bluuebunny/crossref_metadata_2025_split huggingface dataset:
SOCIOECONOMIC STATUS, CHANGES IN HEALTH BEHAVIORS, AND DEPRESSIVE SYMPTOMS AMONG OLDER ADULTS DURING THE PANDEMIC
Authors: Liu Yujun , Wang Heng , Hughes M Courtney 
Published: December 2023

Abstract
Disparities in COVID-19 morbidity and mortality based on race and gender exist among older adults. Few studies have explored the complex relationships between the multiple components of COVID-19 vulnerabilities and the intersectionality across gender and race. This study aims to examine the impact of the COVID-19 pandemic on financial difficulty, health behavior, and depressive symptoms among older adults across the intersectionality of gender and race. Using Round 5 and Round 10 of the National Health and Aging Trends Study (NHATS) linked with the NHATS COVID-19 dataset, our sample included Medicare beneficiaries aged 65 or older in the U.S. (N =3,118). We modeled the interrelationships between financial difficulty, health behaviors, and depressive symptoms using a structural equation model. The results indicate that within the intersectionality framework, female participants reported less walking, more changes in eating habits, less sleeping, and less alcohol consumption during the pandemic than before compared to male counterparts. Compared to Non-Hispanic White, Non-Hispanic Black, Hispanic, and Other races, participants showed higher proportions of experiencing financial difficulty, less walking, less vigorous activity and changes in eating and sleep during than before the pandemic. Financial difficulty was significantly and positively associated with depressive symptoms and sedentary behavior. Active behavior was significantly and negatively associated with depressive symptoms, sedentary behavior was significantly and positively associated with level of depressive symptoms. Health professionals should consider the connection between various sociodemographic and health factors and the impact of COVID-19 on older adults when designing and delivering health and wellness programs post-pandemic.
CHALLENGES AND STRATEGIES TO IMPLEMENTING THE TRANSITIONAL CARE MODEL: LESSONS LEARNED FROM THE MIRROR-TCM TRIAL
Authors: Hirschman Karen , McHugh Molly , Osokpo Onome , Mccauley Kathleen , Shaid Elizabeth , Hanlon Alexandra , Pauly Mark , Naylor Mary 
Published: December 2023

Abstract
The Transitional Care Model (TCM) is an advanced practice registered nurse-led, team-based, care management strategy which has repeatedly been shown to improve outcomes for older adults transitioning from hospital to home. The MIRROR-TCM randomized controlled trial was implemented at three healthcare systems (7 hospitals) in four states. Older adults, hospitalized with heart failure, chronic obstructive pulmonary disease, or pneumonia, were enrolled between September 2020 and January 2023. A parallel evaluation study of “what it takes” to implement the TCM was launched to explore the challenges and strategies necessary to implement the Model’s 10 components, especially in the context of COVID-19. A qualitative descriptive analysis of 167 meetings (clinical, community, leadership) from June 2020 (Pre-Implementation) through January 2023 (implementation/evaluation) was conducted. Codes were developed inductively over the first year of the study. The most common challenges were patient and caregiver factors (e.g., engagement, preferences, medical complexity), staffing coverage (e.g., time off, absences), and collaboration with multidisciplinary teams (e.g., poor or reluctant collaboration/communication). Common strategies to address challenges included: clarifying and adapting TCM processes, establishing an appropriate plan of care, building and engaging networks and relationships across healthcare and community settings, and trialing alternative strategies (e.g., telehealth in place of in-person visits). While some challenges were more common across sites such as patients refusing visits or no weekend coverage, strategies to resolve them tended to be site-specific. Findings provide important insights into what it takes to successfully implement complex evidence-based interventions such as the TCM.
PARENTAL TRANSITION TO LONG-TERM CARE: IMPLICATIONS FOR PSYCHOLOGICAL WELL-BEING OF ADULT CHILDREN
Authors: Kalesnikava Viktoryia , Lane Annalise , Dang Linh , Sneed Rodlescia , Mezuk Briana 
Published: December 2023

