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Romantic relationships are a key factor contributing to health across the lifespan. Within this research line, attachment theory has been a useful framework to understand how relationships impact health. One primary health concern in late adulthood is reduced cognitive functioning: Alzheimer’s disease and related neurodegenerative disorders become increasingly prevalent with age affecting millions of people. Even though much research has identified various sociodemographic, medical, and behavioral risk factors, little knowledge exists on romantic attachment’s psychosocial role for cognitive decline. The purpose of this study was to examine the link between insecure attachment, stress, and cognitive functioning in a large sample of middle-aged and older couples. In particular, we wanted to investigate how insecure attachment is linked to both partners’ cognitive functioning and whether stress mediates these associations. To that aim, we used data of 1,043 romantic couples (Mage = 64.7 years; 38.5% same-sex couples) who reported on their attachment anxiety and avoidance, their stress levels, their cognitive decline, and their and their partners’ dementia symptoms. Couple members also participated in a memory performance task. The results suggest that anxiety is linked to participants’ cognitive decline, while avoidance was linked to partners’ cognitive decline and poorer memory performance. We also detected significant mediational effects for stress in the association between insecure attachment and cognitive functioning. We conclude that potentially malleable psychosocial factors, such as insecure attachment and stress, are important research objects when understanding cognitive functioning in middle and late adulthood.

This paper examines the implications of employers' current COVID-19 protective workplace attendance policies toward older workers, potentially creating the outcomes of increased numbers of involuntary retirees and the discouraged older worker syndrome among otherwise qualified older workforce participants. How potential ageist assumptions and age discrimination under COVID-19 affect workplace decisions in reflection on the Age Discrimination in Employment Act (1967) guidelines is discussed. Older workers may remain in the workforce longer than ever before due to having healthier life expectancies. Workplace policies need to be increasingly sensitive to older employees’ rights to sustain their workplace engagement (Cummins, 2014; Cummins, Harootyan, & Kunkel, 2015). The author reviewed current unemployment trends in 2020 and emerging litigation in reflection upon general issues of COVID-19 related age discrimination in the older workers' workplace attendance decisions by employers and the historical framework of the Age Discrimination in Employment Act (1967, with significant amendments in 1978 and 1986). The policy analysis paper presents the implications of employers' COVID-19 protective policies on older workers and how it may affect the “health” of the workplace and older adults and the economy beyond the pandemic. Lastly, strategies to address an "age-friendly" workplace during a pandemic and post-pandemic are discussed.

One of the most fraught subjects facing a fast growing aging population is the subject of aging into disability. This paper examines the processes of aging into disability as a distinct challenge for not only older persons, but also for the field of gerontology, and public policy-makers. Disability in youth and in middle age has largely defined the disability rights agenda, and elders aging into disability have not been the subject of much attention from scholars in the field of disability. Surprisingly, however, scholars and policy-makers in gerontology have also by and large avoided the subject of older persons aging into disability—a complex process that involves impairment, environmental disablement, and changes in social relationships. This process accelerates with advancing age, and disproportionately affects women. Moreover, when older adults develop mobility limitations, experience falls, become hard of hearing, or experience other such impairments of age related disability, they do not think of themselves as aging into disability, or being disabled. This lack of disability identity may protect them from stigma and from low self-esteem. At the same time, it stands in the way of seeking accommodations and from developing a bond with other older adults who are aging into disability. This paper explores the dynamics of disability avoidance as an ideal that can harm older adults and their caregivers. It aims to bring disability more fully into the normal life-course, and to suggest lines of inquiry for gerontological research, to broaden the field, and to make service communities more inclusive .

This paper presents findings from a University and Community-based Agency collaboration to design and implement a preliminary evaluation of the Elder Abuse Multidisciplinary Team (E-MDT) Intervention. This intervention brings professionals from a variety of fields to investigate and respond to elder abuse. Data from 22 Interviews with staff along with anonymous survey data from E-MDT team members/staff (n=312) sought to establish team successes, challenges in implementation, and ongoing functioning. Themes that emerged in creating successful teams include: Establishing Buy-In and Trust of the team members, The Benefit of sharing experience and practical knowledge with other program sites; and Recognizing the Differences related to Onboarding and Sustaining New programs versus Sustaining Existing Programs. Themes related to responding during COVID revealed challenges such as Adapting to Technology and Inconsistent Access to the Internet. It was noted that remote meetings were easier to attend than face-to-face meetings. Data from the survey found the vast majority of respondents view the E-MDTs as having a positive impact on Clients (93%); while 93% of respondents indicated a positive impact on their Approach to Practice and the service area of their agency. Approximately 80% of the respondents indicated their multidisciplinary teams were Effective. Responses to 3-Open Ended questions included in the survey echoed similar themes from the interviews, as well as comments about their Professional Development and the complexity of responding to elder abuse. The paper will close with a discussion of the strategies used to facilitate the collaboration and complete the evaluation during the COVID-19 pandemic.

This is a diachronic analysis of two quantitative research studies on the aging of Japanese and Japanese Americans living in Greater New York. How have older Japanese individuals, who once have been referred as “model minority,” lived and aged in Greater New York? All the data in this paper are based on the first research study conducted in 2006 and the second in 2018 (Ethical approval reference number 6, 2018). This paper reveals both the social transitoriness and the cultural immutability of the Japanese elderly community in Greater New York. The following is a summary of the findings: (1) a growing Japanese American community with US citizenship, higher academic qualification, and better communication competency has been observed. (2) The allowable range of private expense to hire personal caregivers has been widened. (3) Not only the concerns and anxieties for later lives but also the plans and preparations for aging are much the same. (4) The elderly are provided with culturally specific care (with regard to language, food, and concept of care)—even allowed to live with other Japanese people—and the needs of caregivers who can understand Japanese culture are satiated. (5) Almost half of those in the community find it difficult to eliminate the possibility of returning to Japan, and some of them have already chosen to migrate back to Japan.

During the COVID-19 pandemic, ageist attitudes have been pervasive in public discourse, interpersonal relationships, and medical decision-making. For example, older adults have been portrayed as vulnerable while younger adults have been portrayed as reckless. The current study examined age discrimination during COVID-19 and associations with daily affect and physical symptoms. Positive events and age were examined as moderators. From March to August 2020, 1493 participants aged 18-91 (mean=40) in the U.S. and Canada completed surveys for seven consecutive evenings about discrimination, positive events, affect, and physical symptoms. Multilevel models controlled for age, race, income, education, sample (university students vs. community), and country of residence. Results indicated that individuals who reported more age discrimination had higher negative affect (b=36.44, SE=3.97), lower positive affect (b=-19.07, SE=4.10), and increased physical symptoms (b=3.85, SE=0.49; p

Loneliness is prevalent among older adults and is associated with increased risks for morbidity and mortality. This study examined what types of social interactions could reduce loneliness for older adults and who would benefit the most from social interactions. We used data from 312 community-dwelling older adults (aged 70 to 90 years) who completed ecological momentary assessments (EMA) five times a day for 16 consecutive days using smartphones (n=20,507 reports), as part of the ongoing Einstein Aging Study (EAS). At each EMA, participants reported their social interactions in the past 3 to 4 hours and their current feelings of loneliness. Results from multilevel models revealed that older adults reported lower levels of loneliness on occasions when they had pleasant social interactions (p

