Search

Recent declines in life expectancy in the US, especially for middle-aged White persons, have called attention to mortality from deaths of despair - deaths due to alcohol, drugs, and suicide. Using data from the Centers for Disease Control and the U.S. Census Bureau, this paper examined deaths of despair by race/ethnicity, age, cause of death, birth cohort, and sex in Missouri. We focused on Area Agencies on Aging as geographic units of interest to increase usefulness of our findings to public administrators. Deaths of despair began trending up for all age groups beginning in 2007-2009, with the sharpest increases occurring for Black or African American non-Hispanics beginning in 2013-2015. The most dramatic increases occurred for the population age 50-59 in St. Louis City and Area Agency on Aging regions in southern Missouri. For older adults, considerable variation in rates, trends, and cause of deaths of despair is evident across the state.

This study examined the association between patterns of social engagement and conversion from cognitive impairment, no dementia (CIND) to dementia. It also tested whether social engagement is associated with conversion independently from physical and cognitive engagements.Data from 2 waves (2010 and 2014) of the Health and Retirement Study (HRS) were used. The sample consisted of 1227 people who had CIND in 2010. To identify the heterogeneity of social engagement, latent class analysis was utilized. Multinomial logistic regression analysis was utilized to investigate the association between patterns of social engagement and probability of conversion to dementia and death or dropout.The result showed that patterns of social engagement that represent higher level and more variety of social engagement were associated with lower probabilities of conversion to dementia in 4 years but not with probabilities of death or dropout. The relationship held after controlling for physical and cognitive engagements.Findings implied that promoting social engagement may be protective against developing dementia even for the high-risk group of people with CIND. Future studies should investigate the mechanism behind the relationship between patterns of social engagement and lower probabilities of conversion to dementia.

Population aging has largely been approached as a problem. Demographic shifts toward aging societies have been viewed from a deficit perspective. Certainly, the remarkable extension of human life has created challenges to individuals, families, healthcare and social care systems, and income security policies. Yet, the “age-drain” approach fails to recognize the vast heterogeneity of the older population and the growing human capital among older adults. The productive-aging perspective is an alternative to the age-drain perspective that can shape social approaches to population aging. The concept of productive aging was introduced by Dr. Robert Butler in 1985, and he called for the redirection of attention from the dependencies associated with later life to the actual and potential contribution of older adults. Further, he suggested that society could not afford to dismiss the growing capacity of the older population. From the productive-aging perspective, the capacity of older adults to contribute to families and communities through working, volunteering, and caregiving is highlighted. It is likely that societies will need more people in these roles longer into the life course, and it is possible to facilitate engagement in these roles to maximize positive outcomes for older adults and society. Productive engagement is defined as engaging in activities that produce goods and services, whether paid for or not, including working, volunteering (formal and informal), and caregiving. In all these cases, monetary values have been assigned to the contributions made by people over a certain age, depending on the age selected by the researcher. Outcomes of productive engagement have been conceptualized at multiple levels, including well-being for older people, experienced person-power for organizations, relief to retirement income programs, and stronger civic society. Attaining these outcomes requires social policies and programs that increase opportunities for all segments of the older population. Since the conceptual beginnings, scholars have proposed that productive engagement be viewed as an outcome of extra-individual factors, distinguishing this perspective from the successful aging paradigm that focused more on individual determinants. To date, outdated programs and policies have constrained the engagement of older adults as workers, volunteers, and caregivers. Many innovations have been proposed, and promising interventions are being demonstrated. The aim is to transform work environments and employment policies to enable people to work longer, to increase opportunities to engage older adults in volunteer roles while helping organizations more fully utilize this talent pool, and to improve support for caregiving and other forms of care work in later life. The goal is to create opportunities and to facilitate engagement in productive roles—not to exploit or coerce older people or to exclude lower-resourced individuals who have been marginalized across their life course. Fundamentally, progress depends on changing attitudes about aging and dispelling current assumptions about older adults and aging populations.

Older adults experienced the highest rates of infections and deaths and significant social isolation during the COVID-19 pandemic. While these negative impacts are important to address, the positive outcomes among older adults during the pandemic are equally important. A survey was distributed to adults aged 65 or older living in St. Louis, Missouri from August 2020 through March 2021 to characterize the challenges and positives they found during the pandemic. A total of 103 older adults participated. Compared to previous times in their lives, a majority of participants felt the pandemic had been more disruptive (62%) and more confusing (78%) and a majority were more worried (58%) and more afraid of dying (53%) during the pandemic. The most common positives were increased emotional well-being (23% of responses) and stronger personal connections (20% of responses). This ability to identify positive outcomes of the pandemic demonstrates the resilience of older adults and counters the ageist narrative that dominated the dialogue early in the pandemic, which depicted older adults as weak, vulnerable, and dispensable. As the pandemic evolves, nurturing and leveraging these positives will be key to combatting the cycle of fear and restrictions that the pandemic could bring.

