Feasibility and potential effects of interdisciplinary home-based reablement program (I-HARP) for people with cognitive and functional decline: a pilot trial

Objectives: To test feasibility and potential effects of the interdisciplinary Home-bAsed Reablement Program (I-HARP) that integrates evidence-based strategies and cognitive rehabilitation techniques into a dementia-specific, bio-behavioural-environmental intervention.Methods: A parallel-group randomised controlled pilot trial was conducted in Sydney, Australia, targeting community-dwelling people with amnestic mild cognitive impairment or mild/moderate stages of dementia and their carer (n = 18 dyads). I-HARP comprised: up to 12 home visits by registered nurse, occupational therapist, and psychologist, tailored to the individual client's needs; <A$1000 for home modification/assistive devices; and individual carer support, all provided over four months. Additional allied health services were recommended when necessary. Clients' daily activities, mobility, mood, caregiver burden, and quality of life were assessed at baseline, four months and 12 months. Semi-structured interviews were conducted with I-HARP participants post intervention.Results: Of 51 dyads who expressed interest in participation, 25 were eligible, with 76% consent rate (19/25 eligible dyads consented), and high adherence to the program (all nine intervention group participants completed and complied). Challenges included: need for better carer and allied health support, with more targeted recruitment points to speed up the process. The I-HARP group showed favourable effects across most outcomes at short-term (4 months) and longer-term (12 months) assessments. However, wide Confidence Intervals (CIs) point to the degree of uncertainty around interpretation of these results.Conclusion: The delivery of I-HARP, a dementia-specific reablement program and the trial design concerning randomisation, screening and consent procedures, were deemed feasible, acceptable and appropriate for the target population group. Building on the success and lessons from the pilot, a larger trial is currently underway.

The Value of Home-Based Primary Care: Qualitative Exploration of Homebound Participant Perspectives

Older adults' preference to age in place and health systems' commitment to cost-effective quality care has set the stage for a growing interest in home-based primary care (HBPC). The objective of this study was to explore what patients and caregivers value about HBPC and what modifications could improve its value. Semi-structured individual interviews (n = 20) were audio-recorded, transcribed, and coded for themes. Four themes emerged: (a) HBPC offers peace of mind because patients can access care without leaving the home and can reach the primary care team at all hours, (b) HBPC supports aging in place by providing in-home care, (c) HBPC supports provider rapport building because of the intimate setting and continuity of care, (d) HBPC patients and caregivers have significant nonmedical needs. Findings suggest that teams developing or expanding on HBPC programs should prioritize access to providers, rapport building with patients and families, and supporting patients' and caregivers' nonmedical needs.

"So I am Stuck, but it´s OK": Residential Reasoning and Housing Decision-Making of Low-Income Older Adults with Disabilities in Baltimore, Maryland

Housing preferences and housing decision-making in later life are critical aspects of aging in place, which is a public health priority in many Western countries. However, few studies have examined the economic, social, and health factors that guide older adults' preferences and decisions about where to live, and even less so among older adults with low income or disabilities who may face greater barriers to aging in place. We sought to understand what housing decision-making and residential reasoning means for low-income older adult homeowners in Baltimore, Maryland. Using a grounded theory approach, we interviewed 12 adults with disabilities in June 2017 and February 2018. Our findings revealed how the strong desire to age in place turned into the realization that they had to age in place due to limited resources and options. The core category "shifting between wanting to age in place and having to age in place" was influenced by family needs, being a homeowner, the neighborhood, and coping at home. In conclusion, for low-income older adults with disabilities, it is important to acknowledge that sometimes aging in place may be equivalent to being stuck in place.

Discrimination Is Associated with Elevated Cardiovascular Disease Risk among African Immigrants in the African Immigrant Health Study

Background

African Americans and other persons of African descent in the United States are disproportionately affected by cardiovascular diseases (CVD). Discrimination is associated with higher CVD risk among US adults; however, this relationship is unknown among African immigrants.