Previous studies typically assess caregiver needs when trying to interpret caregiver burden. We propose that both met and unmet needs of care recipients translate into different caregiving experiences with varying levels of benefits and burden combined. We use data on 263 caregivers of community-dwelling Singaporean older adults with cognitive impairment who participated in a community-based dementia care study conducted in 2018-2020. Our analysis produces three major findings. First, latent class analysis identifies three distinct types of caregiving experience based on caregiver-reported burden and benefits of caregiving: intensive (high burden and high benefits, 11% of caregivers), satisfied (low burden and high benefits; 54%), and dissatisfied (low burden and low benefits; 35%). Second, multinomial logistic regression shows that both met and unmet needs of care recipients are positively associated with the intensive caregiving experience, while only met needs are positively associated with the satisfied caregiving experience, in comparison to dissatisfied caregiving experience. Third, met needs in the areas of daytime activities, memory assistance, and mobility are positively related to the satisfied caregiving experience, compared to the dissatisfied caregiving experience. In other words, caregivers are more likely to be satisfied in their caregiving experiences (i.e., low burden and high benefits) if their care recipients’ problems with memory, mobility, and finding suitable and adequate daytime activities are properly managed. Our findings thus call for interventions to fulfill care recipients’ needs in a more tailored manner in order to increase satisfaction among caregivers.

Life course theory suggests that social relationships are tied to overall well-being. In the extant literature social isolation negatively impacts physical and mental health outcomes in later life. In this study, we focus specifically on the association between social isolation and older adult’s self-rated health status. We also examine whether and the extent to which technology use augments negative health consequences attributed to isolation. Using data on 3,758 older adults (ages 65+) from the 2018 wave of the Health and Retirement Study, we contribute to current scholarly examinations at the intersection of technology and isolation. We conduct a series of ordinal logistic regressions to estimate the odds of respondents’ higher self-rated health (from poor = 1 to excellent = 5) on subjective measures of social isolation (i.e. feel left out, lack of companionship and isolated from others) in addition to whether respondents live with a partner and have an adult child who lives in close geographic proximity. Preliminary results show that individuals who perceived higher levels of social isolation evaluated their own health status as poorer. We also find that the use of computers for virtual communications corresponds with higher self-rated health statuses, regardless of the proximity of children or other family members. However, a negative interaction between computer use and isolation indicates the positive effects of technology are limited for those who are highly isolated. These findings suggest that technology impacts on health are nuanced, where an overreliance on technology as a substitute may not consistently yield positive outcomes.

Dementia caregiving has been commonly associated with negative psychological consequences in caregivers. Cognitive fusion, that is, the tendency for been overly influenced by cognition, has been linked to psychological distress in caregivers in cross-sectional studies. Female caregivers and those who are exposed to more stressors such as behavioral and psychological symptoms of dementia report higher levels of distress. However, longitudinal analysis of predictors of caregivers levels of distress are sparse, with no available study analyzing the longitudinal effect of cognitive fusion. The aim of this study is to analyze the longitudinal effect of cognitive fusion in depressive and anxiety symptoms of family dementia caregivers, after controlling for other relevant variables. Face to face interviews were conducted each year through a two-year period (three assessments) with 143 caregivers. Linear mixed models analysis were used to analyze the associations between time-varying values for cognitive fusion, frequency and reaction to care-recipient behavioral problems and depressive and anxiety symptoms, after controlling for caregivers’ age and gender, daily hours and time caring, care-recipient functional capacity and caregivers’ transitions (cessation of caregiving). Results suggest that increases in cognitive fusion and in reaction to behavioral problems, being a female caregiver and being younger, significantly predicted increases in anxiety symptoms over time. Also, increases in cognitive fusion and in reaction to behavioral problems, decreases in care-recipient’s functional capacity and ending of the caregiving role significantly predicted increases in depressive symptoms. Psychological strategies aimed at reducing cognitive fusion and stress levels may be especially helpful for reducing caregivers’ distress.

About 5.8 million older American adults live with Alzheimer’s disease and related dementias; Black American older adults’ prevalence is more than twice that of non-Hispanic white older adults. The Black American dementia caregiving experience can be pictured within the Black Family Social-Ecological Context Model, which provides a conceptual basis for examining social determinants of health at individual, family, community, and societal levels with careful consideration for how the intersecting identities of race, gender, and class of Black American caregivers influence the multiple dimensions of their caregiving experiences. Family dynamics, community setting, and healthcare systems have a potentially bidirectional influence on these caregivers, which is informed by the larger historical reality of systemic racism and general disenfranchisement. This paper outlines how Stress Process and Perceived Control frameworks offer ways for Black American dementia caregivers to achieve a sense of mastery within the complicated and fraught ecology within which their caregiving occurs. We propose a research and development agenda to create a program for enhancing a sense of mastery among Black American dementia caregivers. Two concepts in particular, “constraints” and “efficacy expectations,” provide ways to develop a systematic approach to developing successful coping strategies for the constraints perceived by individuals as they undertake and function in the caregiving role. The recognition of the complexity of the caregiving ecosystem and intersectionality of caregivers’ experience emphasize the importance of individualization: each caregiver’s experience of this ecosystem– and therefore each Black American caregiver’s way to mastery within it– will be uniquely shaped and experienced.

Late working life patterns differ across different social groups and birth cohorts. The mechanisms of these participation differences and role of working life policies can be understood better by using additional working life indicators and historical perspective. This paper investigates how late working life patterns of different age, gender, education groups and birth cohorts are structured in Sweden using participation, employment type, employment break and exit trajectories of different groups. Using Swedish National Registry Data, employment trajectories of the age groups of 60-68 of the birth cohorts 1930, 1935, 1940, 1945 and 1950 are followed. Results show that for all birth cohorts, participation is higher for younger age groups, men and higher educated; leaving the working life before 61 is more common among primary educated; changing employment type in late working life is observed more among higher educated men and usage of sickness compensation is higher among primary educated and women. However, the peak age that individuals exit, and experience employment breaks differs over the years. In addition, although higher educated individuals have lower shares in usage of unemployment and sickness compensation for all birth cohorts, the structure of benefits usage of the other education and gender groups change over the years. Overall, results give important insights how changes in working life policies affect working life patterns of different groups over the years.

Alzheimer’s disease and related dementias begin with mild early symptoms of memory loss, progressing to more severe cognitive and functional impairment. Reports of worsening memory and subjective cognitive decline (SCD) are often the earliest possible signs of dementia onset. The trajectory of certain types of dementia may require early detection of worsening memory in the disease progression for successful interventions. However, the predictive value of subjective measures of cognitive decline is limited; the majority of those who report subjective symptoms do not progress to diagnosed cognitive impairment or dementia. These two realities create a significant challenge in confronting the growing dementia crisis. Population-level data can be beneficial in tracking trends in SCD. Data from the Behavioral Risk Factor Surveillance System (BRFSS) core questions related to chronic diseases and from the SCD optional module from survey years 2015-2019 were aggregated across the participating 50 states, D.C., and Puerto Rico for this analysis. Among 181,097 U.S. respondents aged ≥45 years, 11.3% (95% CI=10.9-11.6) reported SCD; among 20,424 with SCD symptoms, 39.4% (37.6-40.6) reported functional difficulties associated with SCD symptoms and 33.9% (32.4-35.5) needed assistance with day-to-day activities resulting from symptoms. Studies suggest persons experiencing SCD symptoms and associated functional difficulties are at increased risk for dementia compared with those with SCD without functional difficulties. Combining responses about SCD with associated functional difficulties, anxiety, and other measures might help to better inform the future burden of more severe cognitive impairment than SCD status alone.

