bluuebunny/crossref_metadata_2025_split huggingface dataset:
PREPARING FOR ADVANCING ILLNESS AND END OF LIFE WITH DEMENTIA
Authors: van der Steen Jenny 
Published: December 2023

Abstract
Dementia involves coping with advancing illness that involves cognitive and functional decline. Also decision-making capacity diminishes, which implies that preparing for a future and taking opportunities to exercise individual and relational autonomy is particularly relevant in the case of dementia. Engaging the person with dementia and family caregivers meaningfully in formal or informal advance care planning conversations may require addressing specific challenges. Health care providers often lack time or are reluctant to broach these conversations. Often conversations are delayed even in institutional long-term care settings as residents, their family caregivers and care providers may all view advance care planning as uncomfortable and difficult to initiate. Special support for health care providers to develop skills, confidence and taking initiative is needed. This symposium presents about new, large qualitative and quantitative studies with contributions from the UK and Canada, and international work. It addresses preparing for an uncertain future through advance care planning and decision making about future care and treatment which may include conversations about the end of life. We present and evaluate tools to support the process across settings.
DISCUSSING THE FUTURE FOLLOWING A DIAGNOSIS OF DEMENTIA. FINDINGS FROM THE PREPARED STUDY (ENGLAND)
Authors: Dixon Josie 
Published: December 2023

Abstract
The PrepareD study (England) adopts a relational autonomy perspective to examine the various conversations that people with dementia and their families have about the future, with each other and with health and care providers, in the year following a dementia diagnosis. We present survey data gathered from a large cohort of 900 people in England who have been recently diagnosed with dementia and their caregivers about informal conversations about the future and advance care planning conversations with health and care providers. We also present findings from in-depth qualitative research with 30 of these respondents, a purposively selected mix of people with dementia and caregivers. Findings from the qualitative research cover how people with dementia and family members interact; the objectives, hopes and expectations they have for their conversations; and how input from professionals and wider social influences shape these interactions. We use findings from the study to reflect on what effective support for informal conversations between people newly diagnosed with dementia and their families about future care could look like and how, and by whom, it could be provided. We also aim to identify theoretical models of relational autonomy that could be useful for developing these approaches further.
DEVELOPMENT OF A DECISION SUPPORT FRAMEWORK TO PROMOTE COMFORT AMONG PATIENTS WITH SEVERE DEMENTIA IN THE HOSPITAL
Authors: Davies Nathan , Smith Ellen McCoy , Shah Malvi , Sampson Elizabeth 
Published: December 2023

Abstract
Hospital wards can be challenging settings, particularly for those with dementia, and exacerbate symptoms and behavioural issues. Improving care for persons with dementia and providing a simple decision support framework to help guide staff in person-centred and holistic management of these problems has the potential to improve hospital care. We aimed to co-design an evidence-based, practical way to support hospital staff and family carers in identifying discomfort and distress, maximising comfort and reducing behaviours that challenge or are distressing to people with dementia who are towards the end-of-life. We conducted a co-design study informed by data from 1. Literature review; 2. Cohort study of comfort and discomfort in people with severe dementia admitted to hospitals (n=63); and 3. Interviews with family carers and health care professionals (n=18). These data sources were synthesised and presented to key stakeholders through co-design meetings and workshops. The resulting decision support framework uses a three-stage process of: 1) assessment of comfort/discomfort; 2) consider causes of discomfort; and 3) address needs of the individual to manage the discomfort. The framework is presented in the form of a series of flowcharts that can be used easily on busy wards. We will present examples of the framework along with key findings from the cohort study. This is the first study to develop decision support for hospital staff and families addressing comfort towards the end of life. This toolkit has practical implications for everyday working on hospital wards but also a resource for planning for end-of-life care.
EXPLORATION OF THE NEED FOR GRIEF SERVICES: METHODOLOGY OF A COMMUNITY-BASED RESEARCH STUDY
Authors: Stone-Bury Lisa 
Published: December 2023

