM with AMD increased the prevalence of low appendicular LM in the diagnosis of sarcopenia. Therefore, metal implants should be considered to accurately measure LM using DXA.
CARING FOR PARENTS AND IN-LAWS IN CHINA: IMPLICATIONS FOR COGNITIVE FUNCTIONING OF ADULT CHILD CAREGIVERS
Authors: Lin Zhiyong , Duan Haoshu
Published: December 2022

Considerable research and public discourse on family caregiving portrays it as a stressful and burdensome experience with serious negative health consequences. Yet, there is also recent evidence indicating better health status in caregivers compared to non-caregivers. Especially for cognitive health, caring for others involves cognitively stimulating activities that can help prevent cognitive decline. Although the negative consequences of eldercare on the mental and physical health of caregivers are well-documented, how it would affect their cognitive functioning is underexplored. Using three waves of nationally representative data in China, the China Health and Retirement Longitudinal Study (CHARLS, 2011, 2013, 2018), this study investigated the longitudinal association between parental caregiving and cognitive functioning among adult child caregivers, and further examined how this association was conditioned on the relationship type (parent versus in-law), caregiving frequency, and gender of adult children. Descriptive analysis indicated that women are more likely to be occasional caregivers for their own parents and regular caregivers for parents-in-law compared to men. Results from multilevel mixed-effects models showed that caring for own parents was beneficial for adult children’s cognitive functioning whereas caring for parents-in-law was not significantly associated with their cognitive functioning. Both sons and daughters benefited from caring for their own parents although the beneficial effect was stronger for sons. Thus, we recommend to consider relationship types between caregivers and care-recipients when investigating informal caregiving and various health outcomes. Furthermore, we suggest more policies and programs that aim to help children-in-law who look after their parents-in-law.
INTERSECTIONS OF SEXUAL ORIENTATION AND GENDER IN SPOUSAL CAREGIVING: A FOCUS ON COGNITIVE LABOR
Authors: Giles Sadie , Calasanti Toni , Geng Jing , de Vries Brian
Published: December 2022

Our presentation adopts a lens of intersecting inequalities based on gender and sexual orientation in exploring caregiving for a spouse or partner with dementia. How the division of labor shapes caregiving approaches is sometimes examined, but how this might differ by sexual orientation has not been explored. Previous research has often examined physical tasks and, to a lesser degree, emotion work. Here, we focus on cognitive labor (Daminger, 2019): the mental labor involved in managing the household and social relationships, including anticipating needs, identifying ways to address these, making decisions, and monitoring outcomes. This theoretical backdrop informs our analysis of data garnered from in-depth interviews conducted among gay/lesbian and heterosexual older adults (N=57) who care for their spouses with dementia. However couples may have divided these cognitive steps previously, caregivers must perform them all alone, given care receivers’ cognitive losses. Our analyses reveal that caregivers find being responsible for everything exhausting, but this manifests differently based on gender and sexual orientation. Heterosexual women, for instance, found making all the decisions problematic, whereas heterosexual men reported difficulty in anticipating needs. For the most part, the challenging issues for gay and lesbian caregivers were more varied, as their previous division of labor had been negotiated differently, without a reliance on traditional gender roles. Finally, we uncover a novel domain for cognitive labor: being the “memory keeper.” Predominantly undertaken by women, this work involved maintaining important memories and markers of the care receiver’s (and couple’s) past.
FEASIBILITY OF A COMMUNITY-LED VIRTUAL SELF-CARE PROGRAM FOR AFRICAN AMERICAN FAMILY CAREGIVERS
Authors: Keller Abiola , Norris Nia , Easter Bashir , Garr Andrea , Morgan Gail , Dicks-Williams Ramona , Galambos Colleen
Published: December 2022

