bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lessons Learned in a Community-Based, Randomized Controlled Trial of a Complicated Grief Intervention
Authors: Buck Harleah , Cairns Paula , Emechebe Nnadozie , Hernandez Diego , Mason Tina , Bell Jesse , Kip Kevin , Tofthagen Cindy 
Published: December 2020

Abstract
Complicated grief (CG), severe, prolonged (&gt;12 months) grieving, disproportionately affects older adults. A prospective two-group, waitlisted RCT examined whether four sessions of Accelerated Resolution Therapy (ART) was effective in informal caregivers by comparing pre-to-post ART changes and investigating variation in treatment response by baseline CG levels. Inclusion: ≥60 years, Inventory of Complicated Grief &gt;25. Paired t-tests of mean (SD) differences compared pre- to post-ART; pre-ART to 8-week follow-up, and post-ART to 8-week follow-up; then stratified by median baseline level of CG. Mean (SD) age of 54 participants was 68.7 (7.2) years, 85% female, and 93% white. Significantly greater CG reduction (-22.8 (10.3)) vs. waitlist (-4.3 (6.0)) was found. Within-participant effect sizes from baseline to 8-weeks post treatment were 1.96 (95% CI: 1.45, 2.47; p&lt;0.0001). Treatment effects did not substantially differ by baseline levels. Lesson learned was that it was possible to successfully recruit and treat CG in the community.
Self-Efficacy of Family Caregivers of Older Adults With Cognitive Impairment: A Concept Analysis
Authors: Khan Tarik , Hirschman Karen , McHugh Matthew D , Naylor Mary , Khan Tarik S 
Published: December 2020

Abstract
The purpose of this concept analysis is to address fundamental gaps in the understanding of self-efficacy in family caregivers of older adults with cognitive impairment, including updating the 26-year-old concept analysis with a contemporary definition. With the first of the baby boomers set to turn 75 in 2021, the growing number of Americans with Alzheimer’s disease is predicted to more than double over the next 30 years, while the pool of potential family caregivers is likely to diminish by half. Research demonstrates that increased self-efficacy can help family caregivers of older adults with Alzheimer’s and other types of cognitive impairment experience lower burden and depressive symptom severity. This study utilized Walker and Avant’s method of concept analysis, an eight-step iterative process that helps to clarify the meaning of ambiguous concepts. A literature review was conducted from July 1993 through March 2019 using PubMed/MEDLINE, Scopus, CINAHL, and Embase. Eight defining attributes of this concept were identified. The revised definition of self-efficacy in this population is “a family caregiver’s confidence in their ability to: manage behaviors and other caregiving stresses, control upsetting thoughts, acquire medical information, manage medical issues, obtain self-care, access community supports, assist with activities of daily living and other care, and maintain a good relationship with a relative, friend, or neighbor of an older adult with cognitive impairment.” Practice implications include tailoring interventions to improve family caregiver self-efficacy. Policy implications include fostering evidence-based health strategies through payment and delivery incentives that further support caregiver self-efficacy.
Self-Neglect: One Pathway to Surrogate Decision-Making
Authors: Ramsey-Klawsnik Holly , Burnett Jason 
Published: December 2020

Abstract
Self-neglect, the most frequently reported allegation to Adult Protective Services (APS), involves profoundly harmful behaviors often due to functional or cognitive limitations, health problems, and insufficient resources that result in older adults insufficiently meeting their basic needs. Outcomes include high risk of illness, hospitalization and readmission, hospice and nursing home use, early mortality, and placement under surrogate decision-making authority of either well-intended or opportunistic others. APS staff are charged with assessing self-neglect and intervening to reduce client danger. A nationwide APS survey revealed program policies, procedures, resources, and needs affecting the client welfare. For example, 92% of APS programs have provisions for seeking guardianship for self-neglecting individuals, in 25% of programs staff serve as court-appointed guardians, and a wide variety of tools are used within APS programs to assess clients’ mental capacity. Key study findings, implications, and recommendations will be presented.
Service-Specific Surveying to Support Person-Centered HCBS for Older Adults and Their Caregivers
Authors: Walsh Caitlyn , Tice Jessica 
Published: December 2020

