bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cognitive Impairment Trends Among Older Adults in a Medicaid Home and Community-Based Service Program
Authors: Fortinsky Richard , Robison Julie , Steffens David , Grady James , Migneault Deborah 
Published: December 2021

Abstract
Cognitive impairment (CI) is an important risk factor for nursing home admission, but little is known about CI among older adults in Medicaid HCBS programs. Racial and ethnic group CI disparities are found among community-dwelling older adults, but these CI trends have not been explored in Medicaid HCBS populations. In this study, we determined how CI is associated with older adults’ racial and ethnic group identification and educational attainment in Connecticut’s Medicaid HCBS program. The study cohort includes program enrollees age &gt;65 during January-March 2019 (N=3,520). CI measures include: Cognitive Performance Scale (CPS), ranging from 0-8 (cognitively intact to very severe impairment); and a dichotomous measure incorporating Alzheimer’s disease or other dementia diagnosis (ADRD) and CPS score signifying moderate or severe CI. Study cohort characteristics: 75.7% female; age, mean(sd)=79.1(8.2); Non-Hispanic White=47.8%; Non-Hispanic Black=15.9%; Non-Hispanic Other=2.7%; Hispanic=33.6%; HS education=21.7%; mean(sd) CPS score=2.7(1.9); 36.1% with ADRD/high CPS2 score. In multivariate regression models adjusting for age and sex, CPS scores were not independently associated with race and ethnicity, and the likelihood of having ADRD/high CPS scores did not differ by race and ethnicity (all p-values &gt;0.05). In these same models, persons with more than high school education had significantly lower CPS scores (b=-.12; p&lt;.001), and significantly lower likelihood of having ADRD/high CPS scores (AOR=0.61; p&lt;.001), than persons with less than high school education. We conclude that educational level is independently associated with CI, but race and ethnicity are not in this cohort. Policy and practice implications will be discussed.
Development and Formative Evaluation of a Death Education Program for Community-Dwelling Chinese Older Adults
Authors: Liu Mandong , Chi Iris 
Published: December 2021

Abstract
Planning for end-of-life (EOL) care in advance can enhance one’s quality of life at EOL. Culturally sensitive educational programs are needed in Chinese populations to enlighten the public and encourage advance planning due to a culture of death-denying and avoidance. This study describes the team’s efforts to develop and formatively evaluate a death education program designed for community-dwelling Chinese older adults. The program was designed based on the Knowledge-Attitude-Behavior Model, as a 2-session 3-hour program spreading over two days with 1.5 hours for each day. The content paid attention to discussing the importance of making plans for EOL in Chinese culture and discussing how to have death-related conversations with the family and health care professionals. In 2020, semi-structured interviews were conducted by phone with 12 health care professionals and researchers, and four Chinese older adults in China to obtain their feedback on program content and delivery. The directed content analysis method was used to analyze the data. Although they confirmed multiple challenges in conducting death education in China, such as family avoidance even if an older adult initiates the death-related conversation, health care professionals not feeling comfortable with such discussions, etc., they also felt the urgency and importance of delivering death education among older adults and in society as a whole. Detailed suggestions were categorized into relationship building, program preparation (e.g., setting, materials), multiple ways of recruitment, target population, length, various formats of content delivery, content (e.g., pay attention to spiritual care), and general support from the public.
Exploring the Role of Contextual Factors in Medicaid Nursing Homes' Performance: A Qualitative Perspective
Authors: Lord Justin , Ray Midge , Landry Amy , Lee Heather , Ivankova Nataliya , Herbey Ivan , Weech-Maldonado Robert 
Published: December 2021