Methods

The African Immigrant Health Study was a cross-sectional study of African immigrants in Baltimore-Washington, DC, with recruitment and data collection taking place between June 2017 and April 2019. The main outcome was elevated CVD risk, the presence of ≥3 CVD risk factors including hypertension, diabetes, high cholesterol, overweight/obesity, tobacco use, and poor diet. The secondary outcomes were these six individual CVD risk factors. The exposure was discrimination measured with the Everyday Discrimination Scale; summed scores ≥2 on each item indicated frequent experiences of discrimination. Resilience was assessed with the 10-item Connor-Davidson resilience scale. Logistic regression was used to examine the odds of elevated CVD risk, adjusting for relevant covariates.

Results

We included 342 participants; 61% were females. The mean (±SD) age was 47(±11) years, 61% had at least a bachelor's degree, 18% had an income <$40,000, and 49% had lived in the US ≥15 years. Persons with frequent experiences of discrimination were 1.82 times (95%CI: 1.04-3.21) more likely to have elevated CVD risk than those with fewer experiences. Resilience did not moderate the relationship between CVD risk and discrimination.

Conclusion

African immigrants with frequent experiences of discrimination were more likely to have elevated CVD risk. Targeted and culturally appropriate interventions are needed to reduce the high burden of CVD risk in this population. Health care providers should be aware of discrimination as a meaningful social determinant of CVD risk. At the societal level, policies and laws are needed to reduce the occurrence of discrimination among African immigrants and racial/ethnic minorities.

Disability Prevention Program Improves Life-Space and Falls Efficacy: A Randomized Controlled Trial

OBJECTIVES

To evaluate the effects of a home-based disability prevention program on life-space and falls efficacy among low-income older adults.

DESIGN

Single-blind two-arm randomized controlled trial.

SETTING

Participants' homes.

PARTICIPANTS

Participants were low-income cognitively intact older adults (≥65 years old) with restricted daily activities. Our analytic sample for life-space (n = 194) and falls efficacy (n = 233) varied as the life-space measure was introduced 4 months after the trial began.

INTERVENTION

Up to six 1-hour home visits with an occupational therapist; up to four 1-hour home visits with a registered nurse; and up to $1,300 worth of home repairs, modifications, and assistive devices with a handyman, during a course of 4 months.

MEASUREMENTS

Life-space was measured by the Homebound Mobility Assessment; falls efficacy was measured using the 10-item Tinetti Falls Efficacy Scale at baseline and 5 months.

RESULTS

Participants were on average 75 years old, predominantly Black (86%) and female (85%-86%). Compared with participants in the control group, participants receiving the intervention were more likely to have improved versus decreased life-space in areas of bathroom (adjusted odds ratio (OR) = 3.95; 95% confidence interval (CI) = 1.20-12.97), front or back porch, patio, or deck (adjusted OR = 2.67; 95% CI = 1.05-6.79), stairs (adjusted OR = 4.09; 95% CI = 1.34-12.48), leaving the house for any reason other than for health care (adjusted OR = 2.40; 95% CI = 1.01-5.73), and overall life-space (adjusted OR = 2.15; 95% CI = 1.10-4.19). Participants who received the intervention also had an 11% improvement in falls efficacy in performing daily activities (exponentiated coefficient = 1.12; 95% CI = 1.04-1.21).

CONCLUSION

Life-space and falls efficacy were improved through a multicomponent, person-directed, home-based disability prevention intervention. Findings suggest that this intervention should be translated into different settings to promote independent aging.

Leveraging naturally occurring variation in financial stress to examine associations with inflammatory burden among older adults

BACKGROUND

Financial strain is associated with earlier disability and mortality, but causal links are underexplored, partly because it is unethical to randomise people to financial stress. This study leverages naturally occurring random variation in days since monthly Social Security payment arrival among older adults to test associations with inflammatory biomarkers.

METHODS

Biomarker data, including tumour necrosis factor (TNF)-α, interleukin (IL)-6 and C reactive protein (CRP), was collected from 2155 non-working healthy adults aged 70-79 years, participating in the Health, Aging and Body Composition Study. Days since payment arrival was independent of all demographic, socioeconomic or health characteristics measured in this study. Restricted cubic spline models estimated associations separately for each week of the month, stratified by financial strain status (interaction term p value for TNF-α model <0.05).

RESULTS

Among financially strained older adults, more days since payment arrival was associated with higher TNF-α levels during the first week of the month (coefficient=0.102). Associations with IL-6 and CRP differed depending on the degree of financial strain (interaction term p values <0.05). Those with low, but not high, strain had lower levels of IL-6 (coefficient=-0.152) and CRP (coefficient=-0.179) during the first week.

