bluuebunny/crossref_metadata_2025 huggingface dataset:
DEVELOPMENT OF A TRANSITIONAL CARE PROGRAM FOR FRAIL OLDER ADULTS BETWEEN HOSPITAL AND HOME
Authors: Lee Ji Yeon , Cho Eunhee , Kim Sue , Kim Gwang Suk , Lee Kyung Hee , Kim Chang Oh
Published: December 2022

Frail older adults particularly need transitional care between hospital and home due to physical function decline and psychological instability after discharge. This study aimed to develop a transitional care for frail older adults in Korea who are discharged home following hospitalization. The Returning Home (Rehome©) program was established through the three phases according to the Medical Research Council’s 2013 guidelines. 1) Identifying the evidence base phase included a systematic review of literature and needs assessments from interviews with frail older adults. The core intervention components (e.g., geriatric assessment, transitional care planning, home visits, phone follow-up, community service liaison, and family engagement) were determined. 2) At the phase of identifying theory, the transition theory was selected and modified to fit the target population in the context of the Korean healthcare system. 3) Phase three was for the modeling process and outcomes. Based on the result from phases 1 and 2, the Rehome program was developed considering clinically applicable strategies. The final Rehome program consisted of a comprehensive geriatric assessment at admission; structured discharge/transitional care planning (e.g., medication review, education for chronic disease management, emergencies, and geriatric syndromes, and community resource) at discharge; a home visit and six phone follow-up calls up to 12 weeks after discharge; and emotional support and engagement of the family during the entire period. The Rehome program showed good content validity. The Rehome as a frailty-focused transitional care program could improve the transition through implementing a tailored intervention that meets the care needs of these vulnerable populations.
EXPLAINABLE MACHINE-LEARNING FOR PREDICTING PREOPERATIVE FRAILTY PHENOTYPE USING ELECTRONIC HEALTH RECORDS
Authors: Mardini Mamoun , Price Catherine , Tighe Patrick , Manini Todd
Published: December 2022

Pre-operative frailty among patients is strongly associated with poor post-operative outcomes. Operationalizing frailty in clinical practice is challenging due to the lack of resources and pragmatic complexities. Feasible tools are needed to cover the scarcity in this area. Harnessing electronic health records (EHR) to screen pre-operative frailty and its related post-operative outcomes would be important for decision making and planning care management. This study aimed to validate an EHR-based machine learning model for pre-operative frailty ascertainment. Measures of the frailty phenotype (slowness, weight loss, exhaustion, low physical activity, and grip strength) were collected on approximately 14,000 patients (aged 65-100 years) by nurses housed in the UF Health pre-surgical center. Patients with at least 3 out of 5 syndromic components were considered frail. We utilized an explainable machine learning algorithm, eXtreme Gradient Boosting (XGBoost), to build our models to predict pre-operative frailty phenotype. We extracted the important predictors that contributed to predicting the outcome and evaluated their relationship with the outcome. The machine learning model achieved an area under the curve (AUC) of 0.71 in recognizing pre-operative frailty across all surgical specialties. The top five predictors for frailty phenotype were hemoglobin level, sex, education level, history of COPD, and diabetes. Using explainable machine learning approaches on EHR data provides a moderate mapping of the frailty phenotype in pre-operative settings. Funding: UF Claude D. Pepper Older Americans Independence Center P30AG028740 and R01 AG055337.
GLOBAL DIFFERENCES IN ADAPTATION TO SOCIETAL AGING: A CROSS-SECTIONAL COMPARISON OF 143 COUNTRIES
Authors: Chen Cynthia , Maung Kenwin , Koh Jemima , Rowe John W
Published: December 2022

Societal ageing is our success story of advancing public health and medicine in reducing the risk of premature death, the control and prevention of diseases, and improvement in social and economic development. Almost all countries are experiencing growth in size and proportion of older persons. In 2019, 703 million older persons were aged 65 and above, projected to double to 1.5 billion by 2050. We construct a multidimensional ageing Index that extends the Ageing Society Index, to account for global differences in societal ageing from 2015 to 2019 for 18 OECD countries. The Index is a weighted sum of scores for five domains that are important for societal ageing: well-being, productivity and engagement, equity, cohesion, and security. We compare the overall index and domain scores between countries. High-income countries dominated the top rankings. The overall Ageing Society Index ranged between 35.0 for Gabon in Africa to 74.6 for Switzerland in Europe. Top-performing countries were high-income countries from the European and Oceania regions, while the worst-performing countries were countries from the African region. Domain scores ranged from 19 (India) to 91.6 (Singapore) for well-being, 12.8 (Mozambique) to 88.5 (Finland) for equity, 32.8 (Gabon) to 88.8 (Uzbekistan) for cohesion, and 27.8 (Madagascar) to 88.8 (Switzerland) for security. Our multidimensional index helps identify specific societal gaps for policymakers to address. Furthermore, the cross-country comparison can be instructive for policymakers to adapt the experiences of successful countries to domestic policies.
ETHIOPIAN CENTENARIANS: HEALTH CONDITIONS AND SENSORY/COGNITIVE FUNCTIONALITY
Authors: Chane Samson , Adamek Margaret
Published: December 2022