This study explored the experiences of older adult volunteers who pivoted from in-person tutoring to letter writing and online tutoring during the COVID-19 pandemic. Sixty-one older adult volunteers were surveyed in the beginning and end of the school year about their experiences, including their perceived benefits, challenges, and feedback on the pandemic transition. Eleven of the surveyed volunteers participated in focus groups at the end of the school year. Perceived benefits included having a positive impact on a child's life and meaningful engagement during the pandemic, and perceived challenges included difficulty engaging students and lack of control over learning environments. The participants also suggested increasing opportunities for informal interactions with staff and students, technology training, and peer support between volunteers. There was agreement that the remote volunteering experience was not a substitute for in-person tutoring, but it was better than no volunteering at all.

Existing research on spousal care focuses on one spouse receiving care from the other, which fails to address the complexity that is created when both spouses experience some impairments. Our study included situations in which one or both spouses have functional impairments when examining the extent to which spouses from the same couple hold a (dis)similar level of functional impairment and whether such within-couple (dis)similarity has an impact on the spousal care arrangement. A subsample of 1170 older married couples was selected from the 2014 Health and Retirement Study. Descriptive statistics were used for describing the level of each spouse's functional impairment regarding the number of limitations in activities (activities of daily living [ADL]) or instrumental ADL (IADL). Logistic regressions were used to examine whether spousal dissimilarity in functional impairment (dissimilar, similarly low, similarly high) was associated with spousal care arrangement. Within couples with one functionally impaired spouse, the impaired spouse was more likely to receive spousal care when reporting a higher level of ADL/IADL impairment. Within couples with two functionally impaired spouses, the more impaired person was more likely to receive spousal care (without giving back) when spouses reported dissimilar level of IADL impairment; spouses were more likely to report mutual care when they had similarly high levels of IADL impairment. By documenting the role of spousal dissimilarities in functioning for determining spousal care arrangement, our study can inform couple-based interventions that capitalize on each spouse's capabilities and resources.

This study explored variations in self-perceived benefits of intergenerational tutoring. The study’s sample consisted of 329 older adults who tutored children in-person in the 2021–2022 school year. Due to the COVID-19 pandemic, some of the respondents had experienced a period in which volunteering was remote, virtual, or not possible. Demographic information was collected in a fall pre-test survey, identifying first-time volunteers (first time volunteering in ten years), caregivers (100 or more hours in the last two years helping someone who needed assistance), and male volunteers. Self-perceived benefits of tutoring (physical, emotional, and cognitive health, increased social activities, use time more productively, contribute to the well-being of children, and feel better about myself) were collected in a spring post-test survey. Being a first-time volunteer was significantly associated with improved health (X2 = 4.17, p = 0.041, Cramer’s V = 0.11), even after controlling for baseline self-reported health (p = 0.020). A larger proportion of first-time volunteers (34.2%) reported improvements in at least two areas of health (physical, emotional, and cognitive) due to their involvement in the intergenerational tutoring program, compared to non-first-time volunteers (18.5%). There were no significant differences in perceived benefits for caregivers or males. These findings suggest that targeting non-volunteers for involvement in tutoring programs may maximize health benefits of engagement. Specifically targeting males and caregivers may not be necessary, given that they benefit similarly to other populations.

Increased automation, globalization, and longevity demand new thinking by employers and employees regarding productivity. Throughout the life span, fuller engagement in education, and paid and unpaid productive activities can generate a wealth of benefits, including better health and well-being, greater financial security, and a more vital society. We review challenges and opportunities to advance long, healthy, and productive lives. When possible, we review inequities by gender, race, ethnicity, and other social determinants of health to reveal heterogeneity within the growing US population and workforce. We conclude with implications for research, social policy, advocacy, education, and practice.

Universities are experiencing shifts in age distributions of students, with fewer younger students and an increase in the number of people mid-life and beyond seeking education and job training. Thus, there are strong arguments for universities to embrace opportunities to increase age-diversity on campus. This qualitative study explores the challenges, opportunities, and strategies related to university age-diversity from the perspective of Admissions and Career Services staff from one midwestern university. From focus group data, six subthemes were identified as challenges (fitting in; acclimating; stressors; career concerns; return on investment; and ageism/undervaluing age diversity), three subthemes were identified as assets (intentionality; experienced students; and age diverse educational settings) and eight strategies were recommended to better serve an age-diversity student body (support groups; familial supports; social opportunities; job placement; financial aid; targeted outreach; flexibility in learning; and staff support). This article discusses the benefits and challenges of serving older students from the perspective of staff and administrators and provides action steps for universities to promote age-diversity on campus.

Background and Objectives The associations between physical frailty and depressive symptoms among older individuals were established in the existing literature. Taking the person–environment perspective, we argue that neighborhood environment could either buffer the stress derived from being physically vulnerable or worsen it by adding another layer of stressors in the environmental context when physical health declined. The objectives of this study were to explore to what extent the neighborhood-level characteristics moderate the relationship between physical frailty and depressive symptoms. Research Design and Methods Using the China Health and Retirement Longitudinal Study 2011 wave, 6,245 individuals aged 60 years and older were included for analyses. Multilevel mixed-effects models were fitted to examine the moderating effects of urbanicity and neighborhood-level socioeconomic status (SES) on the relationship between frailty and depressive symptoms among older adults, controlling for individual-level characteristics. Results Results showed a stronger relationship between deterioration in physical health and depressive symptoms in rural neighborhoods and neighborhoods with lower SES, after controlling for individual-level SES. Also, the moderating effects of the neighborhood-level socioeconomic factors remained after controlling for urbanicity, indicating that neighborhood SES works beyond the rural–urban contexts. Discussion and Implications Findings from this study demonstrate the important roles of neighborhood socioeconomic characteristics in reshaping, and the need to redefine, China’s rural–urban dichotomy. The findings also identified neighborhoods with low SES as potential targets for policy and practice to reduce the stress associated with health decline.