Villages are consumer-driven programs supporting older adults to age in their own homes while staying socially connected through service referrals, coordination, and the organization of social activities. Although previous studies demonstrated an increase of perceived social support among Village members over time, few studies tested how Village membership influence older adults’ loneliness. To address this gap, a total of 112 members from four Village programs in a Midwest Metropolitan area completed a cross-sectional pilot survey on their social well-being between January and March 2020. The age of participants ranged from 51 to 92 years old (M=72.30, SD=8.38), over 74% of participants were female and over 88% of participants identified as White/Caucasian. The relationship between the 20-item UCLA loneliness scale and length of Village membership was roughly linear according to the Loess Curve. The scores of the UCLA scale range from 20-80 and higher scores indicate higher loneliness. The Cronbach’s alpha of the UCLA loneliness scale was 0.86 in the sample, indicating good internal consistency. The average loneliness score of the sample was 38.45, resembling the average of community-living older adults. Regression results suggested that a one-year increase in village membership was associated with approximately two points reduction in loneliness, holding all else constant. Being female, a racial/ethnic minority, retired, a driver, and having higher frequencies of socializing with friends and neighbors were associated with lower levels of loneliness among Village members. This pilot study provides initial support for the social impact of Villages and informs future larger sample longitudinal studies.

Traumatic escape from Vietnam in 1975 brought 1.3 million Vietnamese refugees to the U.S. Today, Vietnamese are the largest Asian subethnic group in Houston, Texas (81,000+), making Houston the 3rd largest Vietnamese-populated city in the U.S. Despite these numbers, health research on Vietnamese population is limited. To address this gap, we developed the Vietnamese Aging and Care Survey and collected data on Vietnamese older adults (≥65 years) and their caregivers (N=199). The purpose of this study was to examine the association between caregivers’ caregiving characteristics and care recipients’ mental health (N=58 dyads). Descriptive statistics and logistic regression models were used. Caregivers were on average 53 years-old, Vietnam-born (97%), and working (66%). The majority (84%) lived with their care recipients and provided care for 20+ hours/week (69%) in good/excellent health (76%). Care recipients were on average 75 years-old, Vietnam-born (100%) in fair/poor health (81%). Regression results showed stressed caregivers with more-depressed care recipients (OR=1.47, 95%CI:1.02, 2.13) but positive caregiving experiences (OR=0.85, 95%CI:0.74, 0.97) and burdened caregivers (OR=0.79, 95%CI:0.65, 0.96) with less-depressed care recipients. We found the association between stressed caregivers and depressed care recipients (Life Stress Paradigm), but care recipients becoming a “helpful company” reduces caregiver burden and care recipients’ depression (Social Exchange Theory). Vietnamese families live in multigenerational households within ethnic enclaves and remain a tightly-knit family unit showing resilience to their low socioeconomic status (≤25K, 91%). Leveraging a family as their strength, healthcare professionals should take a caregiver-care recipient dyad approach when planning COVID-19 pandemic interventions in Vietnamese communities.

Elder abuse and neglect (EAN) comprises multiple dimensions, is experienced by about 10% of older adults in the U.S in diverse communities, and is severely detrimental to older adults’ (OA) health and wellbeing. However, documentation of EAN among refugee OA is greatly lacking as are services for these communities. Refugee OA are overall underserved members of marginalized communities. This paper reports on a community-engaged study to collect information and raise awareness of EAN among OA in 2 North Carolina refugee communities - Nepali-speaking Bhutanese and Congolese. Research partners included University researchers and community refugee-serving organizations. Surveys and focus group interviews were conducted. 17 Nepali-speaking Bhutanese and 13 Congolese filled out survey questions, including the Elder Abuse Suspicion Index. They participated in focus group discussions (FGDs), separately for men and women of each community. Survey results indicated EAN more among Congolese than Nepali-speaking Bhutanese. FGD results showed both communities prefer to depend on family members, and experience difficulties with language, transportation, and economic insecurity. No EAN was reported in the FGDs. In line with principles of community-engaged approaches, a capacity-building event to increase awareness of EAN was held, attended by 25 persons from the two communities. This study adds documentation on an under-researched area and marginalized communities. Action recommendations include disseminating culturally appropriate EAN information, strengthening English language and job skills and transportation options, encouraging cooperation across state, nonprofit, educational, and service organizations to address needs of older refugee adults.

While midlife hypertension is known as one contributing factor for cognitive impairment and Alzheimer dementia in late-life older adults, less is known about the role of late-life hypertension in resilience to Alzheimer dementia. We examined the relationship between late-life hypertension and Alzheimer dementia resilience among older adults using the National Alzheimer’s Coordinating Center data from 2005-2020 (n=3,170). Hypertension, captured within 5 years prior to death, was defined as blood pressure (BP) ≥ 140/90 mmHg in at least two visits and/or ever treated with anti-hypertensive agents. Resilience was defined as positive Alzheimer disease (AD) pathology (CERAD score moderate or severe and BRAAK stage V or VI) from autopsy and Clinical Dementia Rating (CDR) - Sum of Boxes (SOB): 0.5-2.5 or CDR global (0-0.5) from last data point before autopsy. Student’s t-tests and Chi-square tests were conducted to compare patients with and without resilience. A multivariate logistic regression was conducted to estimate the association between late-life hypertension and resilience, adjusting for covariates of demographics and neuropathological characteristics. We had 55 resilient cases among 1,195 positive AD pathology cases. Those resilient were older (88±6.7) and had higher systolic BP (136 ± 18.2 mmHg) than non-resilient (82±7.9 years old, 130±20 mmHg. Untreated hypertension had a protective effect on resilience (adjusted OR: 3.69 (1.10-13.5, p=0.05). Patients with a systolic BP in the range of 135-145 mmHg and a diastolic BP in the range of 65-75 mmHg had the highest resilience possibility. Unlike midlife hypertension, late-life hypertension may have different effect on dementia, prompting further studies.

From the very beginning of the COVID-19 pandemic older adults have been at the heart of public debate. Early articles argued that public representation of older persons displayed a a resurgence of ageist stereotypes and beliefs in (inter)national media (e.g. Ayalon et al. 2020, Fraser et al 2020, Lichtenstein 2020, Sotomayer et al. 2020). Yet studies confirming this are absent up to now. In this paper, we present findings on the representation of Dutch older adults during the first six months of the COVID-19 crisis in The Netherlands. We analysed 1141 articles about older adults of the five largest newspapers using quantitative content analyses and discourse analysis to systematically explore patterns, sentiments and meaning in the articles. We show that the majority of these articles were published in general news and that older adults were rarely (2%) cited in these articles. Most prominent adjectives were vulnerable and weak. Most prominent substantives were attention, long-term care facility and loneliness. The sentiment was largely negative. Additionally, we find three discursive frames predominate: ‘an older people’s disease’, ‘vulnerability’ and ‘solidarity’. This evidences that the Dutch reporting on older adults during COVID-19 reproduced a discourse of dependency highlighting and further emphasizing the sociopolitical context before COVID-19 while drawing out earlier ageist tendencies. On the basis of our findings and drawing on advisory experiences, we discuss implications for policy, education and practice and how we can reframe and differently address older adults specifically in terms of language and their more (un)conscious positioning in (public) debate.