Abstract
The Florida Department of Elder Affairs (DOEA) annually surveys clients receiving state funded home and community-based services (HCBS) to measure their satisfaction with services. Historically, the same survey instrument was used each year, to afford question-level comparisons across time. However, in 2015 internal contradictions were identified between individual-level satisfaction ratings and qualitative statements made by the respondents later in the survey. The high rates of satisfaction typical in survey responses were also contradicted by findings from a comprehensive program evaluation which revealed high percentages of clients who terminated their services and many caregivers reporting strain and varying types of personal crisis. To address these issues, the annual Client Satisfaction Survey and methodology was redesigned to be more specific regarding details about the delivery of direct services, and the sampling methodology was revised to constrain to the recipients of discreet service types. The results from these new service-level surveys will be presented for each of three direct services: case management, personal care, and homemaker. Findings revealed differences across regions in the state, and highlighted the frustration experienced by HCBS clients with high worker turnover and low training for special conditions, such as Alzheimer’s or related dementia. Complaints and suggestions collected from clients and caregivers were shared with program managers for consideration in changes to policies, training, and other areas of service improvement toward becoming more person-centered. Overall, this service-oriented approach to surveying has yielded more actionable results and has been adopted by DOEA as the preferred method for all client-level surveying.
Impact of Health Systems on Life Expectancy in Taiwan, Singapore, and the USA: Similarities and Differences
Authors: Chen Ya-Mei , Young Yuchi , Schumacher Patrick 
Published: December 2020

Abstract
Like Singapore, Taiwan has universal health care and universal long-term care (LTC). The USA has neither. Those who need LTC in the US pay out of pocket, buy private LTC insurance or spend down to qualify for Medicaid; there are inherent issues related to cost and quality. For example, nursing home care costs over US$100,000/year and only about 8% of the population has private LTC insurance. Many people become impoverished or struggle financially to qualify for Medicaid. Conversely, Taiwan has universal LTC insurance that offers comprehensive services for all, but it is relatively new and its impact remains to be seen. Similarities and differences related to LTC quality indicators such as functional independence, and the NCQA quality measures (e.g., effectiveness of care, access/availability) in Taiwan, Singapore and the US will be presented. The results of this comparison can inform policy makers and stakeholders leading to best practices. Part of a symposium sponsored by International Comparisons of Healthy Aging Interest Group.
Who Are the Heavy Users of Acute and Long-Term Care Services in Changhua County, Taiwan?
Authors: Young Yuchi , Chen Ye-Mei , Chen Kuo-Piao , Chen Hsiu-Hsi , Chang Wei-Jung , Hsu Wan-Hsiang , Yeh Yen-Po 
Published: December 2020

Abstract
Identification of heavy health care users among community-dwelling older adults can lead to strategic care planning and management that positively impacts health care use and costs. This study aims to identify risk factors associated with heavy users of acute care and long-term care (LTC) in Changhua County, Taiwan. Study participants (n=8,090) included residents (age 65+) of Changhua County. Data were collected from 4/1/2017-10/26/2018. Linked hospitalization and LTC use information was provided by the Changhua County Public Health Bureau. Hospitalization was grouped into 1 vs. 2+. Univariate and multivariate logistic models will be used to address the study aim. Preliminary results show the average age was 81 years ranging from 65-105. Of this population, 56% are female, and 10% live alone. The average length of hospital stay was 9.7 days. Risk factors associated with heavy health care users identified in multivariate analysis will be presented and intervention strategies will be discussed. Part of a symposium sponsored by International Comparisons of Healthy Aging Interest Group.
Stories of the Experience of Searching for Long-Term Care and Eldercare: Case Study and Narrative Perspectives
Authors: Corley Connie , McCarty Ryan 
Published: December 2020