Introduction There are numerous effective transitional care interventions yet they are not routinely implemented. Furthermore, few interventions exist for older adults with dementia. A first step in developing effective interventions for dementia patients and increasing intervention uptake for all patients is to understand the current delivery process of transitional care. Methods A mixed methods study using an explanatory multiphase design was conducted. Guided by provider interviews, medical charts were reviewed to collect information on the day-to-day transitional care being delivered to older adults. Then providers were interviewed again to assess the accuracy of those results and provide context. Results The medical charts of 210 older adults (126 with dementia and 84 without) were reviewed and nine providers representing various professional roles including social work, nursing, and case management were interviewed. Social workers and case managers were primarily involved in discharge planning, communicating with providers outside the hospital, advanced care planning, providing social and community supports, and making follow-up appointments. Registered nurses were the primary providers of patient education and medication safety while physicians were primarily involved in ensuring that necessary information was available in the discharge summary and that it was available in the chart. Discussion This study found distinct patterns in the delivery of transitional care, including the unique roles nursing, social work, and case management have in the process. Furthermore, these patterns were found to differ between patients with and without dementia. These findings are both consistent and inconsistent with the existing literature on transitional care interventions.

In this article, we offer a perspective on the re-emergence of social work in China from the viewpoint of a longstanding and very productive partnership between Chinese and U.S. social work educato...

To identify research and practice gaps to establish future research priorities to advance the detection of cognitive impairment and dementia in the emergency department (ED).Literature review and consensus-based rankings by a transdisciplinary, stakeholder task force of experts, persons living with dementia, and care partners.Scoping reviews focused on adult ED patients.Two systematic scoping reviews of 7 medical research databases focusing on best tools and approaches for detecting cognitive impairment and dementia in the ED in terms of (1) most accurate and (2) most pragmatic to implement. The results were screened, reviewed, and abstracted for relevant information and presented at the stakeholder consensus conference for discussion and ranked prioritization.We identified a total of 1464 publications and included 45 to review for accurate tools and approaches for detecting cognitive impairment and dementia. Twenty-seven different assessments and instruments have been studied in the ED setting to evaluate cognitive impairment and dementia, with many focusing on sensitivity and specificity of instruments to screen for cognitive impairment. For pragmatic tools, we identified a total of 2166 publications and included 66 in the review. Most extensively studied tools included the Ottawa 3DY and Six-Item Screener (SIS). The SIS was the shortest to administer (1 minute). Instruments with the highest negative predictive value were the SIS (vs MMSE) and the 4 A's Test (vs expert diagnosis). The GEAR 2.0 Advancing Dementia Care Consensus conference ranked research priorities that included the need for more approaches to recognize more effectively and efficiently persons who may be at risk for cognitive impairment and dementia, while balancing the importance of equitable screening, purpose, and consequences of differentiating various forms of cognitive impairment.The scoping review and consensus process identified gaps in clinical care that should be prioritized for research efforts to detect cognitive impairment and dementia in the ED setting. These gaps will be addressed as future GEAR 2.0 research funding priorities.

This study described how DEI officers across universities/colleges currently think about AGE as a diversity factor; and identified strategies used to increase age-inclusivity. Data were generated through review of university websites, focus groups and one-to-one interviews with DEI staff. Findings suggest that age is acknowledged as a diversity factor but there is less action toward strategies to increase age-inclusion. Examples of initiatives include: training human resource staff to be age-neutral in hiring; eliminating birthdates and other years from applications; workshops on multigenerational workplaces and classrooms; presentations on ageism; and specific programs to support non-traditionally aged students. Some of the motivation to address ageism stems from legal mandates rather than being mission-driven. There is the concern that focusing more on age may require moving attention and resources away from other diversity factors. It appears that there is interest in elevating age as an important factor in DEI efforts.

Villages are consumer-driven organizations that promote aging-in-place. This study documents the effects of the COVID-19 pandemic on Villages and explores variation in response by age of the organization, size of the membership, staffing model, and geographic location. In summer, 2020, we distributed an online survey to executive administrators of 286 Villages in the network. During the pandemic, over 75% of Villages were seen as more or equally valuable for members. Seventy-seven percent of Villages offered virtual socialization events. Most Villages reported a decrease in service requests, given reductions in need for transportation. New services of food and medication delivery were initiated. There is much variation between organizations, but findings suggest that Villages that are older, have more members, and bigger budgets had more capacity and cushion; and although they took a negative hit in income and participation, it was a smaller hit proportionately, compared to younger and smaller Villages. Villages have demonstrated adaptability and creativity. They kept their operations running, provided services, and offered social connection. Vulnerabilities have been exposed: memberships have dropped for many and some members have not been able to participate as before the pandemic. Many lessons learned can help future developments of the Village model.

