bluuebunny/crossref_metadata_2025_split huggingface dataset:
BLAME-SHIFTING OR SHARING RESPONSIBILITY? CHILDREN’S ROLE IN CHINESE OLDER ADULTS’ END-OF-LIFE MEDICAL DECISIONS
Authors: Chen Lu , Zhang Wenjun 
Published: January 2025

Abstract
Filial piety is the core value shaping intergenerational interactions in China, where children are often considered the proxy decision-makers for older adults’ end-of-life treatment plans. End-of-life care decision-making is a complicated and culturally sensitive process. Prolonging older parents’ lives is often considered a reflection of filial piety in the medical decision-making context, however, budget constraints may weave into the decision-making process. The study addressed the literature gap by empirically investigating the role of children in the end-of-life medical decisions in China. Using data with 579 older decedents who had passed away due to illness from the China Longitudinal Aging Social Survey 2020, we examined the association between role of children, proxied by number of children and relative contribution of children to parents’ medical expenses, and end-of-life decision as a process outcome, measured by a categorical variable with four mutually exclusive groups of whether all life-sustaining medical efforts have been made and whether these decisions imposed financial pressure on their families. Results show that families with fewer children were more likely to pursue all potential treatments and experience financial pressure. Compared to families with shared financial responsibilities by all children, families with shared responsibilities by certain children were more likely to exhaust all potential treatments and face financial strain. Post-hoc analyses further showed that older adults with more children were more likely to be overtreated, particularly among those families with no financial concerns to pursue every potential treatment. Family-level interventions are needed to support end-of-life care decision-making in China.
THE SOCIAL, ECONOMIC, AND MORTALITY CONSEQUENCES OF THE FAILURE OF THE FREEDMAN’S SAVINGS BANK
Authors: Warren John , Helgertz Jonas , Esposito Michael , Wrigley-Field Elizabeth , Hacker J David 
Published: January 2025

Abstract
The Freedman’s Savings Bank was chartered in 1865 to serve newly emancipated people across 17 states. Driven by mismanagement and fraud by the bank’s white officials, the bank failed in 1874 ─ costing many depositors large savings. Although there is debate about the short-term financial benefits for Black people of the bank’s creation, there has been no research on the longer-term effects of the bank’s failure on social, economic, or mortality outcomes among depositors who lost their savings. Using linked records from the complete-count 1860 through 1940 U.S. Censuses and exceptionally detailed records on the bank’s branches, deposits, and losses, we use a variety of empirical estimation strategies to estimate the effects of the bank’s failure on the life course outcomes of Black depositors and their children. This work speaks more broadly to the effects of negative economic shocks on the long-term well-being of older people.
AGE-FRIENDLY MEDITERRANEAN COOKBOOK:CULTIVATING CULTURAL TRANSFORMATION
Authors: Naim Sigal , Hirsch-Matsioulas Orit , Katz Ruth , Sapir Adi , Hochman Yael , Zisberg Anna 
Published: January 2025

Abstract
Creating a new reality for old persons on campus, with limited resources but boundless ambition, is both a challenge and an opportunity. In this presentation, we will focus on our experiences over the course of a single academic year, culminating in our university’s inclusion in the global network of Age-Friendly Universities (AFU) – a milestone marking the first institution in the Middle East to achieve such recognition, and only the third in the Mediterranean basin. By embracing the principles of the AFU initiative, we tapped into a broader narrative of societal transformation aligned with the United Nations Sustainable Development Goals (SDGs). Central to our success were cultural values deeply integrated into Israeli society, including collectivity, solidarity, social ties, and audacity. Drawing on these values, we mobilized internal and external stakeholders, forged partnerships, and positioned ourselves as catalysts for change. We conducted comprehensive studies, mapped existing resources, and developed strategic future plans. Our experience illustrates how organizational culture, intertwined with societal dynamics, can drive meaningful change. Community engagement and partnerships played a pivotal role in highlighting the collaborative nature of our initiatives and the importance of involving diverse stakeholders. We invite participants to explore the intersection of culture, age-friendliness, and sustainable development, emphasizing the role of cultural values in shaping age-friendly initiatives. This presentation aims to inspire others to embark on similar journeys, utilizing culture to create inclusive environments where older adults can thrive.
FORTIFYING DEMENTIA CARE: EXPLORING FAMILY SELF-EFFICACY IN DECISION-MAKING, TRUST, AND QUALITY
Authors: Lopez Ruth , Zaguri-Greener Dalit , Kolpina Lola , Zisberg Anna 
Published: January 2025

