bluuebunny/crossref_metadata_2025_split huggingface dataset:
PRAGMATIC CLINICAL TRIALS TO IMPROVE DEMENTIA CARE: IMPLEMENTATION, ADAPTATION, AND OUTCOMES
Authors: Thomas Kali , Gaugler Joseph 
Published: December 2023

Abstract
Pragmatic clinical trials test the effectiveness of interventions in “real-world” settings. One challenge with conducting such research in non-controlled environments is exposure to unpredictable events: in the case of the studies here, the COVID-19 pandemic. This session shares the implementation experiences and findings from four pragmatic clinical trials designed to improve dementia care and describes how the studies were impacted by and adapted to respond to the pandemic. The first speaker discusses a successful, team-based approach for adapting and implementing an intervention to improve sleep for nursing home residents with dementia. The second speaker presents the modifications made to implementation strategies between two trials of a personalized music intervention delivered to nursing home residents with dementia. The third speaker discusses findings from a mixed-methods evaluation with frontline staff at VA Community Living Centers enrolled in a stepped-wedge cluster randomized trial of Montessori-based approaches to improve dementia care. The fourth speaker shares findings from a pilot trial comparing two modes of meal delivery to homebound older adults with dementia. The discussant situates these adaptations and findings in the context of lessons learned by other trialists working to improve care provided to people living with dementia.
PRAGMATIC IMPLEMENTATION OF A BEHAVIORAL INTERVENTION PRE- AND POSTPANDEMIC: A TALE OF TWO TRIALS
Authors: McCreedy Ellen , Dewji Aleena , Dionne Laura , Mor Vincent , Rudolph James 
Published: December 2023

Abstract
We describe two embedded pragmatic trials (ePCTs) of a personalized music intervention for nursing home (NH) residents with ADRD conducted pre-COVID (2019) and 2021 (COVID). Between trials, the implementation strategy was modified to incorporate learnings from the first trial and to address COVID-related restrictions. 54 intervention NHs (27 from Trial 1, 27 from Trial 2) comprised the sample. We compare the trials using the Framework for Implementation Fidelity (FIF) criteria: coverage (number of residents who received the intervention); duration (dose of music received); and frequency (how often nursing staff used the music with the residents). Adherence was worse in Trial 2 (post-COVID) versus Trial 1 (pre-COVID). On average, 12.7 (SD: 3.6) residents were exposed per NH in Trial 1 and 7.5 (SD: 5.5) in Trial 2. Median minutes of music per day was 27.1 (SD: 23.9) minutes in Trial 1 and 2.5 (SD: 5.2) minutes in Trial 2. A greater proportion of exposed residents had nursing staff administer music in Trial 1 (frequency; 0.4 (SD:0.3)) than Trial 2 (0.2 (0.3)). Despite changes to increase nursing engagement and clinical targeting, adherence to intervention was dramatically lower in Trial 2 than in Trial 1. While it is impossible to completely disentangle changes to the implementation strategy from the lingering effects of COVID, it is clear that the NH environment fundamentally changed during the pandemic. With that change comes the need to re-evaluate strategies for implementation and incentivizing participation
POLICY SERIES: ARE WE THERE YET? MEASURING PROGRESS IN ACHIEVING POLICY GOALS FOR FAMILY CAREGIVERS
Authors: Nadash Pamela , Snyder Rani 
Published: December 2023