Recent research has identified neighborhoods as an important contributor to later-life frailty. However, little is known about how neighborhood resources are associated with frailty trajectories over time, especially in developing countries. This study examines the impact of neighborhood physical and social resources on the trajectories of frailty over time among older people in China.Using the four waves of the China Health and Retirement Longitudinal Study (2011-2018), 5673 respondents aged 60 and above at baseline were included for analyses. Multilevel growth modeling was fitted to estimate the effects of neighborhood resources on frailty trajectories over a 7-year period, controlling for individual-level characteristics.Older Chinese people who lived in neighborhoods with better basic infrastructures and a greater number of voluntary organizations were less frail at baseline. Accessible exercise facilities were associated with a lower initial level of frailty only among rural older adults, while higher community-level socioeconomic status (SES) was associated with a lower initial level of frailty only among urban older adults. Over the 7-year follow-up period, better basic infrastructures and accessible exercise facilities were associated with a slower increase rate of frailty scores among rural residents.Neighborhood resources are important contributors to the level of frailty among older Chinese people. Our findings of significant urban-rural differences have important implications for designing and implementing infrastructure development and community building programs in rural and urban China.

OBJECTIVES: Individual-level social needs have been shown to substantially impact emergency department (ED) care transitions of older adults. The Geriatric Emergency care Applied Research (GEAR) Network aimed to identify care transition interventions, particularly addressing social needs, and prioritize future research questions. METHODS: GEAR engaged 49 interdisciplinary stakeholders, derived clinical questions, and conducted searches of electronic databases to identify ED discharge care transition interventions in older adult populations. Informed by the Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE) framework, data extraction and synthesis of included studies included the degree that intervention components addressed social needs and their association with patient outcomes. GEAR convened a consensus conference to identify topics of highest priority for future care transitions research. RESULTS: Our search identified 248 unique articles addressing care transition interventions in older adult populations. Of these, 17 individual care transition intervention studies were included in the current literature synthesis. Overall, common care transition interventions included coordination efforts, comprehensive geriatric assessments, discharge planning, and telephone or in-person follow-up. Fourteen of the 17 care transition intervention studies in older adults specifically addressed at least one social need within the PRAPARE framework, most commonly related to access to food, medicine, or health care. No care transition intervention addressing social needs in older adult populations consistently reduced subsequent health care utilization or other patient-centered outcomes. GEAR stakeholders identified that determining optimal outcome measures for ED–home transition interventions was the highest priority area for future care transitions research. CONCLUSIONS: ED care transition intervention studies in older adults frequently address at least one social need component and exhibit variation in the degree of success on a wide array of health care utilization outcomes.

Life expectancy has increased substantially; yet universities remain age-segregated and fail to educate people across the longer life course. Demographic shifts call for universities to change their orientation toward age and life course. Arguments as to why universities should serve students of all ages and operate as age-diverse communities include: ensuring the capacity of individual workers and the labor force; educating people to succeed in age-diverse settings; producing innovation in an aging society; supporting meaningful engagement, social connection, and cognitive health into later life; and ensuring the supply of students. Conceptual foundations for these arguments derive from ideas about age stratification, where chronological age is used as a criterion for inclusion or exclusion from social expectations, roles, and privileges and where age integration is viewed as a positive alternative. In response to population aging and the constraints associated with age segregation in higher education, the Age-Friendly University Global Network was formed to increase the inclusion of older learners in all aspects of university life. The challenge is to create conditions where nontraditionally aged students expect to engage fully in educational activities, where students of all ages are valued and supported, and where age diversity is a common feature of campus life. The transformation of our universities must be done for the sake of society, for younger and older people, and for the self-interest of institutions themselves.

Background:Racial/ethnic minorities have among the highest risks for Alzheimer disease and dementia, but remain underrepresented in clinical research studies.Objective:To synthesize the current evidence on strategies to recruit and retain racial/ethnic minorities in Alzheimer disease and dementia clinical research.Methods:We conducted a systematic review by searching CINAHL, EMBASE, MEDLINE, PsycINFO, and Scopus. We included studies that met four criteria: (1) included a racial/ethnic minority group (African American, Latino, Asian, American Indian or Alaska Native, and Native Hawaiian or Other Pacific Islander); (2) implemented a recruitment or retention strategy for Alzheimer disease or dementia clinical research; (3) conducted within the U.S.; and (4) published in a peer-reviewed journal.Results:Of the 19 included studies, 14 (73.7%) implemented recruitment strategies and 5 (26.3%) implemented both recruitment and retention strategies. Fifteen studies (78.9%) focused on African Americans, two (10.6%) on both African Americans and Latinos, and two (10.5%) on Asians. All the articles were rated weak in the study quality. Four major themes were identified for the recruitment strategies: community outreach (94.7%), advertisement (57.9%), collaboration with health care providers (42.1%), and referral (21.1%). Three major themes were identified for the retention strategies: follow-up communication (15.8%), maintain community relationship (15.8%), and convenience (10.5%).Conclusion:Our findings highlight several promising recruitment and retention strategies that investigators should prioritize when allocating limited resources, however, additional well-designed studies are needed. By recruiting and retaining more racial/ethnic minorities in Alzheimer disease and dementia research, investigators may better understand the heterogeneity of disease progression among marginalized groups. PROSPERO registration #CRD42018081979.

