Healthy Aging and Older Adults with Autism: A Scoping Review

BACKGROUND AND OBJECTIVES

Autism Spectrum Disorder (ASD) is a lifelong diagnosis. While several studies have examined the effects of autism throughout childhood, few have considered older adulthood and the difference between the allistic (i.e., persons who are not autistic) population and autistic older adults. In literature regarding healthy aging, there is sparse evidence regarding the intersections of older adulthood and autism. The purpose of this scoping review was to examine the state of literature regarding autistic older adults and the domains of healthy aging, utilizing the framework conceived by Arksey and O'Malley (2005).

RESEARCH DESIGN AND METHODS

To identify the research question, we took the following steps: identify the relevant studies; select studies; chart the data; and collate, summarize, and report the results. The specific domains of healthy aging considered include physical health, mobility, mental health, cognition and memory, and social connectedness.

RESULTS

A total of 35 articles were selected for final review. Fifty-seven percent of these studies considered only one domain of healthy aging, 23% studied two domains, while 14% measured three domains and 6% assessed four domains. No study considered all five domains. Of the five domains considered for this scoping review, mental health and cognition and memory were the most represented domains in the studies.

DISCUSSION AND IMPLICATIONS

Overall, healthy aging among autistic older adults is largely understudied. More research is needed to better identify and tailor interventions and services for autistic older adults and their families to support healthy aging.

Remembering the Past with Today's Technology: A Scoping Review of Reminiscence-Based Digital Storytelling with Older Adults

Reminiscence has been identified as a potentially effective intervention strategy for the mental health of older adults. It has been suggested that reminiscence work and subsequent production of a life storybook (e.g., DST: digital storytelling) is associated with improvements in the well-being of older adults. The specific objectives of this scoping review are to: (1) examine how reminiscence-based DST is conducted/used with older adults, (2) identify whether and how intergenerational engagement is included in this literature, and (3) report on the outcomes identified in this literature, including older adults as well as other participants such as co-creators and viewers of DST. A scoping review following the Joanna Briggs Institute's methods and the Arksey and O'Malley framework examined studies published in English that included reminiscence with older adults and incorporated digital storytelling. The initial search resulted in 702 articles for review, and following screening, 35 studies were included for full-text review. A total of 10 articles specifically on reminiscence-based DST were identified for final review. Only one study intentionally included intergenerational engagement in its design. DST impacted older adults on their personal meaning and catharsis, social connectedness, cognitive function, and spiritual and emotional well-being. Impacts on reviewers and creators were also reported. Overall, the combination of individual reminiscence work with intergenerational engagement and the use of DST is largely understudied. Additional research is warranted given there is a credible evidence base for these types of interventions.

Social Cognitive Theory, Driving Cessation, and Alternative Transportation in Later Life

Having viable alternative transportation options could help individuals stop driving when appropriate. This study employs the Social Cognitive Theory (SCT) to understand the barriers and facilitators of alternative transportation among a sample of adults aged 55 and older (N = 32). Using a daily transportation data collection app, MyAmble, the research team asked participants questions structured around environmental, individual, and behavioral factors as outlined in the SCT framework. Responses were analyzed using directed content analysis. Findings suggest a substantial reliance on motor vehicles and it was evident that many participants had never seriously considered what they would do if they could no longer drive. We posit that SCT principles may be applied to help older adults build self-efficacy to transition to driving cessation when needed.

Positive Aging and Death or Dying: A Scoping Review

BACKGROUND AND OBJECTIVES

This scoping review aims to examine the extent and the manner in which research that utilizes successful, active, productive, and healthy aging framework(s) includes death or dying.

RESEARCH DESIGN AND METHODS

An examination of peer-reviewed academic journal articles was conducted following Joanna Briggs Institute's methodological standards for scoping reviews and conforming to Arskey and O'Malley's 5-stage framework. The initial search resulted in 1,759 articles for review, and following the rigorous screening, 35 studies were included for the final review. A qualitative thematic analysis was used to identify how research utilizes the concepts of death and dying in the context of 4 positive aging models.

RESULTS

The core themes identified include (a) the absence of death and dying dimensions in positive aging models; (b) older adults' outlooks on death and dying while aging well; (c) religious and spiritual dimensions of aging well; (d) negative consequences of positive aging models without death and dying dimensions; and (e) the future of death and dying in positive aging models.

DISCUSSION AND IMPLICATIONS

The review delivers a critique by researchers on the noticeable absence of death and dying processes within the framework of successful, active, productive, and healthy aging models. These findings represent a rich opportunity for future research on these concepts.

Application of a Decisional Capacity Assessment for Older Research Participants with Cognitive Impairment

Decisional capacity assessment is important for older adult participants who have cognitive impairment. This paper reports the implementation of the University of California, San Diego Brief Assessment of Capacity to Consent (UBACC) and its potential for practice and research. Nine of the 10 items remained to use except for adapting the last item. Approximately 130 older adults with cognitive impairment completed the UBACC screening. Item-by-item descriptive statistics, exploratory factor analysis (EFA), group comparisons of each item, as well as total sum scores of the UBACC were conducted. Results showed that the items that were most often answered correctly included item #10 (participant will be paid), item #4 (study is voluntary), and item #5 (can withdraw at any time). Conversely, the items that were most often answered incorrectly included item #9 (not any benefit potentially), item #7 (potential risk or discomfort), and item #6 (tasks during participation). Respondents with mild cognitive impairment had higher correct answer rates than those with advanced cognitive impairment. The UBACC screening tool has relative utility for older participants with cognitive impairment.