Abstract
The RAISE Family Caregiving Advisory Council, created under the Recognize, Assist, Include, Support, and Engage (RAISE) Family Caregivers Act (2018) has been tasked to support the Secretary of Health and Human Services in developing a national family caregiving strategy, published in 2022 as its National Strategy to Support Family Caregivers. One key concern identified by advocates and others is the accountability question: how can we hold policymakers at all levels of government accountable for achieving the policy goals articulated in the National Strategy? This symposium discusses that issue by first providing an overview of a key mechanism for state accountability, AARP’s State Scorecard on Long-Term Services and Supports, which identifies support for family caregivers as one of its four dimensions. Susan Reinhard, PhD, Senior Vice President at AARP and Director of its Public Policy Institute, will describe the history, goals, and future of the Scorecard’s family caregiver component. Salom Teshale, PhD, from the National Academy for State Health Policy will describe how states are focusing their energies in current actions supporting family caregivers, while Mike Wittke, MPA, of the National Alliance for Caregiving will discuss how federal actions might be tracked and assessed. Drawing on research supporting the RAISE Advisory Council, Eileen J. Tell, MPH will suggest additional dimensions that could be integrated into the assessment of progress. Rani Snyder, MPA, of the John A. Hartford Foundation will act as discussant.
PREVALENCE AND DISPARITIES OF VERY LOW-INCOME OLDER ADULT RENTERS IN US METROPOLITAN AREAS
Authors: Traver Anthony , Dabelko-Schoeny Holly 
Published: December 2023

Abstract
Income eligibility for federal housing subsidies is based on HUD calculations of area median income (AMI) and family size. Frequently used measures of poverty and income do not reflect the geographic economic variations on which HUD eligibility is based. By integrating Current Population Survey (CPS) data for metropolitan-dwelling people in 2000, 2010, and 2020 with HUD yearly 50% AMI thresholds (very low-income (VLI)), this study aims to provide a novel estimate of the number of metropolitan older adult (OA) (62+) VLI renters and to compare their growth rate, rental assistance use, race, and health with other population groups. Sample weights are used to produce national estimates of four metropolitan OA subgroups: VLI renters, VLI owners, non-VLI renters, and non-VLI owners. Results show that between 2000 and 2020, the total number of metropolitan OAs increased by an estimated 84%, OA VLI renters increased by an estimated 74%, and OA VLI renters without rental assistance increased by an estimated 71%. Across all years, metropolitan VLI OA renters were more likely to be non-white, disabled, report poorer health, and receive rental and utility assistance. Approximately two-thirds of metropolitan VLI OA renters did not receive any form of rental assistance across time points. VLI OA renters without rental assistance face significant affordability challenges as metropolitan rental prices rise faster than most retirement incomes. Communities should proactively link their growing OA VLI renter populations with financial assistance and supportive services to reduce their risk of housing precarity in late life.
LIVING WITH DEMENTIA: AN INTERDISCIPLINARY COMMUNITY-BASED EDUCATION SERIES TO EMPOWER CARE PARTNERS
Authors: Husser Erica , Boltz Marie 
Published: December 2023

Abstract
Approximately 75% of persons living with dementia receive essential day-to-day direct care and support from informal, unpaid care partners who receive little education or guidance from health care professionals on how to negotiate day-to-day challenges associated with living with dementia. This symposium describes the development, implementation, and impact of a comprehensive, four-part Living with Dementia community education program focused on dementia care featuring an optional Memory Café, developed collaboratively by the Penn State College of Medicine and College of Nursing for the purpose of empowering care partners. The first presentation will describe the educational content and instructional strategies, designed by an interdisciplinary team (physician, nurse, and long-term care dementia specialist), and based on the Medicare Cognitive Assessment and Care Plan Services visit and using evidence-based curricula. The second presentation describes the concurrent and collocated intergenerational respite program (Memory Café) for persons living with dementia (PLWD) that enabled care partners to attend the education. Health care students were paired with a PLWD and during the two-hour session each pair engaged in Opening Minds though Art™ (OMA), reminiscence, and music therapy; outcome data includes PLWD pre- and post-mood assessments. The third presentation provides overall evaluation data from the 4-part education series. Respondents were asked about the overall impacts of the program, the skills they learned, the usefulness of the education now and into the future, and what additional support would be most helpful. Our discussant will address the implications of our findings for practice, policy, and future program development.
MEMORY CAFÉ PROVIDES INTERGENERATIONAL ENGAGEMENT OPPORTUNITIES FOR LWD CARE-PARTNERS’ LOVED ONES
Authors: Whitaker Janice , Berish Diane , Rank Jenny , McGraw Meghan , Husser Erica 
Published: December 2023