Abstract
Within the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework, community-based research (CBR) is a key component of Exploration and Preparation. This presentation describes the process of conducting a CBR study on grief service needs within Colorado Springs. A community-academic partnership was formed, resulting in a multidisciplinary team of clinical geropsychology academics, a chaplain, a mental health professional, and a funeral director, with the goal of launching a non-profit grief center that catered to identified local needs. Challenges and successes in this partnership will be explored. Two surveys were created: (1) community-wide survey targeting adults across the lifespan and (2) professional survey targeting individuals who interface with grief in their profession (e.g., healthcare providers, educators, lawyers, faith leaders). The authors facilitated survey development that balanced practical needs with existing empirical literature on grief services. Qualitative and quantitative measurement focused both on past experiences with grief (to understand the community’s history) and use of future grief services (to understand the types of services most desired by the community). The multidisciplinary team pooled resources related to recruitment and dissemination of the surveys, combining traditional research recruitment practices (e.g., undergraduates, research database of older adults) with networks of local community leaders (e.g., places of worship, local healthcare agencies, newspapers). These CBR efforts resulted in large samples of community members (n = 668; age range = 18 to 65+) and professionals (n = 141). Ultimately, this CBR study laid important groundwork to prepare the multidisciplinary team to match their services to the community’s expressed needs.
LATE WORKING LIFE IN THE TRIPLE TRANSITION AND THE GLOBAL PERMACRISIS
Authors: Motel-Klingebiel Andreas , Naegele Gerd , Oylu Gulin , Genelyte Indre , Kelfve Susanne 
Published: December 2023

Abstract
Late working life faces multiple challenges in the triple transition of demographic, technological and environmental change and the global permacrisis. This contribution provides a conceptual framework for research on the significance of extended late work for the sustainability, equity, inclusion, and productivity of aging societies, based on an understanding of the three major long-term shifts as a complex triple transition with potentials and challenges for societies, economies, employers, and individuals. This triple transition is embedded in an ongoing and even accelerating societal and economic permacrisis with increased social risks and limited predictability, in which resilience – of economies, life-courses and welfare states - gains importance, while the dominant tetrad of sustainability, equity, inclusion and productivity remains on the European social and economic policy agenda. The presentation introduces a review of European policy reports on aging and late work and introduces results from the research programme EIWO (www.eiwoproject.org) based on Swedish register information and European survey data to illustrate trends and gaps in European late work, research, and policy. The presentation discusses age integration of life and work courses as a systematic strategy to promote quality of life as well as social sustainability, equity, inclusion and productivity and resilience. Participants will gain an understanding of the conceptualization and implementation of gerontological multi-level research on the macro- and micro-social relevance of late working life in the triple transition and the global permacrisis.
THE PERSISTENCE OF AGE DISCRIMINATION IN SHAPING LATE WORKING LIVES
Authors: Crossdale Rachel , Foster Liam , Walker Alan 
Published: December 2023

Abstract
The aging population and subsequent demographic shift have driven the Extended Working Lives (EWL) agenda to become an important policy goal. However, millions of older workers leave the workforce each year due to unsupportive work environments attributed in part or in whole to ageist policies and practices, raising questions about older workers’ perceptions of themselves in the workforce and what this means for the EWL agenda. Using data from 25 qualitative interviews, our research finds that ageism continues to play a part in the decision-making process of older workers when considering their future. These findings fall into two categories: Age barriers within the workplace and Perceptions. Age barriers within the workplace include tasks or events that incite a feeling of separation from younger peers, such as training, social interaction, and digitization. Perceptions are older workers’ internalized expectations of themselves and their abilities. Our findings suggest these perceptions do not align with the reality for older workers, thus contributing to internalized ageism. The need to target stereotypical attitudes towards older workers was highlighted as an age barrier to employment before the turn of the century. However, despite the Extended working Lives, Active Aging and Fuller Working Lives Agendas changing the policy context around older workers, this research suggests that the same stereotypes continue to pervade older workers both externally from policy and practice and internally in self-perceptions. A life-course approach to policy is needed to improve conditions for older workers and to challenge ageist stereotypes in a meaningful way.
THE IMPORTANCE OF LIFELONG LEARNING FOR AVOIDING EXCLUSION—POLICY FRAMEWORKS AND EXPERIENCES OF OLDER WORKERS
Authors: Penning Nehle , Crossdale Rachel , Reichert Monika 
Published: December 2023

Abstract
Qualification requirements in the labour market in Europe have increased across the board. Increasing provision and accessibility of lifelong learning is central to promoting employability among older workers. However, older workers are more likely to lack formal and to hold out of date qualifications. Sweden, Poland, Germany and the UK, despite differences in regime and political approach to lifelong learning, have unequal distribution of access and opportunity. This paper examines how older workers in the four countries assess the role of lifelong learning throughout working life as well as what links to national policies can be identified. The analysis is based on 100 semi-structured and problem-centred interviews in the four countries with older workers (age 55 and older) of different backgrounds (gender, educational level, sector of employment, ethnicity). Content analysis according to Kuckartz (2018) was used as method of analysis. The interview data shows that lifelong learning plays an important role for older workers in the prevention and/or management of exclusion risks throughout working life. However, the potential of lifelong learning for EWL is limited by barriers at the company and regulative level and differences between the public and private sector are noticeable. In late working life, in particular financial constraints as well as ageism lead to inequalities in relation to lifelong learning opportunities. In all four nations a higher priority need to be given to an integral support of lifelong learning throughout the life-course as well as age stereotypes need to be dismantled for a successful EWL agenda.
OLDER WORKERS’ AND EMPLOYERS’ PERSPECTIVE ON EXTENDING WORKING LIFE: THE CASE OF POLAND
Authors: Perek-Białas Jolanta , Urbaniak Anna , Krygowska-Nowak Natalia , Varlamova Maria 
Published: December 2023