This study explores the potential to consolidate a broad range of activity items to create more manageable measures that could be used in statistical modeling of multi-activity engagement. We utilized three datasets in the United States: Panel Study of Income Dynamics, Health and Retirement Study, and Midlife in the United States. After identifying activity items, exploratory and confirmatory factor analysis were used to empirically explore composite activity measures. Findings suggest that discrete activity items can be consolidated into activity domains; however, activity domains differ across datasets depending on availability of activity items. Implications for research and practice are further discussed.

To summarize research on optimal emergency department (ED) care practices for persons living with dementia (PLWDs) and develop research priorities.Systematic scoping review.PLWDs in the ED.The following Patient-Intervention-Comparison-Outcome (PICO) questions were developed: PICO 1, What components of emergency department care improve patient-centered outcomes for persons with dementia? PICO 2, How do emergency care needs for persons with dementia differ from other patients in the emergency department? A scoping review was conducted following PRISMA-ScR guidelines and presented to the Geriatric Emergency care Applied Research 2.0 Advancing Dementia Care network to inform research priorities.From the 6348 publications identified, 23 were abstracted for PICO 1 and 26 were abstracted for PICO 2. Emergency care considerations for PLWDs included functional dependence, behavioral and psychological symptoms of dementia, and identification of and management of pain. Concerns regarding ED care processes, the ED environment, and meeting a PWLD's basic needs were described. A comprehensive geriatric assessment and dedicated ED unit, a home hospital program, and a low-stimulation bed shade and contact-free monitor all showed improvement in patient-centered or health care use outcomes. However, all were single-site studies evaluating different outcomes. These results informed the following research priorities: (1) training and dementia care competencies; (2) patient-centric and care partner-centric evaluation interventions; (3) the impact of community- and identity-based factors on ED care for PLWDs; (4) economic or other implementation science measures to address viability; and (5) environmental, operational, personnel, system, or policy changes to improve ED care for PLWDs.A wide range of components of both ED care practices and ED care needs for PLWDs have been studied. Although many interventions show positive results, the lack of depth and reproducible results prevent specific recommendations on best practices in ED care for PLWDs.

To synthesize published research exploring emergency department (ED) communication strategies and decision-making with persons living with dementia (PLWD) and their care partners as the basis for a multistakeholder consensus conference to prioritize future research.Systematic scoping review.PLWD and their care partners in the ED setting.Informed by 2 Patient-Intervention-Comparison-Outcome (PICO) questions, we conducted systematic electronic searches of medical research databases for relevant publications following standardized methodological guidelines. The results were presented to interdisciplinary stakeholders, including dementia researchers, clinicians, PLWD, care partners, and advocacy organizations. The PICO questions included: How does communication differ for PLWD compared with persons without dementia? Are there specific communication strategies that improve the outcomes of ED care? Future research areas were prioritized.From 5451 studies identified for PICO-1, 21 were abstracted. From 2687 studies identified for PICO-2, 3 were abstracted. None of the included studies directly evaluated communication differences between PLWD and other populations, nor the effectiveness of specific communication strategies. General themes emerging from the scoping review included perceptions by PLWD/care partners of rushed ED communication, often exacerbated by inconsistent messages between providers. Care partners consistently reported limited engagement in medical decision-making. In order, the research priorities identified included: (1) Barriers/facilitators of effective communication; (2) valid outcome measures of effective communication; (3) best practices for care partner engagement; (4) defining how individual-, provider-, and system-level factors influence communication; and (5) understanding how each member of ED team can ensure high-quality communication.Research exploring ED communication with PLWD is sparse and does not directly evaluate specific communication strategies. Defining barriers and facilitators of effective communication was the highest-ranked research priority, followed by validating outcome measures associated with improved information exchange.

We aimed to describe emergency department (ED) care transition interventions delivered to older adults with cognitive impairment, identify relevant patient-centered outcomes, and determine priority research areas for future investigation.Systematic scoping review.ED patients with cognitive impairment and/or their care partners.Informed by the clinical questions, we conducted systematic electronic searches of medical research databases for relevant publications following published guidelines. The results were presented to a stakeholder group representing ED-based and non-ED-based clinicians, individuals living with cognitive impairment, care partners, and advocacy organizations. After discussion, they voted on potential research areas to prioritize for future investigations.From 3848 publications identified, 78 eligible studies underwent full text review, and 10 articles were abstracted. Common ED-to-community care transition interventions for older adults with cognitive impairment included interdisciplinary geriatric assessments, home visits from medical personnel, and telephone follow-ups. Intervention effects were mixed, with improvements observed in 30-day ED revisit rates but most largely ineffective at promoting connections to outpatient care or improving secondary outcomes such as physical function. Outcomes identified as important to adults with cognitive impairment and their care partners included care coordination between providers and inclusion of care partners in care management within the ED setting. The highest priority research area for future investigation identified by stakeholders was identifying strategies to tailor ED-to-community care transitions for adults living with cognitive impairment complicated by other vulnerabilities such as social isolation or economic disadvantage.This scoping review identified key gaps in ED-to-community care transition interventions delivered to older adults with cognitive impairment. Combined with a stakeholder assessment and prioritization, it identified relevant patient-centered outcomes and clarifies priority areas for future investigation to improve ED care for individuals with impaired cognition, an area of critical need given the current population trends.

