bluuebunny/crossref_metadata_2025_split huggingface dataset:
THE EFFECT OF CAREGIVING EXPERIENCE ON CARE RECIPIENT OLDER ADULTS’ MORTALITY: A SURVIVAL ANALYSIS
Authors: Pristavec Teja , Luth Elizabeth A 
Published: November 2019

Abstract
Health and demographic mortality risk factors among older adults are well documented. However, less is known about the dyadic relationship between caregiver characteristics and care recipient mortality outcomes. In a nationally representative sample of older adults, we prospectively explore 1) whether and how having an informal caregiver is associated with care recipient mortality, and 2) among those with caregivers, how caregivers’ experiences of burden and benefits relate to care recipient mortality. We match 6 waves of National Health and Aging Trends Study (2011-2016) with 2011 National Study of Caregivers data. We conduct survival analysis on 7,369 older adults and a subsample of 1,341 older adult-informal caregiver dyads to address our research questions. First, we find that simply having an informal caregiver increases mortality risk by 71% (p&lt;0.001) over the 6-year time period, even when adjusting for key demographic, economic and health factors. Second, we find that older adults whose caregivers perceive burden have a significantly higher mortality risk. This risk is reduced if the caregiver also perceives caregiving benefits. The risk of death is 41% higher for older adults whose caregivers report burden but no benefit compared to those with caregivers who report neither burden nor benefit. Further research should investigate possible reasons why merely having a caregiver increases older adults’ mortality risk. Interventions to increase caregivers’ sense of benefit and reduce their burden may be an effective way of decreasing mortality risk for older adults with declining health and functional ability.
WORK ENVIRONMENTS AMONG OLDER WORKING CAREGIVERS
Authors: Carr Dawn C , Taylor Miles G , Jason Kendra , Mingo Chivon A , Washington Tiffany R 
Published: November 2019

Abstract
Many older workers balance paid work with care work. Working caregivers face unique challenges that make them more likely to leave the work force. However work environments may be more or less accommodating to their needs, and in addition, they may need to work for financial reasons. Current research on working caregivers has not explored: a) the work environments of older working caregivers; b) whether particular work environments are likely to influence whether caregivers stop working; and c) whether these effects vary by type of care work (spousal versus parental). This study addresses these gaps. Using data drawn from the 2008-2014 waves of the Health and Retirement Study, we used latent class analysis to develop a typology of work environments of individuals 51-75 who are engaged in paid work. Four classes of work environments emerged: A) balanced, supportive work environments (34%); B) average environments with high job lock (30%); C) poor, unsupportive work environments (21%); and D) highly accommodating, stressful jobs (14%). Logistic regression results showed those in group D were less likely than all other groups to leave their jobs. In addition, relative to spousal caregivers, parental caregivers in class A were significantly more likely to leave the labor force. Results suggest that caregivers may be more likely to continue engaging in paid work in supportive work environments, and work environments may be more likely to retain older working caregivers by identifying ways to help them meet their work needs and maintain their caregiving roles.
INEQUALITIES IN FRAILTY BY SOCIO-ECONOMIC POSITION: IT’S ALL IN THE TIMING
Authors: Jagger Carol , Hayward Mark D 
Published: November 2019

Abstract
A number of studies have found that higher socio-economic position (SEP) appears protective of becoming frail. However, not only can SEP be defined in early, mid or late life, by education, occupational status or income/material disadvantage respectively, but frailty may occur in the young old as well as the very old. Do the same measures of SEP reflect inequalities in frailty in the young old as the very old? Does it matter when in the lifecourse SEP is measured? Have inequalities in frailty between SEP groups changed across the generations of older people? We seek to answer such questions from cohorts across the spectrum of later life. The first presentation, from the 1958 British Birth Cohort Study, examines the association between early-life SEP and frailty at age 50 and whether this association is due to continued disadvantage into mid-life. The second presentation moves to very old age, examining the role of early, mid and late life disadvantage on the progression of frailty between ages 85 and 90 in the Newcastle 85+ cohort. The third presentation, based on the electronic health records of adults aged 75 years and over in England, focuses on whether SEP modifies frailty trajectories in the last year of life. The final presentation examines whether SEP inequalities in frailty have changed over different generations of older people, and utilises data from the Cognitive Function and Ageing Studies. Together these presentations increase understanding of which SEP groups should be targeted for interventions to reduce frailty throughout later life.
SOCIO-DETERMINANTS OF FRAILTY: HAVE THEY CHANGED OVER TIME?
Authors: Matthews Fiona , Mousa andria , Jagger Carol 
Published: November 2019

