bluuebunny/crossref_metadata_2025_split huggingface dataset:
Audiometric Age-Related Hearing Loss and Cognition in the Hispanic Community Health Study
Authors: Golub Justin , Brickman Adam , Ciarleglio Adam , Schupf Nicole , Luchsinger José 
Published: December 2021

Abstract
Studies associating age-related hearing loss (HL) with cognition have been limited by non-Hispanic cohorts, small samples, or limited confounding control. We overcome these limitations in the largest study of formal, audiometric HL and cognition to date using the multicentered Hispanic Community Health Study (n=5,277, mean age=58.4 [SD=6.2]). The main exposure was audiometric HL. The main outcome was neurocognitive performance. Adjusting for demographics, hearing aid use, and cardiovascular disease, a 20-dB increase (one-category worsening) in HL was cross-sectionally associated with worse performance in multiple neurocognitive measures: -1.53 (95% CI = -2.11, -0.94) raw score point difference on Digit Symbol Substitution Test, -0.86 (-1.23, -0.49) on Word Frequency Test, -0.76 (-1.04, -0.47) on Spanish-English Verbal Learning Test (SEVLT) 3 trials, -0.45 (-0.60, -0.29) on SELVT recall, -0.07 (-0.12, -0.02) on Six-Item Screener. Because HL is common and potentially treatable, it should be investigated as a modifiable risk factor for neurocognitive decline/dementia.
A Stakeholder-Based Study Improving Resident and Family Engagement in the Safety of Assisted Living
Authors: Beeber Anna , Anderson Ruth , Schwartz Lindsay 
Published: December 2021

Abstract
Assisted living (AL), is a long-term care service that provides housing and care for over 800,000 older adults in 30,000 residences. AL culture and operations have been transforming to enhance resident personhood and increase autonomy, however, these practices are balanced with the need to minimize safety issues (e.g., medication errors, infections, falls, and in cases of dementia, elopement and injuries). In this stakeholder-based study, we are translating existing strategies for improving patient safety to AL residences and developing an evidence-based tool for implementing these engagement strategies in AL. This symposium presents the methods and findings from a federally-funded mixed methods study including qualitative interviews with 105 AL residents, staff and family caregivers, and a series of focus groups with an AL stakeholder group to develop a toolkit to improve resident and family engagement in AL safety. The first paper outlines our methodological approach, including our efforts to work with stakeholders throughout the research process. The second paper reports findings from a scoping review of existing tools to support resident and family engagement in the safety of AL. The third paper presents the findings from our interviews with AL residents, families and staff exploring their safety priorities, and how they differ across stakeholder groups. The fourth paper presents the findings from our qualitative interviews exploring the challenges and promising practice to resident and family engagement in AL safety during the COVID-19 pandemic. All four presentations in this symposium illustrate important issues for future practice, policy, and research.
Tools to Enhance Resident and Family Engagement in Assisted Living Safety: A Scoping Review.
Authors: Vu Thi , Leeman Jennifer , Baernholdt Marianne , Kistler Christine , Moreton Elizabeth , Ottosen Terri , Dardess Pam , Beeber Anna 
Published: December 2021

Abstract
This presentation reports the results of a scoping review which identified and evaluated existing engagement strategies, tools, and interventions for their fit with assisted living (AL). Using the PRISMA criteria, we evaluated 54 empirical studies in assisted living/residential care or nursing homes (NH) for how they engaged families and residents, promoted person-centered and/or safety in AL/NH care, and assessed relevant outcomes (safety, experience, service use, satisfaction with care, health behaviors, and quality of life). The strategies, tools, and interventions aimed to improve residents’ activities of daily living, function, and quality of life. Studies also targeted staff and family caregivers to increase knowledge, improve relationships, and decrease caregiving stress. Overall, the studies reported statistically significant changes in resident quality of life, agitation, antipsychotic use, staff knowledge and job satisfaction. Results from this systematic review will inform the development of a testable toolkit to increase engagement and improve safety in AL.
Integrating the GSA KAER Toolkit Into Practical Training for Primary Care Clinics
Authors: Gaster Barak , Raetz Jaqueline , Belza Basia , Suchsland Monica Zigman , Illes Judit , Olivari Benjamin , McGuire Lisa , Fitzpatrick Annette 
Published: December 2021