Abstract
In Israel and many countries, individuals with advanced dementia often spend their final days in nursing homes (NHs). Families prioritize comfort, yet residents often endure significant symptom burden. This discrepancy arises partly because NH staff depend on families to guide end-of-life care. However, family members often lack confidence as decision-makers and struggle to partner with NH staff to translate their intimate knowledge of their loved ones’ preferences into comfort-focused strategies. The purpose of this pilot study employing cross sectional survey design, was to explore relationships among family self-efficacy for surrogate decision-making, trust with staff, and quality of care measures. Among 66 family members of NH residents with advanced dementia in Israel (average age 60, 53% female) self-efficacy was positively associated with trust (r=.32, p&lt;.001), quality of decision-making (r=.34, p&lt;.001), communication (r=.33, p&lt;.001), family-staff relationships (r=.30, p&lt;.01), basic care, and symptom management (r =.36, p&lt;.001). Recognizing the pivotal role of family self-efficacy, interventions to enhance it may be warranted. Our findings also urge further investigation into the intricate interplay between these factors and the need to explore the directionality of these relationships. Understanding the influence of broader contextual factors, such as overall NH care quality, is crucial. Our study establishes a foundation for future inquiries, fostering a comprehensive understanding to enhance the well-being and advanced comfort of individuals with advanced dementia in NH settings.
FRIENDS WITH UNEXPECTED BENEFITS: COACHING CAREGIVERS OF PEOPLE LIVING WITH DEMENTIA
Authors: Jablonski Rita , Cleverdon Amy , Xiao Chunhong , Bratches Reed 
Published: January 2025

Abstract
Persons living with dementia (PLWD) often exhibit care-resistant behaviors (CRBs), including refusing to take medications or bathe. This randomized clinical trial is currently enrolling caregivers of people living with dementia, who receive nine one-hour coaching sessions designed to help them prevent and manage CRBs. Coaching is the application of evidence-based strategies delivered in a conversational manner; it is a bidirectional, problem-solving approach designed to improve the ability of family caregivers to recognize, prevent, and manage CRB in their daily interactions with their care recipients. We report qualitative findings from 13 caregivers who completed all coaching sessions. The results of the thematic analysis revealed unexpected benefits and feedback. Participants reported a renewed sense of hope and optimism “after nearly giving up.” They expressed feelings of relief that the dementia-related brain changes were responsible for behaviors, not “caregiver mistakes,” or “they are doing this on purpose,” which led to greater compassion for their care recipients. These new insights also contributed to a permanent adjustment of their expectations of their care recipients’ cognition, and re-established connections with PLWD. The participants applied newly learned skills and strategies in unexpected situations, such as improving cooperation during travel and medical appointments. Participants also shared that they taught secondary caregivers, such as sitters, specific techniques to maintain continuity of care. These findings support the need for future studies that emphasize targeted, personalized interactions inherent in this coaching intervention, versus passive presentation of generic information.
CHILDLESSNESS AND SUBJECTIVE WELL-BEING IN 88 COUNTRIES: THE ROLES OF STIGMA, DEVELOPMENT, AND REGION
Authors: Teerawichitchainan Bussarawan , Mair Christine , Sugimori Haruka 
Published: January 2025