Reminiscence and Digital Storytelling to Improve the Social and Emotional Well-Being of Older Adults With Alzheimer's Disease and Related Dementias: Protocol for a Mixed Methods Study Design and a Randomized Controlled Trial

BACKGROUND

Increasing attention is being given to the growing concerns about social isolation, loneliness, and compromised emotional well-being experienced by young adults and older individuals affected by Alzheimer disease and related dementias (ADRD). Studies suggest that reminiscence strategies combined with an intergenerational approach may yield significant social and mental health benefits for participants. Experts also recommended the production of a digital life story book as part of reminiscence. Reminiscence is typically implemented by trained professionals (eg, social workers and nurses); however, there has been growing interest in using trained volunteers owing to staffing shortages and the costs associated with reminiscence programs.

OBJECTIVE

The proposed study will develop and test how reminiscence offered by trained young adult volunteers using a digital storytelling platform may help older adults with ADRD to improve their social and emotional well-being.

METHODS

The proposed project will conduct a randomized controlled trial to assess the effects of the intervention. The older and young adult participants will be randomly assigned to the intervention (reminiscence based) or control groups and then be randomly matched within each group. Data will be collected at baseline before the intervention, in the middle of the intervention, at end of the intervention, and at 3 months after the intervention. An explanatory sequential mixed methods design will be used to take advantage of the strengths of both quantitative and qualitative methods. The quantitative data from surveys will be entered into SPSS and analyzed using covariate-adjusted linear mixed models for repeated measures to compare the intervention and control groups over time on the major outcomes of participants. Conventional content analysis of qualitative interviews will be conducted using data analysis software.

RESULTS

The project was modified to a telephone-based intervention owing to the COVID-19 pandemic. Data collection started in 2020 and ended in 2022. In total, 103 dyads were matched at the beginning of the intervention. Of the 103 dyads, 90 (87.4%) dyads completed the midtest survey and 64 (62.1%) dyads completed the whole intervention and the posttest survey. Although we are still cleaning and finalizing data analyses, the preliminary results from both quantitative and qualitative data showed promising results of this intergenerational reminiscence approach that benefits both the older adults who have cognitive impairments and the young adult participants.

CONCLUSIONS

Intergenerational reminiscence provided by young adult college student offers promising benefits for both the younger and older generations. Future studies may consider scaling up this pilot into a trackable, replicable model that includes more participants with diverse background (eg, public vs private college students and older adults from other agencies) to test the effectiveness of this intervention for older adults with ADRD.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05984732; https://classic.clinicaltrials.gov/ct2/show/NCT05984732.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/49752.

The Senior Companion Program Plus for African American Caregivers of Persons With Alzheimer Disease and Related Dementias: Protocol for a Randomized Controlled Trial

BACKGROUND

Alzheimer disease and related dementias (ADRD) pose significant challenges as chronic health conditions in the United States. Additionally, there are notable disparities in the diagnosis and prevalence of ADRD among diverse populations. Specifically, African American populations have a higher risk of developing late-onset ADRD than White people, and missed diagnoses of ADRD are more common among older African American populations than older White populations. These disparities also impact African American ADRD family caregivers.

OBJECTIVE

The overall goal of this project is to develop a culturally informed, lay provider psychoeducational intervention named Senior Companion Program Plus (SCP Plus), which is specifically designed for African American ADRD caregivers and is potentially accessible, affordable, and sustainable.

METHODS

In the proposed explanatory sequential mixed methods study, a randomized controlled trial will be used that includes 114 African American family caregivers of a relative with ADRD who will participate in the 3-month SCP Plus program.

RESULTS

The study was funded on September 15, 2018, by the National Institutes of Health (1R15AG058182-01A1). Data collection began on May 16, 2019, but due to COVID-19 restrictions, ended 12 months into the planned 27-month recruitment period on March 31, 2023. The study was completed in June 30, 2023, and currently the results are being analyzed.

CONCLUSIONS

The SCP Plus offers promise as an intervention that utilizes an existing platform for the delivery of a lay provider intervention and offers a novel approach for addressing gaps in accessible, community-based support for caregivers of people with ADRD.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03602391; https://classic.clinicaltrials.gov/ct2/show/NCT03602391.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR1-10.2196/49679.

The Senior Companion Program Plus: An Innovative Training Approach for Alzheimer's Disease and Related Dementia

African Americans adults are disproportionately affected by Alzheimer's disease and related dementias (ADRD) and are underrepresented in research about ADRD. Reducing gaps in the knowledge about ADRD in the African American community is important for addressing dementia care disparities. The existing psychoeducation interventions are often limited by cost and scalability; for these reasons, lay provider (i.e., volunteer) interventions are of increasing interest in ADRD research. The purpose of this study was to evaluate a training of African American Senior Companion (SC) volunteers (n = 11) with dementia-specific knowledge (i.e., Senior Companion Program/SCP Plus), as part of a culturally informed, in-home, psychoeducational intervention for African American ADRD family caregivers. Learning outcomes were measured pre- and post-training, using the Knowledge of Alzheimer's Disease/dementia scale (KAD), the Sense of Competence Questionnaire, and the Preparedness for Caregiving Scale. The results showed significant improvements in knowledge of Alzheimer's disease/dementia, one competence item, "It is clear to me how much care my care recipient needs", and preparedness for caregiving. Overall, the study findings suggest the SCP Plus is a promising, culturally relevant, and potentially scalable lay provider training for ADRD with potential benefits that augment the existing Senior Companion Program.