Abstract
This study explored the role of tested contextual factors (structural, market, and management) in high Medicaid (under resourced) nursing homes performance. Four nursing homes in geographically diverse states were purposefully selected for site visits based on high and low performance (quality/ profitability) indicators. Eight nursing home administrators and directors of nursing, and twenty-one nursing staff (RNs, LPNs, and CNAs) and providers of support services were interviewed. Data were analyzed using an inductive thematic approach with NVivo 12 Plus. Within and across case analysis was used to compare participants’ perspectives across nursing homes and across administrators and staff. Several themes provide insight into varied influences of contextual factors on these nursing homes’ performance: focus on quality care, team-based approach, community support and engagement, and staffing retention. Providing quality care to residents was strategic priority in all facilities, which was enhanced by an adopted team-based leadership approach, open-door policy and home-like atmosphere. Community reputation and availability of local training opportunities for CNAs affected nursing staffing which some facilities addressed using creative retention strategies. These research findings will facilitate interventions, such as leadership training and organizational development activities, aimed at improving the performance of low performing facilities in terms of lower costs and better quality.
Injustice Squared? An Intersectional Lens to Research on Productive Engagement in Later Life
Authors: Matz Christina , Halvorsen Cal , Matz Christina 
Published: December 2021

Abstract
Social inequalities over the life course shape later life opportunities and outcomes in important ways. However, research on paid and unpaid work in later life has not always captured (and has sometimes mischaracterized) the variety and complexity of lived experiences in later life—in particular for low-income workers, workers of color, women, and others marginalized due to their social position. Further, statistics often obscure the most important information: how the most marginalized older workers are faring. Intersectionality, a term coined by legal scholar, Dr. Kimberlé Crenshaw, describes the overlapping and intersecting social identities that often influence how we move around in society. Some identities garner privilege and power and others oppression and marginalization; we must look at their intersection to better understand complexity and inform solutions. This symposium will apply an intersectional lens to research on paid and unpaid work in later life. The first paper is a scoping review that assesses the extent to which race and ethnicity are investigated in studies of the longitudinal association between workplace demands and cognitive health. The second paper explores how older Black and Hispanic adults’ work engagement is impacted by COVID-19. The third paper considers gender differences in volunteer engagement among Asian-American older adults. The final paper examines the Senior Community Service Employment Program’s role in participant financial, physical, and mental well-being. A discussant will reflect on these studies and the need for continued research that considers intersectionality in opportunities and experiences for paid and unpaid work in later life.
A Mixed-Methods Approach to the Examination of Cancer Treatment Preferences Among Older Latino Adults
Authors: Carrion Iraida , Neelamegam Malinee , Estape Tania 
Published: December 2021

Abstract
Given the growing population of Latino immigrants 60 years and older and the current lack of relevant data, there is an urgent need to understand this population’s cancer treatment preferences to ensure effective interventions and psychosocial care. A study comprising 200 surveys with areas focused on cancer knowledge, attitudes, prevention, early diagnosis, and treatment was developed and administered in Spanish. The survey included a qualitative component consisting of open-ended questions. The mixed-method study gathered quantitative data regarding treatment preferences as well as the voices of older Latino men and women with a history of cancer, including their cancer treatment trajectory. Additionally, the survey data highlighted the lack of knowledge regarding available cancer treatments. The findings suggest that, while older Latino/as have knowledge about the causes of cancer, they lack knowledge regarding cancer diagnoses, which could potentially cause them to avoid treatment.
Using Conversation Analysis to Examine When Educational Videos Are Introduced in Patient Education
Authors: Halpin Sean , Konomos Michael , Roulston Kathryn 
Published: December 2021

Abstract
As the seas of advanced therapies have swelled in the last few decades, multiple myeloma patients have been empowered, encouraged, and sometimes required, to engage in their care. We applied a conversation analysis approach to 12 nurse-led education visits (1011 minutes of audio) containing reference to educational videos. We indexed extracts based on whether the nurse or patient first mention the video. Patients oriented toward the video to demonstrate knowledge (n=15; 88%) and clarify information (n=2; 12%). Nurses oriented toward the video either through positive (n=14; 39%), negative (n=13= 36%), or neutral (n=9; 25%) assessments. Videos created opportunities for patients to pursue their topics of interest during in-person visits. Also, nurses often oriented toward the videos pre-emptively to achieve their teaching goals either by acknowledging the patients’ exposure to upcoming information or by positively or negatively assessing the videos in ways that enable them to re-orient talk to educational scripts.
Physical Activity and Social Relationships on Social Engagement Among Community-Dwelling Older Adults
Authors: Hou Su-I 
Published: December 2021