Abstract
Education is central to driving change in clinical practice. First, primary care providers and their clinic team members need to understand why detecting cognitive impairment is important, how it can be done efficiently, and what the next steps in referral and management are. To engage primary care clinics in this change process, we developed a continuing education intervention, based on the KAER Model, using a live video format. Four evidence-based, 45-minute training modules presented core knowledge skills, including how to have difficult conversations, which are essential to diagnosing cognitive impairment. To overcome the obstacles to doing so in primary care, our team relied on a deep understanding of busy primary care practice. With a combined 35 years of direct experience in primary care, our collaborative interdisciplinary team was able to use the KAER Model to develop a highly acceptable intervention for primary care.
Implementation of the GSA KAER Toolkit in a Large Clinic System: Workflow Modifications and EMR Tools
Authors: Raetz Jaqueline , Gaster Barak , Belza Basia , Suchsland Monica Zigman , Illes Judit , Olivari Benjamin , McGuire Lisa , Fitzpatrick Annette 
Published: December 2021

Abstract
We implemented the KAER toolkit in the University of Washington primary care clinics. In this session we share the workflows implemented to promote the KAER model and share the tools we developed within EPIC, the system's electronic medical record (EMR). We collaborated with clinic staff to develop interdisciplinary workflows including: training patient service representatives, social workers, nurses, and medical assistants (MAs) about 'red flags;' training medical assistants to complete the Patient Health Questionnaire (PHQ-9) and Montreal Cognitive Assessment (MoCA); and assuring they are appropriately entered into flowsheets in EPIC. We created a checklist (EPIC 'SmartPhrase') and educated the clinics' interdisciplinary teams to utilize it within their scope of practice. Additionally, we created an order set (EPIC 'SmartSet') of commonly ordered tests and referrals to expedite evaluation of patients with suspected cognitive impairment. Lastly, we created a direct link from our EMR to our website containing community resources.
Chronic Inflammation and the Acceleration of Chronic Disease States
Authors: Walston Jeremy 
Published: December 2021

Abstract
The chronic activation of the immune system is commonly observed in older adults, and is highly associated with multiple chronic disease states and Geriatric syndromes including physical frailty, sarcopenia and mild cognitive impairment. Chronic inflammation is multifactorial, and the individual inflammatory mediators that drive the development and propagation of disease states impact normal tissue homeostasis as well as stem cell vitality. This session will discuss age-related etiologies of chronic inflammation and specific inflammatory mediators and their measurement, including Tumor Necrosis Factor (TNF) alpha and its receptors. Inflammation-driven molecular pathways that most impact relevant chronic disease states such as the tryptophan degradation pathway, and its relationship to pathophysiological changes, will also be considered. Finally, discussion of potential treatment modalities, including several emerging from Geroscience research, will be described as will their impact on chronic disease states.
Neighborhood Cohesion and Mobility Limitations Among Older Americans: The Roles of Depressive Symptoms and Mastery
Authors: Wang Fei , Qin Weidi , Yu Jiao 
Published: December 2021

Abstract
Neighborhood environment has been playing an important role in late-life health; yet, the social aspect of neighborhood environment and its impact on mobility limitations have been rarely examined. This study examines the relationship between neighborhood social cohesion and mobility limitations and the potential mediators (i.e., depressive symptoms, mastery) of this relationship. A total of 8,317 Americans aged 65 and older were selected from the Health and Retirement Study. Using ordinary least squares (OLS) regressions, this study shows that neighborhood social cohesion is negatively associated with mobility limitations, and this association is mediated by depressive symptoms and mastery respectively. Specifically, neighborhood social cohesion can reduce mobility limitations through mitigating depressive symptoms and increasing mastery. The findings have implications for developing community measures to promote neighborhood social cohesion and applying psychosocial interventions to reduce depressive symptoms and improve mastery among older adults.
Healthy Lifestyle Does Matter for Community-Dwelling Adults Pursuing Quality of Life
Authors: Liu Li-Fan 
Published: December 2021