Abstract
Extending working life is considered an adequate policy response to population aging and workforce shrinkage. However, in some countries, like Poland, there are still no clear mechanisms supporting extending working life. Poland makes an interesting case, as while the eligible retirement age is one of the lowest in Europe, no plans to increase it are set. The aim of this paper is to present perspectives of older workers and employers on extending working life. We identify factors that constitute supportive and unsupportive working environments from the perspective of older Polish workers and show how employers perceive workers over 50 in the workplace. First, the qualitative component of the programme EIWO ‘Exclusion and Inequality in Late Working Life’ is analysed. We draw from 25 semi-structured interviews conducted between June and November of 2021 with men and women aged 55-75 years old working in private and public sectors in Poland. Secondly, the probability survey among Polish employers (n=1,037) was analysed to show the attitudes and perceptions of employers. Older workers working in the public sector feel less satisfied with the financial aspects of employment, less motivated to extend their working lives, and more often describe practices of pushing older workers out of the labour market. The analyses of employees give matching results. These findings highlight that in the absence of a governmental strategy, extending working life is more dependent on employers and employees that might differ among sectors of employment.
ILLUSTRATIONS OF EXTENDED WORKING LIVES: WHAT INSIGHTS DO THE CONCEPTS OF EXCLUSION AND PRECARITY OFFER?
Authors: Grenier Amanda 
Published: December 2023

Abstract
Amanda Grenier will act as the discussant for the set of papers in this symposia session, bridging insights from European research with North American perspectives. Situated as an attempt to bridge research findings with a larger critical practice of theory-building theory, she will explore what the concepts of exclusion and precarity offer our interpretations of these papers, as well as how the findings of each contribute to the state of knowledge on exclusion and precarity. She will begin with a brief clarification of the definitions and conceptual boundaries of social exclusion and precarity carried out in Europe and North America and situate key findings of the papers as an effort to theorize older workers lives in contemporary conditions. For example, the well-known concept and domains of social exclusion can be considered to offer ways of understanding processes of exclusion at the mezzo level, as exercised through policies, practices, and/or place. Illustrations from the papers will be linked with existing work on exclusion. She will then draw attention to the concept of precarity as a lens of analysis to connect the micro-level vulnerabilities experienced in the working lives of older people with the shifting social and state structures that form the backdrop for older people’s lives (and the systems within which European research is carried out). Specific examples will be drawn from the set of papers, and a moderated question and answer period will follow.
INEQUALITIES IN POLYPHARMACY IN ADULTS AGED 65+ IN ENGLAND
Authors: Iqbal Anum , Hanratty Barbara , Matthews Fiona , Sinclair David , Richardson Connor , Todd Adam 
Published: December 2023

Abstract
Understanding the role of socio-economic factors in the number of medications an individual is prescribed, can help healthcare practitioners target medication reviews and safer prescribing, improving quality of life. We aimed to understand the association between socio-economic factors and polypharmacy - defined as the use of five or more medications at any given time. Data was used from the Cognitive Function and Ageing Study (CFAS), focusing on adults aged 65 years and over. Data from CFAS I and CFAS II, was used to understand the relationship between education (a marker of socio-economic status) and polypharmacy. Individuals were categorised on the number of years in full time education, and baseline cohorts (wave 1) from each study were compared, to identify the longitudinal effect. Logistic regression was used to assess the association between polypharmacy and education. Increased number of years of full-time education was associated with a decreased likelihood in polypharmacy, in CFAS II - those with &lt;10 years of full-time education showed higher odds of polypharmacy, when compared to individuals with 10-11 years of full-time education, OR 1.61 (95 % CI 1.44-1.80). However, similar odds were displayed across each education category and polypharmacy in CFAS I. Results have showcased growing inequalities in healthcare, particularly through the influence of education on polypharmacy. Socio-economic factors could be used to trigger for medication related review services.
BRIDGING RESEARCH TO PRACTICE: PRO-HOME EMPOWERS CARE PARTNERS TO PROMOTE EXERCISE IN HOME CARE
Authors: Muramatsu Naoko 
Published: December 2023