CONCLUSIONS

Days since monthly payments were associated with inflammatory cytokines among older adults who have difficulty making ends meet financially and associations depended on financial strain severity, suggesting that results are attributable to monthly variation in financial stress. Future research should examine whether more frequent Social Security disbursement would modify financial strain and inflammatory biomarkers.

Exergames and Depressive Symptoms in Older Adults: A Systematic Review

To synthesize and critique studies that examined the impact of exergames on depressive symptoms in older adults. Articles were retrieved from the databases CINAHL, Embase, PsychINFO, and Medline. Studies were included in the review if they involved a physical activity/videogame intervention and measured outcomes of depressive symptoms in older adults. The search generated 957 articles for consideration, which were narrowed to 17 articles after applying exclusion criteria. In studies that required depressive symptoms as an inclusion criterion, there was an improvement in depressive symptoms in older adults following the exergame intervention. In studies that did not require depressive symptoms as an inclusion criterion, researchers found mixed results. Future older adult exergame research should measure depression as a primary outcome, utilize control groups with random sampling, consist of larger sample sizes, and include people with disabilities.

Pain in low-income older women with disabilities: a qualitative descriptive study

The purpose of this qualitative study was to identify how low-income older women with disabilities perceive pain, pain management, and communication with healthcare providers. We interviewed 26 low-income women (average age 75 years; SD 7.0), eliciting the following overarching themes: "Invisibility of Pain: Unnoticed or Undetected," "Escalating Pain Leads to Help Seeking," "Communication with Healthcare Providers and Outcomes," "Pain Management Facilitates Function and Accomplishment," and "The Intersection of Pain, Disability, and Depressive Symptoms." Study findings support the ways in which behavior changes from pain can impede pain management.

Socioeconomic disparities in six-year incident dementia in a nationally representative cohort of U.S. older adults: an examination of financial resources

Background

Less educational training is consistently associated with incident dementia among older adults, but associations between income and financial strain with incident dementia have not been well tested in national samples. This is an important gap because, like education, financial resources are potentially modifiable by policy change and strengthening the social safety net. This study tested whether financial resources (income and financial strain) predict six-year incident dementia independent of education and occupation.

Methods

The National Health and Aging Trends Study is a prospective cohort study that recruited a nationally representative sample of U.S. Medicare beneficiaries aged ≥65 years. Incident dementia (2013 to 2018) was classified based on diagnosis, cognitive test scores or proxy-reported changes among participants dementia-free in 2012 (n = 3785). Baseline socioeconomic measures included income to poverty ratio (analyzed separately for those < 500% vs. ≥500% poverty threshold), financial strain, education and history of professional occupation. Discrete time survival analysis applied survey weights to account for study design and nonresponse. Coefficients were standardized to compare the strength of associations across the four socioeconomic measures.

Results

Adjusting for socioeconomic measures, demographic characteristics, home ownership, retirement, chronic conditions, smoking, BMI and depressive symptoms, higher income (hazard OR = 0.84, 95% CI: 0.74, 0.95 among those < 500% poverty) and higher education (hOR = 0.73, 95% CI: 0.65, 0.83) were associated with lower odds, and financial strain with higher odds (hOR = 1.20, 95% CI: 1.09, 1.31), of incident dementia.

Conclusion

Low income and greater financial strain predict incident dementia among older adults and associations are comparable to those of low education among U.S. older adults. Interventions to mitigate financial strain through improving access to economic opportunity and strengthening safety net programs and improving access to them in low income groups may complement other ongoing efforts to prevent dementia.

Pilot Outcomes of a Multicomponent Fall Risk Program Integrated Into Daily Lives of Community-Dwelling Older Adults

Objectives: To evaluate whether a fall prevention intervention reduces fall risk in older adults who have previously fallen. Design: Randomized controlled pilot trial. Setting: Participants' homes. Intervention: LIVE-LiFE, adapted from Lifestyle-Intervention Functional Exercise (LiFE) integrates strength and balance training into daily habits in eight visits over 12 weeks. The adaptations to LiFE were to also provide (a) US$500 in home safety changes, (b) vision contrast screening and referral, and (c) medication recommendations. Control condition consisted of fall prevention materials and individualized fall risk summary. Measurement: Timed Up and Go (TUG) and Tandem stand. Falls efficacy, feasibility, and acceptability of the intervention. Results: Sample (N = 37) was 65% female, 65% White, and average 77 years. Compared with the control group, each outcome improved in the intervention. The LIVE-LiFE intervention had a large effect (1.1) for tandem stand, moderate (0.5) in falls efficacy, and small (0.1) in the TUG. Conclusion: Simultaneously addressing preventable fall risk factors is feasible.

