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Background and Objectives Home- and community-based services (HCBS) are underutilized, despite offering significant health benefits to both care recipients and caregivers. Drawing upon Andersen's extended behavioral model of health services use, we examined individual- and county-level factors influencing HCBS utilization for dementia care in rural Appalachia. Research Design and Methods We analyzed data from telephone interviews with 123 dementia family caregivers in rural Appalachian counties (M age = 64.7, SD age = 12.2). Multilevel analyses were conducted to examine the effects of individual-level and county-level factors on the use of home-based services (home healthcare and personal care services) as well as community-based services (adult day care and transportation services). Results Results indicated that caregivers' receipt of informal support from family or friends was associated with more use of home-based services (B = 0.42, p =.003). Conversely, longer travel times to service providers were linked to use of fewer community-based services (B = −0.21, p <.001). Residing in counties with more home health agencies was associated with higher utilization of home-based services (B = 0.41, p =.046). However, higher county tax expenditures for HCBS were not linked to home-based or community-based service use. Discussion and Implications Findings suggest that informal support in caring for the person living with dementia enables HCBS use in rural Appalachia. In contrast, limited geographic accessibility and service availability can impede HCBS use in rural regions. Policymakers are urged to allocate direct public funding to service providers to expand service availability in underresourced rural regions. [ABSTRACT FROM AUTHOR]

Public health professionals use a three-pronged approach to address broad-reaching issues of societal concern: primary prevention, secondary prevention, and tertiary prevention. Applying this framework to the study of elder abuse, the purpose of this review is to describe the status of elder abuse prevention research on a global scale. Elder abuse prevention articles published between 2015 and 2021 were identified through electronic bibliographic searches (PubMed, Medline, CINAHL, APA PsycINFO, and AgeLine). After removing articles based on inclusion and exclusion criteria, articles were sorted into the three main prevention types and further divided into subcategories for a more in-depth review. Most of the studies identified were conducted in North America (n = 42). Of the 72 articles identified, 13 articles focused on primary prevention (agism, education, and intervention), 35 articles focused on secondary prevention (developing and evaluating screening tools, identifying and reporting abuse, and barriers to detecting and reporting abuse), and 21 focused on tertiary prevention (professional response to cases of abuse, intervention methods, and impact of policy). Collectively, findings bring greater understanding of elder abuse as a public health problem and identify ways of addressing the complexities of elder abuse. Several gaps were identified in the elder abuse prevention literature including the need for global research that includes older adults as stakeholders, evidence-based education and intervention programs, and cultural sensitive and valid tools to identify elder abuse. [ABSTRACT FROM AUTHOR]

A number of studies now confirm that the COVID-19 pandemic has increased and exacerbated mental health problems in the general population. Previous quantitative studies have found similar effects on mental health symptoms among adults with histories of childhood adversity; however, qualitative research is needed to provide a more in-depth understanding of pandemic-related experiences among this vulnerable population. Using semistructured qualitative interviews, we explored perceptions of adults with histories of child maltreatment and neglect to better understand the overall impact of the pandemic on their mental health, reported changes in stress and alcohol use, and reported coping strategies during the first year of the pandemic (N = 40). Approximately half of participants reported that the pandemic had greatly (negatively) impacted their life, relationships, and well-being. Contributing stressors included being fearful of getting sick, navigating work changes, and experiencing economic and housing hardships, grief and loss, and social isolation. Fewer than half of the sample reported more stress (46%), whereas a third (33%) indicated no changes to stress, and 10% had reduced stress. The majority (80%) indicated no changes in their alcohol use. Most participants reported they used positive coping strategies during the pandemic. Three primary themes emerged related to participants' perceptions of getting through difficult times: seeking outside support, engaging in positive reframing, and drawing on internal strength and resources. Findings can guide prevention strategies that strengthen social support and foster resilience among vulnerable populations of adults with histories of childhood maltreatment. Public Policy Relevance Statement: Increased stressors during the COVID-19 pandemic significantly impacted adult mental health. This study found that adults with histories of child maltreatment exhibited resilience and employed positive coping strategies to navigate difficulties. Prevention strategies that support mental health and strengthen social support networks can reduce feelings of isolation and bolster resilience, particularly among adults with histories of childhood adversity. [ABSTRACT FROM AUTHOR]