Apathy is a prevalent neurobehavioral symptom in dementia. Despite that environmental stimulation plays a key role in apathy, it is often overlooked in assessment. The Person-Environment Apathy Rating (PEAR) scale is currently the only validated apathy scale for persons with dementia that addresses environmental stimulation and is only available in English. This project translated the PEAR scale into Mandarin Chinese and evaluated its content validity. The PEAR scale includes two subscales: PEAR-Environment and PEAR-Apathy. Each subscale includes six items. The PEAR scale translation and validation were conducted through a four-step process. First, the PEAR scale was translated from English into Chinese by two bilingual PhD-prepared researchers. Second, the two Chinese versions of PEAR (PEAR-C) were back-translated into English by another two bilingual PhD-prepared researchers. Third, three content experts reviewed the two translated scales and reconciled a final PEAR-C scale. Finally, these three experts individually rated the PEAR-C and evaluated its content validity item-by-item in two aspects: 1) content equivalence: appropriateness to use this scale in Chinese cultural setting, and 2) semantic equivalence: the scale remains the same meaning after translation. The content validity index (CVI) was calculated to sum the ratings across experts. The CVI of content equivalence for all items was 1.0 for both subscales. The CVI of semantic equivalence was 0.98 for the PEAR-Environment and 0.97 for the PEAR-Apathy. The PEAR-C shows substantial content validity. Its reliability and construct validity need further evaluation. This scale is promising to assess apathy for individuals with dementia in the Chinese-speaking community.

Research demonstrates the adverse effects of coexisting multiple chronic conditions (MCCs) on older adults’ health and wellbeing. While most research relies on total counts of chronic conditions, little work explores how specific MCC combinations may have compounding effects on depression and memory. Furthermore, no published research explores differences in the prevalence and correlates of MCC combinations between Black and White older adults. The current study assesses within- and between-group heterogeneity in the prevalence and correlates of MCC combinations to advance health equity research. We utilize a sample of 16,757 Black and White older adults drawn from the 2014 wave of the Health and Retirement Study. Respondents were categorized into one of 32 MCC combination groups. Depressive symptoms and self-rated memory were calculated separately for Black and White respondents across each of the 32 groups. Chi-square tests, t-tests, and ANCOVAs were used to compare differences. Black and White respondents differed significantly in the prevalence of 14 out of 32 MCC combinations. Within-group differences were found such that 45% of Black respondents experiencing only Lung Disease met criteria for clinical depression; this rate is similar to Black respondents experiencing Diabetes + Heart Condition + Hypertension + Lung Disease (44.5%). Between-group differences revealed that Black respondents experiencing Arthritis + Diabetes + Hypertension had worse self-rated memory than White counterparts (MB = 3.24, MW = 3.13; two sample t[1139]= -2.04, p < .05; Cohen’s d = 0.13). Additional findings are presented, and theoretical and practical implications for this work are discussed.

COVID-19 vaccine intentions by older adults reflect individual care seeking behavior and medical system trust and broader systemic cultural shifts related to vaccine hesitancy. The purpose of this paper is to examine the October wave of the rapid response panel survey fielded by the Centers for Medicare and Medicaid Services (CMS) to track and monitor the effects of the pandemic within the Medicare population. With a sample size of 9686 Medicare beneficiaries, the calculated statistics use replicate weights to adjust for the complex survey sample design and balanced repeated replication using Fay’s adjustment of 0.3 for variance estimation. When asked about the likelihood of getting the COVID-19 vaccine if one were available, 58 percent of the Medicare population definitely or probably intended to get the vaccine, 16 percent expressed they would probably or definitely not, and 26 percent were not sure. Black or Hispanic Medicare beneficiaries were significantly more likely to express they would probably not or definitely not get the vaccine than White, non-Hispanic Medicare beneficiaries. Distrust of what government says about the vaccine and concern about the safety or side effects were the most common reasons for not intending to get the vaccine. Those expressing intentions to not get the COVID-19 vaccine in the October 2020 survey wave were more likely to lack access to the internet, which is a potential systematic barrier if they changed their intentions following the FDA approvals of the COVID-19 vaccines and more information became available in the winter and spring of 2021.

As functional health declines, dependency on others increases along with the risk of neglect and its harmful consequences. In this paper, we use data collected during 2015-16 (Round 3) of the National Social Life, Health, and Aging Project (NSHAP) to identify older adults at risk of neglect and to test the hypothesis that high neglect risk predicts poorer health. Specifically, we use NSHAP’s functional health survey module and follow-up care receiving “loop” to categorize respondents as having either “high” or “low” neglect risk. NSHAP’s functional health module assesses respondents’ difficulties with Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). Because ADLs and IADLs are integral to the maintenance of physical health, hygiene, and well-being, the unrequited desire for help with such activities could signal neglect. Accordingly, we assign “high neglect risk” to respondents who report either that they: (a) want but are not getting help with an ADL or IADL; or (b) are getting help with an ADL or IADL, but from a helper who is not very reliable. Motivated by current research that documents higher rates of morbidity and mortality among neglected older adults, we examine associations between neglect risk and other key NSHAP measures, including indicators of physical health, mental health, cognition, social support, social strain, and field interviewer assessed respondent hygiene. Results suggest that this method of risk assessment can be useful in identifying vulnerable populations of older adults. Follow-up interviews are needed to further confirm its utility as a risk assessment tool.

Rural-urban disparities in cognitive health outcomes, such as greater prevalence of cognitive decline among rural-dwelling older adults, have been linked to inequity in access to care. However, few studies have demonstrated whether longitudinal increased access to care may mitigate such disparities. This paper presents data from ongoing systematically collected behavioral health data on new and returning patients at an interdisciplinary geriatrics clinic at the University of Alabama Medical Center. The aim of this study was to determine baseline predictors of cognitive change across three annual visits (n = 42, mean age of 75.63 years (SD = 9.15)). Adjusting for baseline cognitive status, baseline subjective health literacy, and baseline depression and anxiety, results from a univariate ANCOVA showed that age at first visit (B = -.024, 95% CI [-.041, -.008], t(35) = -2.990, p = .005) and rural-urban status (B = .555, 95% CI [.123, .988], t(35) = 2.608, p = .013) predicted cognitive change at timepoint three (T3). Specifically, individuals from rural areas were less likely to experience cognitive decline and scored .555 points better than individuals from urban areas on cognitive screeners at T3 compared with baseline cognitive status. These results suggest that increased access to and utilization of care may ameliorate traditional disparate rates of cognitive decline between rural- and urban-dwelling older adults. Moreover, behavioral health screenings in primary geriatrics clinic care may help identify patient cognitive needs and facilitate integrated care through combined medical, pharmacological, and behavioral interventions to promote positive cognitive health outcomes.

The face of public long term care (LTC) funded largely through the Medicaid program is changing rapidly in the U.S. Over the last decade, most states have moved to managed LTC programs in various forms, with a growing number transferring all their programs, home and community based (HCBS) and nursing home services, to a Medicaid (MLTC) model. The amount of rigorously conducted and reported evaluation results on these programs are still very limited. Enough information is available, however, from other sources for at least preliminary comparison of relative cost-effectiveness of MLTC vs. traditional, non-profit models of public LTC services delivery and financing, as discussed in this paper. This comparison will show that, at this point, the MLTC programs are not more cost-effective than the traditional model of LTC administration. In fact, these initial assessments seem to indicate that the traditional model may be superior to the corporate for-profit MLTC model.