Abstract
Approximately a quarter of US Baby Boomers provide informal caregiving for their parents. Though the psychological burden of caregiving is well-documented, the extent to which this burden relates to parental transition into long-term care is understudied. This study examined the longitudinal associations between parental transition to long-term care and life satisfaction and depressive symptoms among older adults of the ‘Baby Boom’ generation. Sample included respondents with at least one living parent from the Health and Retirement Study, 2010 - 2018 (n = 6,519, mean age = 56). Single-item life satisfaction was assessed on a 5-point Likert scale (range: not at all - completely satisfied). Depressive symptoms were indexed by the Composite International Diagnostic Interview (range: 0-8). Multivariate mixed effects poisson regressions of depressive symptoms and life satisfaction were fit, separately, adjusting for demographic characteristics, total wealth, and interview wave. Over the study period, 12% of respondents had a parent transitioning into long-term care. On average, respondents with parents transitioning into long-term care were older, wealthier, had higher depressive symptoms and lower life satisfaction. Longitudinally, parental transitions to long-term care was associated with mild increase in reported depressive symptoms, but there was no association with life satisfaction. Our findings are generally consistent with previous studies, reaffirming that while placement of parents in long-term care may alleviate caregiving burdens, it may not reduce distress in their adult children.
RECOGNIZING AND ENGAGING FAMILY CAREGIVERS ACROSS THE CARE CONTINUUM: FULFILLING NATIONAL STRATEGY ACTIONS
Authors: Fields Beth , Bangerter Lauren , Bangerter Lauren 
Published: December 2023

Abstract
Millions of family caregivers (relatives, partners, or other support persons) provide support to older adults across the care continuum, but feel unrecognized and disengaged in health care and social service systems. To address this gap, congress passed the Recognize, Assist, Include, Support, and Engage (RAISE) Family Caregiving Act in January 2018. The RAISE Act established a Council to deliver recommendations to the Secretary of Health and Human Services on how to increase recognition and engagement of family caregivers. This Council released the National Strategy to Support Family Caregivers in September 2022, detailing recommended actions for health care and social service systems. In response to the recommended actions, this symposium will present innovative approaches to increase recognition and engagement of family caregivers across the care continuum. This symposium will help bridge the policy and practice gap by offering health care and social service systems examples of how to involve family caregivers across the care continuum. Dr. Riffin will describe a checklist-based intervention to support family caregivers in primary care. Drs Perpezko and Toto will discuss the convergence of goal setting among older adults and their family caregivers in the home setting. Ms. Muntefering will report facilitators and barriers to involving family caregivers in hospital care. Dr. Wyman will identify effective clinician behaviors for including family caregivers in geriatric mental health VA services. Dr. Werner will share an online portal for supporting family caregivers in rural areas.
A CHECKLIST-BASED INTERVENTION TO SUPPORT FAMILY CAREGIVERS IN PRIMARY CARE
Authors: Riffin Catherine 
Published: December 2023

Abstract
Family caregivers commonly accompany older adults to their routine medical visits, but caregivers’ own needs and concerns are not systematically identified or addressed in clinical practice. Collaborative Healthcare Encounters with Caregivers (CHEC) is a checklist-based intervention that uses a prioritization approach to help caregivers efficiently identify and communicate their most salient concerns to primary care providers. This presentation will report findings from a pilot randomized controlled trial of N=37 patient-caregiver dyads who were randomized to CHEC (N=21) or usual care (n=16). The goals of the pilot trial were to evaluate CHEC’s impact on medical visit duration and communication (using time-stamped audio-recordings and a structured coding system) and caregivers’ perceptions of CHEC’s utility (using questionnaires and interviews). Total visit duration was comparable across treatment groups (CHEC: 29.3 minutes vs. UC: 32.8 minutes; p=0.55), but a greater proportion of the visit time was spent addressing caregivers’ concerns among CHEC group participants, as compared to usual care participants (25% vs. 6%; p&lt;.001). In post-visit interviews, caregivers commented that CHEC was useful in helping them to prepare for the visit by thinking about their questions in advance and prompting providers to acknowledge their concerns. Findings from this study explicitly address the RAISE Act’s recommendation for integrating evidence-based caregiver assessment instruments into clinical care delivery (Outcome 2.2) and indicate CHEC’s potential as an efficient, clinically feasible intervention that can support greater inclusion of caregivers in primary care discussions.
AGING IN ENVIRONMENTALLY RISKY AREAS: FINDINGS FROM A NATIONALLY REPRESENTATIVE SURVEY
Authors: Merdjanoff Alexis , Lynch Katie 
Published: December 2023

