bluuebunny/crossref_metadata_2025_split huggingface dataset:
Perception Versus Reality: Subjective and Objective Neighborhood Characteristics and Cognitive Function in REGARDS
Authors: Finlay Jessica , Clarke Philippa , Barnes Lisa 
Published: December 2020

Abstract
Does the world shrink as we age? The neighborhood captures a spatial area someone inhabits and moves through on a daily basis. It reflects a balance between internal perceptions and abilities, and the external environment which may enable or restrict participation in everyday life. We frequently hear that older adults have shrinking neighborhoods given declining functional mobility. This is associated with declines in physical and cognitive functioning, depression, poorer quality of life, and mortality. Knowledge of the interplay between objective and subjective neighborhood measurement remains limited. This symposium will explore these linked yet distinct constructs based on secondary data analyses of the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a racially diverse sample of 30,000+ aging Americans. Finlay investigates how someone’s perceived neighborhood size (in number of blocks) varies by individual and geographic characteristics including age, cognitive function, self-rated health, and urban/rural context. Esposito’s analyses focus on neighborhood size in relation to race and residential segregation. Clarke compares subjective perceptions of neighborhood parks and safety from crime to objective indicators, and examines variations by health and cognitive status. Barnes will critically consider implications for how older adults interpret and engage with their surrounding environments. The symposium questions the validity of neighborhood-based metrics to reflect the perspectives and experiences of older residents, particularly those navigating cognitive decline. It informs policy-making efforts to improve physical neighborhood environments and social community contexts, which are critical to the health and well-being of older adults aging in place.
The Differential Effects of Caregiving Intensity on Overnight Hospitalization in the Previous 2 Years
Authors: Meyer Kylie , Gassoumis Zachary , Wilber Kathleen 
Published: December 2020

Abstract
Caregiving for a spouse is considered a major stressor many Americans will encounter during their lifetimes. Although most studies indicate caregiving is associated with experiencing diminished health outcomes, little is known about how this role affects caregivers’ use of acute health services. To understand how spousal caregiving affects the use of acute health services, we use data from the Health and Retirement Study. We apply fixed effects (FE) logistic regression models to examine odds of experiencing an overnight hospitalization in the previous two years according to caregiving status, intensity, and changes in caregiving status and intensity. Models controlled for caregiver gender, age, race, ethnicity, educational attainment, health insurance status, the number of household residents, and self-assessed health. Overall, caregivers were no more likely to experience an overnight hospitalization compared to non-caregivers (OR 0.92; CI 0.84 to 1.00; p-value=0.057). However, effects varied according to the intensity of caregiving and the time spent in this role. Compared to non-caregivers, for example, spouses who provided care to someone with no need for assistance with activities of daily living had lower odds of experiencing a hospitalization (OR 0.77; CI 0.66 to 0.89). In contrast, caregivers who provided care to someone with dementia for 4 to &lt;6 years had 3.29 times the odds of experiencing an overnight hospitalization (CI 1.04 to 10.38; p-value=0.042). Findings indicate that, although caregivers overall appear to use acute health services about as much as non-caregivers, large differences exist between caregivers. Results emphasize the importance of recognizing diversity within caregiving experiences.
Social Isolation and Loneliness in Older Adults: A National Academies of Sciences, Engineering, and Medicine Report
Authors: Galambos Colleen , Lubben James 
Published: December 2020