Globally, the centenarian population is expected to increase in the coming three decades reaching 3 million by 2050. In Ethiopia, like other Sub-Saharan African countries, information about the health condition, sensory and cognitive functionality of centenarians is scanty. This study examined the health conditions and sensory/cognitive functionality of Ethiopian centenarians. A qualitative case study design was employed. Nine centenarians (1 woman, 8 men) between age 100 and 108 were identified using snowball sampling. Data were generated through in-depth interviews and analyzed using descriptive analysis. All 9 were Orthodox Christians and lived in rural areas either with their wives (3) or other relatives. Four centenarians could read and write, two attended grade eight and nine, and three were non-literate. Before retirement the centenarians engaged in different occupations as farmers (4), shoemaker, government employee, school teacher, priest, “bounty hunter” and mechanic. Most perceived that their sensory and cognitive functionality was normal until their later 90s except for minor complaints. Centenarians faced walking difficulty (5), joint tightness (4), back pain (4), fatigue, dental issues, stuttering, hypertension (3), insomnia, diabetes, anorexia, severe headache, constipation and anxiety. Two centenarians identified themselves as escapers. Centenarians faced hearing defect (4), sight problems, and a decrease in taste and smell. Two reported proper functioning of their sensory organs. Despite various health problems, the Ethiopian centenarians aspired to live longer resiliently. Findings call for further study and the need for social workers, caregivers, and health care practitioners to consider the health conditions, sensory and cognitive functionality of centenarians.
INTERGENERATIONAL TRANSMISSION OF "SEVA": ELDERS MODEL SELFLESS SERVICE IN SOUTH ASIAN HOMES FOR CHILDREN
Authors: Corley Connie , Sherwood Laura , Ghosh Dibendu , Willis David
Published: December 2022

Life course theory is a framework for examining the role of elders in modeling altruistic behavior or "seva" (selfless service) in two homes for children: Unatti (Bhaktapur, Nepal) and Ramana's Garden (Rishikesh, India). Two American women, compelled to impact the plight of children subject to poverty, trafficking and/or caste discrimination (Dalits, the former "untouchables"), each founded homes 20+ years ago and modeled selfless service exemplified by children, some now in "emerging adulthood," who are giving back to their communities. In this intergenerational/intercultural multiple case study, narratives of the program founders now in mid- to late adulthood are presented along with narratives of six young adults who continue to provide nurturance to younger children and engage in projects to educate and feed residents of the homes and nearby communities. The life course principle of time and place situates the children in areas of their countries with relatively low literacy rates. The founders saw the value of education to empower young people, especially girls, to expand their opportunities and serve as role models for children coming into the homes after them. The linked lives principle is evident through shared relationships with the founders as these young people navigate political crises, disasters like the Nepal earthquake, and health crises like the Covid-19 pandemic. Some become leaders themselves as they have been mentored over their life course. A sense of agency is experienced in their young adulthood as more choices for their lives become available as an alternative to subsistence existence and early marriage/childbearing.
ACHIEVING UNIVERSAL HEALTH COVERAGE FOR OLDER ADULTS: A REVIEW OF GHANA’S NATIONAL HEALTH INSURANCE SCHEME
Authors: Asante Samuel , Karikari Grace
Published: December 2022

Universal Health Coverage (UHC) is defined by the World Health Organization (WHO) as ensuring that all people receive quality health services they need without financial hardship. Predicated on the idea of providing universal healthcare to all Ghanaians, Ghana’s National Health Insurance Scheme (NHIS), established in 2003, has done considerably well among some age categories than others. While most studies on this healthcare program have focused on the health-seeking behaviors among users, its implementation, financial sustainability, and the role of national politics in its administration, little has been done to understand the program’s effectiveness in achieving a universal health coverage for and its impact on older Ghanaians. Consistent with WHO’s objective of achieving UHC, as enshrined in the Global Strategy on Aging and Health, this review examines Ghana’s progress toward achieving UHC for all. The paper specifically provides a narrative review of the National Health Insurance Scheme in advancing the interest and welfare of older Ghanaians. Findings revealed that not all individuals considered as older adults, either conventionally or legally, are beneficiaries of the programs; that WHO’s objective of obtaining needed care without financial hardship may be far from reach for most older Ghanaians; and the program only offers basic protection to current beneficiaries. We address these areas of concern to achieving UHC. We also make recommendations for a path forward where all stakeholders—older adults, families, healthcare providers, and policymakers—involved can play a role in ensuring all eligible older adults get the quality of health care they deserve.
PUBLIC MENTAL HEALTH SERVICE USE AMONG US ADULTS AGE 50+ COMPARED TO YOUNGER AGE GROUPS
Authors: Choi Namkee , DiNitto Diana
Published: December 2022

