bluuebunny/crossref_metadata_2025_split huggingface dataset:
COVID-19 AND THE CARE OF ASSISTED LIVING RESIDENTS: THE COVCARES PROGRAM OF RESEARCH
Authors: Hoben Matthias , Maxwell Colleen 
Published: December 2023

Abstract
This presentation describes the goals, design and methods of the COVID-19 and the Care of Assisted living Residents (COVCARES) program of research. Our goals were to address critical knowledge gaps related to how COVID-19 impacted assisted living (AL) residents, family/friend caregivers, and homes, and to compare how outcomes differed between AL and nursing homes (NH). Partnering closely with provincial Alzheimer Societies, family caregiver advocates, and health policy decision makers, we conducted two interconnected studies: The first was a prospective cohort study, surveying family/friend caregivers of AL residents and directors of care of AL homes in the Canadian provinces of Alberta and British Columbia twice (10/2020–04/2021 and 07/2021–09/2021). 673 caregivers and 104 AL homes responded to our first survey. Of those, 386 caregivers and 78 AL homes submitted a second survey. The second was a population-based retrospective cohort study (01/2017–12/2021), using clinical and health administrative data of all AL and NH residents in Alberta. Data included Resident Assessment Instrument (RAI) records, acute care and emergency department admission data, prescription medications, data on COVID-19 infections, and vital statistics of 23,355 AL residents and 41,583 NH residents. Analyzing each of the aforementioned data sets individually, and linking family and facility surveys, as well as resident and facility survey data, we provide unique insights into the impacts of the COVID-19 pandemic on AL settings. The presentations in this symposium will share selected key findings from our program of research.
ASSOCIATION OF ASSISTED LIVING HOMES PREPAREDNESS AND RESPONSES TO THE COVID-19 PANDEMIC WITH RESIDENT LONELINESS
Authors: Devkota Rashmi , Maxwell Colleen , Dampf Hana , Shrestha Shovana , Hoben Matthias 
Published: December 2023

Abstract
Loneliness has been an ongoing problem among Assisted living (AL) residents and has worsened during the COVID-19 pandemic. Loneliness is associated with an increased risk of mental and physical illness, cognitive decline, suicidal behavior, and all-cause mortality. However, the impact of the pandemic on AL residents’ loneliness is poorly understood. We surveyed 42 AL homes in Alberta to understand whether resident characteristics and homes’ pandemic preparedness and response to the pandemic were associated with resident loneliness. The surveys reflected pandemic waves 1 (Mar-Jul 2020) and 2 (Nov 2020-Feb 2021) and were linked to Resident Assessment Instrument (RAI) records of residents who lived in these homes during these periods. Using generalized estimating equation models, we assessed whether resident characteristics, residents’ social relationships, and home preparedness for and responses to the pandemic were associated with resident loneliness (measured as present or absent based on RAI items). Our sample included 1,828 residents (wave 1: 890, wave 2: 938). Almost 13% of the residents reported loneliness (wave 1: 11.2%, wave 2: 14.2%). Depressive symptoms (odds ratio [OR]=2.73, 95% CI, 1.9-3.9) daily/excruciating pain (OR=1.97, 95% CI, 1.4-2.8), and cognitive impairment (OR=0.38, 95% CI, 0.2-0.6) were significantly associated with loneliness. Caregiver availability, hours of caregiver help, and home preparedness were not associated with loneliness, but more communication with caregivers (OR=2.19, 95% CI, 1.1-4.2) and same or improved staff morale (OR=0.61, 95% CI, 0.4-0.9) were. Improving staff morale and communication with caregivers is crucial in addressing resident loneliness.
“SMALL BITES” QUALITY IMPROVEMENT: A SLEEP INTERVENTION FOR RESIDENTS WITH DEMENTIA IN THE NURSING HOME “NEW NORMAL”
Authors: Snow A Lynn , McCullough Megan , Morgan Robert , Baier Rosa , McCreedy Ellen , Richards Kathy , Fry Liam , Hartmann Christine 
Published: December 2023