The continuing COVID-19 pandemic has necessitated changes to research protocols and approaches to mitigate health risks to both study participants and researchers. This is particularly true of studies exploring the biopsychosocial well-being and personal perspectives of older adults and those at elevated risk of COVID-19 complications. While videoconferencing platforms have enabled remote work and social activities, reliance on them may potentially exclude some individuals (e.g., those without digital devices, access to high speed internet or proficiency with technology). Persons living with dementia (PLWD) may experience difficulties navigating videoconferencing systems and building rapport with interviewers, though the inclusion of PLWD in research is necessary to ensuring their equitable representation. This presentation disseminates promising practices and lessons learned from a longitudinal study conducting remote interviews on sensitive topics with PLWD and their care partners (CP). Findings are drawn from a case study of the Better Together Dementia Care Study, an 18-month longitudinal study of PLWD (N=8) and their CPs (N=13), which implemented remote interviewing in Summer 2020 to gather data on the quality-of-life, resilience, relationship quality, adverse childhood experiences, mistreatment, and health status of PLWD. Researchers were able to interview most enrolled PLWD (n=7) via videoconferencing. Paper surveys were mailed to phone-interviewed participants, enabling them to view questions and answer choices in concordance with verbal queries. Researchers also tested a protocol asking CPs to leave the room while PLWD answered questions on sensitive topics. Findings support the use of remote interviewing with PLWD and provide insights to guide replication of these approaches.

Long-term care is a challenging environment for quality improvement due to the high resident acuity, wide variation in resident needs, and wide variation in types and backgrounds of the large staff across three daily shifts. We report results from a learning collaborative undertaken to improve care quality and staff quality improvement skills in the VA CLCs through development of high functioning relationally coordinated teams operating in accord with person-centered care principles. The collaborative included 27 CLCs. Over 9 months leadership teams completed action assignments supported by 5 workshops and regular group coaching calls. Evaluation included fidelity monitoring (attendance, mid- and final progress reports), satisfaction questionnaires, and review of the VA quality measures (CLC Compare). Pre-post participant evaluations revealed a significant increase in positive responses to the question “to what extent do you think applying these new skills/knowledge will improve quality in your CLC?” and positive responses trending toward significance in ratings of abilities to apply new skills. Open-ended survey comments were positive and indicated change in understanding and practice: “utilizing the daily huddle to facilitate real time communication afforded the team a proactive approach to providing care and reducing acute exacerbations. We are able to avert, evaluate as a real time team and make it happen in the now not as a look back.”; “definitely unified front-line staff and CLC leadership.” Some changes were achieved in CLC Compare quality scores (e.g., falls with major injury rate had a 9.6 reduction (average rate = 3.39 pre, 3.07 post)).

Mild Parkinsonian Signs (MPS) are common in older adults without overt neurological disease. MPS are often progressive and predict disability and dementia, yet little is known about predictors for MPS. Low self-reported energy is associated with mobility impairment, which is a hallmark of MPS. Yet whether self-reported energy relates to MPS is unknown. We explored the association of changes in self-reported energy with MPS in 293 participants (aged 83 ± 2.8 years, 58% women, 61% White) free of dementia and Parkinson’s Disease in the Health, Aging and Body Composition Study. Self-reported energy was assessed on a 0-10 scale annually between Year 2 and Year 10 (mean follow-up: 8 years) and its slope was estimated via linear mixed effects models. MPS were evaluated at Year 10 based on the Unified Parkinson Disease Rating Scale motor component. On average, self-reported energy declined 0.06 points per year. In a linear regression model adjusted for age, fatigue, and comorbidities, those with MPS had steeper SEL decline (β [Standard Error] = -0.358 [0.119]) in the prior eight years than those without MPS. Thus, declining self-reported energy may be a risk factor for MPS. Self-reported energy is easily evaluated in routine clinic visits, and may be a modifiable risk factor that can be targeted to reduce the incidence of MPS.

More older adults with multimorbidity are aging in place than ever before. Their mental health may be affected by housing and neighborhood factors. In this paper, we use structural equation modelling (SEM) to examine how the physical environment influences life satisfaction and depressive symptoms in two separate models. We included social environment (i.e., social support, social participation, walking) and loneliness as intermediate variables. Data were drawn from baseline and the first follow-up (after 3-4 years) of the Canadian Longitudinal Study on Aging (CLSA). Participants were N=14,301 adults aged □65 with □2 chronic illnesses. Good model fit were found after controlling for age, sex, education and baseline values (TFI=1.00; CFI=1.00; RMSEA social environment -> loneliness -> mental health. Our model provided excellent explanations of the effects of neighborhood cohesion, especially on life satisfaction. If these associations reflect causal effects, community-based age-friendly interventions should focus on neighborhood cohesion and loneliness to promote the well-being of older adults who are aging in place with multimorbidity.

Adult education and training (AET) over the life-course is necessary to participate in economic, social, and political activities in the time of globalization and technological advancement. However, little research has been done to identify mechanisms to fund AET opportunities among middle-aged and older adults from a comparative international perspective. Our study aimed to identify strategies to finance AET opportunities for middle-aged and older adults through an international lens, to help identify barriers and facilitators in effort to best support adult learners regardless of education background or socioeconomic characteristics. We carried out a descriptive qualitative study to facilitate an in-depth understanding of funding mechanisms available to adult learners in the selected countries, from the perspective of adult education and policy experts. Data were collected using semi-structured interviews with 61 international adult education experts from government agencies, non-governmental organizations, and education institutions. Our informants represented 10 countries including Australia, Canada, Germany, Italy, the Netherlands, Norway, Singapore, Sweden, the United Kingdom, and the United States. Data included at least one in-depth phone or web-based qualitative interview per informant in addition to information gathered from written materials (e.g., peer-reviewed publications and organizational reports). We identified three financing options that arose as themes: government-sponsored funding; employer-sponsored funding; and self-funding. We found that government-sponsored funding is especially important for low-skilled, low-income older adults for whom employer-sponsored or self-funding is not available. Our results have implications for lifelong AET policy changes, such as adaptations of successful AET funding programs across global communities.

The growth of solo living has important implications for the rising “loneliness epidemic” among older adults. This study considers whether two forms of social connectedness—extra-household core discussion networks and formal social participation—buffer the loneliness associated with living alone. Our study uses data from two surveys (National Social Life, Health, and Aging Project; Survey of Health, Ageing and Retirement in Europe) encompassing 20 developed Western countries in 2009/2010 and 2015/2016 (n = 110,817). Harmonizing measures across data sets, we estimate survey-specific and pooled linear regression models with interaction terms. Results indicated that high levels of social connectedness only moderately buffer the loneliness associated with living alone in later life. Findings were largely consistent across regions of Europe and the United States, though the buffering patterns were most robustly identified for widowed solo dwellers. Taken together, the results suggest that extra-household connections are partial compensators, but do not seem to fully replace the ready companionship afforded by residential co-presence in later life. Future research is needed to understand whether the efficacy of compensatory connections differs by gender, race/ethnicity, and across more diverse global regions.