Attitudes toward Aging among College Students: Results from an Intergenerational Reminiscence Project

The detrimental effects of negative attitudes toward aging among younger adults extend to both older and young adults, highlighting the need for attention from academics, applied researchers, and practitioners. To improve college students' attitudes toward aging, an intergenerational reminiscence intervention was conducted. College students, who were randomized to intervention or control groups and matched with older adults, made weekly phone calls to community-dwelling older adults with cognitive impairment for ten weeks. This study investigated whether college students improved their attitudes toward aging after participating in this project. A total of 64 college student participants completed the whole intervention and all data collection. The Fraboni Scale of Ageism was used to measure attitudes toward aging and administered at three time points (pre-, mid-, and post-test). Parametric and nonparametric tests were examined to understand changes over time, and post-hoc analyses were conducted to understand timepoints in which changes occurred. The results showed that both the intervention and control groups evidenced a decrease in the majority of the ageism scale, including statistical improvements in three specific negative items, which were "Seniors are stingy and hoard money", "Seniors live in the past", and "I prefer not to spend time with seniors". Overall, the findings indicate that weekly engagement with older adults is promising in improving attitudes toward aging among college students. Implications for future research on intergenerational contacts to improve attitudes toward aging are discussed.

"Knowing when it's time to take a break": Nursing home social workers' coping during COVID-19

Background

Nursing home (NH) social workers face many challenges in meeting the psychosocial needs of residents while balancing their own well-being needs.

Methods

This study employed a cross-sectional survey of NH social workers via social media and professional networks about their coping strategies during COVID-19. Open-ended responses were analyzed qualitatively using the rigorous and accelerated data reduction technique (RADaR).

Results

The study included a sample of 63 (N = 63) NH social workers. Four themes defined ways the in which NH social workers coped with stress during COVID-19, including relying on friends and family, mindfulness and spirituality/religion, self-care strategies, and setting boundaries at work.

Conclusion

These techniques appear to be effective; however there remains a need for institutional programs and policies to provide the time and space to holistically support coping in NH social workers and to prevent burnout and turnover, particularly during times of crisis.

The Senior Companion Program Plus (SCP Plus): Examining the Preliminary Effectiveness of a Lay Provider Program to Support African American Alzheimer's Disease and Related Dementias (ADRD) Caregivers

OBJECTIVES

A culturally informed, peer-led, lay provider model, the Senior Companion Program (SCP) Plus, was implemented to decrease caregiving burden/stress and improve coping skills and social support for African American ADRD caregivers. This study reported the preliminary effectiveness of this intervention.

METHODS

An explanatory sequential mixed methods design was used in this study, and a randomized control trial was conducted for the SCP Plus intervention among participants in three sites (n = 20). A subsample of participants (n = 7) consented to a qualitative interview about their experiences with the intervention. Wilcoxon signed-rank tests, Friedman tests, and one-way repeated measures ANOVA were computed for quantitative analyses. Thematic analysis was used for the qualitative interviews.

RESULTS

Results demonstrated that knowledge of AD/dementia (KAD) and preparedness for caregiving were significantly improved for all senior companions in the intervention group. Results also showed that caregivers in the intervention group reported significantly decreased caregiving burden, as well as increased KAD, satisfaction with social support, and positive aspects of caregiving. Themes from the qualitative interviews included: learning new skills about caregiving, gaining knowledge about ADRD, and benefits for the dyad.

DISCUSSIONS

Findings from this study implied that SCP Plus was a promising model for African American family caregivers as it benefits both the SC volunteers and the African American ADRD family caregivers.

It Gave Me Somebody Else to Think About Besides Myself: Caring Callers Volunteer Experiences With a Telephone-Based Reassurance Program for Socially Isolated Older Adults

The Caring Callers Program was developed as a telephone-based intervention utilizing Senior Companion volunteers to reach older adults at greater risk for loneliness during the COVID-19 pandemic. This pilot program consisted of trained volunteers who provided supportive, weekly calls as well as community resources with their Caring Callers clients. The purpose of this study was to qualitatively explore the experiences of Senior Companion volunteers in the Caring Callers Program through the lens of productive aging. We completed semi-structured interviews with 18 Caring Callers volunteers. We used Rapid and Rigorous Qualitative Date Analysis (RADaR) which yielded four themes: (1) reciprocity; (2) purposeful use of time; (3) learning new skills; and (4) gaining perspective. Our findings provide insight for gerontological researchers examining volunteering as a productive aging activity and offer strategies for designing peer-led, telephone-based interventions to promote social connectedness in an unprecedented time.

Domestic Violence Survivorship Among a Sample of Older African American Women: An Interpretative Phenomenological Analysis

African American women experience domestic violence at a rate that is 35% higher than the domestic violence rate of White women. Moreover, African American women encompass 8% of the US population but account for 22% of domestic violence-related homicide victims. African American women are at greater risk for facing economic difficulties, homelessness, unemployment, and health and educational disparities due to domestic violence. However, little attention has been given to the lived experiences of older women who are domestic violence survivors. Theories of phenomenology and hermeneutics provided the theoretical framework for this study. An interpretative phenomenological analysis framework guided the research design and data analysis process. Overall, the findings pointed toward the need for generating more culturally sensitive and culturally tailored programs and services to address domestic violence in the African American community. Additionally, services are needed that include faith-based education, training, and prevention programs to enable churches and social workers to address the unique cultural needs of African American women who have endured domestic violence.