Abstract
Socioeconomic inequalities are important drivers of negative health outcomes. This study investigates the effect of social determinants on health using frailty from two studies 20-year apart and examines whether socio-economic differences are widening. A 30-item deficit accumulation score from the baseline data from the two Cognitive Function and Ageing Studies, 1991 (n=7,635) and 2011 (n=7,762) was calculated. For each of the two cohorts separately, binomial regression investigated the relationship between frailty and social determinants. Deprivation was most strongly associated with frailty among the other social determinants. The effect of high deprivation, when compared the lowest tertile, increased in CFAS II (CFAS I: RR=1.21, 95%CI:1.11-1.31; CFAS II: RR=1.47(95%CI: 1.36-1.59). Inequalities in frailty have increased over time, particularly in terms of deprivation. This has important implications for health policy as focusing policies including specific interventions and resources in more deprived areas could greatly improve health outcomes for those areas.
MENTAL HEALTH AND HUNGER: RISK FACTORS FOR HOSPITALIZATION AMONG HOME-DELIVERED MEAL PARTICIPANTS
Authors: Juckett Lisa 
Published: November 2019

Abstract
Home-delivered meals (HDMs) provided through the Older Americans Act (OAA) are intended to reduce hunger, promote socialization, and maximize wellness. However, HDM recipients are at increased likelihood of being hospitalized due to their complex health needs and risk for social isolation and depression. Drawing data from the OAA-HDM National Survey, we evaluated the predictors of hospitalization among HDM recipients in 2017. From our sample (n = 578), we conducted random forest classification analyses to identify the most important risk factors related to HDM recipient hospitalization. Our random forest model yielded an accuracy rate of 66.3% with risk factors most indicative of hospitalization being attributed to number of co-morbidities, depressive symptoms, and feelings of social isolation. These findings indicate that although HDMs may help alleviate hunger among older adults, innovate strategies are warranted to address the unmet mental health needs of HDM recipients.
MEDICAID MANAGED LONG-TERM CARE PROGRAMS VS. THE TRADITIONAL MODEL: COMPARATIVE COSTS AND OUTCOMES
Authors: Polivka Larry 
Published: November 2019

Abstract
Several states have adopted Medicaid Managed Long-Term Care (MLTC) programs over the last several years. At this point at least 30 states are either administering such models or have plans to in the near future. We do not, however, know much yet about the relative cost-effectiveness of the MLTC model when compared to the traditional non-profit model of Medicaid LTC. Is the for-profit MLTC model actually generating savings in the Medicaid program while improving the quality of care? This symposia is designed to address the question through three presentations on experiences with MLTC programs in the states of Ohio, Texas and Pennsylvania and a fourth presentation offering a national overview and critique of Medicaid MLTC in comparison to the traditional Medicaid LTC program still administered through non-profit Aging Network organizations. The state focused presentations describe the current status and results of MLTC in three states that vary in their specific features, extent of formal accountability for outcomes and the political contexts in which the programs currently function. The presentations also include discussions of the implications of each states experiences for the future of Medicaid LTC policy at the state and federal levels. The fourth presentation is a critical analysis of the main differences between the traditional non-profit model of Medicaid LTC services and the for-profit MLTC programs in terms of commonly accepted criteria of cost-effective LTC services, such as access, quality of care and per-person costs and differences in the roles of advocacy and accountability.
MEDICAID-MANAGED LTC: A NATIONAL OVERVIEW
Authors: Polivka Larry 
Published: November 2019

Abstract
Most of the states now have Medicaid LTC programs administered by corporate HMOs. Several states, however, still have programs administered by non-profit community based organizations, most of which are members of long standing Aging Networks which grew out of the Older Americans Act in the 1970s. This paper will offer a comparative overview of these models of LTC administration including a typology designed to identify major cultural and political differences between the states with and without corporate managed LTC models and an analysis of the available information regarding their comparative costs and outcomes, mainly access to care and quality of care. The paper will conclude with an assessment of the implications of the information presented for the future of Medicaid LTC policy and politics at the state and federal levels and for the future of LTC advocacy and accountability across the states.
INTEGRATING ACUTE AND LONG-TERM SERVICES: DOES IT WORK, CAN IT WORK, WILL IT WORK?
Authors: Applebaum Robert A , Heston Jennifer 
Published: November 2019

Abstract
The expansion of managed long-term services and supports has generated considerable interest over the last decade. However, studies on the impact of these efforts have produced mixed findings. Additionally, there is limited information about the care management models used in implementation. This lack of data makes it impossible to assess whether differences in managed care plan approaches have an impact on participants. Our study sought to gain better understanding of the integrated care management models being implemented in Ohio’s MyCare Demonstration. Through qualitative interviews with 50 respondents, including area agency care managers, managed care staff, and service providers, we documented strengths and weaknesses of one integrated care management model used in Ohio’s demonstration. Understanding what is inside the black box of managed care/care management model implementation is key to gaining insights into whether such an approach can ultimately improve the health and long-term service systems for older people with disability.
PARTICIPANT AND CAREGIVER VIEWS OF SELF-DIRECTION OF HOME AND COMMUNITY SERVICES 15 YEARS AFTER CASH & COUNSELING
Authors: Mahoney Kevin J , Putnam Michelle 
Published: November 2019