Abstract
With over 40 million individuals aged 65 years and older in the US, and by 2050 rising to an estimated 89 million, age matters, driving an increased need for long-term care/eldercare. Coupled with the higher costs of care, the search for long-term care/eldercare services can be a difficult prospect for adult children decision-makers. We present the experiences of adult children decision-makers in the US, using two methodological approaches: narrative and case study using autoethnography. In a narrative inquiry of 9 caregivers responsible for making long-term care/eldercare decisions for their parent(s) the zoom model was applied to conduct the analysis. Findings suggest that decision-makers have a strong sense of duty towards helping their loved ones find long-term care solutions. Decision-makers searched for many types of care solutions ranging from home health care to nursing homes. The experiential response most consistently stated by the participants was stress. These results are augmented by an autoethnographic case study in “six acts” illustrating how sense of agency in the caregiving journey can be enhanced. Participants with industry experience had a minimal advantage over those with no experience when it came to navigating the search for long-term/eldercare. We highlight why stories of family search for long-term care/eldercare matter, and how they can be leveraged for fundraising, advocacy, and healing. Implications for policy, research, education and practice are highlighted.
Conceptualizing the Shelter and Housing Needs and Solutions of Older People Experiencing Homelessness
Authors: Canham Sarah , Humphries Joe 
Published: December 2020

Abstract
Newly and chronically homeless older adults have unique pathways into homelessness and distinct physical, mental, and social needs. Using a five-step process, we conducted a scoping review of primary research to investigate the needs and solutions for sheltering/housing older people experiencing homelessness (OPEH). Thematic analysis of data from 19 sources revealed 1) shelter/housing needs and challenges of newly vs. chronically homeless older adults; 2) existing shelter/housing solutions addressing the needs of OPEH, including Housing First, permanent supportive housing, and multiservice homelessness intervention programs; and 3) outcomes of rehousing OPEH. Following, we developed a conceptual model which outlines how unique health and psychosocial needs of newly and chronically homeless older adults can be met through appropriately-designed shelter/housing solutions with individualized levels of senior-specific support. Future shelter/housing initiatives and strategies should use a rights-based approach and prioritize matching diverse OPEH needs to appropriate shelter/housing options that will support their ability to age-in-the-right-place. Part of a symposium sponsored by the Environmental Gerontology Interest Group.
Shelter and Housing Options, Supports, and Interventions for Older People Experiencing Homelessness
Authors: Mahmood Atiya , Humphries Joe , Moore Piper , Burns Victoria , Canham Sarah 
Published: December 2020

Abstract
While older people experiencing homelessness (OPEH) can have life histories of homelessness or experience homelessness for the first time in later life, understandings of shelter/housing models that meet diverse needs of this population are limited. We conducted a scoping review of the international literature on shelter/housing models available to support OPEH. Through an iterative process of reading and rereading 24 sources (published 1999-2019), findings were organized into 5 categories of shelter/housing models that have been developed to support OPEH: 1) Permanent supportive housing (PSH), including PSH delivered through Housing First, 2) Transitional housing, 3) Shelter settings with medical supports, 4) Drop-in centers, and 5) Case management and outreach. Findings expand our understanding of how a continuum of shelter/housing options are needed to support distinct health and housing needs of diverse OPEH. Policy and practice implications related to integrating health and social care to support OPEH to age-in-the-right-place will be discussed. Part of a symposium sponsored by the Environmental Gerontology Interest Group.
Family Caregivers of Veterans Experience High Burden, Mental Health Distress, and Financial Strain
Authors: Shepherd-Banigan Megan , Sherman Sophia , Lindquist Jennifer , Miller Katherine , Tucker Matthew , Smith Valerie , Van Houtven Courtney 
Published: December 2020