Socially assistive robotics and older family caregivers of young adults with Intellectual and Developmental Disabilities (IDD): A pilot study exploring respite, acceptance, and usefulness

Introduction

The need for caregiver respite is well-documented for the care of persons with IDD. Social Assistive Robotics (SAR) offer promise in addressing the need for caregiver respite through ‘complementary caregiving’ activities that promote engagement and learning opportunities for a care recipient (CR) with IDD. This study explored the acceptability and usefulness of a SAR caregiver respite program responsive to feedback from both young adults with IDD and their older family caregivers (age 55+).

Method

Young adults with IDD and caregiver dyads (N = 11) were recruited. A mixed methods research design was deployed in three phases: Phase I with four focus groups to inform the program design; Phase II for program demonstration and evaluation with pre- and post-surveys; and Phase III with post-program interviews for feedback and suggestions.

Results

Both young adults with IDD and their caregivers scored favorably the social presence of, social engagement, and satisfaction with robot Pepper. Though there was no significant improvement of caregiving burden/stress as well as well-being of the young adults with IDD based on surveys, results from interviews suggested that the SAR may offer physical/emotional respite to caregivers by providing companionship/friendship as well as promoting independence, safety/monitoring, and interactive engagement with children.

Discussion

SAR has potential in providing respite for older family caregivers. Future studies need a longer program design and larger sample size to develop a promising intervention and test its feasibility and efficacy.

"Please Don't Let Academia Forget about Us:" An Exploration of Nursing Home Social Work Experiences during COVID-19

Nursing home social workers are on the frontlines during COVID-19 responding to individual resident needs, the needs of staff, and larger health needs of the nursing home. However, it is unclear whether nursing home social workers feel adequately trained and prepared in responding to disasters, such as COVID-19. To explore this, we used a study cross-sectional survey distributed via social media focusing on 1) prior training on disaster preparedness, 2) any content social workers wish had been a part of their education, and 3) suggestions for educators/academics to serve social workers on the frontlines. Data in this study are based on a sample of 63 (N=63) nursing home social workers. Demographic data were analyzed using SPSS and qualitative data were analyzed using the RaDar (rigorous and accelerated data reduction) technique. Findings revealed that most social workers had little to no training in disaster preparedness, and shared areas of future education initiatives. Participants also shared the need for bridging the research to practice gap through open access articles and support from academics. Findings from the present study reveal areas social work programs can expand gerontology-focused course offerings. Additionally, developments promoting practitioner support from academics is worth consideration.

Big and Mini: A Promising Intergenerational Program for Social Connections

Introduction: To help older adults cope with loneliness during COVID-19, a weekly, telephone-based intergenerational program called “Big and Mini” was created in April 2020 to link young and older adults together. As part of an evaluation of Big and Mini, a survey with both close and open-ended questions was sent to participants. Methods: A total of 63 Bigs and 53 Minis completed the survey. Their stress compared to before COVID-19, loneliness, life satisfaction, intergenerational closeness, and satisfaction with the program were measured for participants. Descriptive, bivariate correlation and conventional content analyses were conducted. Results: On average, Bigs and Minis had participated in the program for 3.73 and 3.49 months, respectively. Approximately half of the Bigs (47.6%) and Minis (52.8%) felt the same stress level compared to before COVID-19. A few participants felt “less stressed” compared to before COVID -9 (14.3 and 7.5%, respectively, for Bigs and Minis). All participants reported medium levels of loneliness, high levels of satisfaction with life, satisfaction with the program, and intergenerational closeness. Content analysis suggested that the reasons to join or expectations of the program were friendship, mutually beneficial intergenerational connections, and coping with loneliness. Conclusions: The Big and Mini program offers a promising approach with mutual benefits for participants. Strategies to improve the program and implications for intergenerational programs are presented.

Empirically Evaluated Suicide Prevention Program Approaches for Older Adults: A Review of the Literature from 2009-2021

Mental health in later life and suicide risk among older adults are important topics for social work. There is evidence-based research to support the use selective and indicated strategies for suicide prevention, yet, universal prevention approaches are also needed. However, the extent to which the broader contexts of suicide have been examined remains largely absent from the literature. This article presents findings from a systematic review of articles published between 2009 and 2021, focusing what types of empirically evaluated suicide prevention programs effectively prevent and reduce suicidality in older adults. Using the PICO and PRISMA guidelines, a final sample of 8 articles were reviewed in this systematic review. The articles were categorized into three types of programs: 1) primary and home health care, 2) community-based outreach, and 3) counseling. The articles also examined the involvement of social workers in these programs. Following a description of the articles, the authors assess each study using the GRADE rating system. Lastly, the authors discuss the role of the social worker in mental health promotion and prevention strategies.