Introduction: Uncertainties increase with disease guideline-driven decision-making for older adults as their numbers of chronic conditions and functional limitations increase. A national study found that people with arthritis plus ≥ one other chronic condition have reported significantly higher social participation restriction, serious psychological distress, and work limitation than those with ≥two non-arthritis chronic conditions. However, how arthritis comorbidities contribute to the symptoms such as pain, fatigue, sleep, depression, anxiety, and cognitive abilities that chronically impair people’s daily functioning remain unexplored. Purpose: To explore how arthritis comorbidities predict the symptom severities of pain interference, fatigue, sleep disturbance, depression, anxiety, and cognitive abilities among community-dwelling middle-aged and older adults. Method: 140 community people aged over 50 with arthritis and multimorbidity were recruited. Stepwise regressions predicted the PROMIS symptoms of pain interference, fatigue, sleep disturbance, depression, anxiety, and cognitive abilities with arthritis type and 18 comorbidities measured by the Functional Comorbidity Index checklist after controlling for demographics. Results: Obesity, chronic obstructive pulmonary disease, diabetes, and income significantly predicted pain interference (adjusted R2=35%). Marital status, obesity, and peripheral vascular disease significantly predicted fatigue (adjusted R2=17%). Depression diagnosis and income adequacy significantly predicted depressive symptoms (adjusted R2=23%). Depression, income adequacy, and anxiety diagnosis significantly predicted anxiety (adjusted R2=23%). Age significantly predicted cognitive abilities (adjusted R2=12%). Discussion: Comorbidities and socio-demographics, especially income, impact symptom experiences of people aging with arthritis and multimorbidity. Future studies should explore the pathogenesis among arthritis, comorbidities, and symptoms for tailored intervention while disclosing health disparities associated with the arthritis multimorbidity.

This is a conceptual paper proposing a new model of Strengths-Based Interprofessional Practice and Education (SB-IPE), incorporating appreciative inquiry and narrative, and its application to improve health and social care practice and policy for older adults. Within people, families, communities, and teams are people who understand their assets and culture, hold a collective wisdom derived from their individual biographies and shared history, and are deeply invested in their success. This wisdom and experience can be mined for strengths and best practices to improve health and social care for older adults and their families. The conceptual framework of the model and relationship between concepts are explained, reviewing and synthesizing relevant literature on the strengths perspective, interprofessional practice and education, evolution of the patient voice, appreciative inquiry, and narrative to leverage the voices and experiences of older adults, their families, and interprofessional teams. Providing person-, family-, and community-centered health and social care through SB-IPE involves eliciting, listening to, and processing stories and narratives, then coalescing and co-creating person/family/team narratives throughout the trajectory of care. Appreciate inquiry and narrative can be harnessed to imagine an improved experience of care for older adults and their families. Incorporating the potential disruption of the voices and perspectives of older adults and their families offers value for health and social care delivery and policy innovation. Application of the SB-IPE model holds promise for harnessing these voices and collective experiences leading from disruption to transformation of health and social care practice, health professions education, policy, and research.

Community-dwelling adults with dementia are at higher risks than counterpart without dementia of poor health outcomes, and those with dementia and co-occurring conditions face even greater risks. Optimal treatment for dementia includes functional and psychosocial support through long-term services and supports (LTSS), but use remains low. Our study investigated whether case management provided in primary care and in dementia care settings facilitated LTSS use for Veterans with dementia and comorbidities. We performed a cross-sectional analysis of 2019 VA-paid health care on a cohort of Veterans with dementia, defined by clinical diagnoses (International Classification of Disease, Tenth Revision). Receipt of case management was measured by whether or not a Veteran enrolled in a VA (1) home-based primary care, (2) geriatric primary care, or (3) dementia clinic. Comorbidities were measured by an adapted Elixhauser comorbidities index and dichotomized as ≤ 3 or ≥ 4 comorbidities. LTSS use was measured by whether or not Veterans used home health, home respite, adult day care, hospice, or veteran-directed care. Multivariate logistic regressions showed that LTSS use was higher for enrollees in each case management program compared to Veterans not enrolled in any. LTSS use was also higher for enrollees in each primary care program with more comorbidities than program counterparts with fewer comorbidities. Case management in primary care settings may facilitate functional and psychosocial support to meet dementia and non-dementia related needs for adults who have dementia with comorbidities.

The experience of pain is a widespread phenomenon among adults, especially older adults, and entails high costs to both individuals and society. The objective of the current research is to determine if the ability to pay and supplementary insurance are factors associated with pain medication among individuals over 50. Data came from Survey of Health, Aging and Retirement in Europe (SHARE). The sample included 64,281 individuals 50+ from nineteen European countries and Israel. Joint pain was common with one out of three reporting joint pain. Prevalence of pain was similar among different age groups, and more women reported joint pain. Among those in pain, about 21.5% of the individuals reported mild pain, 52.9% moderate and 26% severe pain. In the multivariate logistic regression, we found that men and those older than 60 suffered more from joint pain, while controlling for education and subjective assessment of the ability to cope economically (Able to make ends meet). A large percentage of those with pain were not taking medication to manage their pain, and there were significant demographic differences between those that did and did not take medication. Those that took medication were younger, male, had more education, were able to cope economically and had supplementary insurance. Our study showed that about half of the individuals with pain were not taking medication to manage their pain. Our results demonstrate that among individuals over 50 in Europe income is strongly associated with taking pain medication and that there is economic inequity in medication access.

Increasing attention has been paid to the potential role of care planning in buffering future eldercare challenges. However, little is known about the characteristics of care planning among Chinese ageing families. It is also of interest to reflect how recent events such as COVID-19 pandemic may affect their views of the future care planning. From a family systems perspective, this study explored the extent, processes, and contents of intergenerational care planning of Chinese ageing families in Hong Kong. Dyadic interviews were conducted with 60 adult child-older parent pairs, and individual interviews were conducted with another 33 adult children. Intergenerational discrepancies in extent and processes of care planning, intergenerational congruence of care expectations and struggles, facilitating role of family capital and hindering role of cultural capital in care planning were primary themes. Although both generations demonstrated strong awareness of future eldercare needs, they were found engaged in different levels and processes of care planning. Adult children’s level of engagement in planning activities may influence parents’ extent and contents of care planning. Intergenerational transmission of eldercare values contributed to intergenerational congruence of care expectations but also led to similar struggles and ambivalent attitudes toward future care. Moreover, family capital was found to facilitate family care planning while Chinese cultural values that emphasize family care may hinder both generations’ efforts in care planning. The findings will deepen our understanding on characteristics of intergenerational care planning in Asian Chinese communities and inform services to improve adult children and ageing parents’ preparation for future eldercare.

This contribution has two key objectives. First, inspired by earlier studies in comparative welfare state and in (social) gerontology, we develop a conceptualization of autonomy that is rooted in its social dimensions. This concept is then deployed to assess its policy considerations within the field of home care, both with regards to access and generosity in 21 industrialized countries. Second, this contribution performs a comparative assessment of the key factors resulting in a prioritization of the social dimensions of home care and social services in long term care. This study involves an-depth analysis of policy instruments deployed by public authorities to enhance the (social) autonomy of older adults, complemented with interviews with policy makers in diverse home care policy settings (Canada, France, South Korea, Sweden, and the United States). As such, this study features an evaluation of the presence of social elements in the definition and supply of care needs across 21 countries. It leads to the construct of a social dimensions of autonomy index based upon these instruments and the budgetary prioritization of home care within long term care policies. Among core findings, one discovers broader access and more generous funding when home care responsibilities are firmly embedded at the local level.