Despite increasing numbers of older-adult mental health service users, few studies have examined their use of public mental health services. Using the 2018 and 2019 Mental Health-Client Level data (N=4,291,737 in 2018 and N=4,513,946 in 2019 for those age 18+), we examined age group differences in the types of mental disorders diagnosed in outpatient-only, both outpatient and inpatient, and inpatient-only service settings. Of all users, 25.3% were age 50-64 and 6.7% were age 65+. Multivariable logistic regression results, controlling for gender, race/ethnicity, census region, and alcohol/substance use disorder, showed that compared to the 30-49 age group, the 50-64 and 65+ age groups had higher odds of having depressive disorder in outpatient-only settings (aOR=1.28 [95% CI=1.28-1.29] and aOR=1.08 [95% CI=1.08-1.09] for the 50-64 and 65+ age groups, respectively). Both older groups also had higher odds of delirium/dementia disorder in all three service settings. In addition, they had consistently higher odds of a diagnosis of schizophrenia or other psychotic disorder in all three service settings (aOR=1.88 [95% CI=1.86-1.89], aOR=1.70 [95% CI=1.65-1.74], and aOR=1.44 [95% CI=1.39-1.49] in outpatient, both outpatient and inpatient, and inpatient-only settings, respectively). Community mental health centers (CMHC) are on the frontlines in serving vulnerable communities and received increased federal funding during the COVID-19 pandemic. Our findings indicate that CMHCs also need programs dedicated to and tailored for older adults. More research is also needed on older adults who receive public mental health services and unmet mental health needs among low-income older adults with serious mental illness.
PARTNERING TO DEVELOP COUNTY-LEVEL DATA PROFILES
Authors: Phillips Karon , Wolfe Megan
Published: December 2022

Building robust data systems that include information on the health of older adults is crucial to developing programs and services that meet their health and social needs. Organizations and agencies can use this information to target resources and identify community partners, as well as using data to support grant applications. But there are challenges to building such systems, even within the public health system, due to lack of expertise, funding, and access to underlying data sources. Through its Age-Friendly Public Health Systems initiative, Trust for America’s Health’s has worked directly with several state public health departments to explore opportunities to develop and expand their county-level data profiles on older adults. This session will highlight the unique collaborations and partnerships between departments of health and other institutions, including academia, to develop data profiles. Through these innovative partnerships, departments of health have been able to develop dynamic data profiles that they share with aging services providers to discuss strategies to support their older adults in their communities. Best practices and lessons learned through the profile development process will also be discussed.
EFFECTS OF A SPECIFIC NARRATIVE GROUP PRACTICE ON HEALTH OUTCOMES OF CHINESE OLDER ADULTS: AN RCT STUDY
Authors: Chow Esther , Fung Sai-fu
Published: December 2022

In view of the rising chronicity during older adulthood, a specific narrative group practice is developed to improve well-being. Narrative therapy (NT), views people as experts in their own lives, and have accrued their life wisdom through their lifespan. To test its effects, a randomized controlled trial design was used to assess and compare outcomes between the intervention and waitlist-controlled group. A total of 157 older adults were recruited, 82 of which was randomly assigned to 9 intervention groups to receive four 2-hour NT sessions, recording difficult life circumstances, through narrative conversations, which made them stronger. Quantitative assessment of well-being, and depression were conducted at baseline (T0), at the end of treatment (T1), and at two (T2) and 8 months after treatment (T3). By employing the SEM parallel-process latent growth curve model, the results from the 4 waves of longitudinal data suggesting that the NT intervention have positive impact the participants, in particular the improved well-being of the participants contributed to the reduction of depressive symptoms with standardised estimate -0.502, p = 0.007. The estimated model fulfilled the criteria of mediocre fit, with TLI = 0.943; CFI = 0.969; RMSEA = 0.053. No adverse reaction was recorded in any of the cases mentioned at all study-sites. These findings have significant theoretical and practice implications for both health and social care professions. NT offers an effective practice to develop a strength- and meaning-based group practice and ground a new theory for to develop a constructive perspective to late life development.
SUPPLEMENTAL PAYMENTS AND NURSING HOME STAFFING: A CASE STUDY OF INDIANA
Authors: Sharma Hari , Xu Lili
Published: December 2022

Adequate reimbursements are key to improving quality in nursing homes (NHs), but Medicaid payments remain low. Indiana implemented Medicaid supplemental payment program to non-state government (NSGOs) owned NHs to boost Medicaid payment rates. Under the program, NSGOs contribute the state-share of the supplemental payments through intergovernmental transfers allowing the state to claim federal matching funds. The supplemental payments are distributed between NSGOs and NHs but little is known about whether NHs invested the supplemental payments to improve staffing levels. In this study, we examine whether NHs receiving supplemental payments, proxied by NSGO-ownership, have higher staffing hours per resident day (HPRD) for registered nurse (RN), licensed practical nurse (LPN), and certified nurse aide (CNA) compared with NHs without supplemental payments. We use facility-year data on NSGO ownership (State of Indiana), staffing levels (Nursing Home Compare), and facility and resident characteristics (LTCfocus.org) on 500 NHs from 2009 to 2017. We use difference-in-difference (DD) regressions with year and facility fixed effects to estimate the potentially causal effect of NSGO ownership on NH staffing controlling for facility and resident characteristics. DD estimates suggest that NSGO-ownership is associated with decreased staffing level across all three types of staffing. More specifically, RN staffing decreased by 0.019 HPRD (p< 0.05), LPN staffing decreased by 0.041 HPRD (p< 0,05), and CNA staffing decreased by 0.089 HPRD (p< 0.001). Policymakers should increase the transparency of supplemental payment programs and audit the expenditures to ensure that supplemental payments are tied to quality improvement.
VARIATION AND CONSISTENCY IN ALLOCATION OF HCBS: MASSACHUSETTS AGING SERVICES ACCESS POINTS
Authors: Flieger Signe , Katz Gabrielle , Bishop Christine
Published: December 2022