Abstract
Social isolation and loneliness (SIL) are serious yet underappreciated public health risks for many older adults (AARP, 2018a). Strong evidence suggests that, for older adults, social isolation and loneliness are associated with an increased likelihood of early death, dementia, heart disease, and more (AARP, 2018b, Holt-Lunstad and Smith, 2016). While all ages may experience SIL, older adults are at increased risk because they are more likely to face predisposing factors such as living alone, the loss of family or friends, chronic illness, and sensory impairments. Health care providers may be in the best position to identify older individuals who are at highest risk for SIL – individuals for whom the health care system may be the only point of contact with their broader community. The National Academies of Sciences, Engineering, and Medicine (NASEM) developed a consensus study report on this issue. This symposium presents the study recommendations. Dr. Holt-Lunstad examines the recommendations to develop a more robust evidence base for effective assessment, prevention, and intervention strategies for social isolation and loneliness. Dr. Galambos examines the recommendations to translate current research into health care practices and to improve awareness of the health and medical impacts of SIL. Dr. Lustig examines the recommendations to strengthen ongoing education and training and to strengthen ties between the health care system and community-based resources. Dr. Demiris examines the role of technology across all of these recommendations. Loneliness and Social Isolation Interest Group Sponsored Symposium
The Intersection of Medicaid and Assisted Living for Residents with Dementia
Authors: Kaskie Brian , Taylor Seamus , Xu Lili 
Published: December 2020

Abstract
Medicaid has increasingly offered coverage to persons residing in assisted living (AL). However, the scope of coverage across states is unknown. We sourced 2019 state administrative regulations specific to Medicaid and AL and determined forty-five (45) states link Medicaid with AL. Twenty-seven (27) do so as part of their state plan, 32 use a §1915(c) waiver, and 11 use a §1115 waiver. Forty-four states limit Medicaid coverage to a specific population, 16 limit coverage to those with a diagnosed disability, and 1 state limits coverage to a specific geographic region. In addition, 33 states provide payment for room and board with 28 states upholding a payment cap. In regards to services, 13 states reimburse a limited range of services while 32 offer a more expansive range of services. As Medicaid programs have extended coverage to residents of AL, researchers must now consider the impact on AL access and residents’ outcomes. Part of a symposium sponsored by Assisted Living Interest Group.
State Variability in Emergency Department Visits among Assisted Living Residents With Dementia
Authors: Hua Cassandra , Zhang Wenhan , Cornell Portia , Rahman Momotazur , Dosa David , Thomas Kali 
Published: December 2020

Abstract
Emergency department (ED) visits are associated with poor outcomes; however, state variation in ED use among assisted living (AL) residents is not well understood. Using 2017 Medicare data, we identified a cohort of 88,880 beneficiaries with dementia residing in larger ALs (25+ beds) and calculated risk-adjusted rates of all-cause and injury-related ED use per 100 person years, by state, adjusting for demographics and chronic conditions. Risk-adjusted state rates of all-cause ED visits ranged from 129.5 visits/100 person-years (95%CI=114.6,148.2) in New Mexico to 246.1 visits/100 person-years (95%CI= 224.9,274.8) in Rhode Island. The risk-adjusted rate of injury-related ED visits ranged from 91.4 visits/100 person-years (95%CI=83.0,101.4) in New Mexico to 135.9 visits/100 person-years (95%CI=126.9,146.6) in Montana. Potential reasons for these state variations will be discussed. Part of a symposium sponsored by Assisted Living Interest Group.
Stepping Into the Breach of Federal Inaction: Reforming the Financing of Long-Term Services and Supports
Authors: Cohen Marc , Miller Edward , Feder Judith 
Published: December 2020

Abstract
The growing need for long-term services and supports (LTSS) poses significant challenges to both individuals and government. For the current cohort of adults aged 65 years and over, it is estimated that the total cost of LTSS (including the value of care provided by family members) will exceed $6.3 trillion. These staggering national costs are driven by the large and rapidly growing number of individuals in need, their longer life expectancies, significant caregiver shortages, and the high costs of care. Neither private health insurance nor Medicare cover these expenses; Medicaid serves as a safety net for individuals once they have impoverished themselves. With limited to no retirement savings, most older adults cannot cover this liability. Moreover, few people have private long-term care insurance to cover this risk and the private market for such insurance is troubled. Thus, the ability to pay for LTSS is sharply bifurcated: people must be either be rich enough to pay out-of-pocket, or poor enough to qualify for Medicaid. However, even Medicaid-eligible individuals may not be able access needed care due to the waiting lists common in Medicaid. The purpose of this symposium is to document the continuing failure to tackle this problem by the federal government, and to review state and national proposals and initiatives aimed at filling the void left by federal inaction. Marc Cohen and Edward Miller will serve as presenters and chair and co-chair, respectively; Eileen Tell will also present; Judy Feder will serve as the discussant.
Social Work Training and Readiness for Trauma-Informed Care in Nursing Homes
Authors: Kusmaul Nancy , Becker Todd 
Published: December 2020

