American Association Of Retired Persons Research Articles

Higher levels of state funding for Home- and Community-Based Services linked to better state performances in Long-Term Services and Supports.

To examine the relationship between the level of state funding for Home- and Community-Based Services (HCBS) and state overall and dimension-specific performances in Long-Term Services and Supports (LTSS). We employed state-level secondary data from the Medicaid LTSS Annual Expenditures Reports, the American Association of Retired Persons (AARP) State Scorecards, the U.S. Census, and Federal Reserve Economic data, spanning the timeframe of 2010-2020. Overall state LTSS rankings, along with dimension-specific rankings, were modeled separately against state Medicaid spending on HCBS relative to total Medicaid spending on LTSS. All models were adjusted for state covariates, secular trend, and state fixed effects. The study sample included all 50 states and the District of Columbia. However, California, Delaware, Illinois, and Virginia were excluded from FY2019 due to missing data on Medicaid HCBS expenditures. Every 10 percentage-point increase in the proportion of Medicaid LTSS spending to HCBS demonstrated 2.05 points improvement (95% confidence interval [CI]: -3.88 to 0.22, p = 0.03) in rankings for state overall LTSS system performance, 2.92 points improvement (95% CI: -4.87 to 0.98, p < 0.01) in rankings for the Choice of Setting and Provider dimension, as well as 1.73 points (95% CI: -3.14 to 0.32, p = 0.02) ranking improvement in the dimension of Effective Transitions. Our study suggested promising effects of increased state funding for HCBS on LTSS performance.

IDENTIFYING FACTORS THAT CONTRIBUTE TO THE FINANCIAL STRAIN OF HISPANIC CAREGIVERS OF OLDER ADULTS

Abstract Informal caregiving has been shown to have negative effects on the caregiver’s physical, mental, and financial health. To date, studies have mainly focused on the physical and mental health of caregivers; however, finances too are an area of caregiver vulnerability. In this study we examined which types of financial hardships are the greatest predictors of financial strain in Hispanic caregivers (N=184) for persons 50 or older. Data were obtained from the American Association of Retired Persons (AARP) Caregiving in 2020 survey, which oversampled for Hispanic caregivers. A hierarchical regression analysis was conducted to predict caregiver financial strain. Independent variables were entered in three steps: (1) age and gender, (2) emotional strain, physical strain, length of expected caregiving, and attitude towards caregiving (3) taking on more debt, borrowing money, unable to afford basic expenses, late/unpaid bills, using short-term savings, using long-term savings, being unable to save, and moving to a less expensive home. Age and gender were not significant (ΔR2=.007, p=.531). Emotional (β=.309, t=3.512, p&amp;lt;.001), and physical strain (β=.229, t=2.627, p=.009) were both predictors of financial strain (ΔR2=.312, p&amp;lt;.001). Additionally, the specific financial hardships related to financial stress above and beyond steps one and two (ΔR2=.137, p&amp;lt;.001) were being unable to afford basic expenses (β=.356, t=4.161, p&amp;lt;.001), and using long term savings (β=-.308, t=-4.372, p&amp;lt;.001). These results have implications for education and interventions concerning financial hardships and options for Hispanic caregivers of older adults.

A Follow Up to the AARP Age-Friendly Community Survey Through a Focus Group Study.

Introduction: In an effort to help communities plan for their burgeoning aging population, the American Association of Retired Persons (AARP) has facilitated community surveys to enable older adults to rate the current state of their own community for "aging in place." This Focus Group Study extended the findings of the AARP Age-Friendly Community Survey in a small-sized New England City, adding to our knowledge of an older adult population. Aim: In order to elicit the points of view of older adults in one small New England city, six focus groups were conducted via Zoom during the height of the pandemic, from the spring and fall of 2020 on the topic of aging in place. Method: The six focus groups had a total of 32 participants, all of whom were 65 years and older and living in the same New England city. Results: The challenges to aging in place small New England city that the focus group participants described included: knowing where to get complete and reliable information about vital services, the barriers to walkability, and the challenge of transportation when one can no longer safely drive. Conclusion: The Focus Group Study extended the findings of the AARP Age-Friendly Community Survey in a small-sized New England City through the voices of the older adults which led to a more nuanced understanding of what it takes to age in place. The results of the study were utilized by the city in order to write an action plan as a guide to becoming more age-friendly.