Massachusetts’ 27 Aging Services Access Points (ASAPs) are nonprofit organizations responsible for guiding clients and families in their geographic service areas through a maze of financial and functional eligibility criteria to receive needed home and community-based services (HCBS). These services aim to sustain function and promote engagement for older adults and persons with disabilities, and to maintain individuals in the community rather than in residential settings. Payment for HCBS flows from numerous state and Federal funding programs, including but not limited to state Medicaid waivers and Older American Act programs. We conducted semi-structured interviews with 10 ASAP directors and gathered information from documentary sources to delineate the pathways to funded HCBS that these agencies open for clients. We identified variation in the 27 ASAPs’ contractual relationships with service providers. State data revealed variation in budgetary resources and area population characteristics. These nonprofit corporations appear to flexibly adapt to local conditions and needs. Understanding variation across ASAPs will support analysis of client data to examine whether ASAP processes result in different service outcomes for similar clients. Alternate payment models for health services (managed care, managed long-term services and supports, accountable care organizations) are broadening their reach, encouraging health systems to recognize the importance of functional supports and services. Some health systems are charging their own dedicated units with assigning HCBS to enrollees, avoiding the ASAPs. Understanding and modeling the allocation of services by the ASAPs will allow investigation of trends in services for persons with varying needs under various payment methods.
FROM PILOT TO PRODUCT: EVOLUTION OF A REMINISCENCE THERAPY INTERVENTION FOR PERSONS LIVING WITH DEMENTIA
Authors: Orsulic-Jeras Silvia , Ejaz Farida , Rose Miriam , Powers Sara , Cordell Ashlee , Wilk Christa , Sanders Lisbeth
Published: December 2022

Reminiscence therapy (RT) and life story work are effective techniques for eliciting engagement in persons living with dementia (PLWD) and helping inform direct care staff about residents’ lives and preferences to facilitate quality person-centered care. However, there are challenges in bringing such programs to scale in a feasible and cost-effective way. Two studies were conducted to test development and evolution of an RT program, LifeBio Memory. A pilot study of the original LifeBio protocol was conducted with 238 residents in 16 Ohio nursing homes. Most residents (88%) indicated at posttest that they enjoyed telling their life stories, and 87% would recommend the program to other residents. However, manually gathering and processing life story data led to challenges with feasibility. Subsequently, novel software was developed to streamline the process using machine learning and artificial intelligence via a tablet application. Acceptability and feasibility were examined in two rounds, 9 months apart, of seven focus groups (n=35) conducted with PLWD, family care partners, and residential care staff. Audiotapes of the groups were transcribed; thematic data analysis was used to generate a list of recommended changes and showed high levels of acceptability and feasibility. Based on these results, it was determined that LifeBio Memory was preferred for obtaining life story information over the previous manual method (e.g., handwriting life story notes). Potential barriers to implementing the new platform in residential care settings were also identified. Implications include the importance of maintaining person-centered care practices when creating technological solutions to address PLWD needs.
MULTIPLE SCALES OF SOCIAL RELATIONS IN REMINISCENCE ACTIVITIES FOR OLDER ADULTS
Authors: Robbins-Panko Jessica
Published: December 2022

Memory, especially autobiographical memory, is central to personhood in contemporary North America and Europe (Herskovits 1995). Cultivated practices of reminiscence, in which older adults are prompted to remember events and experiences from the past, can be pleasurable, meaningful, and therapeutic activities that shape personhood and contribute to wellbeing (Coleman, 1999; Sherman, 1987). Although reminiscence practices include both individual (e.g., Butler, 1963; Woods et al., 2018) and social (Hash et al., 2021; Sass et al., 2021) elements of remembering, less attention has focused on the myriad scales of social relations that are part of reminiscence activities. Moreover, the mechanisms through which reminiscence creates positive transformations remain unclear (Menn et al., 2020). Anthropological theories of personhood show that social relations at multiple spatiotemporal scales play key roles in transforming personhood (Carsten, 1995; Robbins, 2021), thus suggesting a nuanced framework within which to understand how social relations shape personhood and contribute to wellbeing for older adults. Drawing on a systematic review of interdisciplinary literature on reminiscence activities for older adults, this paper documents the multiple scales of social relations (interpersonal, institutional, regional, [trans]national) that are part of reminiscence activities, and interpretively analyzes their significance for personhood and wellbeing. Key findings of this study are: 1) collective memory plays an important role in reminiscence activities; and 2) fostering reminiscence activities that focus on meaningful elements of the shared past can promote wellbeing for older adults. These findings have implications for 1) refining gerontological theories of reminiscence, and 2) improving reminiscence-based practices for older adults.
SOURCES OF INTRINSIC MOTIVATION IN LATER ADULTHOOD: A QUALITATIVE ANALYSIS
Authors: Heinz Melinda , Benton Nathan , Gleissner Laura
Published: December 2022