Abstract
This study examined physical activity (FITNESS) and social relationships (FRIENDS) on social engagement among community older adults. Members from two Florida aging-in-village programs participated. Three five-Likert scales were used: A 5-item FITNESS (weight, endurance, strength, flexibility, health), 4-item FRIEND (family, friends, neighbors, communication), and a 3-item social engagement scales (social-leisure activities, stay involved, healthy independent) (Cronbach alphas: .82~.92). Among the 96 participants, 79% were females, 91% were whites, 56% were married, 86% had college education, and 46% living alone. Mean age was 70.7 (SD=10.10). Participants reported at least 30-min. physical activity about 4.2 days per week. Overall social engagement was high (mean=4.38), FITNESS was median (mean=3.46), and FRINED was high (mean=4.19). FITNESS was significant to more 30-min. physical activity. Yet, higher FITNESS, FRIENDS, age, and volunteers were all significant to social engagement. Results has implications on promoting social engagement among older adults participating in aging-in-community programs.
The Importance of Social Support Networks on Mental Health Status of Custodial Grandparents
Authors: Whitley Deborah , Lee Youjung , Xu Yanfeng 
Published: December 2021

Abstract
This symposium presents a collection of papers that examine the concept of social support and its effect on custodial grandparents’ (CG) mental health state. Each paper explores a different perspective about grandparents’ access to and/or use of social support networks and mental health outcomes; several papers view social support within the context of the COVID-19 pandemic. Nadorff and colleagues explore social support by middle-generation family members and its effects on grandparents’ stress and depressive symptoms. Musil and colleagues report on psychosocial and social support predictors of self-appraised healthcare and financial security by CG during the Covid-19 pandemic. Whitley and Kelley describe current social networks relied upon by a preliminary sample of CG while managing the daily stresses and strains associated with COVID-19 and its restrictive mandates. The final two papers report the use of specialized technology and support services delivered to homebound CG during the COVID-19 pandemic. Lee and colleagues describe a telemental health model using Solution-Focused Brief Therapy to serve socially isolated grandparents experiencing mental health distress as during the pandemic. Mendoza and Park report on program challenges and outcomes of implementing a support service for grandparents living under COVID-19 restrictions. The highlights of the papers will be discussed by Yanfeng Xu and give attention to the ways scholars and practitioners can build upon these works to maximize the mental health outcomes of CG, while managing to live in socially restrictive and challenging environments.
Perceived Accomplishment in Later Life: The Influence of Past Decisions Between Family and Work
Authors: Park Jeongsoo , Larkina Marina , Smith Jacqui 
Published: December 2021

Abstract
Whereas previous studies have investigated life regrets, little attention has been paid to the important accomplishments older adults include in their autobiographic life narratives. Phenomenon such as the memory positivity effect suggest that accomplishments should be observed. We used a Health and Retirement Study 2017 Life History Mail Survey (N = 2,165) to examine the characteristics of participants over age 65 who reported accomplishments (max = 3), what was reported, and whether early-life decisions about balancing family and work are associated with the reports. Women, whites, and people with at least high school education and normal cognitive status were more likely to report accomplishments (67%). We categorized reports as family-related (39%), personal (19%), combined family/personal (25%) or other (16%). Multinominal logistic regression models revealed that participants who themselves favored family over work in early life or whose spouse decided for family, were more likely to report family-related accomplishments.
Bridging the Family Care Gap
Authors: Gaugler Joseph , Schulz Richard 
Published: December 2021