Comparison of Cardiovascular Disease Risk Factors Among African Immigrants and African Americans: An Analysis of the 2010 to 2016 National Health Interview Surveys

Background Racial/ethnic minorities, especially non-Hispanic blacks, in the United States are at higher risk of developing cardiovascular disease. However, less is known about the prevalence of cardiovascular disease risk factors among ethnic sub-populations of blacks such as African immigrants residing in the United States. This study's objective was to compare the prevalence of cardiovascular disease risk factors among African immigrants and African Americans in the United States. Methods and Results We performed a cross-sectional analysis of the 2010 to 2016 National Health Interview Surveys and included adults who were black and African-born (African immigrants) and black and US-born (African Americans). We compared the age-standardized prevalence of hypertension, diabetes mellitus, overweight/obesity, hypercholesterolemia, physical inactivity, and current smoking by sex between African immigrants and African Americans using the 2010 census data as the standard. We included 29 094 participants (1345 African immigrants and 27 749 African Americans). In comparison with African Americans, African immigrants were more likely to be younger, educated, and employed but were less likely to be insured (P<0.05). African immigrants, regardless of sex, had lower age-standardized hypertension (22% versus 32%), diabetes mellitus (7% versus 10%), overweight/obesity (61% versus 70%), high cholesterol (4% versus 5%), and current smoking (4% versus 19%) prevalence than African Americans. Conclusions The age-standardized prevalence of cardiovascular disease risk factors was generally lower in African immigrants than African Americans, although both populations are highly heterogeneous. Data on blacks in the United States. should be disaggregated by ethnicity and country of origin to inform public health strategies to reduce health disparities.

Living in the Community With Dementia: Who Receives Paid Care?

OBJECTIVES

Paid caregivers (eg, home health aides and personal care attendants) provide hands-on care that helps individuals with dementia live in the community. This study (a) characterizes paid caregiving among community-dwelling individuals with dementia and (b) identifies factors associated with receipt of paid care.

DESIGN

Cross-sectional analysis.

SETTING

The 2015 National Health and Aging Trends Study (NHATS), a nationally representative study of Medicare recipients aged 65 years and older.

PARTICIPANTS

Community-dwelling individuals with dementia (n = 899).

MEASUREMENTS

Paid and family caregiving support was determined by participant or proxy report of help received with functional tasks. Multivariable logistic regression was used to examine factors associated with receipt of paid care. NHATS population sampling weights were used to produce national paid caregiving prevalence estimates.

RESULTS

Only 25.5% of community-dwelling individuals with dementia received paid care, and 10.8% received 20 hours or more of paid care per week. For those who received it, paid care accounted for approximately half of the 83 total caregiving hours (paid and family) that they received each week. Among the subgroup of individuals with advanced dementia (those with impairment in dressing, bathing, toileting, and managing medications and finances), nearly half (48.3%) received paid care. Multivariable analysis, adjusting for sociodemographic, family caregiving support, functional, and clinical characteristics, found that the odds of receiving paid care were higher among men (odds ratio [OR] = 1.91; 95% confidence interval [CI] = 1.24-2.95), the unmarried (OR = 2.20; 95% CI = 1.31-3.70), those with Medicaid (OR = 2.16; 95% CI = 1.27-3.66), and those requiring more help with activities of daily living (ADLs) (OR = 1.32; 95% CI = 1.18-1.48) and instrumental ADLs (OR = 1.29; 95% CI = 1.14-1.46).

CONCLUSIONS

New ways of making paid caregiving more accessible throughout the income spectrum are required to support family caregivers and respect the preferences of individuals with dementia to remain living in the community. J Am Geriatr Soc 68:186-191, 2019.

The Epidemiology of Social Isolation: National Health and Aging Trends Study

OBJECTIVES

Social isolation among older adults is an important but under-recognized risk for poor health outcomes. Methods are needed to identify subgroups of older adults at risk for social isolation.