Abstract
Most adults have experienced traumatic events (SAMHSA, 2017). Late-life traumas may compound upon trauma histories (Maschi, et al., 2013), accentuating the risks confronting older adults. Per CMS’ updated Requirements for Participation, nursing homes (NHs) must implement trauma-informed care (TIC) approaches, effective November 2019. Many NHs do not staff Masters of Social Work (MSWs), despite their expertise in providing mental health care. Notwithstanding, employed MSWs feel unprepared to help their NHs implement TIC. This presentation discusses findings from a national survey of NH social service directors (N = 932). Results showed 71% (n = 650) reported moderate to strong interest in TIC training. A Kruskal-Wallis H test revealed a statistically significant difference in TIC training interest χ2(1) = 43.690, p &lt; .001, such that MSWs reported higher interest (M = 486.47) than non-MSWs (M = 375.23). There was no difference between those with and without a Bachelor of Social Work.
Everyday Ageism and Health: Evidence From the National Poll on Healthy Aging
Authors: Allen Julie Ober , Solway Erica , Kirch Matthias , Singer Dianne , Kullgren Jeffrey , Malani Preeti 
Published: December 2020

Abstract
This study examined the prevalence of everyday ageism, routine types of age-based discrimination, prejudice, and stereotyping that older adults encounter in their daily lives, and its relationships with health in a nationally representative sample age 50-80 (N=2,048, 52% female, 71% White). Nearly all older adults said they sometimes or often experienced everyday ageism (96% age 65-80, 92% age 50-64). The most common types were beliefs that health problems were an inevitable part of getting older (78%), hearing jokes about aging/older people (61%), and seeing material suggesting that older adults were unattractive/undesirable (38%). Those reporting more experiences with everyday ageism (&gt;3 types) were less likely than those reporting fewer types to have excellent/very good physical health (31% vs. 50%); similar results were found for mental health (60% vs. 80%). This poll documented the ubiquity of minor, but not inconsequential, everyday ageism reported by older adults and its potential ramifications for health.
Quality in Assisted Living: Does It Lie in the Eyes of the Beholder?
Authors: White Diana , Ozcan Tunalilar , Hasworth Serena , Winfree Jaclyn 
Published: December 2020

Abstract
Quality is defined in multiple ways and by different stakeholders (e.g., residents, regulators, informed observers). Using a two-stage stratified sampling strategy, we collected data from N=241 residents living in 31 assisted living and residential care communities (AL/RC) in Oregon. Residents rated their overall satisfaction and satisfaction with the AL/RC as a place to live and to receive care. Each interviewer completed a facility profile summarizing their observations about the setting, including quality of staff-resident interactions and physical environment. Residents and interviewers were also asked whether they would recommend the community to others. Finally, we used deficiency citations given during regular inspections by the licensing agency to proxy regulatory perspective. Results show that perceived quality varied by stakeholder (e.g., residents’ assessments differed from deficiency citations). Given this variation, findings suggest that efforts to make quality indicators publicly available should include multiple measures and perspectives, especially residents.
Homeless on Main Street: Using Photovoice to Highlight Older Adults Among the Hidden Homeless
Authors: Versey H Shellae 
Published: December 2020

Abstract
Homelessness is a reality for a growing number of Americans living in small towns and rural areas. However, unlike in cities, housing instability may be less visible. Using a photo-elicitation method (i.e., Photovoice), this study explores the meaning of place and obscured visibility to currently and formerly homeless older adults living in a small town in central Connecticut.
Participants (N = 27) were recruited from a local service agency, given cameras and asked to photograph areas around town that were meaningful to them. Photographs were developed and followed by in-person, semi-structured interviews with participants in which photos and experiences during the project were discussed. Primary themes included belonging, generativity, social isolation, and place-making as meaning-making. The study culminated in a community photography exhibition in which photographs from the project were displayed in public spaces around town. Implications for community-based interventions to reach homeless groups in rural areas are discussed. Part of a symposium sponsored by the Qualitative Research Interest Group.
Exploring the Relationship Between the CFPB Financial Well-Being Score and the Elder Index
Authors: Mutchler Jan 
Published: December 2020