Abstract
Regular physical activity (PA) benefits people of all ages. Mounting scientific evidence shows PA’s health benefits in older persons with chronic conditions. However, there remains a large research-to-practice gap in PA, especially in long-term services and supports (LTSS). Older adults who need help with basic daily activities, such as walking or standing, continue to face barriers at multiple levels of LTSS to become and remain physically active. This symposium will address the much-debated research-to-practice gaps, focusing on frail community-dwelling older adults in the context of a NIA-funded clinical trial. “Promoting Seniors’ Health with Home Care Aides (Pro-Home)” tests the effectiveness of a gentle, low-intensity PA program delivered by home care aides (HCAs) for community-dwelling older adults with nursing-home eligible care needs in real-world home care settings. Pro-Home is innovative because it empowers direct care workers (HCAs) with an easy-to-learn toolkit to deliver the program and keep their older clients motivated. The symposium starts with an overview of Pro-Home (Muramatsu), barriers and facilitators of Pro-Home at multiple levels of the LTSS system (Cruz Madrid), followed by Pro-Home’s critical elements: of research and practice: client-HCA dyad relationships and partnerships with stakeholders (Hu), in-home assessment of motor function in frail older adults (Yin), and inter-professional co-learning (Skowronski). The symposium concludes with a dialogue with the audience to identify actionable policy and practice strategies for building research-to-practice and practice-to-research bridges to build health promotion into LTSS to promote the well-being of older adults with disabilities and their care partners.
PRO-HOME: AN IMPLEMENTATION SCIENCE FRAMEWORK FOR MULTILEVEL BARRIERS AND FACILITATORS IN LTSS
Authors: Madrid Katya Cruz , Berbaum Michael , Walton Surrey , Zanoni Joseph , Marquez David , Muramatsu Naoko 
Published: December 2023

Abstract
Promoting Seniors’ Health with Home Care Aides (Pro-Home) is a randomized controlled trial (RCT) of a gentle physical activity program for frail older adults conducted in a community-based long-term services and supports (LTSS) delivery setting. Pro-Home is a hybrid effectiveness-implementation study, which aims to examine (1) the effectiveness of the program delivered by home care aides (HCAs) in maintaining physical function in older homecare recipients, and (2) how the intervention works in a real-world Medicaid-funded LTSS system. This paper describes barriers and facilitators that have long existed or evolved during the Pro-Home development, using quantitative/qualitative data from the mixed-method study informed by an implementation science framework. Facilitators include the knowledge and partnerships that resulted from multiple preliminary studies that illuminated HCAs’ work/life-related stressors, coping resources, and underutilized capacity and motivation to promote the health of clients and HCAs themselves in the context of the LTSS system. Another facilitator has been the physical activity program developed in another state’s LTSS service setting (not in an academic setting). The program was easy to learn and adapt into a program to be delivered by HCAs (as opposed to care managers). Barriers included turbulent LTSS environments (e.g., rapidly growing managed care presence, COVID-19). Those barriers have been addressed through partnership with stakeholders at multiple levels. Having completed the intervention and data collection phases, we found the project’s planning and implementation challenging but rewarding. Pro-Home has produced rich information that will have many implications for research, practice, and LTSS services delivery and financing systems.
HOME CARE DYADS AND STAKEHOLDERS IN THE CONVOY OF SOCIAL RELATIONSHIPS: A BASIS OF COMMUNITY-BASED RCT
Authors: Hu Elise , Yin Lijuan , Caceres Maria 
Published: December 2023

Abstract
Relationships within homecare dyads are the core in both informal and formal caregiving. Home care aides (HCA), a type of formal (paid) caregivers, provide in-home non-medical care to older adults who need assistance with daily activities. The Pro-Home study relied on client-HCA relationships and collaborating homecare stakeholders to recruit dyads in this randomized controlled trial (Randomized N = 128). Participating clients were mostly unmarried and unable to meet with family/friends multiple times a week. More than half lived alone, two thirds were cared for by a HCA who was not a family member, and the majority reported having a good relationship with their HCA. Most participating clients kept the same HCA throughout the 4-month intervention, before and throughout the ongoing COVID-19 pandemic. These characteristics highlight the critical role of homecare workers in caring and health promotion as older clients’ social convoy. However, the pandemic has posed challenges to these dyads. A higher proportion of clients participating in the intervention during the pandemic lost or were reassigned a HCA (20%) compared to those completed the intervention prior to the pandemic (10%). Our community collaborators reported increased staff turnovers and nationwide HCA shortages that created difficulties in care coordination. These findings will inform the ongoing debate on future financing and delivery systems of long-term services and supports, which are increasingly provided in home and community settings in the U.S. and other countries.