METHODS

We constructed a typology of social isolation using data from the National Health and Aging Trends Study (NHATS) and estimated the prevalence and correlates of social isolation among community-dwelling older adults. The typology was formed from four domains: living arrangement, core discussion network size, religious attendance, and social participation.

RESULTS

In 2011, 24% of self-responding, community-dwelling older adults (65+ years), approximately 7.7 million people, were characterized as socially isolated, including 1.3 million (4%) who were characterized as severely socially isolated. Multinomial multivariable logistic regression indicated that being unmarried, male, having low education, and low income were all independently associated with social isolation. Black and Hispanic older adults had lower odds of social isolation compared with white older adults, after adjusting for covariates.

DISCUSSION

Social isolation is an important and potentially modifiable risk that affects a significant proportion of the older adult population.

Longitudinal and reciprocal associations between financial strain, home characteristics and mobility in the National Health and Aging Trends Study

BACKGROUND

Older adults need homes that suit their physical capacity. Financial strain may limit home repairs and modifications and prompt relocations; repairing, relocating or modifying may increase financial strain. Likewise, reciprocal relationships may exist between financial strain and home characteristics and mobility; financial strain and home characteristics may influence mobility and mobility declines may increase financial strain, limit home repairs and modifications and prompt relocations. We test cross-lagged associations between financial strain, home disorder, relocation, home modifications and mobility.

METHODS

In the National Health and Aging Trends Study, ability to complete a walking test, speed among those able to complete, financial strain, home disorder, relocating and modifying the home were recorded annually for 3 years (2012-2014). Structural equation models separately examined ability to walk and walking speed among those able, accounting for sociodemographic characteristics, social support, health prior health characteristics and autoregressive effects. Sampling weights accounted for the complex survey design and non-response over time.

RESULTS

In both models (n = 3234 and n = 2467), financial strain predicted greater home disorder and vice versa, but cross-lagged associations were not found with relocating and modifications. Greater home disorder predicted lower odds of ability to walk and slower speed among those able. Financial strain and home modifications predicted lower odds of ability to walk. Also, faster walking speed predicted lower odds of subsequent financial strain and lower subsequent home disorder scores and ability to walk predicted less subsequent home disorder and lower odds of relocating.

CONCLUSIONS

Home disorder links financial strain with reduced mobility in a national sample of U.S. older adults. Cross-lagged associations between financial strain and home disorder and between home disorder and mobility suggest reciprocal effects that may accumulate over time. Also, financial strain, reduced mobility, relocations and modifications predicted greater home disorder. Together, these results highlight home disorder as a social determinant of mobility for older adults. Greater attention should be given to repairing and modifying home environments and supporting stable housing for older adults with financial strain.

Longitudinal and reciprocal associations between financial strain, home characteristics and mobility in the National Health and Aging Trends Study

Background

Older adults need homes that suit their physical capacity. Financial strain may limit home repairs and modifications and prompt relocations; repairing, relocating or modifying may increase financial strain. Likewise, reciprocal relationships may exist between financial strain and home characteristics and mobility; financial strain and home characteristics may influence mobility and mobility declines may increase financial strain, limit home repairs and modifications and prompt relocations. We test cross-lagged associations between financial strain, home disorder, relocation, home modifications and mobility.

Methods

In the National Health and Aging Trends Study, ability to complete a walking test, speed among those able to complete, financial strain, home disorder, relocating and modifying the home were recorded annually for 3 years (2012–2014). Structural equation models separately examined ability to walk and walking speed among those able, accounting for sociodemographic characteristics, social support, health prior health characteristics and autoregressive effects. Sampling weights accounted for the complex survey design and non-response over time.

Results

In both models (n = 3234 and n = 2467), financial strain predicted greater home disorder and vice versa, but cross-lagged associations were not found with relocating and modifications. Greater home disorder predicted lower odds of ability to walk and slower speed among those able. Financial strain and home modifications predicted lower odds of ability to walk. Also, faster walking speed predicted lower odds of subsequent financial strain and lower subsequent home disorder scores and ability to walk predicted less subsequent home disorder and lower odds of relocating.