Culture, embedded in language and reflected in colloquial expressions, influences behaviors and cognitive constructs that affect health. To reach Latino older adults, health promotion efforts should include congruent cultural aspects—such as relevant metaphors, values, and proverbs—that will resonate with their cognitive constructs. However, this content should also be situated within a broader social context. For community-dwelling Latino older adults, this means considering their care systems and the multiple stakeholders within. In this paper presentation, we describe an innovative, interdisciplinary collaboration to culturally and linguistically adapt existing Illinois Extension curricula to meet the needs of Latino older adults and their families living in Cook County, which includes Chicago and its neighboring suburbs. We will demonstrate how concept-mapping (CM) studies can be used to structure the cultural adaptation of educational curriculum to a Latino audience. Specifically, we describe these CM studies, which asked how multiple stakeholders and Latino older adults living in the Chicagoland area defined positive aging provided empirically-grounded direction for our 11-member steering committee, composed of investigators, service leaders, and Latino older adults. We also will describe how the current project deepens relationships in the community that facilitate dissemination efforts to Latino older adults.

Studies conducted at the beginning of Covid-19 precautions suggested that older adults were stressed, but hopeful. Less is known how coping has changed for older adults after experiencing months-long pandemic precautions. We explore differences in coping between the initial pandemic declaration in March 2020, and 9 months later, via an internet survey fielded in November 2020 (n= 781). We present summary data, using chi-square tests for subgroup analyses. A majority of respondents (aged M=66 yrs, range 60-89) were women (64%) and White (94%). When asked to compare their feelings to the beginning of the pandemic, 44.8% were more frustrated, 38.7% were more stressed, and 32.7% were more anxious. However, 38.3% were more appreciative. Women were significantly more likely than men to report increases in feeling frustrated, angry, scared, stressed, sad, and hopeless. Introverts were significantly more likely than extroverts to report an increase in loneliness and stress. Since the first few weeks of the pandemic, respondents reported more communication through video calls (45.2%), texting (40.2%), and phone calls (28.8%). Additionally, 61.5% spent more time on computers/tablets, 47.2% spent more time watching TV, and 24.5% spent more time praying. Extroverts were significantly more likely than introverts to report an increase in time with TV, phones, and computers/tablets. Women were significantly more likely than men to report increased texting and praying. These data provide further understanding of the impact of long-term pandemic precautions on older adults and suggest particular subgroups of older adults may benefit from public health and mental health interventions.

Home Health Aides’ (HHAs) are one of the fastest growing workforces in the country, yet the industry struggles to recruit new aides into the field and retain current workers. This study explored HHAs’ experiences with the level of autonomy and control granted to them within their day-to-day work. Findings from six focus groups with 37 HHAs showed that many aides select home care because of the control and independence the positions offer. Interacting one-on-one with clients and being able to self-structure their daily tasks were major benefits that drew HHAs to the field. Additionally, the HHAs highlighted the control they have over their schedule and the flexibility the position offers to enable them to accommodate other responsibilities, like childcare or other jobs. Being able to decline a client because of travel distance, the hours required, or not feeling that it is a “good fit” was also a welcomed aspect of the position. Despite complaints about the job, such as low pay, lack of benefits, and limited support, many of the HHAs admitted staying on in their positions because of the flexibility, autonomy, and control provided. Findings highlight the value that HHAs place on autonomy and control and the potential benefit that these job qualities have for promoting greater recruitment and retention of the home care workforce. Amplifying opportunities for these aspects of the job may thus entice new individuals to pursue a career as an HHA, as well as help to maintain those individuals currently in the position.

Aim: We aimed to estimate the extent to which diabetes shortens disability-free survival, and identify which factors may prolong disability-free survival in older adults with diabetes. Methods: A total of 2,216 disability-free participants aged ≥60 were followed up to 15 years. Diabetes was ascertained through antidiabetic drug use, medical records, or HbA1c ≥ 6.5%. Disability-free survival was defined as the survival until the occurrence of disability. Data on behaviours (healthy vs. unhealthy), leisure activities (active vs. inactive), and social network (moderate-to-rich vs. poor) were collected at baseline. A favourable (vs. unfavourable) lifestyle profile was defined as the presence of at least one of healthy behaviours, active engagement in leisure activities, and/or moderate-to-rich social network. Data were analysed with Cox regression and Laplace regression. Results: During the follow-up, 1,345 (60.7%) participants developed disability/death. Diabetes was related to the outcome (HR 1.29, 95% CI 1.06–1.57), and shortened 2.15 (1.02–3.27) years of median disability-free survival. Additionally, disability-free survival (95% CI) was shortened by 3.29 (1.21–5.36), 3.92 (2.08–5.76) and 1.66 (0.06–3.28) years for participants with diabetes plus unhealthy behaviours, inactive leisure activities, or poor social network, respectively (reference: no diabetes plus healthy behaviours, leisure activities, or moderate-to-rich social network). Among participants with diabetes, a favourable profile led to a non-significant HR of 1.19 (0.93–1.56) for disability/death and prolonged disability-free survival by 3.26 (2.33–4.18) years than those with unfavourable profile. Conclusions: Healthy lifestyle and/or moderate-to-rich social network attenuates the risk of diabetes on disability/death and prolongs disability-free survival in people with diabetes by 3 years.

Dementia is a costly disease that places great burden on individuals and families. The substantial time and financial resources taken away by living with persons with dementia (PWDs) may make their spouses forgo essential health care, thus deteriorating long-term health and increasing downstream healthcare costs. However, such negative externality is understudied. This paper studied the impacts of spouse's incident dementia diagnosis on an individual's use of needed care, defined as annual flu shot and regular doctor visits for those with preexisting conditions. Using HRS linked to Medicare claims, I employed a fixed effects approach to compare the use of flu shot and doctor visit during 1 year before and after the index, for individuals whose spouse had dementia (N=691) and otherwise similar controls (N=5,073). After adjusting for time-varying health, caregiving roles, and other socio-demographic factors, spouse’s dementia onset was associated with greater likelihood of getting flu shot and seeing doctors. Among those transitioning into caregiving, spouses of PWDs had a marginally higher risk of skimping on doctor visits, compared to controls (p=0.053). In this broadly representative sample, there lacks evidence for rationed health care ensuing spouse’s dementia incidence, at least within a 1-year time frame. However, for new spousal caregivers, the impact of dementia is more profound and complex than deprivation of time. This group may face a trade-off between caring for spouses with dementia and caring for themselves, for whom policy support merits further study and consideration.

Dementia and cancer are two common chronic conditions in older adults. However, there are few studies examining the prevalence of comorbid cancer and dementia and the longitudinal impact of these comorbid conditions on health outcomes. This study investigated the prevalence and longitudinal impact on health outcomes in older adults with comorbid cancer and dementia. This is a secondary analysis, using data from the 2010 and 2016 waves of the Health and Retirement Study (HRS). The health outcomes of the study included nursing home stay, hospital stay, home care use, activities of daily living (ADL) limitations, instrumental activities of daily living (IADL), self-rated health status, mortality, and the out-of-pocket medical expenditure in older adults with cancer and dementia. Data were analyzed using descriptive statistics, logistic regression, and linear regression analyses. The results revealed that the prevalence of comorbid cancer and dementia ranged from 2.6% to 2.8% over the 6-year period. Older adults with comorbid cancer and dementia demonstrated higher likelihood of nursing home stay, ADL and IADL limitations, and mortality; but a decreased likelihood of homecare use and hospital stay compared to older adults with cancer only or dementia only (some outcomes were not significant for dementia only group). Findings point out the risk of increased functional decline and mortality in older adults with comorbid cancer and dementia. Future research is needed to explore the contributing factors of the risk and identify interventions to promote physical function and reduce mortality for this population.