Abstract
Although childlessness is often hypothesized to be associated with poorer subjective well-being among aging populations, cross-national empirical evidence suggests substantial variation across countries. Yet, the reasons for this variation have yet to be identified. We hypothesize that childless older adults have lower subjective well-being in country contexts with higher stigma against childlessness, net of region, fertility, and economic development. We use multilevel modeling to analyze recent data (2017-2022) from the World Values Survey, United Nations, and World Bank, focusing on 63,067 adults aged 45+ in 88 low-middle, middle-high, and high-income countries to examine individual-level associations between childlessness and subjective well-being (life satisfaction and happiness) and moderation of country-level variables (stigma, economic development, and region). Overall, childless respondents report lower subjective well-being (life satisfaction and happiness), but these associations vary by country-level factors. Childless respondents in countries with high stigma report the lowest life satisfaction, net of fertility rate, economic development, and other factors. Happiness increases with economic development for both childless and non-childless individuals, and does not appear to be associated with stigma against childlessness. Regional differences are also evident. We discuss these findings in light of heterogeneity in the experiences of childless aging populations cross-nationally. Additionally, we highlight the potential contextualizing role of country norms and stigma when considering childlessness and well-being, particularly in family-centered or low-middle income countries.
RELATIONSHIP BETWEEN CHILD MORTALITY, SOCIAL SUPPORT, AND PSYCHOLOGICAL DISTRESS AMONG WAR SURVIVORS IN VIETNAM
Authors: Kuy Kakada , Kim Korinek , Zimmer Zachary 
Published: January 2025

Abstract
Social support has been documented as a key factor contributing to improved well-being among grieving parents in the bereavement process. However, how different forms of support interact with the experiences of child death is less understood among aging populations in post-conflict settings. This study examined the psychological impact of child death on older Vietnamese with a focus on the mediating role of social support and the moderating effect of war exposure. Data came from the 2018 Vietnam Health and Aging Study of 2,447 older adults aged 60 and older. We assessed experience of child loss by enumerating the mortality and survivorship status for all children. Mental distress was measured using the Self-Reporting Questionnaire with nine items. Social support was conceptualized along two dimensions: 1) Received social support was divided into instrumental and emotional domains; 2) perceived social network support was broken down into functional and structural aspects. Path analysis substantiated a significant relationship between child death and heightened mental distress. Emotional and labor support significantly buffered the impact of child. Moderated mediation analysis suggested that individuals with higher levels of war exposure received a noticeable benefit from emotional support. However, other forms of support did not demonstrate a significant mediating role. Results underscore the value of emotional support in this context. Findings suggest the integration of mental health support within existing social services for older adults in Vietnam with an emphasis on providing emotional support to those who have experienced child loss.
FROM REACH TO MINDFULNESS: SHIFTING PARADIGMS IN SUPPORT OF CAREGIVERS OF VETERANS LIVING WITH DEMENTIA
Authors: Savla Jyoti , Sapra Mamta , Luci Katherine , Hagemann Lauren 
Published: January 2025

Abstract
Enhancing interventions to alleviate stress among caregivers is a key area of focus for the Veterans Health Administration, especially given the anticipated tripling of dementia cases among Veterans in the upcoming years. Existing programs, like REACH-VA, have focused on cognitive behavioral approaches to reduce caregiver strain. However, mindfulness practices, known for stress reduction, psychological well-being improvement, and relationship enhancement, have not been extensively explored for caregivers of Veterans. This study evaluated the comparative effectiveness of a four-session, multi-faceted mindfulness-based intervention called Practice of Acceptance, Awareness, and Compassion in Caregiving (PAACC) to REACH-VA program for family caregivers of Veterans living with dementia. PAACC combines mindfulness with caregiver skill-development to improve the caregiving experience. It aims to assist caregivers in developing immediate awareness of stressors and their responses to stressors, while fostering empathy towards their relative with dementia. This approach differs from strategies that challenge or replace negative or unrealistic stress-related thoughts, considering the often progressive and unchangeable nature of such stressors. A randomized-controlled trial involving 133 family caregivers (Mage = 67 years; 81% White; 89% co-residing) assigned to either REACH-VA or PAACC demonstrated significant reductions in perceived stress, caregiver burden, and rumination after participating in either of the interventions. However, multi-level models revealed that caregivers who received PAACC showed lower anxiety (B=-2.76, p&lt;0.001) and depressive symptoms (B=-2.50, p&lt;0.01), and higher mindfulness (B=6.04, p&lt;0.01) compared to caregivers who received the REACH-VA intervention. Findings will be discussed in the context of the intervention’s mechanisms, lessons learned, and alternative avenues for utilizing PAACC.
SUCCESSFUL AGING AND FACTORS ASSOCIATED WITH IT AMONG OLD PEOPLE LIVING IN OLD AGE HOMES IN NEPAL
Authors: Chalise Hom Nath , Singh Satya 
Published: January 2025