Predictive factors on caregiver burden in caregivers of individuals with cognitive impairment

Introduction Informal caregivers, mostly family members or friends, have often been required to engage in medical/nursing tasks and to navigate complex healthcare systems. It is unclear whether those activities impact caregiver burden. Therefore, the purpose of this study was to examine predictive factors of caregiver burden in consideration of healthcare-related factors (caregivers’ perception of performing medical/nursing tasks, care coordination, and number of hospitalizations). Methods Secondary analysis of cross-sectional survey data taken from the Caregiving in the U.S. 2015 was conducted. Data were collected by the National Alliance for Caregiving and the American Association of Retired Persons (AARP). Self-identified caregivers (n = 304) who provided care for individuals with cognitive impairment (ICI), and who were living in the community were participants in the study. Results The overall model explained 38.4% of the variance in caregiver burden (F = 20.48, p &lt; 0.001). When examining each factor, perceived difficulty in medical/nursing tasks (β = 0.38, p &lt; 0.001) was the most influential factor, followed by caregivers’ physical health (β = −0.27, p &lt; 0.001), income (β = −0.13, p = 0.01), and level of the care coordination (β = 0.12, p = 0.02). Discussion Although caregivers’ involvement in healthcare-related activities for ICI is necessary, this involvement has a considerable impact on caregiver burden. Healthcare providers should be cognizant of caregiver burden related to healthcare-related activities. Moreover, researchers should develop interventions and community services to decrease caregivers’ difficulty in performing their roles.

Psychosocial measures in relation to smartwatch alerts for atrial fibrillation detection

Psychosocial measures in relation to smartwatch alerts for atrial fibrillation detection

The impact of grants’ capabilities on performance of local NGOs: Evidence from developing market

This study aimed at assessing grants capacity and performance of local non-governmental organizations (NGOs) in Jordan. It also aimed to find answers to key research questions: How do grants’ capabilities affect the performance of local NGOs)? Can NGOs maintain peer connections with local actors? Finding out the impact of different grants’ capabilities on the performance of local NGOs in Jordan will allow updating and order to inform the capacity building programs that are provided to local NGOs in Jordan by various stakeholders. NGOs performance proxy developed through two bases: American Association of Retired Persons (AARP) &amp; common performance. While, grants’ capabilities are measured through five dimensions: governance and humanitarian principles, human resources, financial and accounting practices, procurement practices, and programmatic and monitoring practices. Different methods (interviews, questionnaires, and focus groups discussions) were used to collect the data from 69 local NGOs. The sample represents six groups located in different geographical areas. The study result indicates that there is a significant impact of the governance and human resource capacities on the performance of local NGOs in Jordan; while, there is no significant impact of the remaining grants’ capabilities factors on the performance of local NGOs. Finally, the study outlined the main challenges that local NGOs in Jordan face regarding access to funds

Multivitamin Use and Overall and Site-Specific Cancer Risks in the National Institutes of Health–AARP Diet and Health Study