Abstract
The Elder Index is a cost of living indicator that measures the income older adults need to meet their living expenses while staying independent in the community, calculated on a county-by-county basis for the United States. Analyses based on the Elder Index show that a large segment of the age 65+ population has incomes below the Index, reflecting a level of insecurity that is considerably higher than suggested by the poverty rate. Moreover, comparison of the Elder Index to household income illustrates differences across states in the extent to which incomes cover the cost of necessary expenditures. In this paper we explore how cost of living contributes to subjective financial security among older people, as measured by the CFPB Financial Well-Being Score, using a data match of the Understanding America Study with the Elder Index. Results document this association, offering insight to spatial patterns of financial insecurity in later life.
Empowering Through Education: Understanding Financial Well-Being Among Low-Income Older Adults
Authors: Powers Sara , Edwards Sonya 
Published: December 2020

Abstract
Recognizing the need for and importance of financial capability education among low-income older adults, the non-profit agency, Empowering and Strengthening Ohio’s People (ESOP), implemented an 11-part financial education workshop series with a sample of older adults enrolled in the Senior Community Service Employment Program (SCSEP). Over the course of 10-months, participants attended workshops that covered an array of topics (e.g., budgeting and goal setting, avoiding financial exploitation) and completed a variety of measures aimed at understanding their financial situation and well-being (e.g., CFPB Financial Well-Being Scale, Financial Shocks, Material Hardship, Financial Skill). Results indicated that financial well-being scores significantly increased from the beginning of the workshop series (M=54.49, SD=7.23) to the end (M=58.10, SD=8.10); t(48) = 3.66, p=.001. Discussion will offer insights into the subjective financial experiences of low-income older adults who were actively trying to seek and gain permanent employment to improve their financial situation.
Implementing IG Best Practices in Community-Based Settings: A Pre-Implementation Study
Authors: Juckett Lisa , Jarrott Shannon , Naar Jill , Scivano Rachel , Bunger Alicia 
Published: December 2020

Abstract
Programs that intentionally engage unrelated young and old persons often lead to mutual benefits; however, specific implementation strategies that support the use of evidence-based intergenerational programming in community settings are understudied. With strong demand for training resources among intergenerational program providers, this pilot study examined how a multifaceted training strategy facilitated the implementation of 14 distinct evidence-based intergenerational best practices. Intergenerational programming was implemented with nine staff from two small community sites using three implementation strategies including educational meetings, ongoing consultation, and routine practice reminders. Observational analysis of video recorded intergenerational program sessions indicated that staff adopted an average of 81.7% of intergenerational best practices suggesting the feasibility of implementing IG in community settings. Findings yield valuable insight that can inform training refinements, and selection of strategies for improving implementation. Next steps include aligning specific practices with participant outcomes.
Mortality and Morbidity Among Nursing Home Residents Exposed to Hurricane Irma
Authors: Dosa David , Skarha Julianne , Peterson Lindsay , Jester Dylan , Sakib Nazmus , Ogarek Jessica , Andel Ross , Hyer Kathryn 
Published: December 2020

Abstract
We combined Medicare claims and nursing home (NH) administrative data to determine the mortality and morbidity effect of Hurricane Irma on nursing home residents. We utilized the Centers for Medicare and Medicaid Services (CMS) Standard Analytical Files (SAFs) combined with the Minimum Data Set (MDS) to create an exposure cohort of NH residents residing in Florida facilities immediately prior to Hurricane Irma’s landfall on September 10, 2017. We created a control group of residents who resided in the same NHs over the same dates in 2015, a year when there were no hurricanes. Outcome variables included 30/90-day mortality and first hospitalizations post storm. Compared to the control, an additional 260 more NH deaths were identified at 30 days and 429 more deaths at 90 days. Long stay residents (≥100 days) were at particular risk for mortality compared to short stay residents (&lt;100 days). Hospitalization was also markedly increased.
Mechanisms of Lifespan Extension by Sirt6 in Drosophila melanogaster
Authors: Taylor Jackson , Wood Jason , Finn Matthew , Liu Julianna , Mizerak Evan , Gordon Sarah , Hutfilz Corinne , Helfand Stephen 
Published: December 2020