Abstract
To facilitate attendance by care partners attending the Living with Dementia (LWD) education sessions, an optional Memory Café was available at the same location. We describe the design and implementation of the Memory Café, which included evidence-based programming to engage and provide socialization for the older adults. Basic health, safety, person-centered, and care preference information was collected at registration to ensure quality supervision and support during the Memory Café. The Café was facilitated by interprofessional staff and included Opening Minds through Art (OMA), an intergenerational no-fail art-making experience for persons with neurocognitive disorders (“artists”) that fosters creative self-expression and engagement for persons living with dementia (PLWD). Facilitators also integrated reminiscence, music, and movement therapies during the two-hour LWD education session. Nineteen community dwelling PLWD attended an average of two of the four Memory Café sessions, 26 participants were recruited from a care home at one location, and 124 volunteers were paired with PLWD for OMA and attended at least one Memory Café (volunteers included undergraduate nursing students, graduate students, Penn State faculty and staff, and community members). Fifty-one pre- and post-mood assessments were completed by the 19 community dwelling OMA artists (using a 5-point Likert scale of faces, from frowning to smiling, to indicate how they felt in the moment) and data showed mood improved by an average of .67 points (standard deviation = .95). Care partner evaluation data was positive; 8 (22%) reported that having the Memory Café option made it possible for them to attend LWD.
MINORITY STRESS AND LONELINESS IN A LIFESPAN SAMPLE OF SEXUAL MINORITIES
Authors: Vale Michael 
Published: December 2023

Abstract
Marginalized individuals often experience social isolation (i.e., loneliness), which is a risk factor for diminished health, especially for older sexual minorities (i.e., LGB+) who were socialized in a period with less social recognition and overt stigmatization (i.e., minority stress). Although it is known that minority stressors contribute to loneliness, little is known about the contextual factors that predict this relationship, such as age/cohort. First, we examined cross-sectional baseline data from a lifespan sample of sexual minorities (N=333, ages 18-90) to investigate the relationship between seven different minority stressors and loneliness. Compared to their younger peers, older sexual minorities reported lower levels of loneliness and minority stress; however, age moderated the links between internalized homonegtaivity (B=.01, p&lt;.01), anticipated stigma (B=.02, p&lt;.01), and family-directed stigma (B=.01, p&lt;.05) on loneliness, respectively. Secondly, daily experiences of minority stress and levels of loneliness were examined across a 21-day period (N=1,878 days) from a subsample of the baseline study (N=112, ages 19-79). There was higher daily loneliness on days when participants concealed their identity and had higher internalized homonegativity. Conversely, loneliness was lower when participants disclosed their identity. We further explored lagged-effects and found that loneliness was significantly higher following high internalized homonegativity (B=-.02, p&lt;.001) from the prior day and that this change was moderated by age. These findings underscore the importance of considering age and cohort when examining minority stress. They also highlight the need for interventions that address minority stressors in this population to prevent poorer well-being and higher levels of loneliness.
IT’S GRATEFULNESS: THE ROLE OF GRATITUDE ON ADVERSE OUTCOMES AMONG BEREAVED BLACK ADULTS
Authors: McDuffie Danielle 
Published: December 2023

