bluuebunny/crossref_metadata_2025_split huggingface dataset:
REAL-TIME HEALTH OUTCOMES AMONG OLDER ADULTS INITIATING MEDICAL CANNABIS FOR CHRONIC PAIN
Authors: Wang Yan , Sibille Kimberly , Li Zhigang , Przkora Rene , Schmidt Seigfried , Lo Margaret , Abrantes Ana , Cook Robert 
Published: December 2023

Abstract
Background: Rigorous data are needed on the short- and long-term effects of medical cannabis (MC) on older adults with chronic pain. In response, this prospective study combines technology-based ecological momentary assessments (EMA) and in-person visits over 12 months to obtain subjective and objective data on MC’s effects on older adults. Method: The study recruits and follows older adults (50 years or older, 50% male) with chronic pain for one year. Some will have initiated MC (MC group) and others will not use MC (comparison group). Target enrollment will be 328 (1:1 ratio for MC and comparison group) participants. Collection of subjective and objective data occurs at in-person visits (baseline & 12 months) and via smartphone- and sensor-based measurement bursts at 1, 3, 6, and 9 months. The EMA data capture detailed MC use patterns and subjective short-term outcomes (e.g., pain intensity rating). These data will be integrated with objective data collected using a wearable sensor-based Fitbit (e.g., physical activity and sleep). Results: Multilevel modeling will examine changes in real-time symptoms measured by EMA and objective, sensor-based behavioral outcomes. Results will include changes in momentary pain intensity rated on 0-100 visual analog, real-time anxiety and depressive symptoms, daily sleep duration and quality, and level of physical activity. Conclusions: Our results will provide evidence on whether older adults who initiate MC will have greater reductions in real-time pain intensity and more improvements in physical and emotional functioning compared to those in the comparison group.
ADVANCE CARE PLANNING FIDELITY TOOL IN THE CONTEXT OF COGNITIVE IMPAIRMENT: THE SHARE TRIAL
Authors: Cagle John , Roth David , Boyd Cynthia , Hussain Naaz , Smith Ambrym , Reiff Jenni , Scerpella Daniel 
Published: December 2023

Abstract
2. Conducting high-quality advance care planning (ACP) conversations with persons living with ADRD and their family members is inherently challenging. Differing levels of cognitive function, judgment, ability to engage, and care partner involvement adds to the complexity of such ACP conversations, necessitating flexible fidelity monitoring to accommodate contextual factors. This presentation will focus on the process of measuring ACP fidelity. The SHARE ACP fidelity checklist was developed to measure the protocol adherence during ACP meetings, monitor for areas in which ACP facilitators may require re-training or additional support, and to inform analyses of the impact of the overall exposure to the study intervention. The fidelity checklist items are organized into three overarching domains: Meeting Set-Up, ACP Meeting Topics, and Facilitator Communication Skills. For the present study, a fidelity adjudication team from a pool of 7 raters, listened to and independently rated recorded conversations for protocol adherence. Each checklist item is scored ranging from 0 to 2 (0=not done; 1=needs improvement; or 2=effective) with higher scores indicating greater adherence. Fidelity ratings tended to improve over time, suggesting a facilitator experience effect. The goal to achieve an overall fidelity rating of ≥80% was met in 63% of dyad conversations. Based on subscale scores, project targets were most frequently met on the Communication Skills subscale and less frequently accomplished on the Meeting Set Up subscale. Despite some challenges, preliminary assessments of SHARE intervention fidelity appear promising, and evidence suggests the fidelity checklist is both valid and reliable.
ACCESS TO DENTAL CARE AND ORAL HEALTH INEQUITIES AMONG DIVERSE POPULATIONS IN THE UNITED STATES AND CHINA
Authors: Qi Xiang , Chen Xi , Ghezzi Elisa 
Published: December 2023

Abstract
Although the oral health status of the world population has improved over the years, structural and societal inequities in dental care and oral health are pervasive with older adults. This symposium discusses findings from three studies that examine structural and societal determinants of dental care and oral health inequities among diverse populations in the US and China. Mao’s study investigated correlates of dental care utilization among informal dementia caregivers in the US. Findings demonstrate that spousal caregivers and those who provide intensive care are less likely to visit a dentist. These findings suggest that dementia caregiver support intervention strategies should target these populations to improve dental care-seeking behaviors. Qi’s study examined the population attributable fraction of poor oral health on incident dementia in comparison with other modifiable risk factors. This study found that poor oral health, including edentulism and oral health problems, is a significant risk factor for incident dementia. The study highlights the need to integrate dental care as an integral component of a comprehensive approach to promoting cognitive health. Qu’s study explored social structural disparities in dental care utilization among adults in China’s megacities. This study revealed that social structural factors, such as hukou status, occupational status, and city of residence, are associated with disparities in dental care utilization. Overall, these studies shed light on important factors that impact dental care utilization and oral health. Addressing disparities in dental care utilization and oral health should be a priority in promoting overall health and well-being, particularly among vulnerable populations.
MATERNAL DIFFERENTIAL TREATMENT AND ADULT CHILDREN’S DEPRESSIVE SYMPTOMS IN THE FACE OF COGNITIVE IMPAIRMENT
Authors: Suitor J Jill , Gilligan Megan , Frase Robert , Ogle Destiny , He Ranran 
Published: December 2023