A distinct sense of purpose and motivation is increasingly recognized as a contributing factor in successful aging and prolonged health in older adults. While prior studies have established the relationship between intrinsic motivation, defined purpose, and health outcomes, it is essential for care providers and researchers to understand the underlying sources of purpose and motivation for older adults. This study examined qualitative data collected over a two-week period from a sample of older adults (N = 15) in the Midwest. Participants documented daily, through written journal entries and photography, aspects of their lives that they felt illustrated sources of purpose and motivation. The journal entries were then transcribed, aggregated, coded, and analyzed for potential themes. Two researchers coded the data; and a codebook was used to increase coding consistency. Using latent thematic analysis, three distinct themes developed from the dataset. First, engagement in behaviors and activities that incorporated aspects of mindful practices, particularly sensory awareness and grounding, proved to be motivating for many of the participants. The second theme discovered that participants found purpose in active social participation, where a subtheme regarding the impact of technology on maintaining relationships emerged. In the third theme, a goal-oriented mindset proved to be a key aspect of ongoing motivation, with a particular focus on cognitive and physical development, lifelong learning, and planning for the future. Overall, the data pointed to three distinct themes that can be used to foster ongoing opportunities for greater meaning in the lives of older adults.
VARIABLE PREDICTORS OF COGNITIVE PERFORMANCE WITHIN ETHNIC/RACIAL GROUPS USING A COMPUTERIZED COGNITIVE BATTERY
Authors: Deters Kacie
Published: December 2022

The Computerized Cognitive Composite (C3) may provide an efficient assessment of early cognitive impairment to inform early interventions and screening criteria for Alzheimer’s disease clinical trials. The C3 battery, which includes the CogState Brief Battery, has components assessing memory, reaction time and aspects of executive function. The battery has little demand for spoken language and may reduce the sociocultural biases of traditional paper-and-pencil tests. The goal of this project was to determine demographic and genetic predictors of cognitive performance on the C3 battery across different ethnic/racial groups. We examined 4,026 cognitively normal participants (self-identified non-Hispanic Black, Asian, or White; Hispanic) at baseline visit from the Anti-Amyloid Treatment in Asymptomatic Alzheimer's Disease (A4) clinical trial. Linear models were performed to examine the association of C3 and years of age, years of education, gender/sex, and Apolipoprotein E (APOE) genotype, within ethnic/racial group. We found variation in demographic and genetic risk factors that predicted cognitive performance within ethnic/racial groups. These findings highlight the importance of within group analysis to identify risk factors for cognitive impairment.
LAY PERSPECTIVES ON SUCCESSFUL AGING IN ROMANIA
Authors: Roquet Angélique , Barbut Mariana , Pocnet Cornelia , Jopp Daniela
Published: December 2022

Successful aging is a topic of world-wide interest, yet much work focuses on specific and highly industrialized countries, such as the USA. The present study investigated lay perspectives of the concept of successful aging in young, middle-aged, and older adults from Romania. Ninety-three participants aged between 20 and 84 years were asked about definitions and determinants of successful aging. Based on a previous study, codes were developed to capture common themes among the answers, resulting in 14 categories. Participants mentioned four themes on average to describe successful aging, which varied by sociodemographic, health and psychological variables: individuals of younger age, with higher levels of education, in better health and those more satisfied with their aging mentioned more themes. Regarding specific topics, Social resources and Health were mentioned most frequently, followed by Quality of life, Financial situation, and Attitudes/Mechanisms. Young adults were more likely to mention Social resources, Success/Respect, and Aging themes, while older adults mentioned more often Meaning of life themes. Finally, we found that the themes mentioned were related to self-perception of aging, particularly among older adults: Older adults more satisfied and with positive views own aging were more likely to mention Social resources, Independence, and Attitudes/Mechanisms themes, while those with negative views on aging were more likely to mention Micro-environment themes. In sum, findings support the multidimensionality of lay perspectives of successful aging and offer insights on the understanding of successful aging in Eastern Europe, including topics and links to general and personal aging experiences.
TAILORED INTERNET-BASED SEXUAL EDUCATION FOR OLDER ADULTS: NEEDS ASSESSMENT AND ALGORITHM DEVELOPMENT
Authors: Berdychevsky Liza , Nimrod Galit , Rogers Wendy
Published: December 2022