The Porchlight Project: A Pilot Study to Adapt the Senior Companion Program to Enhance Memory Care Services and Supports

Older adult volunteer programs present an important opportunity to provide low cost, community-based support to families living with Alzheimer's disease and Alzheimer's disease related dementias (AD/ADRD). In this mixed methods pilot study, volunteers (n = 15) from the Minnesota Senior Companion Program received training in AD/ADRD and palliative care, with the objective of providing more "dementia capable" support to people living with memory loss and their family caregivers. Volunteers applied their skills by engaging clients in a series of guided conversations over 3 months of dementia capable visits. Despite enrollment challenges, volunteers, clients, and caregivers reported that the intervention was appropriate and useful to improve understanding of memory loss and enhance volunteer-client communication. Results of the pilot study were used to refine the Porchlight Project for a future statewide evaluation.

Nursing Home Social Workers Perceptions of Preparedness and Coping for COVID-19

OBJECTIVES

Social work has a long history of responding to the needs of vulnerable populations during times of crisis and disaster. Social workers are working at the front lines responding to the current COVID-19 pandemic in a variety of health care practice settings, including nursing homes; however, it is unclear how social workers perceive their preparedness during this time.

METHODS

This study employed a cross-sectional survey to nursing home social workers via social media on feelings of preparedness for COVID-19, what has been most professionally helpful for social workers during these times in their role in COVID-19, as well as demographic questions. Demographic data were analyzed using SPSS and qualitative data were analyzed using the rigorous and accelerated data reduction technique.

RESULTS

Data are based on a sample of 63 (N = 63) nursing home social workers. Findings revealed that while some social workers felt prepared for the coronavirus, many respondents stated that they were unprepared to meet the demands and challenges they were facing. Moreover, participants shared that professional support was critically important to get through COVID-19.

DISCUSSION

These findings are important, as social workers are tasked with ensuring each resident attains their highest level of psychosocial well-being, which can be achieved only when nursing home staff are supported. Findings from the present study suggest that additional support for nursing home staff ought to include peer mentoring and mutual support. Additionally, improved leadership across health care settings is worth assessing.

Using Community-Based Participatory Research Strategies in Age-Friendly Communities to Solve Mobility Challenges

The number of older adults is steadily increasing in the United States and across the globe. Aging is linked to an increased risk of disability. Disabilities that limit one or more major life activities such as seeing, hearing, walking, and motor skills impact a person's ability to drive a car. Low utilization of alternative transportation by older adults and people with disabilities may put them at risk for social isolation. Social isolation is associated with a variety of negative health outcomes. While communities are challenged to create available, acceptable, accessible, adaptable and affordable mobility options, there are widely held, inaccurate biases around older adults' abilities to contribute to the development and improvement of alternative transportation options. Gerontological social workers are well-positioned to address this bias. This paper presents a case study of a large metropolitan county in the Midwest where community-based participatory research (CBPR) strategies were used to engage older residents to support the development of alternative transportation options supporting the tenets of environmental justice.

“THEY SHOULD PUT ALZHEIMER’S GROUPS IN THE CHURCHES”: A SYNTHESIS OF AFRICAN AMERICAN CAREGIVERS’ LIVED EXPERIENCES

Alzheimer’s disease and related dementias (ADRD) are challenging chronic health conditions that disproportionately impact African Americans. Caring for a family member with ADRD can be a taxing experience that impacts the mental, social, and physical realms of the caregiver’s life. Chronic fatigue and high levels of anxiety, depression, and agitation have all been associated with caregiving. The extant literature on caregivers is limited by being conducted primarily in settings with White participants, excluding the cultural attitudes and values that may impact caregiver experience. As part of a larger, mixed-methods team studying the impact of an innovative psychoeducational intervention, the researchers conducted a qualitative interpretive meta-synthesis (QIMS) to better understand the experiences and perceptions of African Americans who care for family members with ADRD. A QIMS was chosen as the methodology for this study because of its ability to create a more holistic understanding of the phenomenon, while maintaining the integrity of the original studies. An exhaustive literature search yielded 1,285 potentially relevant studies. Studies were compared across a priori inclusion criteria. Findings of this study indicate that overall knowledge of ADRD is relatively low among caregivers and participants are unsure of how to access educational materials. Synthesis of these studies also indicate a need for incorporating spiritual well-being into caregiving services. Results of this study may help social workers and other health care professionals to better understand cultural perceptions of the disease and how to better provide psychoeducational interventions related to the specific needs of African American caregivers.

BUILDING SAFE ROUTES TO AGE IN PLACE THROUGH PARTNERSHIPS WITH AGE-FRIENDLY COMMUNITIES

Participation in active transportation by older persons has been associated with higher quality of life and longevity. Efforts across the United States to increase active transportation (walking, biking and fixed route transportation) by older adults have lacked meaningful input by older adults, are non-theoretical and have had inconclusive results. This paper describes the findings from Phase 1 of the Safe Routes to Age in Place project, a collaboration between Age-Friendly Franklin County, The Ohio State University (OSU) and the University of Texas-Arlington (UT-A), funded by the Ohio Department of Transportation. The aim of the study is to increase the options and safe utilization of active transportation by older persons in three pilot neighborhoods in Franklin County, Ohio utilizing community-based participatory action research strategies with a customized data collection app, MyAmble. The purpose of Phase 1 was to engage city and regional planning students, government officials and older adults to identify “hot spots” in the three pilot neighborhoods. Heat mapping of community data including locations of densely-populated vulnerable older adults, fixed transportation routes, bus stop signage and benches, shared bike stations, bike routes, paratransit routes and pedestrian crash data was completed. Maps were used to identify areas of focus and discussions with municipal leaders and older adult residents further refined target areas to be used in the second phase of the study. Older residents completed walk audits using the MyAmble app and identified issues with sidewalks, crosswalk timers and bus stops. Implications related to age-friendly communities and active transportation are offered.