Abstract
We describe the caregiving experiences and needs of family caregivers of older Veterans enrolled in the U.S. Department of Veterans Affairs (VA). We conducted telephone surveys with 1,509 caregivers to assess caregiver health and well-being. Caregivers were primarily female, &lt;50 years old, white, and the Veterans’ spouse. Veterans had substantial functional limitations and required care for multiple conditions, commonly, mental illness, dementia, and heart disease. On average, caregivers provided care for 9.6 hours per day and 6.7 days per week. Burden and depressive symptoms were above clinical thresholds with average scores of 21.8 (Zarit burden) and 11.5 (CES-D 10). Levels of perceived loneliness and financial strain were high. As this population needs emotional support, respite care services, social engagement, and training to care for aging Veterans, the expansion of enhanced caregiver services and supports to this population (expected in 2020) through the VA Mission Act of 2018 will be beneficial.
Mortality and Health Outcomes for Older Adults Screened by an Area Agency on Aging Over a 4.5-Year Period
Authors: Gum Amber , Schonfeld Lawrence , Kip Kevin , Goldsworthy Mary , Bell Jesse , Conner Kyaien , Green Ohad , Parkinson Katie 
Published: December 2020

Abstract
Area Agencies on Aging (AAA) screen older adults and oversee delivery of a wide range of home- and community-based services (HCBS). We examined the assessment process, services, and mortality and health outcomes for older adults screened by an Area Agency on Aging in west-central Florida. Most were self/family referred (78.9%). Using data from July 2013-December 2018, 23,225 older adults were screened. Individuals had an average of 2.6 years follow-up in the dataset, during which time 63.6% received additional assessments: follow-up screening (50.6%), comprehensive assessment for enrollment in HCBS (35.7%), or assessments for congregate meals or other services (13.7%). Results revealed differences in mortality: 22.5% of clients receiving services died compared to 32.1% of clients prioritized as lower risk and on waiting lists for services. Long-term care placement and functional decline outcomes also will be reviewed, along with implications for service delivery and managing waitlists.
Social and Physical Contexts of Long-Term Services and Supports
Authors: Fabius Chanee , Clarke Philippa 
Published: December 2020

Abstract
In the coming years, inevitably growing numbers of older populations will yield more older Americans with extensive medical and long-term care needs. This will lead to an increasing need for long-term services and supports (LTSS) to assist older adults with routine daily activities (e.g., bathing, dressing, medication management). There is a growing interest in understanding how social and physical environments contribute to health outcomes and the provision of services and resources for older persons with disabilities requiring assistance from LTSS. Decisions about care and subsequent experiences are likely a result of factors that extend beyond personal preference or individual factors, such as neighborhood quality, housing context, and living situations (i.e., homebound status) among community-dwelling older adults. Given population aging and the shift of LTSS from nursing homes toward community settings, there is a pressing need for more information about contextual factors that might help better develop supports for vulnerable older adults. This symposium will feature four presentations that provide novel insight regarding social and physical contextual factors contributing to LTSS. Presentations leverage data from the National Health and Aging Trends Study (NHATS), a nationally representative survey of Medicare beneficiaries aged 65 and older, and will describe: 1) associations between individual and home environment risk-factors, neighborhood-level social deprivation, and falls; 2) the relationship between neighborhood-level social deprivation and caregiving intensity (number of hours of caregiving per week) among community-dwelling older adults; 3) associations between living in single-family vs. multi-unit housing and social networks; and 4) community tenure among homebound older adults.
Social Isolation and Loneliness: Translating Current Research into Health Care Practices and Improving Awareness
Authors: Galambos Colleen 
Published: December 2020