Conclusions

Home disorder links financial strain with reduced mobility in a national sample of U.S. older adults. Cross-lagged associations between financial strain and home disorder and between home disorder and mobility suggest reciprocal effects that may accumulate over time. Also, financial strain, reduced mobility, relocations and modifications predicted greater home disorder. Together, these results highlight home disorder as a social determinant of mobility for older adults. Greater attention should be given to repairing and modifying home environments and supporting stable housing for older adults with financial strain.

Attention control group activities and perceived benefit in a trial of a behavioral intervention for older adults

Researchers trialing behavioral interventions often use attention control groups, but few publish details on attention control activities or perceived benefit. Attention control groups receive the same dose of interpersonal interaction as intervention participants but no other elements of the intervention, to control for the benefits of attention that may come from behavioral interventions. Because intervention success is analyzed compared to control conditions, it is useful to examine attention control content and outcomes. The purpose of this study is to report on attention control visit activities and their perceived benefit in a randomized control trial. The trial tested an aging-in-place intervention comprised of a series of participant goal-directed visits facilitated by an occupational therapist, nurse, and handyman. The attention control group participants received visits from a lay person. We report on the number and length of visits received, types of visit activities that participants chose, and how much visit time was spent on each activity, based on the attention visitor's records. We report on participant perceptions of benefit based on a 10-item Likert-scale survey. The attention control group participants (n = 148) were cognitively intact, at least 65 years old, with at least one Instrumental Activities of Daily Living. Attention control group participants most often chose conversation (20.1% of visit time), and playing games (18.7%), as visit activities. The majority of attention control group participants (63.4%) reported "a great deal" of perceived benefit. Attention control group visits may be an appropriate comparison in studies of behavioral interventions for community-dwelling older adults.

BIDIRECTIONAL ASSOCIATIONS BETWEEN SLEEP COMPLAINTS AND DEPRESSION: FINDINGS FROM THE NHATS STUDY

Depression and insomnia are prevalent in older adults and show bidirectional relationships. Sleep initiating and maintenance difficulties are the two frequently seen complaints of insomnia diagnostic criteria. Whether these two sleep complaints differ in their associations with depression is unknown. Using the National Health and Aging Trends Study (NHATS), we examined whether sleep initiating and maintenance difficulties at baseline (T1) predicted depression onset at 12 months (T2) and 24 months (T3) in 4,048 T1 non-depressed participants and whether depression at T1 predicted these two sleep complaints at T2 and T3 in 3,581 T1 non-insomnia participants. Participants who developed depression at T2 tended to be Hispanic, non-Hispanic black, less educated, live alone, physically inactive, and have more painful locations and chronic conditions. Participants with sleep complaints at T2 tended to be less educated, live alone, physically inactive, and have more painful locations and chronic conditions. Sleep initiating difficulty persistently predicted depression onset at T2 (OR: 1.62, 95% CI: 1.14, 2.31) and T3 (OR: 1.84, 95% CI: 1.21, 2.81) after adjusting demographics, lifestyles and health condition-related covariates. Depression at T1 persistently predicted sleep initiating difficulty at T2 (RRR: 2.19, 95% CI: 1.44, 3.34) and T3 (RRR: 1.70, 95% CI: 1.07, 2.70) after adjustment. Sleep maintenance difficulty at T1 did not predict depression onset at either time point and vice versa. This study suggests a bidirectional association of depression with sleep initiating difficulty but not sleep maintenance difficulty in older adults. Interventions targeting difficulty initiating sleep may moderate depression onset in older adults.