The dominant nonpharmacological therapeutic approach in dementia care is “person-centered.” The racial disparities in disease and diagnosis affliction, represents an urge to incorporate trauma sensitivity. Antipsychotic use rates among this population being substantially higher than two years ago, as well as increasing evidence of ACE scores being a significant risk factor in dementia development, we need to consider the emancipatory power of trauma-informed dementia care. Data were collected from 103 peer-reviewed journal articles. Person-centered care practices were analyzed for adherence to SAMHSA’s principles that guide a trauma-informed approach. Studies were rated on a Likert-scale in six areas: safety; trustworthiness and transparency; peer support; collaboration and mutuality; empowerment and choice; and cultural, historical & gender issues. It was observed that of the 103 search returns, 38 met study criteria. Within these data, it was observed that the majority of studies scored low on incorporation and adherence to SAMSHA’s trauma-informed approach. While a few studies mentioned the magnifying effects of a current traumatic event on preexisting vulnerabilities, no study highlighted the growth or flourishing potential in triggering past trauma and the current traumatic event offering an opportunity of mind-somatic integration. This paper proposes trauma-informed dementia practices consider: 1) intake and assessment to include a screening of ACE score; 2) evaluation of (re)integrating current losses into current developmental and lifespan phase; and 3) offering therapeutic support of current traumatic event (COVID-19) to metabolize past traumatic events in the context of current developmental and lifespan phase.

Family caregivers may experience reduced stress by maintaining their sense of self throughout their time in a caregiving role. Working towards personal goals is helpful for maintaining a sense of self, but pursuing one’s own goals amidst caregiving responsibilities may be challenging. In this study, we analyze the processes by which caregivers pursue their own personal goals – and how those processes impact daily stress – in an effort to develop a deeper understanding of goal-pursuit as a potential caregiver stress-reducing strategy. We utilized daily data from spousal (N=256 days) and adult-child (N=400 days) caregivers who participated in the PULSE (Personal Understandings of Life and Social Experiences) Project, a 100-day microlongitudinal study on goal pursuit amongst people 50 and older (Hooker et al., 2013). In daily surveys, caregivers reported progress made towards a personally-identified health and social goal, along with a 4-item measure of daily stress. We ran multi-level models to assess how daily goal progress was associated with same-day stress. Spousal caregivers’ daily stress was lower on days when their health goal (Estimate = -1.07, SE = 0.20, p

This research explores support provided by licensed nurses (LNs) to certified nurse aide (CNA) coworkers in the nursing home (NH). Using purposive sampling, we interviewed 12 LN and 12 CNA participants individually and as part of an LN/CNA caregiving pair. Semi-structured interviews were recorded, transcribed verbatim, and coded for meaning using NVivo software. LN and CNA participants described anticipated and unanticipated holistic support for CNAs. We applied the term undergirding to this phenomenon , and we present descriptions and examples of undergirding in nine categories: listen and respond, show respect, help with resident care and answer call lights, protect the CNA, support physical needs, and provide emotional support. Undergirding promotes work success for the CNA and the LN, as the LN job includes oversight of CNA responsibilities. Most notably, participants report undergirding facilitates high-quality resident care. These findings may be helpful for educators and administrators, but perhaps are most important for policymakers. CNAs need additional support to decrease turnover, improve retention, and elevate NH residents' quality of care. The study design identified and explored optimal collaboration as it is possible in the current NH setting. It does not represent all LN/CNA caregiving pairs.

In a recent meta-analysis of interventions for dementia caregivers, psychoeducational interventions were found to be effective only if they required caregivers to apply knowledge and skills through active engagement. This emphasizes the importance of understanding which intervention components enhance application in order to improve caregiving interventions and the mechanisms by which they work. The purpose of this presentation is to identify and assess elements of active engagement within dementia caregiving interventions. Articles included in this review were published between 2009 and 2018 and identified as psychoeducational dementia caregiving interventions. Each intervention was assessed to describe: 1) how active engagement was defined, 2) the logistics for implementing the active engagement techniques, 3) and the process for evaluating active engagement components. Of 36 articles meeting inclusion criteria, 25 mentioned active engagement components of the intervention. Active components included discussion, problem-solving, practice, role-play, action plans, and homework. Only five articles provided partial descriptions of the active components, five mentioned assessing active engagement, and only one study examined the efficacy of an engagement technique. This demonstrates a significant gap in our understanding of interventions for dementia caregivers. Active engagement enhances outcomes, yet to our knowledge, the specific steps taken to engage caregivers actively and the mechanisms by which these work are unclear. This is a barrier to optimizing active engagement within intervention delivery. Clarifying processes and methods for testing mechanisms of action can further enhance caregiver engagement with interventions.

This paper examines the association between educational mobility and age-related decrements in kidney function. Data from the main survey and the Biomarker Project of the Midlife in the United States (MIDUS) Wave 2 and Refresher samples were combined, resulting in 1,861 adults (54.5% female; age 25-84, Mage=53.37) who self-identified as non-Hispanic Black (n=326) and non-Hispanic white (n=1,535). The estimated glomerular filtration rate (eGFR) was based on serum creatinine, calculated using the CKD-EPI formula. Intergenerational educational mobility was based on the comparison between parental education (no high school/HS degree versus HS degree or higher) and participant’s education level (HS degree or lower versus some college versus bachelor’s degree or higher). Results from regression analysis indicated that Black participants in the moderate upward mobility group (parental education = no HS degree, participant’s education = some college) showed significantly steeper age-related decrements in eGFR across adulthood compared to Black adults with higher stable high status (parental education = HS degree or higher, participant’s education = bachelor’s degree or higher), B=-0.70, SE=0.26, p=.008, or white adults with higher stable high status, B= 0.58, SE=0.29, p=.044. A steeper age-related decrement in eGFR is known as a reliable risk factor for chronic kidney disease and cardiovascular disease. These findings support the notion of skin-deep resilience among Black adults who experience upward socioeconomic mobility. We explored multiple psychosocial factors that may explain these findings, including lifetime and daily discrimination, social status and financial strains, and perceived stress and depressive symptoms.

The demand for adult education and training (AET) opportunities throughout the life course is substantial as labor markets often require workers to obtain advanced skills. AET opportunities are more often pursued by high-income and high-skilled workers than low-skilled or low-income workers. With the increased prominence of job automation and technological advances in the workforce, low-skilled workers are at risk for fewer opportunities within the labor market. These factors emphasize the importance of providing learning opportunities throughout the life course. In this mixed-methods study, we analyzed 2012/2014 data from the Program for the International Assessment of Adult Competencies (PIAAC) for the U.S., Canada, the Netherlands, Norway, and Sweden to compare participation rates in non-formal education (NFE) by high and low-skilled adults. Countries were selected based on qualitative findings that inform best practices. Additionally, to gain insights of policies and programs that promote NFE, international key informant interviews (n = 33) were conducted. AET policies and programs, along with barriers such as cost, motivation, and time, were explored with key informants. Findings include (1) aging and skills are negatively correlated in all nations of interest; (2) low-skilled adults are less likely to participate in NFE than their high-skilled counterparts; (3) low-skilled workers in Norway and the Netherlands are more likely to participate in NFE than their U.S. counterparts; and (4) NFE is often more acceptable to low-skilled adults due to previous negative experiences with formal education. Using these findings, we discuss successful AET programs in Nordic countries for overcoming barriers.