Abstract
It has been well documented that socioeconomic factors influence lifestyle behaviors and all the physical and mental status at the individual level do matters for elderly people experiencing healthy aging. This study aimed to explore to what extent the healthy lifestyle including exercise and social participation influence on the health status of the community dwellings and their quality of life in Taiwan. Using a cross-sectional survey design, 1032 adults, aged ≥ 50 years, were interviewed with complete data from four communities in southern Taiwan. The results showed that for older community dwellings adults, doing exercise was significantly associated with feeling less stress, less depress, higher life satisfaction and higher quality of life (p&lt;0.001). Being volunteers was found to be significantly associated with better quality of life (p&lt;0.001). In the aging society, it is necessary to apply multifaceted approaches extending from individual solutions to public policy efforts in promoting healthier lifestyles.
Age Differences in Preparedness for the Continuation of COVID-19: Important Roles of Social Support
Authors: Chen Zhirui , Cong Zhen , Liang Daan , Cao Guofeng 
Published: December 2021

Abstract
This study examined the association between age and preparedness for the continuation of COVID-19. The moderation effects of three types of social support, namely, emotional, financial, and instrumental assistance were also tested. Using a sample of 443 adults in Dallas county which has the most confirmed cases in Texas, results of multiple linear regressions showed that compared to those aged between 18 and 64, older adults aged 65 and reported better preparedness for the continuation of COVID-19. Receiving emotional, financial, and instrumental assistance were respectively more important for older people to get better prepared than for younger adults, which is consistent with the socioemotional selectivity theory. Our findings directed attention to the strengths and resilience of older adults during COVID-19 from a life course perspective and highlighted the importance of social support and social relationship in their post-disaster recovery and ongoing preparedness.
Physical Distancing and Social Connectedness Among Older Adults
Authors: Lutz Julie , Bower Emily , Beckwith Ellen , Choi Julie , Van Orden Kim 
Published: December 2021

Abstract
The COVID-19 pandemic has significantly impacted older adults; due to elevated risk, many older adults have followed physical distancing guidelines. These efforts, while critical to public health, have also impacted the social interactions and connectedness of older adults. In this mixed-methods study, we conducted qualitative interviews and administered questionnaires to 23 adults age 60 and older to examine how physical distancing has affected their social connectedness; what strategies and supports they have utilized to maintain or improve social connectedness despite physical distancing; and what types of supports, programs, and interventions they feel could promote and foster social connectedness among older adults during physical distancing. The results may have implications not only for the pandemic, but also for older adults who cannot leave their homes or experience barriers to typical social activities for any reason (e.g., being homebound, having functional impairments).
Using Visual Demonstrations of Learning to Promote Age-Integrated Problem Solving
Authors: Borrero Lisa 
Published: December 2021

Abstract
Working to dismantle the “othering” of older adults requires active effort to reverse deeply ingrained cultural perceptions and attitudes. As gerontology educators, we are uniquely positioned to “move the needle” on this issue by providing students with the opportunity to engage with older adults in meaningful ways and to see the world from their perspective. In this presentation, visual demonstrations of student learning will be shared that allow students to demonstrate their mastery of course concepts in a creative way and to problem-solve a particular issue by engaging with their own future selves. This approach also allows for a deviation from the routine of written demonstrations of learning by appealing to a different set of student skills. Approaches discussed will include concept maps to deconstruct community collaboration; book bentos to explore optimal aging; multimedia presentations on meaning-making in older adulthood; and a photo elicitation project to address outdoor fall hazards.
Utilization of Home and Community-Based Resources by Family Caregivers in a Native American Community
Authors: Wyman Mary , Miller Debra , Wheelock Sunshine , Petri Florence , Metoxen Elijah , Lambrou Nickolas , Gleason Carey 
Published: December 2021