Abstract
The Black population has been found to experience more bereavement than other racial/ethnic groups. Accompanying loss for Black populations is often other stressful factors such as racial trauma, childhood trauma, and comorbid depression. However, despite these hardships, one of the most prevalent strengths in the Black population is their engagement in religious faith as a means of coping. Gratitude, a major factor in Positive Psychology, shares many tenets with religious beliefs; however, the utility of gratitude has yet to be fully investigated within a Black bereaved population. This study sought to identify whether gratitude moderated the relationship between experienced negative life events (i.e., racial trauma; RT, adverse childhood experiences; ACEs) and depression in a sample of bereaved Black middle to older adults. 103 Black adults aged 45+ (33% female) were administered items assessing depression, gratitude, RT, and ACEs as part of a larger bereavement study. ACEs and RT both significantly predicted depression (p=.009, p=.008, respectively), and there was a significant conditional effect of gratitude on depression, reflecting differences in the endorsement of depression across levels of ACEs and RT. Accordingly, with the significant role of gratitude amongst the present sample, there is evidence for utilizing a strengths-based, Positive Psychology informed approach in the clinical care of Black adults experiencing bereavement, particularly in the context of impactful and racially traumatic events. Additionally, a fruitful direction for future research and policy is addressing the role of adverse traumatic events on Black bereavement.
LONGITUDINAL CHANGES IN WELL-BEING ASSOCIATED WITH AGING ATTITUDE, COGNITIVE STATUS, AND WIDOWHOOD TRANSITION
Authors: Li Lydia 
Published: December 2023

Abstract
This symposium brings together four studies that employ national data collected from older Americans to examine longitudinal changes in older adults’ cognitive, social, and psychological health. The first study focuses on the role of self-perception of aging in memory decline and social mechanisms linking aging perception and memory. It found that negative perceptions of aging predicted memory decline 8 years later and that loneliness and social isolation were pathways. The second study is concerned with neuropsychological changes before the onset of dementia. Using latent growth modeling, it found that the trajectory of depression increased over time in a quadratic fashion before the onset of incident dementia. Further, there were racial/ethnic group differences in levels of depression. Using fixed-effect linear regression, the third study reports that changes in cognitive status were associated with changes in social isolation in older adults. Specifically, it found that transitioning from cognitive intact to cognitive impairment status was associated with increased social isolation. The fourth and final paper examines changes in psychological well-being related to the transition to widowhood. It found that during the year right after the spouse died, older adults experienced increased depressive symptoms and reduced positive well-being. But adaptation is evident—the surviving spouse returned to pre-loss levels of psychological well-being around two years after the death. Together, the four studies show that attitude, cognitive status, and life course transition shape the dynamics of cognitive, social, and psychological health in later life.
EXCLUSION FROM CIVIC ENGAGEMENT IN TWO DISADVANTAGED NEIGHBORHOODS IN BRUSSELS, BELGIUM: A LIFE COURSE PERSPECTIVE
Authors: Dikmans Bas , De Donder Liesbeth , Sarah Dury , Serrat Rodrigo 
Published: December 2023

Abstract
Although research into older people’s civic engagement has come a long way in the last decades, there are still some blind spots on this scholarship. Notably, the influence of neighbourhood features on in- or exclusion from civic activities, as well as the multifaceted nature of civic engagement and the dynamics of such processes across the life course have been scarcely addressed. Therefore, this research focuses on the life course trajectories of older people in two socioeconomically disadvantaged neighborhoods in Brussels, Belgium, in order to understand their inclusion and exclusion from multidimensional forms of civic engagement, including formal volunteering, informal helping behaviours, memberships in associations, political participation and digital civic engagement. We conducted forty semi-structured interviews supported by life diagrams that focused on the changes of in- and exclusion from multidimensional civic engagement throughout the life course. The life stories of these older residents are thematically and narratively analyzed. The outcome of this study underlines the importance of a life course perspective in understanding older people’s experiences of inclusion and exclusion from multidimensional civic engagement. The findings will be used for informing policy recommendations to foster multidimensional civic engagement for older people living in disadvantaged communities.
IMPACTS OF COVID-19 ON TRAINING HEALTH CARE WORKERS AT EAST LOS ANGELES COMMUNITY COLLEGE
Authors: Velazquez Janice 
Published: December 2023