Abstract
Results of the Cash and Counseling controlled experiment are now more than ten years old. This symposium, based on a recent Special Issue of the Journal of Gerontological Social Work on self direction of home and community-based services and supports for people with disabilities, begins with an overview of the status of self-direction in the United States where now over 1.1 million people are managing their own services and supports. After summarizing the six research studies in this Special Issue presenting feedback on the self-direction model from participants, their caregivers, and unpaid representatives followed by participant views on remaining unmet needs, the ideal and undesired characteristics of support brokers, and a research study to develop modules for training care managers and support brokers on person-centered planning and self-direction, papers will be presented focusing on two of these studies highlighting improvements needed in the self-direction approach if it is to become available to all persons with disabilities. The first paper is titled, “Unmet Needs Even When People Have Control of the HCBS Budget”; the second deals with the “Tasks and Characteristics of Supportive Support Brokers”; while the third paper looks at “Present Efforts and Recommendations for Training Support Brokers on the Principles, Values, and Skills to Assist People with Disabilities Who Wish to Direct Their Own Supports”. The session ends with a presentation on the program and policy implications of this research for federal agencies.
PARTICIPANT VIEWS OF THE TASKS AND CHARACTERISTICS OF SUPPORTIVE SUPPORT BROKERS IN SELF-DIRECTION PROGRAMS
Authors: Mahoney Ellen K , Oh Grace , Morano Carmen , Mahoney Kevin J , DeVellis Andrew 
Published: November 2019

Abstract
This qualitative study draws on 76 ethnographic case studies with Cash and Counseling participants, examines what participants and their caregivers saw the support broker doing, and looks at what the participants found helpful and less than helpful. Participants and their caregivers saw support broker duties as Coaching, Problem Solving, Advocacy and Monitoring. Equally important was how the support broker performed these roles. Six attributes that mattered to participants were: Familiarity, Supportive Relationship, Proactive Engagement, Responsiveness, Knowldge and Cultural Friendliness. These findings from the participant and caregiver perspective have great import for the training of present and future care managers and support broker, and have implications for regulatory and even licensure requirements. These results can be a first step in constructing a quality framework for self-directed supports and services.
RESEARCH CAN CHANGE PROGRAMS AND POLICY
Authors: Gerhard Lori 
Published: November 2019

Abstract
In addition to increasing knowledge, research is meant to improve practice and policy. The papers presented in this symposium draw from the experiences and insights of actual participants and their caregivers in major government-sponsored program options for people with disabilities wanting to remain in the community. Many of these programs are administered by our Administration for Community Living. For all, ACL serves as a main source of information for people in the community. These papers give us first-hand knowledge of what participants like and what they want improved. They give us guidance on how consumers define quality; the results can guide efforts to improve program design and the training of support brokers and representatives who assist people who want to manage their own supports and services. I will give a few examples starting with the paper on the Veterans-Directed Care Program and drawing ideas from the other papers.
IS VARIABILITY OF FREE-LIVING ACTIVITY ASSOCIATED WITH PHYSICAL AND MENTAL FATIGABILITY IN OLDER ADULTS?
Authors: Graves Jessica L , Krafty Robert T , Harezlak Jaroslaw , Shiroma Eric J , Glynn Nancy W 
Published: November 2019

Abstract
Greater fatigability in older adults may be moderated by physical activity (PA). However, what features of PA timing are most strongly related to fatigability remains unknown. We examined the relationship between variability of free-living activity patterns and perceived physical and mental fatigability using the Pittsburgh Fatigability Scale (PFS, 0-50pts, higher=greater fatigability) in older adults from the Developmental Epidemiologic Cohort Study (DECOS, n=57, age=70-91yrs, 61% female). We assessed PA using ActiGraph GT3X+ over 7 days. Mean activity, standard deviation (SD) of mean activity across days, and relative activity [(mean at each bin)/(total mean)] were calculated across 24-hours in 4-hour bins , adjusting for estimated rise-time. Lower SD of PA from 0-4 hours after rising was associated with greater PFS physical scores (r=-0.27, p=0.05). No measures of PA correlated with PFS mental scores. In older adults with lower physical fatigability, associations with greater variability in activity may indicate larger energy reserves.
FACTORS THAT INFLUENCE LIFE SATISFACTION IN AL RESIDENTS
Authors: Holmes Sarah 
Published: November 2019