MISSING VALUE IMPUTATION VIA GRAPH COMPLETION IN QUESTIONNAIRE SCORES FROM PERSONS WITH DEMENTIA

Background: Questionnaires are widely used to evaluate cognitive functions, depression, and loneliness of persons with dementia (PWDs). Successful assessment and treatment of dementia hinge on effective analysis of PWDs’ answers. However, many studies, especially pilot ones, are with small sample sizes. Further, most of them contain missing data as PWDs skip some study sessions due to their clinical conditions. Conventional imputation strategies are not well-suited as bias will be introduced because of insufficient samples. Method: A novel machine learning framework was developed based on harmonic analysis on graphs to robustly handle missing values. Participants were first embedded as nodes in the graph with edges derived by their similarities based on demographic information, activities of daily living, etc. Then, questionnaire scores with missing values were regarded as a function on the nodes, and they were estimated based on spectral analysis of the graph with a smoothness constraint. The proposed approach was evaluated using data from our pilot study of dementia subjects (N=15) with 15% data missing. Result: A few complete variables (binary or ordinal) were available for all participants. For each variable, we randomly removed 5 scores to mimic missing values. With our approach, we could recover all missing values with 90% accuracy on average. We were also able to impute the actual missing values in the dataset within reasonable ranges. Conclusion: Our proposed approach imputes missing values with high accuracy despite the small sample size. The proposed approach will significantly boost statistical power of various small-scale studies with missing data.

NAO TAKES A BOW: USING SOCIAL ROBOTS TO ENHANCE THE MOOD OF OLDER ADULTS LIVING IN RESIDENTIAL CARE SETTINGS

Social robots have been utilized in research with older adults, however, few studies have integrated participatory arts (e.g. theatre) into social robotic platforms with this population. An interdisciplinary team designed an intervention integrating theater and social robotics with the aim of improving the mood of older adults. A purposive sample of persons age 65 and older (N = 15) participated in this 3-session pilot study that involved a Shakespeare activity using the robot, NAO. Mixed methods included interview questions as well as short survey measures of depression, loneliness, and a simplified face scale for mood pre and post each session. Results from Repeated Measurement Analysis of Variance (ANOVA) showed that face scale scores significantly decreased across six time periods (F = 2.72 (5, 50), p <. 05) and this decrease marginally differed between participants with dementia (M = 2.50, SD = 1.73) and those without dementia (M = 1.62, SD = 0.52). In addition, depression scores marginally significantly decreased after intervention (F = 2.28 (5, 40), p <. 10) and these declines were also marginally significantly different for participants with (M = 0.67, SD = 0.58) or without dementia (M = 0.86, SD = 0.69). Qualitative findings suggest that participants were highly engaged and responsive to the intervention. We discuss the promising aspects of using social robotics as a platform for participatory arts interventions with older adults and offer recommendations for future interdisciplinary studies involving the use of innovative technology in residential care settings.

Turning Doctoral Students into Faculty in Gerontological Social Work: The AGESW Experience

Developing faculty interested in aging may help social work meet the needs of our growing aging population. However, doctoral students need a variety of supports to complete PhDs and become gerontological social work faculty. This study explored one program's role in supporting the development of social work doctoral students to faculty in gerontology. An e-mail invitation was sent to all former participants (2010-2016 cohorts) of the Association for Gerontology Education in Social Work (AGESW) Pre-Dissertation Fellows Program (PDFP). The 38-question online survey consisted of Likert-type scales, multiple answers, and one open-ended question per section about the program's impacts on their academic career development in teaching, research, mentoring, and support. Forty-five respondents, representing all six cohorts, completed the survey. More than half reported that the PDFP contributed to their ability to publish their research (64.4%, n = 29), grow their professional network (86.7%, n = 39, and teach (55.5%, n = 25). Doctoral programs provided different experiences than the PDFP, including mentoring, methodological training, professional development, networking, and peer support. Results suggest the PDFP provides content recipients value that supplements instruction received in their institutions. The program's ability to connect students to each other and to national leaders enhances their career development and socialization into academic roles.

What Can an Evaluation of the AGESW Predissertation Fellows Program Tell Us about the Mentoring Needs of Doctoral Students?

Good mentoring is a key variable for determining success in completing a doctoral program. The Association for Gerontology Education in Social Work (AGESW) provides leadership in the areas of gerontological social work education, research, and policy. In 2010, AGESW began offering the Pre-Dissertation Fellows Program (PDFP) to enhance social work doctoral students' professional development and skillset for academia. The purpose of this study was to examine student participants' perceptions of the PDFP in its role to providing mentorship and training for an academic position that encompasses research, teaching and professional service. This qualitative study examined eight cohorts (2010-2018) of the AGESW PDFP (N = 85). Participants identified a number of aspects of professional development gained, gratitude for the training, an appreciation for candid advice received, and areas of professional development they felt they were lacking within their doctoral training. Implications for doctoral education, doctoral mentorship programs, and the AGESW pre-dissertation program are discussed. Further, programs such as AGESW pre-dissertation fellowship program can serve as a model for other doctoral training initiatives to prepare students to work in academia.