Abstract
This symposium aims to create a scientific and policy roadmap to offset the impending shortage of family caregivers available to assist older adults in the U.S. (i.e., the “family care gap”). Drawing on public health, cultural frameworks, family care science, and policy analysis, this symposium will orient future research, intervention development, dissemination and implementation, and policy innovation to more effectively address the family care gap. The selected presentations will include the need to apply and understand cultural adaptation and humility to support a rapidly diversifying older population (Drs. Nkimbeng and Parker). In addition, systematic review methodology will be applied to obtain insights as to what intervention models/strategies actually reduce caregiving time (Drs. Baker, Jutkowitz, and Gaugler). The next presentation will leverage the existing evidence base of translational efforts that aim to disseminate and implement dementia caregiver interventions into practice (Drs. Hodgson and Gitlin). The final presentation of our symposium will focus in-depth on a potential solution to the family care gap: more systematic approaches to identifying and assessing family caregivers in healthcare systems (Drs. Riffin and Wolff). Our discussant, Dr. Richard Schulz, will bring his extensive and renowned experience in caregiving to summarize the public health and policy implications of the family care gap.
Diverse, Culturally Rich Approaches to Family Care in the United States
Authors: Nkimbeng Manka , Parker Lauren 
Published: December 2021

Abstract
Despite the projected rise in the diversity of caregivers and caregiving in the US, the health system is not prepared to accommodate this growth. Interventions and supports often are not adequately tailored to meet the cultural needs of older adults. Additionally, the limited interventions available for racial/ethnic minority populations frequently fail to capture and report culturally tailored perspectives. Therefore, the purpose of this presentation is to describe how culture influences caregiving in the US. Specifically, it will: (1) provide a contemporary definition of culture; (2) identify cultural domains that impact caregiving; (3) offer examples of how caregiving is influenced by different cultural/demographic backgrounds; (4) provide examples of culturally tailored caregiving programs, and (5) discuss how to approach cultural needs that may not be addressed by current interventions.
Race and Ethnic Group Differences in Social Engagement Among Older Adults
Authors: Quach Lien , Nguyen Uyen-Sa , Pham Van , Burr Jeffrey 
Published: December 2021

Abstract
Social engagement is considered crucial for older adults’ well-being, generating social capital, connecting them to information about healthy lifestyles, and providing coping strategies for addressing daily challenges. Little is known about race and ethnic disparities regarding social engagement. This study examines the relationship between race, Hispanic ethnicity, and social engagement among community-dwelling adults age 65 or older. Data are taken from the Health and Retirement Study (2014) (n=6,221). Race and ethnic status are measured as: non-Hispanic white, non-Hispanic black, non-Hispanic “Asians and other race,” and Hispanic (any race). Social engagement includes frequency of contact with friends and family and participation in social activities (e.g. volunteering and attending religious services). Covariates included age, sex, education, number of co-morbidities, and alcohol consumption. Linear regression analyses were performed using SAS 9.4. The mean age was 74.6, and sixty percent of the sample was female. Race and ethnic distribution were 78.6% non-Hispanic white, 11.9% non-Hispanic black, 7.89% Hispanics, and 1.7% non-Hispanic “Asians and other race.” The mean score for our social engagement index was 3.3 (range 0-6). Hispanic persons, Asian persons, and persons from other race groups had lower social engagement compared with non-Hispanic white persons [β:-0.29, p&lt;.0001; β:-0.27, p=0.04 respectively), after adjusting for covariates. These race and ethnic group differences in social engagement likely contribute to well-document health disparities in later life. Understanding racial and ethnic disparities in social engagement and the factors that create these differences can help identify appropriate social intervention programs regarding improving the well-being of all older adults.
Older Adults and Family Discord or Violence During the COVID-19 Pandemic: Results of a Canada-Wide Survey
Authors: Gutman Gloria , de Vries Brian , Beringer Robert , Gill Paneet , Dault Helena , Karbakhsh Mojgan 
Published: December 2021