Abstract
Together with three nursing home (NH) corporations, we co-designed and adapted a “small bites” approach to pragmatic clinical trial (PCT) implementation that was successful even during the pandemic height. Our pilot PCT to improve sleep for nursing home residents with dementia began with the start of the pandemic, with its increased resident acuity and resident care burden, increased workforce shortages and instability, and need for increased leadership involvement. Using co-design principles, we reviewed all procedures with our first NH and identified ways to reduce staff burden by “bite-sizing” the as much implementation protocol as much as possible (e.g., serial 5-minute staff trainings). We implemented revised procedures in all three pilot NHs. To identify adaptations, we used a modified version of the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) to code meeting minutes, researcher fieldnotes about adaptations, and 35 group interview transcripts with the leadership/champion teams. We also coded for feasibility, acceptability, and sustainability. We used an iterative, rapid content analytic approach to qualitative analyses. Most adaptations occurred in the pre-implementation phase, although some occurred in the pilot implementation phase. Adaptations concerned reducing staff burden, such as moving from in-person visits to a fully virtual approach that used 30-minute once-a-week project meetings and streamlining how staff completed measures. The resulting intervention package worked in all corporations on all levels: feasibility, outcome, and sustainability. Necessity being the mother of invention, we landed on a better process than originally planned, one that may be valuable for the wider nursing home research community.
THE ROLE OF THE LTSS SCORECARD IN PROMOTING STATE ACCOUNTABILITY FOR CAREGIVER POLICY
Authors: Reinhard Susan 
Published: December 2023

Abstract
In 2011, the AARP produced its first LTSS Scorecard in “Raising Expectations: A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers”. This presentation discusses the history, background, and goals of the Scorecard, which examines four key dimensions of state LTSS system performance: affordability and access; choice of setting and provider; quality of life and quality of care; and support for family caregivers. This presentation focuses on the extent to which support for family caregivers was a focus of that first report and how that focus has changed over time. In addition, the presentation will consider the extent to which the Scorecard has proved an effective policy tool in holding states accountable for progress in supporting family caregivers. Has the Scorecard achieved its stated goal to “to spark conversations, galvanize broad-based coalitions, and focus stakeholders’ attention on the factors that most directly impact consumers and their families”? What has AARP learned through its experience of developing and administering the Scorecard, and what changes are being considered with respect to the dimensions pertaining to family caregivers? The presentation will conclude by noting synergies with the work of the RAISE Family Caregiver Advisory Council and the priorities indicated in its National Strategy to Support Family Caregivers.
IMPLEMENTING A STAKEHOLDER AND POLICY MAP TO TRACK FEDERAL CAREGIVER POLICY ACTIVITY
Authors: Wittke Michael 
Published: December 2023

Abstract
A top priority for family caregiver policy should be a focus on accountability and transparency regarding federal actions identified within the National Strategy to Support Family Caregivers. It is crucial to have accountability and transparency as the National Strategy is being updated and refined over the course of time that occurs between the release of the initial strategy and the publishing of the next version of the strategy. Increased accountability and transparency are especially important as stakeholders continue to champion and build on the foundation that has been established in the process of creating the 2022 National Strategy to Support Family Caregivers. Establishing outcomes measures will also inform how the stakeholder community may shift their priorities and operations to align with successes and challenges outlined in an updated National Strategy. To ensure that accountability and transparency are at the forefront of public interest, and as agency leadership communicates the intended outcomes of their critical contributions to America’s family caregivers, it is essential to establish a process to communicate the meaningful impact regarding federal actions on this population. As the National Strategy is being examined for future updates, NAC has facilitated a systematic process to map the actions that federal agencies have identified as core priorities and track their progress toward implementation. That mapping process will be revealed and analyzed during this presentation.
THE NATIONAL STRATEGY TO SUPPORT FAMILY CAREGIVERS: A STATE-LEVEL PERSPECTIVE ON IMPLEMENTATION
Authors: Teshale Salom 
Published: December 2023