Abstract
This study aimed to assess Successful Aging (SA) and its association with Nepali older people. A cross-sectional analytical study was conducted among 206 elderly people of seven old age homes in the Kathmandu district. The interview technique using a structured questionnaire was taken after informed consent. The data collection tool was based on the determinants of SA and the Successful Aging Inventory (SAI) tool. The Geriatric Depression Scale (GDS) was used as an indicator of success in mental health. The ethical review board of Nobel College in Nepal permitted this study. The majority of the respondents (63.5%) were successful agers according to SAI Indicators and represented the SA components such as 90.4% in SP, 87.5% in PC, 93.3% of respondents self-rated health (SRH), 55.8% were involved in mind diversional activities(MDA), 99% have resilience with illness and almost two third of the respondents were mentally healthy according to GDS analysis. Most of the SA was from the 71+ age group (60.6%)with the odds of having success in the 71+ age group being 2.45 times more compared to the 60-70 years age group. Mann Whitney-U test for a non-normally distributed population showed a statistically significant difference found between the Female and Male group for SA, the difference was also found in PC and MDA among SA and Usual Aging. Although the majority of the respondents were successful agers, there needs to be improvement in all aspects especially the mental health of SA components to achieve better SA among older people.
ANNUAL WELLNESS SCREENING AND COVID-19: A MISSED OPPORTUNITY TO ADDRESS HEALTH DISPARITIES
Authors: Allen Nancy , He Yao , Foster Norman 
Published: January 2025

Abstract
The COVID-19 pandemic had the greatest effect on the most vulnerable. Medicare annual wellness visits (AWV) are the best opportunity for early detection of cognitive impairment and could address inequities in dementia care. We examined how preventive care through AWV changed as our healthcare system responded to pandemic disruptions. We hypothesized that disruptions would exacerbate pre-existing disparities in AWV administration. We conducted an observational retrospective chart review of AWV of Medicare-eligible adults ≥65 years of age in our health system from Jan 2018 to Dec 2022. In 2020 at the beginning of the COVID-19 pandemic, there were 32.9% fewer AWV performed than in 2019. A month-by-month analysis showed a sharp 91% decline in AWV when clinic operations were most restricted. When operations largely resumed by June 2020, AWV returned to the pre-pandemic proportion of January 2020. However, previous disparities in AWV performance continued or were exacerbated. Post-pandemic, AWV were more frequent in younger (&lt; 75 years; 32.5%) rather than older individuals (&gt;75; 21.4%), in white (30.9%) rather than non-white patients (24.2%), and in non-Hispanic (30.5%) rather than Hispanic individuals (23.7%). Patients without diabetes had more AWV (31%) than those without (31% vs. 27.6%). Success in resumption of AWV occurred by the continuation of conscious and unconscious scheduling biases, rather than addressing previously recognized disparities. This represents a missed opportunity and highlights the need for policy changes to address health equity in AWV. The disparities in AWV mirror the disparities in dementia diagnosis and treatment.
IMPACT OF OLDER ADULT PATIENTS AND CAREGIVER ATTITUDES AND PERCEPTIONS AND LOCAL CULTURE ON IN-HOSPITAL MOBILITY
Authors: King Barbara , Zisberg Anna , Brown Cynthia 
Published: January 2025