Abstract
Child abuse and intimate partner violence rates are known to increase during and in the aftermath of disasters. Research on elder abuse during disasters, including the current pandemic, is limited. As part of an online survey that explored older Canadians’ current experiences and future care plans during the COVID-19 pandemic, we aimed to determine the prevalence, contributing factors and potential outcomes of frequent family discord involving physical violence (FFD/PV) as a proxy for elder abuse. The survey was conducted between Aug 10 and Oct 10, 2021. Respondents (n=4380) were recruited using social media, direct email, Facebook advertising and with the assistance of 85 local community, regional and national organizations. The sub-sample reporting FFD/PV (n=76, 1.8%) was compared with other survey respondents regarding socio-demographic characteristics, negative and positive emotions, difficulty accessing basic needs, food, health care and support. Respondents experiencing FFD/PV were found to be significantly younger and less educated and were more likely to be non-white and not working than other respondents. The subgroup sustaining FFD/PV reported significantly higher rates of feeling depressed, lonely, isolated, anxious, sad, and judged/shamed and felt less happy, relaxed and accepted in their community. They also reported higher rates of challenges in accessing basic material needs such as food, support, medical care, mental health treatment and experienced more changes in life routines. Although only a small percentage reported FFD/PV, our results highlight a disturbing pattern that merits serious attention of adult protection agencies, seniors' advocates and disaster response organizations.
VA Problem-Solving Training During COVID-19 for Clinicians of Patients With Complex Comorbidities
Authors: Beaudreau Sherry , Otero Marcela , Walker Jessica , Gould Christine , Wetherell Julie 
Published: December 2021

Abstract
To address the shortage of mental health providers in geriatrics, VA has implemented clinician training in a VA Problem Solving Training (PST) protocol adapted to the needs of mostly older patients with complex comorbidities. This presentation will summarize PST implementation adaptations during COVID-19, and compare Veteran treatment outcomes before (2019) and during COVID-19 (2020). Sixty-one clinicians attended a workshop and small-group consultation for two training cases. Consultants provided ongoing feedback to program leadership about pandemic-related implementation challenges. Program adaptations during COVID-19 addressed challenges related to delivering treatment by telephone, video, or in-person and recruitment barriers. Veterans in both cohorts (N = 122) had significant reductions in mental health symptoms from baseline to posttreatment in paired t-test comparisons (ps &lt; .01). Flexibilities afforded to clinicians in the training during the pandemic did not diminish the effectiveness of the intervention, thus supporting continued implementation of the training program with added flexibility.
Aligning to a New Normal During COVID-19
Authors: Munoz Lizette 
Published: December 2021

Abstract
The Acute Life interventions Goals and Needs Program (ALIGN) is an inter-professional team of medical and social work providers dedicated to offering time-limited intensive ambulatory care to the most complex, high cost, high needs older patient population at Mount Sinai Hospital in NYC. During the 2020 COVID19 pandemic, ALIGN pivoted to focus on emergency planning actions. Such actions included language and culturally concordant goals of care discussions with patients and family, completion of electronic Medical Orders for Life Sustaining Treatment, reassessment of patient’s social determinants of health, determination of adequate access to food, medication, and emotional support to those alone and isolated, and assistance with video telemedicine. ALIGN’s model of care has shown how adaptable this program and others were during the height of the pandemic.
Feasibility and Acceptability of Tele-Enhance Fitness in Older Adults With Knee Osteoarthritis
Authors: Patel Kushang , Hoffman Elise , Simon Neta , Gell Nancy 
Published: December 2021

Abstract
Enhance Fitness (EF) is an evidence-based, group exercise program for older adults. When COVID-19 halted in-person EF classes nationally, we adapted EF for remote delivery (tele-EF) by engaging key stakeholders. To determine feasibility and acceptability of tele-EF, we conducted a mixed methods study among 42 older adults (≥65 years) with knee osteoarthritis. Participants attended EF classes for 1-hour, 3 days/week for 4-5 months (1-3 months in-person EF and 2-4 months in tele-EF). Attendance for in-person EF was 80.0% versus 91.0% for tele-EF. Nearly all participants (95.2%) reported that they were satisfied or very satisfied with tele-EF. Qualitative exit interview data mapped well onto Social Cognitive Theory constructs. With tele-EF, participants found that livestream classes facilitated accountability and self-efficacy to participate in exercise and that interactive instruction provided encouragement and support to exercise. Thus, tele-EF is a viable remotely-delivered exercise program for older adults that retains many features of in-person EF.