Many older adults are sexually active, but ageism fuels the neglect of older adults' sexuality in research and sexual education. The purpose of this study was to (1) assess older adults’ willingness to adopt technology tools to receive innovative, tailored sexual health education via the internet, (2) investigate their sexual health needs, and (3) contribute to development of an assessment tool and tailoring algorithm. Tailoring is a precision approach that matches educational content to users’ needs instead of offering the same suboptimal one-size-fits-all content to everyone. We conducted an online survey using Qualtrics research panels of older adults (N = 836, with equal representation by gender and balanced representation in each 5-year cohort from age 60 to 80+). We found that 30% reported they were likely to try tailored internet-based education for older adults; an additional 34% were unsure. The results establish priority areas in sexual health needs, including behavioral patterns, knowledge gaps, health-related constraints, and attitudinal and communicational issues. These components provide the basis for the tailoring assessment questionnaire. Respondents also rated the personal relevance of 28 educational modules covering sex in later life (e.g., sexual ageism, sex as quality-of-life issue, sex-related communication, body image, health conditions, gender-specific issues, sexual attitudes, broadening sexual definitions and repertoires, sexual adaptations, inhibitions, sex aids/toys/robotics, medications/treatments, orgasm, self-stimulation/masturbation, dating, risk-taking, celibacy, LGBTQIA+, sexual rights, abuse). Statistical relationships between sexual health needs and personally relevant modules contribute to the development of a tailoring algorithm for creating educational bundles matched to older adults’ unique needs.
INTERNET LITERACY FROM GRANDCHILDREN OR YOUNGER GENERATION: A NEW DIRECTION FOR GERONTECHNOLOGY
Authors: Sarker Ananya , Kahana Jeffrey , Kahana Eva
Published: December 2022

Internet literacy offers a modern set of tools that can help older adults achieve the three pillars of successful aging, especially in the post-pandemic world. In the United States, older adults have shown significant growth in the usage of the internet and online services. However, information and social connectivity for older adults with lower incomes and education levels still lag. The current pandemic raises the public question of whether internet access and education should be deemed as a basic human right. Internet access is even more critical for older adults who need additional technology access and training, tailored to fit their varying experience, disability, and cognitive ability levels. The pandemic has demanded numerous technological skills for daily life: videoconferencing to carry on work, ordering groceries, taking exercise classes online, talking to family members and healthcare providers, and now registering for vaccination. Thus older adults need help with technology use more than ever. We need awareness of the “digital divide” and collaboration from designers, developers, services, products, and programs or interventions from various public and private sources. Identifying social and logistical barriers to technology literacy, we propose a conceptual model of using intergenerational training strategies to ameliorate the digital divide experienced by older adults. In this paper, we will review successful intergenerational programs like Students to Seniors, and Zoomers to Boomers, and introduce a similar model for internet literacy. The intergenerational mentoring model is advocated due to its wide-ranging potential benefits for both the older generation and the younger generation.
THE EXPLORATION OF CORRELATES OF LONELINESS AMONG COMMUNITY-DWELLING OLDER PEOPLE’S TECHNOLOGY LITERACY
Authors: Kang Suk-Young , Kim Jeungkun , Poplawski Antonina
Published: December 2022

Social isolation is a major public health risk among older adults, even considered to be as harmful as smoking. The aim of this study was to explore the benefits of digital literacy and the correlates related to levels of loneliness on older people.Mail-survey data were collected from community-dwelling adults over the age of 65. There were 192 total participants, with information from 180 people being included in the analysis.The six-item De Jong Loneliness Scale was used to measure levels of loneliness. Among the 180 participants, the mean was 2.02 (SD = 1.68).Regression analysis revealed that the equation explained 48.2% of variance (adjusted R-squared = .446) in levels of loneliness (F (11,162) = 13.682, p <.000). Variance inflation factor (VIF) values were smaller than 10, indicating that multicollinearity among the correlates was not an issue. Correlates of levels of loneliness included aging anxiety, depression, social network, and self-evaluated technology literacy with computer software programs compared to peers. Results confirmed the correlates related to loneliness among older people identified in previous studies. This shows quality of life related to mental health may be improved by a positive attitude towards technology use.This study further found that digital literacy affects loneliness when controlling for income, depression, level of network, and physical health.Participants who could increase their digital literacy are interested in more opportunities on how to use new technology. Policy changes that allow for lifelong learning options could support this, while also decreasing levels of social isolation and loneliness.
GIVING AND GETTING ACROSS THE GENERATIONS: NEW INSIGHTS INTO INTERGENERATIONAL TIES
Authors: Carr Deborah , Carr Deborah
Published: December 2022

Population aging raises debates about who will care and provide for older adults, while shifting economic and family patterns suggest that young adults may require ongoing support from their (grand)parents. These five papers use diverse methods and data to shed new light on upward and downward intergenerational exchanges. Fingerman and colleagues use data from a small racially diverse sample of young adults (ages 18 to 29) providing care to grandparents. They document psychological benefits yet potentially harmful life course disruptions (e.g., education). Wiemers and co-authors use the Health and Retirement Study Core and COVID-19 Module to document how adult children’s transfers of time, money, and coresidence changed in response to the COVID-19 pandemic. Minoritized and lower SES older adults were less likely to receive help from family members, due to children’s constraints. Whitworth documents disparities in the types of support college students receive from midlife parents, using the Panel Study of Income Dynamics Transition to Adulthood Supplement. Higher SES parents tend to provide financial support, whereas lower SES parents provide coresidence. Silverstein et al. use multigenerational data from Longitudinal Study of Generations. They find religiosity of parents during the offspring’s adolescence affects their cognitive and behavioral religiosity in later life. Avni uses cross-national attitudinal data from the International Social Survey Programme (ISSP) and finds that Americans believe family should be responsible elder care, whereas Israelis and Germans believe the government should provide care. The discussant highlights implications of the study results for research and policies regarding intergenerational relations.
UNDERSTANDING THE PREDICTIVE FACTORS THAT INFLUENCE THE PERCEIVED BURDEN OF DEMENTIA CAREGIVERS
Authors: Lucas Kaitlyn , Judge Katherine
Published: December 2022