Abstract
The Aging in Risky Environmental Areas (AREA) Study is a novel cross-sectional dataset of community-dwelling adults in the U.S. ages 50 and older. The sample of 1,504 participants was collected in November 2022 and is nationally representative. The survey examines several topics related to aging during the climate emergency including, recent climate-related disaster exposure; perspectives on climate adaptation and mitigation strategies; disaster resilience; and, various measures of healthy aging. There is a misconception that a majority of older adults do not believe in climate change or are unwilling to make behavioral changes to decrease their carbon footprint, despite their vulnerability to climate-related disasters. Results from the AREA Study demonstrate that a majority of older adults (50+) are willing to make “a lot” or “some” changes to the way they live or work in order to reduce the impact of climate change and that there are no statistically significant differences among age groups (50-64; 65-74; 75+). Instead, factors such as region, political affiliation, prior disaster exposure, and place attachment are significant predictors of willingness to engage in adaptation strategies. Findings suggest that an overwhelming majority of older adults (74%) believe that climate change is happening and are willing to be active participants in efforts to reduce negative impacts.
BREATHLESSNESS AND BIOSOCIALITY: AN ETHNOGRAPHY OF LIVING WITH RESPIRATORY DISEASE IN LATER LIFE
Authors: Nyman Fredrik 
Published: December 2023

Abstract
This paper is based on multi-sited ethnographic fieldwork conducted predominantly amongst support groups for older people with respiratory disease in the North of England, and sheds light on how communities are formed around chronic breathlessness. By utilising (and reconceptualising) the postmodern framework of biosociality, this paper explores how people living with respiratory disease negotiate and incorporate different kinds of health-related knowledge in their everyday lives—explicitly in support group settings outside of the clinic. People are living longer than ever before according to the World Health Organization, and chronic conditions are now the chief causes of death globally and have surfaced as major causes of disability and functional dependency. More specifically, in the United Kingdom 115,000 people die each year of chronic respiratory disease, which makes it one of the three biggest killer disease areas in the country. These mortality figures have remained stagnant for the past decades. What is more, in the era of neoliberalism respiratory care is individualised. Public health responses now emphasise the responsibility of individuals over collective or institutional responsibility, which is predominantly enforced through self-care and by training (or activating) patients in taking their medications and monitoring their pulmonary performance. By attending to public health responses in neoliberal times where respiratory healthcare regimens are habitually individualised, this paper contributes to understandings of biomedical subjectivities. Explicitly, it examines how support groups—as biosocial gatherings—can be understood as technologies for bridging dialogues between subjective and collective bodily experiences of health, illness, and wellbeing.
COMPARING SELF-REPORTED MEASURES OF SUBJECTIVE COGNITIVE DECLINE
Authors: Olivari Benjamin , Omura John , Shean John , McGuire Lisa 
Published: December 2023