Abstract
Parental differential treatment has been shown to have a negative impact on adult children’s psychological well-being, particularly among daughters. In this paper, we explore whether mothers’ cognitive impairment (CI) moderates the impact of maternal favoritism/disfavoritism on psychological well-being when children are entering their later years (M=60), and their mothers are in their 80s-90s. We address these questions using mixed-methods data from 297 adult children who participated in wave 3 of the Within-Family Differences Study. Quantitative and qualitative analyses revealed that the effects of perceived favoritism/ disfavoritism were shaped by the combination of child’s gender and mothers’ CI status. Perceptions of disfavoritism, particularly regarding mothers’ disappointment, affected daughters’ depressive symptoms; however, the effect was decidedly muted by mothers’ CI. In the case of mothers’ preferences regarding their future caregivers, the differences by cognitive status were particularly striking. Contrary to expectations, daughters’ perceptions that they were their mothers’ preferred caregivers predicted depressive symptoms when mothers showed no signs of CI, but had no impact when mothers were cognitively impaired. Among sons, depressive symptoms were not affected by mothers’ favoritism or disfavoritism, regardless of mothers’ CI status; a gender difference in the impact of mothers’ appraisals on well-being that we have seen emerge across the 20 years we have followed these families. Qualitative analyses suggest that mothers’ CI reduced daughters’ emotional reactions to their mothers’ differential treatment because they believed that their mothers had less control of their behaviors and less awareness of the negative impact of their appraisals and expectations.
CHANGES IN ADULT SIBLING CONFLICT AND OLDER PARENTS’ COGNITIVE IMPAIRMENT: THE MODERATING ROLE OF CARE PROVISION
Authors: Gilligan Megan , Suitor J Jill , Ogle Destiny 
Published: December 2023

Abstract
The life course concept of “linked lives” emphasizes that the life events of one family member have implications for other family members. Health events have been shown to be particularly salient in later-life families. We considered the consequences of older parents’ cognitive impairment on adult sibling relationship quality. Using mixed methods data from 327 adult children (nested within 96 families) collected as part of the Within-Family Differences Study (WFDS) T3, we examined the role of adult children’s care provision in the association between parents’ cognitive impairment and adult sibling tension. At T3 of the WFDS, the adult children were on average 60 years old and their parents were on average 90 years old. We conducted lagged multilevel linear regression modeling to account for nonindependence and to control for sibling tension seven years earlier before parents were experiencing cognitive impairment. The results of the quantitative analyses revealed that reports of sibling tension were higher in families in which parents experienced cognitive impairment. Moderation analyses indicated that the association between parents’ cognitive impairment and sibling tension was stronger for caregivers than noncaregivers. Qualitative analyses revealed that discrepancies in perceptions of the caregiving situation between caregivers and noncaregivers fueled sibling tension. Noncaregivers often seemed unaware of the caregiving situation or actively disengaged to avoid conflict. Taken together, these findings indicate that sibling tension is particularly high in the context of caring for older parents with cognitive impairment. In particular, adult children who are providing care are at increased risk of sibling tension.
SUPPORT EXCHANGES IN COUPLES COPING WITH EARLY-STAGE ALZHEIMER’S DISEASE
Authors: Huo Meng , Kim Kyungmin 
Published: December 2023

Abstract
People living with Alzheimer’s disease (AD) typically receive considerable support from their spousal caregivers. Yet, we know little about whether people with early-stage AD may still be able to help their caregivers and how potential support exchanges in these couples may vary depending on the quality of their relationships. We drew on dyadic data from 37 older couples in which one partner lives with mild-to-moderate AD (Mage = 77yrs, 48% male) and the other serves as a spousal caregiver (Mage = 76yrs, 53% female). Couples participated in concurrent interviews during which they each reported on a variety of demographic and relationship characteristics, such as relationship quality, and couple support exchanges. People with early-stage AD perceived their relationships with spousal caregivers as more positive and less negative than did these caregivers. Support did not flow unidirectionally in these caregiving couples, especially not among those in better-quality relationships. Specifically, caregivers who viewed their relationships as more positive/less negative considered it less stressful to provide emotional and practical support to their partners with AD. Patients who viewed their relationships as more positive/less negative provide more frequent emotional and practical support to their caregivers and also found such support provision more pleasant and less stressful. Findings reveal positive contribution that older adults with dementia, who have been solely treated as recipients of care, can make and shed light on the development of dyadic interventions by highlighting the importance of mutually beneficial relationships in early stages of AD.
DISSECTING RACIAL DIFFERENCES IN THE PERCEPTION OF DOMAIN-SPECIFIC LIFE SATISFACTION
Authors: Goler Timothy , Bhatta Tirth 
Published: December 2023