Burden is a significant negative outcome for caregivers of individuals with dementia. Guided by the Stress Process Model, the following study examined the impact of several novel constructs on burden including: compassion for others, family functioning, coping styles, and positive and negative affect. Data were gathered through Amazon Mechanical Turk from 102 dementia caregivers. Participants were 62% female, 72% Caucasian with a mean age of 39.5 years old. Burden was significantly related to positive affect (r =-.31, p =.01), negative affect (r =.56, p =<.01), family functioning (r =.43, p <.01), and dysfunctional coping (r =.37, p <.01). Compassion for others was not correlated with burden. Multiple regression analysis results found the set of predictors accounted for 65.0% of the total variance in burden (F(5,96) = 14.17, p < .01, R2= .65), with positive affect (β = -.26, p = .01), negative affect (β = .19, p= .05), and dysfunctional coping (β = .31, p= .01) predicting significant and unique variance. Results from mediation analyses indicated dysfunctional coping mediated the relationship between positive affect and burden (effect= -.14 95% bootstrap CI= -.26, -.04) as well as the relationship between negative affect and burden (effect= .24, 95% bootstrap CI= .07, .48). A mediating relationship between dysfunctional coping and family functioning and burden was not supported. Discussion will highlight the implications of the study findings in developing innovative caregiver programs aimed at reducing dysfunctional coping and the broader theoretical implications of the role of affect in family caregivers of individuals with dementia.
LOCI RESPONSIBLE FOR RACIAL DISPARITY BETWEEN WHITE AND BLACK AMERICANS IN ALZHEIMER’S DISEASE
Authors: Nikitin Stanislav Kolpakov , Akushevich Igor
Published: December 2022

We tested the following genotype-related mechanisms generating race-dependent disparity in Alzheimer’s Disease (AD) risk: i) the frequencies of SNPs with genotypes associated with AD are higher in the Black subpopulation; ii) the effects on AD risk of genotypes associated with increased AD risk is higher in the Black subpopulation; iii) there is a small group of SNPs with a large difference in the effects on AD race-dependent risk generating disparities; alternatively, the disparities are generated by a collective effect of multiple SNPs with minor or moderate effects. We modified the GWAS algorithm to use it with the Cox regression multivariable model and the outcome accounting for race-related differences in AD risk. Using the modified GWAS we have identified loci in charge for the disparity between Whites and Blacks and used the results along with SNPs of a special interest which were identified from the literature in the Cox multivariable regression model and generalized Oaxaca-Blinder approach. The following genes had the strongest effects on racial disparities: i) NYAP1 neuronal tyrosine-phosphorylated phosphoinositide-3-kinase adaptor; ii) RPA3-UMAD1 loci RPA3 replicates protein A, interacting with gastric tumor and hepatocellular carcinoma; iii) TOMM40 associated with an increased risk of developing late-onset AD; iv) ACE - responsible for making the enzyme which converts angiotensin which regulates blood pressure; v) PSME3IP1 - proteasome activator subunit 3 interacting protein 1; vi) MARCHF1 regulator of glucose-tolerance and lipid storage and vii) LINC01146 which belongs to coagulation cascade pathway and linked to hepatocellular carcinoma.
IMPACT OF EHR IMPLEMENTATION IN NURSING HOMES ON FINANCIAL PERFORMANCE
Authors: Dayama Neeraj , Felix Holly , Pradhan Rohit , Morris Michael , Karim Saleema
Published: December 2022

Nursing homes (NHs) are a critical part of the US healthcare system providing care to the sick and fragile elderly, and research suggests that they can benefit from the implementation of health information technology (HIT). However, for multiple reasons—exclusion from HITECH incentives; limited financial wherewithal; hazy return on investments (ROI), they have lagged in HIT implementation compared to other significant components of the US healthcare system. Utilizing the resource-based view (RBV) of the firm, the purpose of this study was to examine the longitudinal impact of HIT on NH financial performance potentially building a sustainable economic argument for its implementation. To examine this relationship, we merged data from five different sources between the years 2009-2013-: Health Information and Management Systems Society, LTCFocus, Online Survey Certification and Reporting/Certification and Survey Provider Enhanced Reporting, Area Health Resource Files, and Medicare Cost Reports. The outcome variable was financial performance which was measured in four ways: operating cost and revenue, operating margin, and total margin. The independent variable of interest was HIT implementation and was measured using a novel HIT Adoption Score (HAS) reflecting NH implementation of five different HIT applications. Four separate multivariate linear regression models were estimated, and we included a series of organizational and market characteristics in the analyses. We report a positive association between NH implementation and improved profitability (operating margin) (p≤0.01), and lower operating cost (p≤0.05). Our results, suggesting a potential business case for EHR implementation within NHs, have important policy and managerial implications that are discussed.
INTERGENERATIONAL VIRTUAL YOGA INTERVENTION INVOLVING OLDER ADULTS AND COLLEGE STUDENTS: A PILOT STUDY
Authors: Martens, PhD Nancy , Schutte Debra , Templin Thomas , Cinader-Galvan Morgan
Published: December 2022