The Geriatric Emergency Care Applied Research (GEAR) Network (1) conducted a scoping review of the current literature on the identification of and interventions to address elder abuse among patients receiving care in emergency departments and (2) used this review to prioritize research questions for knowledge development. Two questions guided the scoping review: What is the effect of universal emergency department screening compared to targeted screening or usual practice on cases of elder abuse identified, safety outcomes, and health care utilization?; and What is the safety, health, legal, and psychosocial impact of emergency department-based interventions vs. usual care for patients experiencing elder abuse? We searched five article databases. Additional material was located through reference lists of identified publications, PsychInfo, and Google Scholar. The results were discussed in a consensus conference; and stakeholders voted to prioritize research questions. No studies were identified that directly addressed the first question regarding assessment strategies, but four instruments used for elder abuse screening in the emergency department were identified. For the second question, we located six articles on interventions for elder abuse in the emergency department; however, none directly addressed the question of comparative effectiveness. Based on these findings, GEAR participants identified five questions as priorities for future research - two related to screening, two related to intervention, and one encompassed both. In sum, research to identify best practices for elder abuse assessment and intervention in emergency departments is still needed. Although there are practical and ethical challenges, rigorous experimental studies are needed.

Objectives:Despite known benefits of productive aging, it is unclear what explains time allocation in productive activities. We investigated whether productive engagement in older people can be explained by their age, health, socioeconomic status, and perceived life expectancy in Hong Kong.Methods:We interviewed 390 community-dwelling older persons for their health and perceived life expectancy, followed by a 7-day ecological momentary assessment to record their activities.Results:A total of 366 participants who completed the study (age 75 ± 8.3 years; 79% women) reported an average perceived life expectancy of nearly 10 years. The majority (59%) engaged in productive activities. Estimates of the structural equation model (RMSEA = 0.046) showed that age and health were associated with productive engagement, mediated by perceived life expectancy.Discussion and Implications:Future efforts in promoting productive aging and related research should include interventions addressing perceived life expectancy, a potentially modifiable factor.

As we started to think about a Special Issue of the Journal of Gerontological Social Work honoring Rosalie Kane, we turned to the Spring 2012 Issue of Generations entitled, “30 Years of HCBS: Movin...

This study, launched in June 2020, documents the impact of the COVID-19 pandemic on Villages nationally. Villages are non-profit, membership-based organizations that provide support from volunteers and social connections to enable aging in place. We distributed on-line surveys to the leaders of the 287 Villages in the national network to capture the effects of the pandemic on organizational operations, membership recruitment, service provision, and member well-being. A 40% response rate (n=116) was obtained. A majority of Villages reported that the pandemic greatly affected the organization, with the top concerns being: 1) membership recruitment, 2) the health and well-being of members and volunteers and 3) connecting with their members outside of normal in-person events. Over half of the respondents reported that the mental health of members had declined; and there were high levels of disruption to usual health care. New member recruitment efforts were thwarted and most Villages lost revenue. About 70% offered virtual programming but, in general, participation in these on-line events dropped. From the survey respondents’ perspective, the value of the Village to members and their family increased (48%) or remained the same (22%). New opportunities emerged that may be continued post-pandemic: new meal and medicine delivery volunteer services, more on-line communication and telephone reassurance, and new family and community connections. Findings indicate a wide range of experiences during the pandemic, with variation stemming from age of the Village and size of membership. The study informs the sustainability and growth efforts of Villages during and after the pandemic.

Social workers are familiar with the challenges brought on by the coronavirus pandemic; and we apply three gerontological social work perspectives that might increase our chances of minimizing negative outcomes and improving health and quality of life for everyone. First, the reality that the older population is very heterogeneous challenges ageism and age-stereotyping that has surfaced with COVID-19. Second, concepts of cumulative disadvantage and intersectionality offer clear explanations of the disparities that are being illuminated and lead us to advocate for fundamental changes to reduce disparities in later life and for people across the life course. Third, a strength-based perspective highlights the assets of the older population and the opportunities for positive developments coming out of the crisis. We can capitalize on momentum to increase advance care planning, to reduce social isolation, and expand the use of on-line technology for service provision. We can bolster our arguments to support older workers, volunteers, and caregivers. The fact that these social work perspectives are so applicable to the coronavirus situation reminds us of their fundamental relevance. Gerontological social work has much to offer in our roles as researchers, educators, practitioners, and advocates during this crisis, and our foundational principles serve us well.

As we look toward recovery from the COVID-19 pandemic, we overview challenges to be minimized, including economic setbacks, health and well-being effects, and highlighted ageism, racism, and classism. We articulate opportunities to be seized, including increased comfort with technology and online platforms; stronger family and intergenerational connections, renewed energy to combat social isolation; more respect for self-care and time management; increased awareness about the importance of advance directives; and, potentially, increased interest across disciplines to work on issues of aging society. Ongoing efforts to improve policies and programs for longer, healthier lives might now be more productive, as we communicate to consumers, public officials, and everyday citizens who may be more aware of what isn't working, what is at stake, and what might be improved.