As the population of older adults in the U.S. increases, the need for family caregivers will mirror this growth. Despite a greater intensity of caregiving, African American caregivers are less likely to access formal support services and engage in self-care practices. To address the self-care needs of African American family caregivers, a community-engaged approach was used to develop and implement a half-day virtual self-care program. The development of the program was guided by the Individual and Family Self-Management Theory. This study evaluates experiences of program attendees. The specific aims are to examine the acceptability and practicality of the virtual self-care program. Women who self-identified as African American and a caregiver (i.e., taking care of another adult) were personally invited to attend. All attendees were emailed an electronic survey containing Likert-type and open-ended questions. Responses were examined for patterns and key content-related categories using inductive content analysis. Eleven of the sixteen attendees responded to the survey. All eleven strongly agreed (64%) or agreed (36%) that the event met their expectations and/or needs. In addition to providing opportunity to take time to engage in self-care, the event created a virtual space for women to focus on themselves. Women spoke about three distinct ways the event met their needs: 1) learning and trying new things, 2) access to resources, and 3) having a shared experience. These findings suggest that virtual programs may be used as an additional resource to support the health of African American women who care for older adults.
THE WORST PART OF THE DAY: DAILY REFLECTIONS OF DEMENTIA FAMILY CAREGIVERS
Authors: Xiao Chunhong , Winstead Vicki , Pickering Carolyn
Published: December 2022

Family caregivers struggle with multi-dimensional demands in caring for persons living with dementia (PLWD). The challenges of caregiving combined with the requirements of daily life can impact the care of PLWD and the health and well-being of the caregivers. The purpose of this study was to describe caregivers’ perceptions of the worst part of their day in the context of daily caregiving challenges. Family caregivers completed online surveys reporting on various parts of their day. The survey included an optional open-ended question: “what was the worst part of your day?” Caregivers (N=165) completed diaries for 21 days resulting in 1,773 surveys that included a response to the optional open-ended question. A subset of data was analyzed using content analysis to identify initial codes and themes; further content analysis of the complete dataset was used to confirm and refine the identified codes and themes. Final analysis revealed 6 themes describing caregivers’ perceptions of the worst part of their day. These themes included days in which they had to: 1) cope with changes in their relationship with the PLWD, 2) manage their own health-related issues such as illness and lack of sleep, 3) struggle when there was a lack of help or support, 4) deal with daily life demands in the home along with the demands of caregiving, 5) cope with negative emotions such as sadness, grief, or anger over the disease process, 6) cope with physical exhaustion. The findings reflect daily stressors associated with caregiving for PLWD.
POOR SLEEP COMMON AMONG HOSPICE FAMILY CAREGIVERS AND ASSOCIATED WITH WORSE CAREGIVER HEALTH
Authors: Starr Lauren , Washington Karla , Pitzer Kyle , Demiris George , Oliver Debra Parker
Published: December 2022

Over 1.2 million hospice family caregivers in the United States are at risk for interrupted, insufficient sleep due to overnight caregiving responsibilities, anxiety or intrusive thoughts, and inadequate caregiving support. Insomnia contributes to health inequities yet is underrecognized and undertreated. The prevalence of insomnia among hospice family caregivers is not well understood. The purpose of this preliminary study was to describe insomnia prevalence among hospice family caregivers and identify factors that differentiate caregivers with sleep difficulties from caregivers without sleep difficulties. This observational study included 57 hospice family caregivers of cancer patients enrolled in a randomized clinical trial for caregivers [NCT02929108]. Results showed 49.1% of hospice family caregivers had subthreshold insomnia to severe clinical insomnia, as measured by the Insomnia Severity Index. Although social determinant of health variables did not differ based on caregiver insomnia status, caregivers with insomnia (5.0, median) self-rated their physical health significantly lower than caregivers without insomnia (8.0, median) (P< 0.001). Directionally, the distance a caregiver lived from a care-recipient also differed by insomnia status, with 70% of caregivers with insomnia co-residing compared to 46% of caregivers without insomnia. Overall, 78.9% of hospice family caregivers had no caregiving support; anxiety and depression were highly prevalent. Clinicians should screen hospice family caregivers for sleep disorders and seek to improve caregiver health by offering sleep interventions tailored to the specific needs of hospice family caregivers and connecting caregivers to health resources for their own wellbeing. Policy makers must expand hospice benefits to include additional caregiver support.
BARRIERS AND FACILITATORS FOR ECONSULT: IMPROVING ACCESS TO SPECIALIST ADVICE IN LONG-TERM CARE
Authors: Fung Celeste
Published: December 2022