Abstract
The 2022 National Strategy to Support Family Caregivers includes action steps that a wide range of non-federal organizations, including states, can take to support family caregivers. States have a variety of ways that they can approach supporting family caregiver policy via action steps, including but not limited to strengthening access to services, collaborating among agencies and organizations to coordinate activities, and tracking caregiver data to help ensure services are meeting caregiver needs. Several states are taking the lead in promoting use of caregiver assessment tools. States can monitor whether initiatives and activities are achieving their goals of supporting caregivers and care recipients through tracking the implementation of the state’s actions to support family caregivers. Drawing on the National Academy for State Health Policy’s role in supporting states through its Resource and Dissemination Center, this presentation will highlight ranges of action steps in the National Strategy that states can take to support family caregivers; note frameworks that states can consider using to track implementation of action steps; and highlight states’ initiatives aligning with action steps.
HIGH-INTENSITY WALKING EXERCISE REDUCES FRAILTY AMONG PREFRAIL AND FRAIL OLDER ADULTS
Authors: Danilovich Margaret , Corcos Daniel , Cheung Ying , Conroy David , Bonner Lauren Balmert 
Published: December 2023

Abstract
Exercise is the most recommended therapeutic intervention for frailty, yet the precise exercise prescription remains elusive. The purpose of this study was to use a cluster randomized controlled trial to evaluate the impact of exercise intensity on frailty in older adults. We tested a high (HIW) vs. low (LIW) intensity walking intervention among n=165 pre-frail and frail residents from n=12 independent living communities. The 3x/week, 4 month supervised intervention targeted &gt;70% heart rate reserve for HIW participants and &lt; 50% heart rate reserve for LIW participants. The primary outcome was frailty category improvement as assessed by the SHARE-FI. We measured usual and fast gait speed, 6-minute walk test, Timed Up and Go, SPPB, Berg Balance, Falls Efficacy, and PROMIS Global Health. Participants were on average 79 years of age, 79% female, and 75% white. We analyzed outcomes based on a modified intention-to-treat principle using a linear or generalized linear mixed model with fixed arm, baseline outcome measure score and random cluster effects. We found increased odds of improving at least one SHARE-FI frailty category in the HIW group (OR=2.91 [reference group=LIW], 95% CI 1.19,7.13, p=0.02, N=103). Among secondary outcomes, there was a significant difference in change in usual gait speed (mean difference = 0.078, 95% CI = 0.026, 0.131, Hochberg adjusted P-value = 0.0357), as well as 6-minute walk test (mean difference = 160.72, 95% CI = 69.2, 252.2, Hochberg adjusted P-value = 0.0075). Results suggest that older adults should engage in more intensive/higher heart rate cardiovascular exercise to reduce frailty.
PLASMA NEUROFILAMENT LIGHT CHAIN IS ASSOCIATED WITH PHYSICAL FRAILTY IN OLDER ADULTS WITHOUT DEMENTIA
Authors: LI Junxin , Gill Jessica , Huang Jing , Waszczuk Daniel , Szanton Sarah L 
Published: December 2023

Abstract
Evidence suggests a link between brain biomarkers of neurodegeneration and physical function and frailty. However, the association of neurodegenerative biomarkers in the plasma with physical frailty in older adults remains unelucidated, as current evidence is limited and inconsistent. We tested the association between plasma neurofilament light chain (NFL), a plasma neurodegeneration biomarker, and physical frailty in a sample of community-dwelling older adults. We used baseline demographics, frailty, and plasma NFL data collected from 97 participants in a randomized controlled trial in community-dwelling, sedentary older adults without dementia [Montreal Cognitive Assessment (MoCA)&gt;17]. Physical frailty was assessed using a composite measure of weakness, slow walking speed, unintentional weight loss, exhaustion, and low physical activity. Participants’ frailty levels were categorized into robustness, pre-intermediate frailty, and frailty. Multiple linear regression and ordinal logistic regression models adjusting for age, sex, race, education, and comorbidities were conducted to test the associations of NFL with frailty and levels of frailty. The sample was 70.0 ± 6.0 years old, with 80% being females, 72% having intact cognition, and 28% having mild cognitive impairment (MCI). In the adjusted models, higher plasma NFL was associated with higher frailty scores (β=0.16, 95%CI [Confidence Interval] = [0.06,0.26]) and a higher likelihood of being in a higher level of frailty group (odds ratio=1.28, 95% CI =1.02, 1.61). In summary, plasma NFL was associated with greater frailty in our sample of non-demented older adults. Plasma NFL may be a sensitive and promising neurodegenerative biomarker for physical frailty in older adults without dementia.
MULTIMETHOD COMMUNITY-BASED DEMENTIA CARE EDUCATION TO EMPOWER CARE PARTNERS AND IMPROVE WELLNESS
Authors: Wright Rollin , Whitaker Janice , Chabala Peg 
Published: December 2023