Abstract
This paper examines the evidence to support the need to translate current research into health care practices about social isolation and loneliness (SIL) among older adults. The health care system may be in the best position to identify those at highest risk—namely, older adults, whose only interactions are with members of the health care system. This paper reviews recommendations related to periodic assessments, including the use of validated tools to identify those at highest risk. Through this identification, clinicians and health care researchers may be able to use these findings to better target meaningful clinical and public health interventions. Additionally, a critical step toward preventing, mitigating, or eliminating negative health impacts will be to improve awareness about the problem and impact of SIL within the older adult population. This paper reviews recommendations for improving overall awareness by including SIL in national health strategies and public campaigns. Part of a symposium sponsored by Loneliness and Social Isolation Interest Group.
Social Isolation and Loneliness: Strengthening Education and Training
Authors: Lustig Tracy 
Published: December 2020

Abstract
This paper reviews recommendations for a variety of opportunities to improve education and training of the health care workforce on the health impacts of SIL and clinical approaches for assessment as well as testing different approaches for such education and training. The fifth goal of the NASEM study is to “strengthen ties between the health care system and community-based networks and resources.” Similar to other social determinants of health, addressing SIL will require coordinated efforts among a variety of stakeholders. This paper reviews recommendations for improving coordination, including team-based care and promotion of tailored community-based services, as well as the creation of a centralized repository for new evidence and best practices. Finally, connections between this NASEM study and the 2019 report Integrating Social Care into the Delivery of Health Care are discussed. Part of a symposium sponsored by Loneliness and Social Isolation Interest Group.
Barriers to Meeting the Social and Emotional Needs of Nursing Home Residents
Authors: Roberts Amy Restorick , Bern-Klug Mercedes 
Published: December 2020

Abstract
Presenters will describe barriers to psychosocial care and identify which factors increase the odds of experiencing a psychosocial care barrier. Reported major barriers include: insufficient number of nurse aide staff (31%), having to do things other people could do (29%), lack of resources to provide residents with opportunities to leave the nursing home on outings (25%), pressure to admit and discharge post/sub-acute patients takes time away from attending to the social and emotional needs of long stay residents (23%), and not enough social service staff for the number of residents (21%). With data from the 2019 National Nursing Home Social Services Directors Survey, a series of logistic regressions found that significant predictors varied by specific barrier, although devoting more time to short-term residents predicted a greater likelihood of reporting a major barrier in four of the five outcomes. Strategies to address these structural and contextual factors will be discussed.
Reassessing the Aging Enterprise: New Perspectives on the Social Construction of Later Life
Authors: Phillipson Chris 
Published: December 2020

Abstract
Four decades on from the publication of 'The Ageing Enterprise', this paper provides a critical review of the relationship between social theory and social policies for later life. To what extent do current theoretical perspectives in gerontology bear the influence of ideas laid out in that pioneering book? How has the ‘ageing enterprise’ fared given the dominant ideology of neo-liberalism and the precarious lives faced by people moving through the life course? The paper considers these questions in the context of globalization processes, and the imposition of austerity policies. The paper will consider the continuing importance of ‘The Ageing Enterprise’ by reviewing three main themes: first, assessing the changing relationship between the state and social policy; second, through examining current perspectives within critical gerontology; third, highlighting new forms of empowerment developing amongst older people, and the relationship of these to the values and ideas expressed in ‘The Ageing Enterprise’. Part of a symposium sponsored by the Women's Issues Interest Group.
Working While Caregiving: A Scoping Review of the Experiences of Employed Female Caregivers
Authors: McLaughlin Jessica King 
Published: December 2020

Abstract
The negative consequences of caregiving disproportionately impact women, as women make up the majority of informal caregivers and spend more time doing caregiving duties than men. The competing demands inherent in being a caregiver while working can increase levels of stress and burden that these individuals may experience. However, the nuances of the challenges of working female caregivers are still not salient. This review synthesizes the extant literature on working female caregivers to clarify the dilemmas they face and factors that impact their ordeals. Thirty studies on working female caregivers met inclusion criteria. Findings indicate common themes that emerged across the studies. These themes indicate the need to more comprehensively support the multifaceted nature of working female caregivers’ experiences in the workplace and outside of work. Furthermore, this review identifies areas in which informed policy can have a meaningful impact on working female caregivers’ lives.