Background: High levels of alcohol consumption have been shown to be related to cardiovascular disease, cancer, diabetes, and other chronic disease and is an important variable in the global burden of disease. Purpose: This study explored the relationship between alcohol consumption and depressive symptoms among older Chinese adults in mainland China. Methods: Participants included 7601 people aged 60 or older who participated in the 2011 China Health and Retirement Longitudinal Study (CHARLS). Hierarchical generalized linear modeling (HGLM) was used. Results: Findings indicate that men have a decreased risk of experiencing depressive symptoms by 47% when controlling for other independent variables. People living only with a spouse were less likely to experience depressive symptoms compared to people living alone. Discussion: The findings have important implications in educating Chinese about alcohol and the relationship between alcohol and disease-related variables. Translation to Health Education Practice: The results of this study may assist those developing and delivering alcohol Health Education and health promotion programs in China to focus on the relevant predisposing, reinforcing, and enabling factors influencing alcohol consumption.

Background and Objectives Coronavirus disease 2019 (COVID-19) created a "perfect storm" for financial fraud targeting older adults. Guided by the Contextual Theory of Elder Abuse, we focused on individual and systemic contexts to examine how older adults became prey to financial fraud. Research Design and Methods In July 2020, 998 adults who were 60–98 years of age (93% White; 64% female) completed an online survey about experiences with financial fraud. Participants were recruited from gerontology research registries at Florida State University, University of Pittsburg, Virginia Tech, and Wayne State University. Results Over half (65.9%) of the respondents experienced a COVID-19-related scam attempt, with charity contributions (49%) and COVID-19 treatments (42%) being the most common. Perpetrators commonly contacted older adults electronically (47%) two or more times (64%). Although most respondents ignored the request (i.e. hung up the phone and deleted text/e-mail), 11.3% sent a requested payment, and 5.3% provided personal information. Predictors of vulnerability included contentment with financial situation, concern about finances in the aftermath of the pandemic, and wishing to talk to someone about financial decisions. Respondents targeted for a non-COVID-19 scam attempt were less likely to be targets of a COVID-19-related scam. Discussion and Implications Older adults who were financially secure, worried about their financial situation, or wished they could speak with someone about their financial decisions appeared susceptible to falling victim to a fraud attempt. The high number of attempts indicates a need for a measurable and concerted effort to prevent the financial fraud of older adults. [ABSTRACT FROM AUTHOR]

Although the benefits of home- and community-based services (HCBS) to support the needs of older adults are well-established, researchers have persistently reported service underutilization by dementia caregivers to assist them with their caregiving responsibilities. Using the Health Behavior Model and Conservation of Resources Theory, the aim of the current study was to understand what barriers prevent caregivers from using HCBS and the toll it takes on them. Utilizing a sample of 122 rural family caregivers (74% female, 87% white, Mage = 64.86 years) of persons living with dementia (PLwD), simultaneous ordinary least square regressions were employed to understand the association between barriers to service use and the current use of support services and personal services, and concurrently on caregiver role overload. Financial barriers, caregiver's reluctance to use services, and their capability of seeking services were associated with lower use of support services. After controlling for need and enabling factors, caregivers who used more support services, and those who reported system complexities to using support services experienced higher role overload. Financial barriers, system complexities, and caregivers' reluctance also affected the use of personal care services. Despite the use of personal services, caregivers of PLwD with greater needs and fewer enabling factors experienced higher role overload. Study findings suggest that reducing system complexities of HCBS and improving prevention and intervention efforts to facilitate caregivers' awareness of HCBS are needed to address lack of service use and reduce caregiver overload. [ABSTRACT FROM AUTHOR]