Abstract
Family caregiving is uniquely significant for elder care within American Indian/Alaska Native (AI/AN) communities. Compared to other populations, AI/AN older adults are disproportionately impacted by chronic conditions and AI/AN are more likely to be family caregivers. However, AI/AN are underrepresented in aging research. We describe a successful research partnership with the Oneida Nation of Wisconsin and report results of a recent survey of tribal members and affiliates (N=405), covering demographics of caregiving, awareness and use of home and community-based resources, and perceptions of factors impacting service use. Approximately 42% of respondents were current caregivers; of these, roughly one-third knew how to access various resources. Most common sources of knowledge were a health care/social worker or finding information on their own. Traditional cultural values were viewed as variably supportive of resource utilization, depending on service type. Implications for efforts to address disparities for AI/AN aging and support caregivers will be discussed.
Association Between Advance Care Planning for Older Adults and Family Caregivers’ Sense of Security
Authors: Shinohara Masumi , Sakka Mariko , Inagaki Asa , Yasaka Taisuke , Fukui Chie , Noguchi-Watanabe Maiko , Igarashi Ayumi , Yamamoto-Mitani Noriko 
Published: December 2021

Abstract
Family caregivers’ (FCs’) sense of security benefits older adults who receive homecare. Advance care planning (ACP) is reported to have positive effects on FC’s experience, but it might differ depending on FCs’ kin relationships with the older adults. We examined whether ACP for older adults in homecare settings is associated with FCs’ sense of security. Further, we assessed whether such an association depends on their status as spouses or as adult children. We conducted a secondary analysis of data from a prospective cohort study in Japan. The participants were older adults who used home-visit nursing services, their FCs, and the nurses who cared for them. The FCs were asked to answer a sense of security questionnaire, and nurses were asked whether ACP was conducted. Multivariate logistic regression analyses were performed to examine the association between ACP implementation and positive changes in the sense of security scores after three months. Data from 169 cases were analyzed. Of the FCs, 28.1% were men and 55.6% were spouses. ACP was performed in 53.8% of the cases. The results of the multivariate analyses showed an interactive effect between ACP implementation and FC kin relationships. For spouses, ACP was significantly associated with a positive change in their sense of security. For adult children, such an association was not found. ACP might have a positive effect on caregiving spouses’ sense of security. Adult child caregivers, who often have multiple responsibilities and have difficulties facing their parents’ physical decline, may need support, in addition to ACP.
The Burden of Having to Wonder: Minority Stress Experiences of LGBTQ+ Hospice Family Caregivers
Authors: Cloyes Kristin , Jones Miranda , Vega Marilisa , Hebdon Megan Thomas , Thompson Casidee , Rosenkranz Susan J , Reblin Maija , Ellington Lee 
Published: December 2021