Long-term care (LTC) residents continue to receive most of their specialist care outside of the home. These visits present significant risks and burdens for residents. Such risks can be mitigated by eConsult, which facilitates timely, resident-specific, and practical recommendations between primary care providers (PCPs) and specialists to support clinical decision making, reduce unnecessary transfers, and positively impact resident care and quality of life. During focus groups in LTC homes where eConsult is used, PCPs, senior leadership, and a nurse champion recognized eConsult as having great value for residents, especially those with challenges travelling outside of the home. However, they also described LTC homes as under resourced, with minimal IT infrastructure and coupled with time constraints present barriers to eConsult adoption in LTC. Enabling factors (engaging clinician champions, establishing delegates, integration into existing workflows) similarly identified as supporting eConsult implementation more broadly were discussed.
COLLECTIVE TRAUMA AND PERSON-CENTERED PRACTICE IN NURSING HOMES
Authors: Morgan Jennifer , Chen Yun-Zih , Ahmad Waqar , Burgess Elisabeth
Published: December 2022

Nursing home staff have experienced multilayered collective trauma. Grief from experiencing numerous resident deaths, perceived threats to their safety, stress from understaffed working conditions, financial stress, and interpersonal conflict within overwhelmed teams may impact practice. COVID-19 precautions and pandemic working conditions may have provided additional barriers to implementing person-centered care. This study (N=379) descriptively analyzes data gathered from the staff of eleven Georgia nursing homes (summer 2021) to assess the perceived impact of COVID-19 on person-centered care practice. Approximately 40% of respondents agreed that 76-100% of resident members in nursing homes were infected with COVID-19. Over 75% of staff agreed that staff experienced anxiety related to COVID 19 precautions, COVID 19 precautions made it difficult for staff to give choice to residents, and the nursing home is more short-staffed. Conversely, more than 75% of staff reported that they were satisfied with their job, they received the appropriate training and support to be successful, nursing home managers treated direct care workers with respect and they were provided with the necessary PPE. Fewer staff (60-65%) reported that there never seemed to be enough time to get everything done, that COVID 19 precautions impacted their relationships with residents, they were provided with resources for emotional support or they received recognition for working through the pandemic. Future research is needed to understand the limiting and promoting factors for person-centered care as staff experience collective trauma.
THE VALUE PROPOSITION FOR DIVERSITY: CREATING A PIPELINE OF DIVERSITY IN THE LTSS SECTOR
Authors: Bryant Natasha , Hennessa Alexandra , Ruffin Adrienne , Stone Robyn
Published: December 2022

The long-term services and supports (LTSS) sector is a microcosm of systemic racism that exits in our society. Nationally, half of frontline professional caregivers are nonwhite, while mid- and executive-level managers and board members are predominately white. Research has identified this lack of diversity in management and leadership as a major contributor to turnover and recruitment challenges among frontline staff. We will summarize the findings from three applied research activities: 1) DEI survey of chief executive officers (CEOs) of multi-setting LTSS organizations; 2) interviews with chief diversity officers and CEOs on current workplace DEI efforts and the challenges; and 3) interviews with leaders of color who have had experience with the LTSS sector. Not-for-profit multisite organizations and life plan communities lack diversity among the senior leadership team and board members (12% are people of color). A DEI initiative is more likely to be successful if it has buy-in from the CEO and board members, aligns with the organization’s strategic plan and mission, is integrated into the organizational culture, and is assessed regularly to measure its impact and identify needed adjustments. Leaders of color in aging services acknowledge the barriers – lack of diversity among leaders and residents and the microaggressions that people of color experience - that make it challenging for people of color to work in the field. They recommend increasing diversity among senior leaders, investing in enhancing DEI, and spreading awareness of the LTSS field and its career opportunities to communities of color.
REFLECTIONS OF ADULTS TRANSITIONING TO LONG-TERM CARE FACILITIES: LOOKING BACK AND LOOKING FORWARD
Authors: Chang Pei-Fen , Hersch Gayle
Published: December 2022

Making a transition to a long-term care facility (LTCF) is often difficult for older adults. This study's intent was to explore ways in which life experiences and culture of older persons facilitate a successful transition to a LTCF. Eighteen participants were interviewed using a semi-structured interview guide to understand significant life events and personal factors impacting their lives. Interview data were analyzed using NVivo software to organize and manage emerging themes. The analysis revealed three related themes: person, current environments, and lifelong occupations. Within each major theme, subthemes were identified providing greater detail of how adaptive strategies are utilized to make such transitions positive. Participants were enabled to reflect upon their strengths and strategies available to adapt to these new residential settings. These perspectives are beneficial for healthcare practitioners to understand so as to personalize care and individualize the person's adjustment to a 'new' home.