Using Social Network Analysis to Assess Professional Network Development among AGESW Pre-Dissertation Fellowship Program Participants

Professional networks are important for the success of doctoral students and early career faculty members, yet there is little research about what types of experiences help emerging scholars develop these networks. Social network analysis may be an ideal method for studying the effectiveness of training programs in nurturing network development among emerging scholars. We describe one application of this method, which was used to examine the professional networks formed through participation in the Association of Gerontological Education in Social Work (AGESW)'s Pre-Dissertation Fellowship Program (PDFP). Alumni (n = 12) from the first three cohorts of the program (2010-2012) reported meeting an average of 20 scholars (SD = 13.2) through AGESW, which led to potential professional interactions and collaborations on conference presentations and manuscripts. Although challenges with missing data limited the conclusions that can be drawn, we find that this method holds promise for helping to identify key factors that facilitate professional network development in pre-dissertation training programs such as the PDFP.

Utilizing the Senior Companion Program as a platform for a culturally informed caregiver intervention: Results from a mixed methods pilot study

To address the need for accessible, affordable, and sustainable Alzheimer's disease and related dementia caregiver interventions with minority populations, we developed the Senior Companion Program Plus, a three-phase pilot study that used a mixed methods experimental design. The intent was to determine if participation in a lay provider, peer-led psychoeducational intervention designed for African American Alzheimer's disease and related dementia caregivers (N = 16) improved caregiver burden and/or stress, coping skills, and social support. Focus groups with Senior Companions informed the intervention design. Quantitative results indicated that caregivers experienced improvement in their overall level of social support and well-being in meeting basic needs. Qualitative findings suggested that caregivers experienced improvement in their knowledge about the disease, experienced increased coping with Alzheimer's disease and related dementia caregiving, and reported benefits of using a lay provider model. Overall, the data suggest that the Senior Companion Program Plus is a promising intervention for African American Alzheimer's disease and related dementia caregivers.

Providing Care for Persons with Dementia in Rural Communities: Informal Caregivers' Perceptions of Supports and Services

Dementia is one of the costliest and most time-consuming diseases among older persons. Although informal caregivers provide the majority of care for persons with dementia, little is known about the self-perceived need for social services of caregivers of persons with dementia within rural areas. This pilot study examined the knowledge, access and intent of the practice-oriented service model of caregivers of persons with dementia in rural communities in the Midwest U.S. After a systematic training, researchers interviewed 11 rural caregivers of persons with dementia (n = 11). Data were analyzed using thematic analysis. Although similarities with other caregivers of persons with dementia were found, important differences suggesting unique issues among these rural caregivers of persons with dementia. Many participants found strength in their community, which often served as a safety net of support. Consistent with existing literature, participants expressed financial concerns, geographic barriers and lack of dementia-specific services when using formal services. The need for more specialized formal services in rural areas to supplement existing informal care networks is discussed. Policies and services based on rural caregivers' unique concerns and challenges and that build upon their existing care networks are recommended.

Caregiver Burden and Desire for Institutional Placement-The Roles of Positive Aspects of Caregiving and Religious Coping

Based on stress coping theory, this study investigated whether and how positive aspects of caregiving (PAC) and religiosity buffered the association between caregiving burden and desire to institutionalize (DTI). Secondary data (N = 637) were drawn from the baseline assessment of the Resources for Enhancing Alzheimer's Caregiver Health II project. Descriptive analysis, bivariate correlation, and multiple linear regressions were conducted. The results indicated that higher levels of caregiver burden, daily care bother, and Revised Memory and Behavioral Problem Checklist bother were all significantly associated with higher level of DTI. Both PAC and religious coping were negatively associated with DTI; however, only PAC was significant. Only the interaction between daily care bother and religious coping was significant, which indicated that the harmful effect of daily care bother on DTI was significantly buffered among those who have religiosity. Study findings have important implications for policy makers and for providers who serve dementia family caregivers.

The Social Construction of "Emerging Elders": Implications for Age-Friendly Community Assessments

The term “emerging elders” has surfaced in age-friendly community assessment tools to denote a subset of older adults; however, limited guidance is provided on its application to aging populations. The goal of this study was to develop a data-driven conceptualization of “emerging elders” as part of an age-friendly community assessment. Adults, aged 55 years and above, were asked about their subjective meaning of “emerging elder” within the context of a larger study of aging well in a large U.S. metropolitan city. Using inductive and deductive methods, the researchers analyzed qualitative data (N = 38) collected from individual interviews with homebound older adults (n = 15) and participants of three focus groups (n = 23). Four themes suggest that emerging elderhood is related to chronological age, functional ability, transitions, and self-identity. Findings suggest that the term emerging elderhood may foster negative images of older adults consistent with Western cultural discourse, despite the positive connotations associated with “emerging elder” in indigenous and spiritual communities. Findings underscore the need to further refine age-friendly community assessments that take into account the social constructions ascribed to older adults and need for strategies to engage emerging elders in future research of age-friendly communities.

Sizing up assisted living: an examination of long-term care ombudsman complaint data

Long-term care ombudsmen are resident advocates who receive, investigate, and resolve complaints relating to quality of care and violations of resident rights in assisted living (AL). More research is needed to understand systemic differences in source, type, and number of ombudsman complaints in AL. Ombudsman complaint data (n = 5,705 complaints) in small, medium, and large ALs in Dallas, Texas were analyzed using proportion Z tests. Findings suggest that all facilities had a high number of environmental complaints. Compared to larger facilities, small ALs have a disproportionately high number of complaints, a significantly higher number of complaints related to access to information, visitors, and ombudsmen, lower number of complaints related to care and staffing, family are less likely to complain, and residents are least likely to voice concerns. We recommend strategies for ombudsmen and AL providers to better meet residents' needs. We conclude with a call to action underscoring the increasing importance of the role of the ombudsman in AL.