Abstract
Sirt6 is a multifunctional enzyme that regulates numerous cellular processes connected to longevity. Overexpressing Sirt6 extends lifespan in mice, but the underlying cellular mechanisms are unclear. Here, we used the powerful genetic tools and short lifespan of Drosophila melanogaster to better understand the precise mechanisms by which Sirt6 regulates longevity. Sirt6 OE in flies produces robust extension of median lifespan in both sexes. Molecular and biochemical analyses reveal that Sirt6 OE reduces expression of genes involved in protein synthesis, including many Myc target genes, via epigenetic regulation. We will further discuss our findings on the connection between Sirt6, Myc, and the molecular regulation of protein synthesis and lifespan, as well as additional Sirt6 longevity mechanisms we identified, including autophagy and silencing of transposable elements.
Alzheimer’s Staffing, Services, and Outcomes in Adult Day Health Centers
Authors: Spetz Joanne , Flatt Jason 
Published: December 2020

Abstract
Growing demand for care for Alzheimer’s Disease and related Dementia (ADRD) has resulted in rising use of adult day health centers (ADHCs), which employ teams of professionals including licensed nurses, nursing aides, social workers, and activity directors. This study evaluates the scope of services and staffing models of ADHCs that provide care to persons with ADRD compared to ADHCs that do not, and examines whether there is an association between staffing and client outcomes, measured as rates of hospitalizations, falls, and emergency department visits. We used facility-level data from the 2014 National Study of Long-Term Care Providers (NSLTCP) Adult Day Services Center module. We conducted bivariate comparisons and estimated multivariate regressions to identify ADHC characteristics associated with staffing and client outcomes. ADHCs that offered ADRD services had higher average daily attendance, greater shares of revenue from Medicaid and self-payment, and greater proportions of Blacks and females. They also had greater percentages of enrollees with depression, cardiovascular disease, diabetes, and needing assistance with activities of daily living. There were also greater numbers of registered nurse, licensed practical nurse, and social worker hours per enrollee day, but fewer activity staff hours per enrollee day. Multivariate regressions focused on ADHCs that offered skilled nursing services and revealed that total staff hours per enrollee day were not higher in ADHCs that provided ADRD services, controlling for other characteristics. However, staffing was greater in chain-affiliated ADHCs. Higher staffing levels were associated with lower rates of falls and emergency department visits.
Dopamine-Related Genotype Predicts Trajectories of Gait Reserve in Older Adults
Authors: Sprague Briana , Rosso Andrea , Zhu Xiaonan , Rosano Caterina 
Published: December 2020

Abstract
The capacity to increase one’s gait speed is critical for maintaining safe community ambulation. There is limited work on the longitudinal changes in this capacity and its predictors. Because lower dopamine is associated with lower task adaptation and motivation, we hypothesized that lower dopamine would predict more decline in rapid gait speed. Catechol-O-methyltransferase (COMT) polymorphism and at least 3 repeated rapid and usual pace gait speed assessments were obtained over 10 years in 1,261 older adults (mean age=75.2, 867 White, 659 women). Linear mixed models computed person-specific rapid and usual pace gait speed trajectories. Regression models adjusted for usual gait trajectory tested whether COMT predicted rapid gait trajectory; covariates included, demographic, psychological, cognitive, and physical factors. Val/Val carriers (lower dopamine) declined more in rapid gait compared to Met/Met carriers (higher dopamine; adjusted b=-.002, SE=.001, p=.042). Modifying dopamine may positively influence the ability to maintain rapid gait over time.