Abstract
Older adults commonly lose functional ability during a hospital stay, often cause by limited ambulation. This phenomenon has been identified globally as a hospital associated disability (HAD). Multiple barriers related to how care is delivered in hospitals have been identified that prevent hospital staff from getting patients up to walk. Only recently have studies explored other factors that may prevent or influence whether older patients ambulate, including older adults’ experiences and perceptions of in-hospital ambulation, the impact of patient and or family caregiver attitudes on in-hospital mobility, and influence of local unit culture on patient mobility. This symposium will present results from hospitalized older adult mobility studies conducted in 3 countries. Paper 1 will describe older adult patient perceived Value for Walking during hospitalization; paper 2 will discuss the impact of patient and family attitudes on patient mobility; paper 3 will present how diversity and cultural difference of family caregivers impacts patient mobility; and paper 4 will describe how local unit culture mediates mobility of older adult patients. HAD in older adults is a global health epidemic. Designing effective person-centered mobility interventions need to be multifactorial and include patient and family/ caregiver perspective and unit culture in order to improve older adult patient ambulation and decrease the incidence of HAD. Additional research is needed to understand the impact of patient and family caregiver factors and local unit culture on whether older adult patients are engaged in walking during their hospital stay.
CULTURAL DIFFERENCES IN CAREGIVERS’ ATTITUDES TOWARD IN-HOSPITAL MOBILITY OF OLDER ADULTS
Authors: Shulyaev Ksenya , Zisberg Anna , Smichenko Juliana , Shadmi Efrat , Gur-Yash Nurit 
Published: January 2025

Abstract
Older adults are often accompanied by their family caregivers during hospitalization and their attitudes could influence care processes and outcomes. However, little is known about the cultural differences of family-caregivers attitudes. We aim to explore cultural differences in family-caregivers’ attitudes toward in-hospital mobility of hospitalized relatives. In this study participated 156 pairs of hospitalized older adults and family caregivers, included 23(15%) Israeli Arabs, 33(21%) - ex-USSR migrants and 100(64%) native, or veteran Israeli Jews. Socio-demographic, health, functional and physical status were collected at admission. Caregivers’ Attitudes Toward Mobility (ATM) were collected during their hospital visits. In all cultural groups caregivers tend to be positive toward mobility of older adults, attitudes (measured 1 for negative, 5 for positive) of the caregivers were: 3.48±.80 for Arab, 3.69±.64 for ex-USSR migrants and 3.82±.70 for Jews. Significant differences in caregivers’ attitudes between the groups were found (F(146,2)=4.02, p=.02) even after controlling for patients’ characteristics including age, gender, functional status, level of independence in ADL, severity of illness, comorbidities and previous falls. Multivariate regression analysis included all mentioned covariates demonstrated that being an Arab family-caregiver significantly predicted worse attitudes toward in-hospital mobility (β=-.214, p=.009). To conclude, cultural differences exist in attitudes of the family-caregivers regarding the mobility of their older family members. Arab caregivers tend to prefer that their relatives will be less mobile during hospitalization. Clinical practices should address cultural difference that influence mobility.
EXPERIENCES OF CARE TRANSITIONS FROM HOSPICE: ADRD FAMILY CAREGIVERS SOCIAL CONTEXTS
Authors: Washington Karla , Wladkowski Stephanie , Coccia Kathryn , Berg-Weger Marla , Wallace Cara 
Published: January 2025

Abstract
Patients with ADRD are the largest group of Medicare hospice beneficiaries. They are also more likely to experience a live discharge than any other diagnosis, particularly after 6 months of care without presence of an acute event, indicating removal due to decertification. Although expected prognoses have changed, patients still require substantial care and caregivers often struggle to process feelings of abandonment and uncertainty. Increased burden is placed on primary caregivers who may be unprepared for this transition and are more likely to be socially isolated and lonely. This study interviewed caregivers of patients with ADRD who experienced a live discharge from hospice (n=32). Using the ecological model of resilience for caregivers, this presentation examines how caregivers describe their circle of support (CoS), the way their CoS functions (or does not function) when caregivers need help, and the attributes that impact how and when they utilize members in their supportive network. Results suggest that experiences of care transitions are buffered by patient’s location of care (home versus facility) and by availability of resources (both financial and fulfillment of core functions by CoS members). Understanding the way support systems help caregivers during this time of transition provides important implications for assessment during a live discharge to help hospices identify caregivers that may need additional support and resources during the discharge. With a growing population of patients living with ADRD and the rates in which live discharge impacts patients with ADRD-related diagnoses, supporting caregivers during this critical care transition is of utmost importance.