Abstract
Life satisfaction is a multidimensional concept that addresses a personal judgment of quality from the resident’s perspective. Components of life satisfaction include satisfaction related to health, the physical environment, relationships and activities. The purpose of this study was to test if there was a relationship between demographic factors, pain, falls, and use of psychotropics with life satisfaction. The sample included the first two cohorts from the FFC-AL-EIT study including 508 residents from 54 settings across Maryland, Pennsylvania, and Massachusetts. The majority of the participants were female (70%), white (97%) and the mean age was 87.72 (SD=7.47) . Based on a stepwise linear regression analysis there was a significant association between pain (r=-.20, p=.003) and psychotropic use (r=-.19, p=.003) and the model explained 11% of the variance in life satisfaction. Ongoing research is needed to consider the impact of the environment and staff-resident interactions on life satisfaction.
THE INTERSECTION OF VULNERABILITY AND OLD AGE: ETHICAL CONSIDERATIONS FOR LONG-TERM SERVICES AND SUPPORTS
Authors: Niles-Yokum Kelly 
Published: November 2019

Abstract
This session focuses on ethical considerations in the context of long-term services and supports (LTSS) for vulnerable older adults. Long-term supports for vulnerable older adults can no longer adhere to a “one-sized fits all” solution. We will explore the intersection of vulnerability, old age, and community which present a myriad of ethical issues in both the planning and delivery of supports for older adults. The quest for a just society goes beyond understanding and considering the critical issues of the vulnerability of older adults in our society in that this pursuit provides a pathway to develop and implement programs and services that allow all of us the opportunity to live in a world that both protects and can provide the opportunity for self determination and dignity.
APPLIED GERONTOLOGY: HOW STUDENTS ADDRESS LONELINESS IN THE LOCAL COMMUNITY
Authors: Schoenmakers Eric 
Published: November 2019

Abstract
Fontys University of Applied Sciences offers an Undergraduate program in Applied Gerontology. Full-time and part-time students are trained in gerontology and in applying this knowledge in developing and implementing products and services in order to improve quality of life of older adults. In our vision, students learn in practice. Therefore, the educational program largely consists of authentic projects for real organizations in the local community. In one of these ongoing projects, students research loneliness in the local community. A network of organizations, which communicates intensively with the University, is involved. For these organizations, students study how clients and employee’s think about (coping with) loneliness, write testimonials about interventions, and advise in improving the services of organizations. For students, these kind of projects offer opportunities to learn in practice. For the community, students’ involvement means extra manpower to further develop services and society as a whole.
THE ROLE OF COMMUNITY COLLEGES IN PARTNERSHIPS WITH UNIVERSITIES IN PRODUCING QUALIFIED GERONTOLOGY PROFESSIONALS
Authors: Kopera-Frye Karen 
Published: November 2019

Abstract
Today is especially critical for community colleges and universities to work together to allow for pathways in educating professionals in the field of gerontology. At New Mexico State University, Public Health Sciences Department, we have partnered with Dona Ana Community College and Central New Mexico College through articulation agreements to allow transfer of credits and an accelerated pathway to a Gerontology Minor for workforce development. This paper will discuss the steps we took in bridging these educational opportunities as an example for other institutions to consider. By incorporating joint Advisory Boards, faculty and administrators entering into articulation agreements, and coordinated course offerings, we were able to systematize the curriculum and allow for transfer of up to 12 credits from the community colleges into our Public Health Bachelors degree program, with attainment of the Gerontology minor along the way. Lessons learned during this process will be shared.
RACIAL-ETHNIC DISPARITY IN DENTAL CARE IN NURSING HOMES
Authors: Ye Zhiqiu , Wu Bei 
Published: November 2019

Abstract
Minority older adults are at higher risks of poor oral health. Little is known about the extent of and the contributing factors to racial/ethnic disparity in dental care quality in the long-term care settings. Previous studies suggest that organizational and system-level factors are key determinants of oral health among minority older adults. We examined the racial/ethnic disparity in dental care delivery in nursing homes (NHs) by facility and market characteristics. We analyzed the 2000-2016 national Inspection Survey data for all certified-NHs (n=248,975 facility-years). Two designated deficiency citations were used to measure dental care performance. Generalized estimating equations were used to compare the rates of deficiency citations among NHs in different quartiles of the share of minority residents, adjusting for facility characteristics, market characteristics, year and state fixed effects. Overall, compared to NHs in the lowest quartile of the share of minority residents (average % minority residents =0.24%), NHs in the highest quartile of the share of minority residents (average % minority residents = 46.5%) and those in the second highest share (average % minority residents=13.9%) had 46.8% and 31.2% higher odds of receiving dental care citations(p&lt;0.001 for both), respectively. The increased citation rates persisted over time (p=0.40) and were greater among for-profit NHs (p=0.02). Our study suggests that minority older adults in NHs are disproportionately affected by poorer dental care performance. There is a great need to improve quality of dental care in NHs, particularly for those that are for-profit and those that disproportionately serve minority residents.