Abstract
This study examines factors contributing to racial differences in domain-specific life satisfaction. Our study offers a major contribution to prior research that has tended to pay greater attention to psychological well-being outcomes such as life satisfaction which do not directly pertain to material circumstances of older adults. Those studies generally report better life satisfaction and fewer depressive symptoms among Black older adults than their White counterparts. Our study is based on 409 randomly selected older adults from Cleveland (mean age 79 and 25% African American). We considered socioeconomic status, stressors such as recent negative life events and coping resources such as religiosity to understand their impact on domain specific life- satisfaction (e.g., satisfaction with neighborhood, housing, and standard of living). Our ordinary least squares regression estimates suggest that, on average, Black older adults reported lower levels of domain-specific life satisfaction (b=-0.81, p&lt; 0.01) compared to their White counterparts, despite having stronger social support and being more religious. Even though social support and religiosity did not contribute to racial differences in domain specific life satisfaction, the inclusion of education, income, and recent negative life events fully explain such differences. Findings indicate that interrelated factors such as socioeconomic disadvantage and greater life adversities such as negative life events contribute to lower domain life satisfaction among Black older adults. This finding highlights the need for further exploration of factors shaping material-related well-being outcomes for Black older adults. Our study informs future policies addressing racial well-being inequities.
RELIGIOSITY AND SPIRITUALITY DEVELOPMENT ACROSS MID- TO LATER LIFE: AN ACCELERATED LONGITUDINAL DESIGN
Authors: Nelson Niccole , Joiner Raquael , Martinez Brandy , Bergeman Cindy 
Published: December 2023

Abstract
It is widely accepted that religiosity and spirituality (R/S) increase with age, although the multidimensional nature of R/S complicates this conclusion. Specifically, religiosity entails engagement in communal and independent religious practices, whereas spirituality refers to a sense of communion with divine being(s). Furthermore, religious and/or spiritual individuals may use their faith to carry them through hard times, and thus engage in positive and/or negative religious/spiritual coping. Critically, these R/S facets may follow distinct developmental trajectories across adulthood, and the nature of these trajectories remain unclear. Therefore, in the present study, we followed an accelerated longitudinal design, modeling developmental trends in six R/S facets across ages 45-80. Participants included 768 subjects from the Notre Dame Study of Health & Well-being (NDHWB), a 10-year, multi-cohort, longitudinal study of adult development and aging (Wave 1 Age: Mean= 59.24, SD= 8.65). Using two-level, hierarchical linear modeling, we estimated no change, linear change, quadratic change, and cubic change trajectories across ages 45-80 in communal and independent religious practices, spirituality, positive and negative religious/spiritual coping, as well as composite R/S; cohort effects in these change trajectories were also tested. Communal and independent religious practices, spirituality, negative religious/spiritual coping, as well as composite R/S, followed unique, cubic trajectories across mid- to later life. Positive religious/spiritual coping followed a linear trajectory, although cohort effects precluded the interpretation of developmental change in this R/S facet. Individuals appear to engage with their faith in different ways as they age, meaning extant conclusions about age-graded increases in R/S may be oversimplified.
INTERGENERATIONAL COURSE ABROAD EXPLORES AGE INCLUSIVITY IN SCOTLAND
Authors: June Andrea , Andreoletti Carrie 
Published: December 2023

Abstract
In 2017, Central Connecticut State University (CCSU) joined the Age-Friendly University (AFU) global network. Guided by the AFU framework to promote age inclusivity in higher education, many programs and services at CCSU have been expanded to encourage the participation of older adults in all core activities of the university. The authors have a particular interest in fostering intergenerational learning opportunities, for which there are reciprocal benefits (e.g., Andreoletti & Howard, 2016). With the goals of promoting intergenerational connection and global age-inclusivity, we developed a course abroad to Scotland called Global Aging & Age-Friendly Initiatives. Prior to traveling, students are introduced to theory and research in lifespan development and to the World Health Organization’s (WHO) definition of healthy aging and domains of livability aimed at enhancing well-being and longevity. Livability community efforts in the USA are explored so that similarities and differences can be examined while in Scotland. During 9 days of travel, students are exposed to urban and rural areas of Scotland, noting the accessibility of public transportation, the availability of green spaces, the cultural attitude toward older adults, and other domains of livability. They will also hear from local academics and community organizers invested in promoting engagement across the lifespan. In June 2023, eight age-diverse learners will travel with the authors. In addition to providing more detail on the development and implementation of the course abroad, this presentation will share feedback from students and international collaborators with the goal of encouraging other AFUs to develop similar opportunities.
MEDICAL VERSUS FINANCIAL RISKY DECISION MAKING IN OLDER AND YOUNGER ADULTS
Authors: Frank Colleen , Pachur Thorsten 
Published: December 2023