Using the Eco-Map and Ecosystems Perspective to Guide Skilled Nursing Facility Discharge Planning

Growing numbers of seniors across the United States require skilled nursing facility care after an inpatient hospital stay. Previous studies indicate that roughly 20 percent of all hospitalized Medicare beneficiaries are admitted to a skilled nursing facility following a qualifying hospital stay. Social workers address psychosocial problems, social support, networks, and healthcare needs during transitions in care, particularly discharge planning. Ecosystems perspective and the eco-map as a discharge planning tool is presented. Social workers can use these tools to examine the patient with respect to their transactional relationships with systems. This will further will facilitate provision of wrap-around services upon discharge.

Marital Status and Persons With Dementia in Assisted Living

Despite the prevalence of dementia among residents in assisted living (AL), few researchers have focused on the length of stay (LOS) in AL among this population. Little is known about the factors that may contribute to LOS in these settings, particularly for residents with dementia. In the current study, a sub-set of AL residents with dementia (n = 112) was utilized to examine whether marital status was associated with LOS in AL as this has received sparse attention in previous research despite studies suggesting that marital status influences LOS in other health-care and long-term care settings. The Andersen-Newman behavioral model was used as a conceptual framework for the basis of this study of LOS, marital status, and dementia in AL. We hypothesized that persons with dementia who were married would have longer LOS than unmarried persons with dementia in AL. Cox regression was used to examine the association between marital status and LOS in AL of residents with dementia and whether activities of daily living were related to discharge from AL settings among married and unmarried residents with dementia. Main effects for marital status and the interaction between marital status and mobility with LOS were examined. Study findings provide information related to the psychosocial needs of AL residents with dementia and offer implications for assessing the on-going needs of vulnerable AL residents.

Exploring the Personal and Environmental Factors Related to Length of Stay in Assisted Living

This study explored to what extent personal and environmental factors, as defined by the ecological model of aging, help us to understand length of stay in assisted living (AL). A convenience sample (N = 218) of administrative records of AL residents admitted between the years 2006 and 2011 was collected and included AL residents' demographic and healthcare information as well as dates of admission and discharge. Cox regression was used to determine which personal and environmental factors influenced length of stay in three AL programs. Number of medical diagnoses, level of care score, and facility were found to be significant predictors of length of stay. The analyses identified a median survival time of 32 months as well as critical periods for discharge from AL. Implications for future research and social work practice are presented.

Beyond respite: the role of adult day services in supporting dementia caregivers

Adult day services (ADS) are the leading provider of community-based care for persons with dementia and their caregivers. While the provision of caregiver respite is well-documented, little is known about the provision of other forms of dementia caregiver support. Logistic regression analyses of ADS providers (N = 297) in the MetLife Study indicated that the number of hours of social work support was a significant predictor of case management services, while nonprofit status was a significant predictor of caregiver education and support groups. These findings have implications for practice and policy related to this growing provider of dementia services.

Inclusion or exclusion? Exploring barriers to employment for low-income older adults

Faced with economic uncertainty and declining retirement security, older adults have increasingly tried to remain in, or return to, the workforce in recent years. Unfortunately, a host of factors, such as ageism and changing skill requirements, present challenges for older adults seeking employment. Low-income older adults, in particular, may lack necessary education and skills and have limited access to job opportunities and training. In this review, we examine factors that inhibit and support employment for low-income older adults and explore the role of social work in facilitating their inclusion in the workforce.

The effectiveness of adult day services for older adults: a review of the literature from 2000 to 2011

Adult Day Service (ADS) centers offer a variety of services to meet the needs of older adults and their caregivers. During the last decade, ADS has received increased attention due to shifts in policy toward home and community-based services for an aging population. This article reviews the effectiveness of ADS from 2000 to the present, with particular attention given to caregiver and participant outcomes, health care utilization, and future directions in ADS research. Multiple databases were searched to identify relevant research and 61 articles were selected for review based on inclusion criteria. The results of this review emphasize the need to implement and test more specific interventions targeting the needs of the ADS population.

Understanding the impact of early-life trauma in nursing home residents

Reactions to early life trauma can reemerge or be exacerbated in later life as coping resources and abilities are compromised by age-related changes and declines in health. For newly admitted nursing home residents, this can impact their receptiveness to assistance with care and elicit challenging reactions to environmental and situational triggers. Unfortunately, current assessment tools fail to account for reactions to early-life trauma. In this article, we review existing literature on early-life trauma and aging and introduce a hypothetical case to illustrate the importance of identifying nursing home residents with past trauma experiences.

The role of the gerontological social worker in assisted living

This qualitative study reports on thirteen assisted living (AL) administrators' perspectives of the role and the importance of the AL social worker in addressing the unmet needs of older adults as they move and transition into AL. Participant interviews were analyzed using the constant comparative method. Administrators described 5 AL social work roles: (a) decision-making and adjustment coordinator; (b) resident advocate; (c) mental health assessor and counselor; (d) family social worker; and (e) care planner. Implications include directly examining AL social workers' views, analyzing costs and benefits of employing AL social workers, and developing social work practicum sites within AL.