EXPERIENCES OF DISCRIMINATION ARE ASSOCIATED WITH DECREASED FUNCTIONAL ABILITY IN AFRICAN IMMIGRANT OLDER ADULTS

Discrimination impacts functional health outcomes of African Americans and other racial/ethnic minorities in the United States; yet this is understudied in African immigrants whose population has risen by 137% since 2000. We examined the relationship between discrimination and physical function with a convenience sample of first-generation African immigrants age 50+ recruited through community-based organizations (N=124). Discrimination was measured with the Everyday Discrimination scale with higher scores indicating more experiences of discrimination (range=0-23). High versus low levels of discrimination were categorized at the mean. Physical function was measured using the PROMIS Physical Function measure with high scores indicating greater functional ability (range=11-50). Raw function scores were converted to standardized T-scores with a population mean of 50 and standard deviation (SD) of 10. Linear regression was used for analyses. Mean age of the sample was 61.4(SD=7.9) years. About two-thirds (63%) were female, more than half (52.4%) immigrated in search of better opportunities and half of the sample had high levels of discrimination. The mean function score was 44.2(SD=8.3) indicating that this sample had functional ability 6 points less than the population average. After adjusting for demographic and migration factors, the mean physical function score was 2.5 points lower (b=-2.53, 95% CI= -5.04, -0.01) for participants with more experiences compared to those with fewer experiences of discrimination. In conclusion, discrimination was associated with poor physical function in African immigrant older adults after adjusting for covariates. Longitudinal studies of discrimination and physical functioning should be pursued in more diverse, larger samples of African immigrants.

INNOVATIONS IN HOME MODIFICATION RESEARCH: THE STATE OF THE ART

The overwhelming preference of older adults is to stay in their homes for as long as possible (AARP). However, most housing lacks supportive features and presents barriers that jeopardize residents’ ability to successfully age in place. Only 1% of houses have five key features to ensure accessibility: no-step entry, single-floor living, lever door handles, accessible electrical controls, and extra-wide doors and hallways (Harvard Joint Center for Housing Studies), making the vast majority unsuitable for persons who use wheelchairs and problematic for the growing number of people with activity limitations. Persons least likely to have such features in their homes need them the most: old-old, low income, frail, and residents in older housing stock. Although home modification can support people as their needs change and preclude the need to move, often to institutional settings, the majority of older adults lack these supports. Recent studies have demonstrated the role of home modification in health, safety, and cost effectiveness. This symposium will convene a panel of researchers to share evidence-base in home modification, recent cost-saving innovations including the CAPABLE Program, and policy change to improve service delivery.

HIGHER COPING SELF-EFFICACY ASSOCIATED WITH LOW SELF-PERCEIVED LONELINESS IN OLDER ADULTS WITH CHRONIC DISEASE

Loneliness is an emotional state involving social network perceptions and linked to worse health outcomes. Coping self-efficacy evaluates confidence in ability to manage problems effectively using problem-solving, emotional regulation and social coping. The purpose of this cross-sectional study (N=151 community dwelling adults ages ≥ 65) was to evaluate associations between loneliness and coping self-efficacy. All participants had at least one chronic condition and were cognitively intact. In this sample, 32.08% were lonely (score ≥ 5 on UCLA 3-item loneliness scale (range 3-9). Higher coping self-efficacy was significantly associated with low loneliness after adjustment for age, sex, race/ethnicity, social support, depressive symptoms, body mass index, and a chronic disease-function score (β= -0.03, p=0.014). Causality could not be assessed; higher loneliness may lead to lower self-efficacy or lower self-efficacy may lead to higher loneliness. Nonetheless, loneliness and self-efficacy are both modifiable with great potential for improvement, possibly bettering health outcomes.

ROBBING PETER TO PAY PAUL: HANDLING FINANCIAL CHALLENGES AMONG LOW-INCOME OLDER ADULTS

Low income older adults often face financial challenges which increase their risk for earlier disability and mortality. This study explored the social norms, beliefs and practices relevant to handling financial challenges among low-income community-dwelling older adults residing near Baltimore, MD whom we recruited using convenience and snowball sampling. Four vignette-based focus group sessions included 28 participants. Using hierarchical thematic analysis, three key themes emerged. First, the theme “Rob Peter to pay Paul” describes the consensus that individuals must prioritize financial needs, which required individuals to “work with a budget”, apply for aid, “cry for [aid]” and, when needed, “work something out” with landlords and lenders. One participant described the amount of work by saying “We’re retired but we’re working for ourselves.” Secondly, the theme “Your rent should be first” describes how low income older adults prioritize housing over food and other needs because “resources for housing is a problem” and because homelessness is both more permanent and socially stigmatizing than hunger - “Don’t nobody know you’re hungry unless you tell them, but everybody know when you outdoors.” Finally, the theme “We need to put the word out” describes the consensus that public benefits and community resources should be made more visible and accessible. Many individuals only know about resources because they seek information (“you go and you find out”), but “ it’s hard to ask for help. ” These results can inform the development and improvement of financial and community programs and policies for low-income older adults addressing financial challenges.