Abstract
Symptoms of subjective cognitive decline (SCD) can be early indicators of possible future dementia. Estimates of self-reported SCD prevalence are available from various data sources including the Behavioral Risk Factor Surveillance System’s (BRFSS) current Cognitive Decline Optional Module. Recent revisions to the Module were proposed based on input from subject matter experts, including reducing introductory phrasing and refining question and response options. It is unknown how these changes may impact estimates of SCD prevalence. To assess whether prevalence of SCD differs based on Module phrasing and conceptualizations of SCD-related questions, this analysis used data (n=3526) from the 2022 FallStyles survey. Respondents were randomly assigned to one of two groups receiving different sets of Module questions: group A received questions mirroring the former language and group B received the revised phrasing. Estimates were weighted to match the 2021 US Current Population Survey. SCD prevalence among respondents aged ≥18 years was 8.9% in group A versus 16.9% in group B. Among adults aged ≥45 years, SCD prevalence in group A (9.3%) was similar to the 2019-2020 BRFSS estimate (9.8%), while it was nearly double (17.6%) in group B. Within both groups, SCD prevalence was higher among those earning less than $25,000, with lower educational attainment, and who identified as female than their counterparts. Simplified prompts and refined questions may provide higher estimates of SCD prevalence. Given the subjective interpretation of respondents’ own memory changes involved in measuring SCD, understanding the impact of question phrasing and language is critical when interpreting resulting data.
PROVIDING DEMENTIA CARE ACROSS LOW-RESOURCE COMMUNITIES
Authors: Holmes Sarah , Corazzini Kirsten 
Published: December 2023

Abstract
The growing number of persons living with dementia (PLWD) require ongoing care and supportive services, but dementia care access and quality are more limited in communities with fewer health resources and these limitations are exacerbated by current dementia care workforce shortages. Across low-resource communities—including poorer urban and rural settings—health resources tend to be limited and PLWD are predominantly socioeconomically disadvantaged and have few personal financial resources to contribute to care provision. Although there is growing evidence about the consequences of care inequities for PLWD, less is known about key issues and opportunities for improving dementia care in low-resource communities. This symposium features presentations that highlight unique social and economic challenges and opportunities for providing dementia care in low-resource communities. The first presenter reports results from a community-based, participatory research study in four long-term care settings in federally designated medically underserved areas (two rural, two urban) that highlights strategies used by long-term care providers to recruit and retain dementia care staff and describes their perspectives on quality dementia care. The second presenter shares findings from an innovative pilot program of case management services to address challenges of PLWD who are living alone in the community through collaboration with local paramedicine services. The third presenter provides an overview of the Person-Centered Options Counseling Certification program with a discussion on strategies for implementing person-centered dementia care initiatives in low-resource communities. This symposium reveals complexities in providing care for PLWD in diverse low-resource communities and generates directions for addressing dementia care inequities.
A FRAMEWORK OF SUPPORT: THE NURSING HOME PERSON-CENTERED OPTIONS COUNSELING CERTIFICATION PROGRAM
Authors: Crary Kate , Mandrell Melissa , Davie Laura 
Published: December 2023

Abstract
Person-centered initiatives and approaches are the cornerstone of best practices when it comes to supporting older adults and persons living with dementia. Lack of person-centered care has been associated with higher medical costs and negative health outcomes, particularly in low-resource communities. Implementing person-centered care may help to address disparities and improve care outcomes in these communities, although it is often unclear which approaches are most appropriate. The Person-Centered Options Counseling Certification program attempts to address this gap via a mentoring program and competency framework. Developed and piloted in rural New Hampshire, this framework helps professionals and organizations evaluate the approaches that works best for them, while creating fidelity for ongoing support through a rigorous mentorship program. The framework shows promise of being cost effective, an important consideration for many low-resource communities. Professionals can attain knowledge, skills, and abilities without incurring higher education costs and agencies can utilize pre-developed instructional materials. Pilot data was collected to evaluate the program and demonstrated that professionals found the educational training delivered within the framework was relevant to their community and increased their knowledge about person-centered care, although some expressed hesitancy when applying the skills learned with individuals. Professionals who completed both the training and participated in the mentorship program reported a high level of competency, satisfaction, and confidence in delivering person-centered care. The use of this framework may support staff retention in low-resource communities and approaches can be tailored across different environments to facilitate the delivery of person-centered care.
BRIDGING THE PRACTICE-RESEARCH DIVIDE: BUILDING SUCCESSFUL PARTNERSHIPS WITH STATE GOVERNMENT
Authors: Davitt Joan , Baik Sol , Davitt Joan 
Published: December 2023