This study aims to examine the effect of the death of a family member or friend on psychological well-being, specifically the moderating effects of first-time volunteering and social network. With the sample of 354 volunteers from the Experience Corps® (EC) programs, Analysis of covariance (ANCOVA) estimated the differences in psychological well-being. Among volunteers who had experienced the death of a family member or friend, new volunteers showed significant improvement in positive affect compared to experienced volunteers. EC members gained additional social contacts through volunteering. Formal volunteering has a salutatory effect on older adults' health after the loss of family members.

Background and Objectives The health benefit of activity participation at older ages is documented in the current literature. Many studies, however, only explored the health benefits of engaging in a few activities and did not examine mechanisms connecting activity participation to health. We investigated the pathway between activity and health by testing the mediation role of the nature of engagement (physical, cognitive, and social) on physical, mental, and cognitive health of older adults. Research Design and Methods We analyzed data of 6,044 older adults from the 2010 and 2012 Health and Retirement Study linked with 2011 Consumption and Activity Mail Survey. We used latent class analysis to identify the patterns of participating in 33 activities as well as patterns of nature of engagement, and examined how these patterns were associated with cognition, depressive symptoms, and self-rated health in later life. Results Meaningful patterns of activity (high, medium, low, passive leisure, and working) and the nature of activity engagement (full, partial, and minimal) were identified. High and working groups, compared to the passive leisure group, showed better health and cognition outcomes. The nature of engagement mediated the relationship between activity patterns and health, especially for older adults who were either full or partially engaged. Discussion and Implications The nature of engagement may play a more important role than the activity itself in relation to health. Identifying the heterogeneity in activity engagement in later life is critical for tailoring interventions and designing programs that can improve the health of older adults.

In a learning health system, the system’s own data and the experiences of its workforce are integrated with external evidence to provide better care. In an age-friendly health system, core principles of age-friendly care are integrated into every point in the system. Disruptions caused by the COVID-19 pandemic, and the innovations that addressed them, present an opportunity to discuss how these two frameworks may be combined and leveraged to transform care for older adults. We will present examples of pandemic-related disruptions, including rapid changes in how patients and providers move within and between facilities and the significant toll on healthcare workers’ mental health. We will also highlight innovative solutions to these disruptions that could transform healthcare systems. Critical to these points is a discussion of how these disruptions have disproportionately impacted healthcare workers and patients of color and how the innovations must be implemented using an anti-racist, health equity lens.

Implementation science, defined by NIH as “the scientific study of the use of strategies to adopt and integrate evidence-based health interventions,” continues to grow within research, education, and practice-based settings. Building on principles from organizational psychology, intervention science, health economics, and health services research, implementation science aims to explore how, and under what conditions, evidence-based interventions are successfully implemented and sustained in real-world settings. Applying implementation science to aging programs and settings may help to accelerate the translation of effective programs and policies into practice. This interdisciplinary symposium will provide an introduction to key principles and applications of implementation science. The first three presentations will focus on largescale spread of interventions while the last two presentations will focus on broader applications of implementation science. The first two presentations will focus on adapting interventions from delivery in one setting or population to another. The third presentation will discuss the role of implementation strategies in scaling an intervention from a controlled research setting into a large integrated healthcare system. The third presentation will focus on the intersection of implementation science and policy. The final presentation will discuss the role of implementation science in alleviating health disparities and advancing health equity. Each presentation will utilize examples from ongoing research studies to demonstrate principles. The session will close with an interactive discussion on the role of implementation science within aging, including challenges and considerations for aging programs, policies, and populations as well as opportunities for further training and education.

Objective: Examine the effects of a 6-month health multidimensional intervention on physical function, bone density, and mood in a diverse sample of community-dwelling older adults at risk for frailty and excess disability. Method: A quasi-experimental, pre- post-program design was implemented. Adults aged 55 years and older ( n = 337, 60% African American) participated in the intervention and received assessments at baseline, 6 months, and 12 months. Results: Physical function was maintained during the intervention for both African American and White elders but declined at 12 months for both groups ( p < .0001). Symptoms of depression improved during the intervention ( M = 0.65 ± 0.07, M = 0.15 ± 0.04, M = 0.68 ± 0.07, p < .001, respectively) but worsened at 12 months ( M = 0.68 ± 0.07, p < .001). Bone density scores remained stable from baseline (distal: −1.62 ± 1.17, proximal: −2.73 ± 1.85) to 12 months (distal: −1.72 ± 1.21, proximal: −3.11 ± 1.85, ps > .05) for both groups. Discussion: Program findings may serve as a basis for the development of a randomized, controlled study to provide empirical evidence of intervention efficacy. Such findings may help inform the development of community-based programs to identify vulnerable older adults and provide vital preventative care to decrease frailty and excess disability.