Abstract
Inspired by the Medicare Cognitive Assessment and Care Plan Services visit, we describe an Age-Friendly 4Ms curriculum developed to empower informal dementia-care-partners to understand dementia, develop skills to communicate and work with people living with dementia (PLWD), and plan for the future with dementia. Curriculum was developed by an interdisciplinary team and included the integration of evidence-based approaches to care, such as the Positive Approach® to Care model. Through 4 interactive workshops (Understanding Dementia-related Brain Changes, Understanding Behaviors as a Form of Communication, Resources for Dementia Caregivers, Planning for the Future with Dementia) we introduced and had care partners process and practice material to help them navigate everyday challenges faced by PLWD with the aim of assisting them to find opportunities to help improve quality of life with the disease for both themselves and their PLWD. We reached a total of 146 attendees in 3 rural and suburban communities in Central Pennsylvania. Fifty-nine (40.4%) people attended 1 session, 39 (26.7%) people attended 2 sessions, 22 (15.1%) people attended 3 sessions, and 26 (17.8%) people attended all 4 sessions. Across all four sessions, more than 80% of attendees reported knowledge and skill gains, and most attendees reported meeting session objectives. Final evaluation results suggest attendees wanted a way to stay informed, stay connected, and remain supported by the program.
LIVING WITH DEMENTIA: COMMUNITY-BASED CARE PARTNER EDUCATION EVALUATION RESULTS
Authors: Husser Erica , Wright Rollin , Whitaker Janice , Berish Diane , Rubio Olivia , Fick Donna 
Published: December 2023

Abstract
A mixed methods overall series evaluation was administered at session four in each location to assess preparedness, perceived increase in caregiver self-efficacy and wellness, development and implementation of skills, and overall program value. Fifty-five participants (73% response rate) completed the evaluation; 44 (80%) were care partners of a person living with dementia (PLWD). Twenty-four (44%) participants attended all four sessions, 9 (16%) attended three, 8 (15%) attended two, and 11 (20%) attended one. Those who attended all four sessions were more likely to strongly endorse that they felt better prepared (96% vs. 75%; X2 = 3.7, p = 0.05). On a 5-point scale (1 = Strongly disagree, 2 = Disagree, 3 = Neither agree/disagree, 4 = Agree, 5= Strongly agree), 38 (85%) reported agree or strongly agree to improved preparedness to meet the needs of their PLWD, and 41 (93%) reported improved confidence as a care-partner. The top 5 communication skills learned: Using fewer words (89%); Slowing down speech (89%); Focusing on the relationship (86%); Ending an encounter with thank you (86%); and Going with the flow (84%). Content analysis of qualitative data suggest care-partners’ new understanding and improved communication skills were having a positive influence on the pace and quality of daily life and reported less conflict and improved mood; challenges persisted with activities of daily living, such as showering and toileting. Programs like LWD that provide care partners education, skill development and support for self-care can improve daily life for care-dyads living with dementia.
DISCRIMINATION AND MINORITY STRESS IN OLDER ADULTHOOD: NEW DIRECTIONS FOR PSYCHOLOGICAL RESEARCH
Authors: Wilson Megan 
Published: December 2023