Abstract
The Pandemic changed how community colleges prepare the next generation of healthcare workers, and they are slowly adjusting to remain relevant in the current environment. How community colleges train their students will determine how well their communities will be cared for, which is why this topic is important. Some of the strategies implemented to fulfill the East Los Angeles’ College (ELAC) workforce demands following COVID are: aligning basics skills with some of the courses; providing career counseling, including mock interviews; opportunities to branch out and transfer in two years; connecting students with services to address their basic needs including mental health. Faculty are also required to stay current, and they need support from their local Districts and national collaborators. Some completed specialized training in humanizing curriculum and transforming faculty learning programs to improve undergraduate STEM faculty’s instructional practice. Moreover, the ELAC faculty felt that developing a humanities course tailored to Health and Human Services could be a great start to connect current needs with our academic programming. Faculty are revising and collecting content to address recent changes impacting our society and how we operate in the fast-changing work environment. After the Pandemic, the use of technology is more common and accepted. This change facilitates interactions, and this is a contributing factor to the program development process. For example, the advisory questionnaire is now available electronically, and therefore expecting more participation. Faculty have more variety and options for training to improve content development and delivery strategies.
LONG-TERM ASSOCIATION OF AN INTENSIVE LIFESTYLE INTERVENTION ON GLOBAL COGNITIVE FUNCTION
Authors: Espeland Mark , Hayden Kathleen , Rapp Stephen , Sachs Bonnie , Pleasants Debbie , Booth Debbie , Wing Rena , Neiberg Rebecca 
Published: December 2023

Abstract
The long-term effects of mid-life changes in lifestyle on later life cognitive function have not been rigorously assessed among individuals with type 2 diabetes. The Look AHEAD Aging study examined differences in standardized composite cognitive function scores in 1367 individuals, currently aged 64 to 95 years, who had enrolled an average of 20 years previously in a randomized controlled trial to compare a 10-year multidomain intensive lifestyle intervention (ILI) to a condition of diabetes support and education (DSE). The composite averaged standardized scores from the telephone administration of tests chosen to capture the individual cognitive domains of memory, attention/processing speed, executive function, and global cognitive function. At enrollment into the Look AHEAD Aging study there was no overall difference between intervention groups in cognitive test scores: mean [SE]: -0.01 [0.03] ILI versus 0.00 [0.04] DSE (p=0.76). However, among participants with overweight at Look AHEAD enrollment, those assigned to ILI had mean [95%CI] of 0.33 [0.08, 0.57] better global cognitive function scores than those assigned to DSE. For those initially with obesity, there was no relative intervention benefit: mean [95%CI] -0.08 [-0.18, 0.03] (interaction p=0.003). Benefits for those with overweight appeared to be strongest for tests of memory. ILI should be recommended to individuals with type 2 diabetes and overweight to provide long-term resilience against cognitive aging. The cognitive benefits we have reported earlier for individuals with overweight during intervention delivery endure for a decade following the cessation of the intervention.
CROSSING THE DIGITAL DIVIDE: ASSESSING DIGITAL READINESS AMONG UNDERSERVED OLDER ADULTS
Authors: Navarro Sheila Salinas , Yan Mengzhao , Lomeli Sindy , Wilber Kathleen 
Published: December 2023

Abstract
The California Department of Aging launched the “Connecting, Health, Aging, & Technology (CHAT) Program, “aimed at bridging the digital divide and mitigating social isolation among older adults by providing an iPad device and technology training. Because providing a device does not guarantee uptake, we examined factors associated with technology adoption among research participants (n=1,219). We used a global “digital readiness” scale, and two open-ended questions to examine potential device uptake. We ran multivariate regressions with explanatory independent variables including demographic characteristics (age, gender, race/ethnicity, living arrangement, and education), health indicators (self-rated health and mental health status) and the intention to adopt technology against the global readiness question. The analysis showed that digital readiness was associated with age and education, and Asian or Pacific Islander older adults were more ready than non-Hispanic Whites. Further, digital readiness was negatively associated with mental health but positively associated with self-rated health. Digital readiness was also associated with an increased intention to adopt technology. A content analysis of the open-ended questions in Atlas.ti informed the regression analyses and revealed participants’ strong desire for digital self-efficacy, informed citizenship, lifelong learning, a proactive desire to improve quality of life, and the desire to foster connection to family and friends. Our research highlights the personal and multifaceted nature of technology adoption among older adults, and the complexity of fostering digital inclusion on a large scale.