Abstract
While risky decision making is often tested using monetary outcomes in the laboratory, many decisions in the real-world elicit considerable levels of affect––for example, when deciding about a medical treatment that has bodily consequences, such as side effects to a medication. Previous research suggests that choices systematically diverge between these more “affect-rich” medical decision problems and economically equivalent “affect-poor” monetary problems, leading to what is called an ‘affect gap’ in risky choice. However, it is unknown to what extent this pattern holds in older adults, who make some of the most consequential medical and financial decisions among the population, and for whom it has been hypothesized that affect may be a more important guide. Thus, in the present, preregistered study, we examined age-related differences in the affect gap of risky decision making. We compared decision quality and risk attitude between affect-rich (medical side effects) and structurally identical affect-poor (monetary losses) decisions in 100 older (aged 65-80, M=69.7) and 100 younger (aged 18-29, M=23.5) adults. In line with previous findings, we found that individuals were more risk-averse (Odds Ratio (OR) = 1.52) and made worse quality decisions (OR = 2.13) for affect-rich, compared to affect-poor, problems and this did not differ between younger and older adults. Follow-up work using computational modeling will reveal if decision strategy differed between age groups. These findings indicate that the affect gap is also present in older adults, which has serious implications for risk communication in medical decision making
WE CAN WORK IT OUT: NURSING HOME SOCIAL WORK AND CONFLICT MEDIATION
Authors: Roberts Amy , Kusmaul Nancy , Bern-Klug Mercedes 
Published: December 2023

Abstract
Drawing from a nationally representative survey of social service directors (N=922), this presentation will provide an overview of nursing home staffing trends and describe the ways in which social service staff routinely interact with residents, families, and staff. Social workers are involved in many aspects of care, including the admissions process, planning and providing care, care transitions, and general supportive services. As members of the interdisciplinary team, social workers advocate for resident rights, and support decision-making and care planning in times of family crisis and high conflict situations. Summary statistics will be presented to identify the directors’ frustrations with the role – including their perceptions of major barriers to care, and draw attention to the changes that would improve job satisfaction (e.g., higher salary/wage, 51%; lower staff turnover among direct care staff, 47%; and more time to focus on the social and emotional concerns of residents, 45%). The presentation will conclude with an overview of directors’ interest in training topics that may help to mediate conflicts among residents, families, and staff. Specifically, we will share how prepared directors feel to train other staff in conflict-resolution skills (e.g., working with the resident/family and team to balance resident self-determination with the nursing home’s responsibility to minimize risk), and the use of an ethical framework to guide action.
SOCIAL WORKERS AS INFORMAL LEGAL INTERMEDIARIES: RESOLVING CONFLICTING RIGHTS IN NURSING HOMES
Authors: Perone Angela 
Published: December 2023

Abstract
Conflicting rights arise often in nursing homes among residents, staff, and family. Nursing home social workers sit at a unique nexus of these rights, given their macro, mezzo, and micro-level training. This study employs a multi-method qualitative design with semi-structured staff interviews (n=90) (direct care, mid-level professional, top management), content analysis of long-term care facility policies (n=376), and ethnographic observation of two facilities (n=8 months) for a multi-layered cross-comparative in-depth case study. While social workers represented only a very small number of the overall nursing home workforce, data revealed the overwhelming reliance on social workers to resolve conflicting rights that arose among residents, staff, and family. Certified nursing assistants, nurses, directors, and administrators regularly deferred to social workers via written policies and unwritten practices to resolve a variety of issues, including discrimination concerns by staff, residents, or family, concerns about quality of care and workforce shortage, and concerns about conflicting rights to resident autonomy, dignity, medical decision-making, and safety (e.g., bed rails). Staff at all levels and professions described the emotional labor and unique professional experience that these conflicts required and felt ill-equipped to resolve these issues. While social workers resolved most of these conflicts, they, too, reported feeling ill-prepared for this role and worried about out-of-scope practice. Ultimately, they relied on their social work training in systems-level change, case management, and interpersonal communication to resolve conflicting rights. This presentation will discuss social worker challenges as informal legal intermediaries and opportunities for better support and training.