Social isolation is common in older adults and students and is associated with poor health outcomes. While evidence suggests active and yoga interventions improve health, interventions encouraging intergenerational social interaction are limited. The objective was to implement and evaluate a twice-weekly, 6-week, intergenerational yoga intervention delivered virtually. Specific aims included evaluation of feasibility and acceptability, examination of estimates of efficacy on health outcomes, and examination of age cohort effects on acceptability, feasibility, and efficacy. Older adults were recruited through a community activity center and randomized to the control group (N=10) (Mage= 70.05, SD 5.83) or intergenerational older adult treatment group (N=11) (Mage= 72.32, SD= 5.81) with students (N= 12) (Mage= 25.98, SD= 5.64). Older adult outcome measures included Center for Epidemiological Studies Depression Scale (CES-D), PROMIS Social Isolation Scale (SI), Meaning-in-Life Questionnaire, and Tilburg Frailty Index; outcomes for the students included the CES-D, SI, and Image of Aging Scale. Outcomes were assessed at week 0, 3, 6, and 12 (6-weeks post-intervention). Attrition was minimal; 81% of older adults and 80% of students received the full intervention. Using the Acceptability of Intervention Measure, 77.8% of older adults and 100% of college-age adults indicated their willingness to participate again. There were no significant intergenerational effects; however, the effects of yoga were in the expected direction with significant values in CES-D, P < .01 and Meaning-in Life, P < .01. While the acceptability and feasibility of the intervention were supported; additional research is needed to strengthen the intergenerational component of the intervention.
SMART HOME DATA VISUALIZATION FOR PROACTIVE HEALTH MONITORING OF COMMUNITY DWELLING OLDER ADULTS
Authors: Wuestney Katherine , Ramirez Javier , Cook Diane , Fritz Roschelle
Published: December 2022

The role of Ambient Assistive Living and smart home technologies, which utilize unobtrusive sensors to detect changes in health, is becoming increasingly important in the delivery of healthcare services to older adults. However, these technologies must be designed to meaningfully incorporate into clinicians’ decision making. Research has shown when clinicians are engaged in the design process of smart home systems, the accuracy and efficacy of the systems are improved. We present the process undertaken by a team of nurse researchers and computer science engineers to design clinically meaningful behavior markers derived from smart home sensor data that can be used by nurses to proactively identify changes in patient status. During the first phase of design, nurse researchers qualitatively analyzed time series from smart home sensors installed in the homes of community dwelling older adults and identified patterns in these data related to significant health changes. From this analysis, we assembled a candidate list of 15 sensor-based behavior metrics, such as percent time spent in each room or frequency of bathroom use. During the second phase of design, we will build on lessons we learned from participatory design to create behavior markers and visualizations that are inspired by clinical experience. These include visualizing behavior change over time, highlighting behavioral anomalies at multiple time scales, and calculating markers that are not directly observable such as time spent out of home. Lessons learned from clinicians using the data visualizations to proactively screen for health changes in near real time will also be discussed.
IMPROVING VIDEO DEVICE USAGE AMONG OLDER RURAL VETERANS WITH USER-CENTERED DESIGN
Authors: Lum Hillary , Kelley Lynette , Nearing Kathryn , Walker Leah , Johnson Gerhardt , Barczi Steven
Published: December 2022

The Veterans Administration (VA) established pathways to provide VA-issued tablets and increased access to internet for Veterans without these resources. Veterans aged above 65, experience barriers with telemedicine such as access and usability. We sought to improve the usability and experience of telemedicine for rural, older Veterans receiving a VA-issued tablet by modifying materials and qualitatively evaluating their experience with set-up and preparing for their first appointment, guided by user-centered design. We conducted a rapid exploratory evaluation, to understand Veteran and care partner experiences setting up VA-issued tablets and logging into their first appointment using standard 9-page instructions. We interviewed telehealth technicians, and providers to better understand patient barriers from their perspective. Using insights from interviews and evidence-informed guidelines on educational materials for older adults, we created a two-page guidance. A group of Veterans and care partners reviewed the materials and provided feedback. Received feedback provided 17 suggestions, 8 of which were utilized, including enlarging graphics, clarifying abbreviations (or wording), consolidating the instructions further and emphasizing pertinent information further. Modified materials reduced standard written instructions from nine pages to two. Feedback suggests that updated materials are helpful, aesthetically pleasing and preferred over current materials. Utilizing user-centered design methods, addressed barriers experienced by older, rural Veterans with initial telemedicine device and appointment set-up. Veterans, care partners, providers, and telehealth technicians perceived materials adapted for older adults as supportive of video device usability, helping to alleviate barriers that prevent Veterans from initiating telemedicine.