Abstract
State governments collect data on LTSS but frequently lack resources to analyze it. Simultaneously, researchers often struggle to translate research to policy and practice realms. This symposium will elucidate strategies and challenges in building successful relationships between researchers and state government to enhance LTSS. Paper 1 explores the growing trend of states developing Multisector Plans for Aging (MPA) and opportunities for researchers to ensure that these state-led planning resources utilize evidence to transform and coordinate aging services across the state. This paper will discuss how states use data to promote accountability and monitor implementation of MPA initiatives. Paper 2 describes the development of a statewide data dashboard for Virginia that can be used by state and local agencies to leverage funding and improve programming. This paper will describe the process of developing and eliciting input from a stakeholder task force and the dashboard design. Paper 3 explores efforts in Minnesota to capitalize on existing data to inform policy advocacy and regulatory reform in assisted living. Data from annual survey inspections is utilized to explore trends, target education, and recommend policy changes. Paper 4 focuses on building relationships with Maryland’s Adult Protective Service division to engage collaboratively in logic modelling and continuous quality improvement. Strategies for translating existing administrative data into research ready formats and primary data collection methods will be discussed. Symposium participants will have an opportunity to discuss effective strategies for engaging state government in research.
MULTISECTOR PLANS FOR AGING: RESEARCH AND STATE GOVERNMENT PARTNERSHIPS TO TRANSFORM AGING SERVICES
Authors: Graham Carrie 
Published: December 2023

Abstract
As the US population becomes older and more ethnically diverse, state leaders are increasingly seeing the need to conduct high-level, cross-sector planning to meet the needs of their aging populations and promote equity. A state Multisector Plan for Aging (MPA)-- also called a master plan or strategic plan-- creates a valuable roadmap that can help states transform the infrastructure and coordination of services for all people who are aging in the state. Developing an MPA requires a state-led process that brings various state agencies (Aging, Medicaid, Public Health, Social Services, Housing, Transportation, etc.) together with stakeholders and researchers to outline a clear framework for addressing the needs of older adults, people with disabilities, and caregivers, for 10 years or more. The growing movement of states developing MPAs offers a unique opportunity for aging researchers to partner with state policymakers and stakeholders to ensure that the state’s MPA is grounded in evidence and that implementation progress is evaluated using appropriate data and benchmarks. This paper describes the experience of several states that are developing MPAs and how aging researchers in the state have successfully partnered with policymakers, using their research to help the state garner buy in for developing an MPA, elevate the most pressing issues, project population characteristics and needs in the future to inform the development process. Individual researchers, universities and research subcommittees working with states on MPA development can also partner to mine available state data, identify benchmarks, and create data dashboards to guide implementation and monitoring progress.
BRIDGING THE PRACTICE–RESEARCH DIVIDE: BUILDING SUCCESSFUL PARTNERSHIPS WITH STATE GOVERNMENT
Authors: Moone Rajean , Hakanson Megan , Shippee Tetyana 
Published: December 2023

Abstract
In 2021 Minnesota implemented systemwide regulatory reform to transform loosely regulated housing with services establishments into licensed assisted living facilities. The new framework aligns assisted living facilities more closely with nursing homes. Today over 2,000 assisted living facilities are licensed in Minnesota ranging in size from two to 377 residents. While considered consensus legislation by consumer and provider groups, small, culturally specific providers were largely absent from negotiations. This absence has resulted in disparities in conforming to new regulatory requirements. The University of Minnesota has partnered with the Minnesota Department of Health to conduct analyses of regulatory inspection surveys. The analysis includes comparisons between small (under 15 residents) and large (over 15 residents) facilities as well as qualitative interviews of licensed directors of assisted living facilities that serve culturally specific communities. This paper focuses on the nature of the partnership between the University and state to organize and obtain survey inspection results and the subsequent development of recommendations to enhance regulatory policy.