Background and objectives Individual stressors of depressive symptoms in old age are well identified, yet little is known about the neighborhood stressors of depressive symptoms. Guided by the ecological extension of the Pearlin's Stress Process Model, this study explores the rural and urban differences in neighborhood stressors of depressive symptoms among older adults in China. Research design and methods Data came from two waves of the China Health and Retirement Longitudinal Study, a nationally representative survey. The study included 6,548 older adults ages 60 and above in 2011, with follow-up in 2013. Predictors (individual and neighborhood characteristics) were drawn from the 2011 baseline, and outcome, depressive symptoms, was extracted from the 2013 wave. Results Multilevel modeling results showed that after controlling for depressive symptoms at the baseline, symptoms decreased in neighborhoods where physical environment and social environment were better. Among rural respondents, neighborhood stressors stemmed mainly from the physical environment, whereas among urban residents, the stressors came from the social environment. Discussion and implications This study demonstrated and discussed the role that neighborhoods may play in reducing depressive symptoms in later life. Community organizers and policy makers are encouraged to ameliorate community environments to improve mental health among older adults in China.

Ferguson, Missouri became the center of the nation's attention when an unarmed African American teenager was killed by a Caucasian police officer. Civic unrest continued for weeks. The aim of this study was to learn how older adults experienced the social unrest. Ten focus groups were conducted with 73 participants. Eight themes were identified. Issues related to safety were most commonly discussed. Participants reported a breakdown in intergenerational communications and expressed a desire for more exchange. Findings are being discussed with relevant organizations to increase the involvement of older adults in on-going community development efforts and to provide opportunities for intergenerational dialogue.

The World Health Organization (WHO)’s Age-Friendly Community (AFC) initiative has gained worldwide momentum. Yet, measures have not been validated in regions with various levels of socio-economic development. This article used a nationally representative dataset in China to (a) analyze community-level measures within the framework of AFC and (b) compare the age-friendliness between rural and urban settings in China. Chi- square and t-tests examined the rural and urban differences. Results suggest that many AFC concepts did not apply well in developing areas. The Chinese survey measured important environmental aspects in developing regions that were missing in the WHO AFC framework.

Dear President-elect and Members of Congress,The United States is experiencing a significant demographic shift due to lower birth rates and increasing life expectancy, both of which are dramaticall...

This study aimed to assess the association between social engagement and conversion from Cognitive Impairment No Dementia (CIND) to dementia and to investigate the mediating role of cognitive and physical engagements on that relationship. Data from two waves (2010 and 2014) of the psychosocial and core modules of the Health and Retirement Study (HRS) were used. The sample consisted of 929 people who had CIND in 2010 and participated in the survey in 2014. Latent Class Analysis (LCA) with eight indicators of social engagement (activities with children, volunteering with youth/others, attending educational course/organization, meeting up, speaking on the phone, writing or emailing) found three groups: formal and informal social engagement (20.7%), informal social engagement only (48.9%), and low social engagement (30.5%). Binary logistic regression analysis showed sub groups with higher levels and greater variety of social engagements were associated with lower probability of conversion to dementia in four years. Path analysis with structural equation modeling (SEM) framework showed the relationship between patterns of social engagement and lower conversion to dementia was mediated by having higher engagement in cognitive activities (e.g. home maintenance, playing sports), but not by engagement in physical activities (e.g. playing games, using computer). Results from this study implied (1) promoting active social engagement may be a promising intervention to prevent or delay conversion from CIND to dementia, and (2) promoting social engagement may be a particularly effective and efficient strategy since it promotes other activity engagements that may itself prevent or delay conversion from CIND to dementia.

As age diversity in universities increases in response to demographic shifts, changes in educational practices, programs and policies are needed. To inform these transformations, this research focuses on opportunities and challenges of increasing age-diversity. We conducted 5 focus groups and included 31 professional staff at Washington University in St Louis who work in admissions and career services. A thematic content analysis revealed themes in two main categories: challenges of serving non-traditionally aged students (fitting in, career concerns, acclimating to learning environment and technology, ROI, and ageism) and benefits of older students (intentional students, experienced students, and classroom diversity). Recommendations emerged, including affinity groups, social opportunities which include families, community engagement for job placement, financial aid, targeted outreach to older students, academic flexibility, and administrative support. Findings will be used to advocate for increasing age-diversity among students at Washington University and other institutions in the Age-Friendly Global Network..

The establishment of the Age-Friendly University (AFU) network and adoption of the 10 principles by institutions of higher education, was a major advance in the United Nations Sustainable Development Goal of promoting healthy and active aging through opportunities for intergenerational communities. AGHE endorsed the principles in 2016, since then over 60 institutions have joined the global network. Tools are needed to identify benchmarks that institutions can use to assess progress toward realizing the AFU principles on their own campuses. This symposium shares work done at the University of Massachusetts Boston, to develop and refine the AFU Inventory and Campus Climate Surveys (ICCS), a survey-based assessment instrument (developed from a prior pilot study in 2018) based on the premise that it is necessary to assess both the institution’s actual age-friendly practices and its perceived age-friendliness or campus climate. In August, 2019, the University of Massachusetts President’s office endorsed the 10 principles for the entire UMass system of 5 campuses, presenting an opportunity to assess a multi-campus system. To date, we have surveyed UMass Boston, UMass Lowell, UMass Dartmouth and UMass Medical (n=2,704). Testing and refinement of the AFU ICCS will contribute to both short- and long-term recommendations to assist in strategic planning by higher education institutions. Whitbourne will present the Inventory reporting tool. Bowen will present the Climate Survey. Gautam and Revell will describe the AFU work at UMass Lowell and UMass Dartmouth respectively and the use of the assessment tools on their campuses; Morrow-Howell will serve as Discussant.