Abstract
Home hospice care relies heavily on informal caregivers, often patients’ family and close others. Hospice family caregivers report stress, burden, and unmet support needs associated with poor health and bereavement outcomes. These outcomes are sensitive to the quality of interactions with professional hospice providers, especially for historically marginalized groups, yet little research examines experiences of LGBTQ+ hospice family caregivers. Informed by minority stress theory, we conducted in-depth interviews with LGBTQ+ home hospice family caregivers across the U.S. (N=20). Participants reported demographics and described their caregiving experiences including interactions with hospice providers. Interviews were audio-recorded, transcribed, and content-analyzed. Participants were mostly white (n=15, 75%), non-Hispanic (n=19, 95%), cisgender (n=19, 95%), gender binary (n=19, 95%), lesbian (n=10, 50%), women (n=12, 60%); average age was 52.3 (range 25-67, SD=13.84). Along with known end-of-life caregiving stressors, participants experienced minority stress that complicated caregiver-provider communication. Distal stressors included lack of LGBTQ+ competent resources, inadequate legal protections, providers’ assumptions about relationships, and difficult dynamics with unaccepting relatives. Proximal stressors included perceived risks of disclosure, expectation of poor treatment, feeling the need to modify presentation of self or home, and wondering whether negative provider interactions were due to being LGBTQ+. This generated a background level of uncertainty, caution, and concern that was particularly distressing in the home setting. Minority stress affects LGBTQ+ people across the lifespan and generates added burdens and support needs for hospice family caregivers. Providers who understand these effects are better positioned to deliver safe, effective care to all families at end of life.
Working Family Caregiver Well-Being: Work Impact, Workplace Supports, and Family Discord
Authors: Xu Jiayun , Liu Pi-Ju , Peng Yisheng , Beach Scott 
Published: December 2021

Abstract
A recent study by our team showed that family discord about care provision among multiple family caregivers was a significant predictor of caregiver burden, anxiety, depression, and activity restrictions. This study examined the combined effects of family discord, work impacts (missed work, caregiving affects work), and workplace supports (flexible hours, caregiver benefits) on caregiver well-being. We conducted a secondary analysis using cross-sectional survey data from the Western Pennsylvania Family Caregiving Project 2017-2018. Participants were family caregivers who worked outside the home and shared older adult (i.e. over age 50) caregiving responsibilities with family (n=364, mean age: 52.59 years, female: 71.7%, White: 79.7%, cared for a parent: 69.5%, mean work hours/week: 37.30). Hierarchical regression analyses were conducted testing for main effects of family discord, work impacts, and workplace supports; and interactions between discord and work impacts/workplace supports. The presence of family discord negatively impacted all caregiver well-being outcomes (p&lt;0.05). Having more work impacts increased the risk for anxiety (p&lt;0.04), activity restrictions (p&lt;0.01) and burden (p&lt;0.01). No main effects were found for workplace support. Moderating effects were found, such that anxiety was high when family discord and work impacts were higher (p=0.025). Additionally, more activity restrictions occurred when caregivers had low workplace support and higher family discord (p=0.020). Results suggest having less family discord, more workplace support, and less negative work impacts may improve caregiver well-being. Future work is needed to determine which work supports are most beneficial to this population and how family discord and negative work impacts can be reduced.
Friendship and Loneliness Among People Living With Dementia: Social Practices and Identity
Authors: Saunders Pamela , Gan Daniel R Y , Swinton John 
Published: December 2021

Abstract
More people living with dementia (PLWD) are aging in place in the community. The number of PLWD aging in community is estimated to comprise 61-81% of the total number of PLWD in North America. Since most PLWD do not drive (Foley et al., 2000), many may (or may not) spend much of their time closer to home, barring occasional visits out of town. Yet, one’s everyday environment may not always provide “ways of being in the world that are more accepting and embracing” (Hillman & Latimer, 2017) and kind, to the varied socio-cognitive struggles of PLWD. Meaningful relationships are required to support continued social participation and citizenship (Bartlett & O’Connor, 2007; Swinton, 2020). In addition to dementia diagnosis, these everyday experiences in community may significantly alter PLWD’s self-perception and confidence. PLWD may feel more or less comfortable forging relationships depending on their past experiences. In other words, the identity of PLWDs are often challenged and (re)constructed (Saunders et al., 2011). Amid persistent power imbalances, malignant social practices may reshape one’s identity such that social isolation, whether self-imposed and/or due to restrictions from others, appear the best way to tide over overwhelming loneliness. This symposium explores how community and friendships may intercept the formation of such lonely self-identity among PLWD. We use advanced qualitative methods to elucidate the varied experiences and challenges of PLWD in community. Findings from three perspectives, namely sociolinguistics, sociology, and social work, will be discussed identify new social practices to undo stigma and support PLWD in community.