Abstract
The experience of marginalization can be harmful to individuals, in part because of increased experiences of discrimination (cite) and stress related to minority identities (cite). While older adults do tend to report experiencing less discrimination, past work suggests that older adults may be more impacted by experiences of discrimination compared to younger adults. Considering older adults from marginalized groups specifically, these individuals may be particularly susceptible to negative effects of discrimination related to age and other group identities that may harm their well-being and health. Given the wide-ranging negative implications of experiences of discrimination for older adults in particular, there is a need to examine potential strategies for combatting these negative effects. Thus, this symposium will examine the roles of discrimination and marginalization across aspects of health and well-being, and how these effects may differ for different marginalized groups. In addition, the symposium will discuss potential strategies and tools to help reduce harmful effects of discrimination and marginalization on older adults’ lives. First, Danielle McDuffie will present work on bereavement and gratitude for Black adults. Next, Megan Wilson will discuss nuances in the relationship between discrimination and purpose and their implications for health. Next, Lydia Ong will examine the effects of daily discrimination on cortisol reactivity. Finally, Michael Vale will discuss minority stress and loneliness for sexual minority individuals.
DISCRIMINATION IN OLDER ADULTHOOD: UNDERSTANDING THE IMPACT ON PURPOSE IN LIFE
Authors: Wilson Megan , Spears Isaiah , Norton Sara , Bogdan Ryan , Oltmanns Thomas 
Published: December 2023

Abstract
Experiences of discrimination negatively impact individuals across a variety of outcomes, and may similarly impact individuals’ sense of purpose, meaning the feeling that one has meaningful goals and direction in life (Ryff et al., 2003). However, counter to a deficit perspective on marginalization, research also suggests that discrimination may be less negatively associated with sense of purpose for minority groups (Wilson & Hill, 2023a). One possible reason is that members of minority groups may be more likely to find purpose through discrimination (Wilson & Hill, 2023b). Thus, the current study examined a sample of 1630 older adults (Mean Age = 73.08) in order to understand the relationship between discrimination and sense of purpose, and moderators of this association. Results indicate that discrimination is negatively associated with sense of purpose. Contradicting past work, this effect did not differ for racial minority group members. However, we do find that individuals with higher education show a less negative association between discrimination and sense of purpose, suggesting education as a potential pathway to overcome discrimination in the pursuit of meaningful life goals. Moreover, while discrimination was negatively associated with health, sense of purpose moderated this relationship, suggesting a potential for sense of purpose to serve as a resilience factor to protect individuals from harmful effects of discrimination. Findings will be discussed in terms of how we may help older adults foster a sense of purpose and life direction, and in terms of the broader implications on older adults’ well-being and health.
AGE DIFFERENCES IN EVERYDAY DISCRIMINATION AND CORTISOL DYNAMIC RANGE IN DAILY LIFE
Authors: Ong Lydia , Klaiber Patrick , Wen Jin , Stuart Nicole , Sin Nancy 
Published: December 2023

Abstract
Extensive work has linked everyday discrimination with poorer health. However, research testing age differences in this relationship is limited. The current study examined everyday discrimination and cortisol dynamic range, and whether the association differed by age. Cortisol dynamic range is believed to reflect physiological responsiveness to external demands such as stressors, with a compressed range indicating less responsiveness. Participants were 250 community-based adults living in British Columbia (ages 25-88, mean=46 years, 64% White, 68% women). At baseline, participants completed the Everyday Discrimination Scale, followed by four days of at-home saliva collection 3x per day: upon waking, 30 minutes post-waking, and before bed. Cortisol dynamic range was calculated as the log-cortisol peak minus log-cortisol nadir across the four days. Multiple regression controlled for race/ethnicity, education, gender, medications, average length of waking day, and depressive symptoms. Results showed a negative association between age and cortisol dynamic range, such that older age was associated with a smaller range (b=-0.01, SE=0.003, p&lt;0.001). There was no main effect of everyday discrimination on cortisol dynamic range. However, there was a significant interaction between age and everyday discrimination. Among younger adults, more frequent everyday discrimination was associated with a smaller cortisol dynamic range. In contrast, among middle-aged adults, more frequent everyday discrimination was associated with a larger range (b=0.37, SE=0.08, p&lt;0.001). There was no significant association between discrimination and cortisol dynamic range among older adults. Findings indicate differing patterns in discrimination and cortisol dynamic range between younger, middle-aged, and older adults.