BackgroundMultivitamins are among the most commonly used supplements in the United States, but their effectiveness in preventing cancer remains unclear. ObjectivesWe prospectively examined the association between multivitamin use and risks of overall and site-specific cancer in a large, well-characterized cohort to ascertain potential preventive or harmful relationships. MethodsWe examined 489,640 participants ages 50–71 in the NIH–American Association of Retired Persons (AARP) Diet and Health Study who were enrolled from 1995 to 1998. We linked to 11 state cancer registries in order to identify incident cancers. Multivitamin use was assessed by a baseline questionnaire. Cox proportional hazards regression models of multivitamin use were used to estimate HRs and 95% CIs for cancer risks in men and women, adjusted for potential confounders, including age, BMI, smoking, physical activity, the Healthy Eating Index 2015 score, and use of single-vitamin/-mineral supplements. ResultsA slightly higher overall cancer risk was observed in men (but not women) who consumed 1 or more multivitamins daily compared to nonusers [HRs, 1.02 (95% CI: 1.01–1.04) and 1.03 (95% CI: 1.00–1.07), respectively; P-trend = 0.002]. The latter reflected higher risks for prostate cancer (HR, 1.04; 95% CI: 0.98–1.10; P-trend = 0.005), lung cancer (HR, 1.07; 95% CI: 0.96–1.20; P-trend = 0.003), and leukemia (HR, 1.26; 95% CI: 1.02–1.57; P-trend = 0.003). Taking more than 1 multivitamin daily was also strongly positively associated with the risk of oropharyngeal cancer in women (HR, 1.53, 95% CI: 1.04–2.24; P-trend < 0.0001). By contrast, daily multivitamin use was inversely associated with the colon cancer risk in both sexes (HR, 0.82; 95% CI: 0.73–0.93; P-trend = 0.0003). ConclusionsWe found little evidence to support a cancer-preventive role for multivitamin use, with the exception of colon cancer, in both sexes in the NIH-AARP Diet and Health Study. In addition, slightly higher risks of overall, prostate, and lung cancer, as well as leukemia, were observed for greater multivitamin use in men, with a higher oropharyngeal cancer risk in women.

EAST Meets West Symposium: Community-Based Programs for Dementia Prevention and Support

This East Meets West Symposium presents cross-cultural evidence of community-based programs developed to address cognitive health needs of older adults or to support dementia family caregivers. It includes five studies from mainland China, Taiwan, and the U.S.A. The first study explored the adherence to computerized cognitive training to promote cognitive health among Chinese older adults using a qualitative approach. External encouragement, and self-awareness of performance improvement were found influential to older adults’ adherence. The second study spearheaded by American Association of Retired Persons (AARP) in the U.S.A shed further light on technology use in promoting brain health by comparing in-person versus online cognitive training to older Americans during the COVID-19 pandemic. The third study tested the effectiveness of a cognitive health management model for community-dwelling older adults including healthy and mild cognitively impaired (MCI) ones in Shanghai, China. Older adults with MCI who received the management service showed better cognition outcomes compared to their counterparts in the control group. The fourth study focused on a community program named “Carer Café”, developed to support dementia family caregiver in Taiwan. Participants (n=375) reported reduced stress and increased access to service referrals. The last study examined the stakeholders’ perceptions of dementia friendly initiatives (DFI) being implemented in U.S.A, mainland China, and Taiwan to support persons with dementia and family caregivers. The impacts of DFI made, challenges DFI faced, and strategies DFI used during COVID-19 pandemic were discussed. The discussant will comment on each article’s contributions and limitations in the context of literature.

Aging Veterans in the State of Alabama

ABSTRACT Objectives This study identifies specific target areas (health, healthcare, home stability, food stability, and caregiving status) for serving middle-aged and older military veterans in Alabama. Methods The American Association of Retired Persons (AARP) conducted a survey of Alabama military veterans (n = 556) in 2018 related to health issues, healthcare utilization, home stability, food stability, and caregiving status. Results The most prevalent health issue among Alabama veterans was high blood pressure (55.36%), followed by diabetes (30.88%), heart disease (16.49%), and cancer (14.27%). Results showed that 11.06% of veterans used mental health services in the last 12 months. While less than 5% of veterans reported hunger risk, 20.09% of veterans experienced housing instability in the last 12 months, and 9.94% of veterans reported being a caregiver. Discussion Veteran support organizations could help the veteran population by addressing health, healthcare, home and food stability, and caregiving issues. Implications and suggested interventions are discussed.

Social Isolation of Older Adults in Long Term Care as a Result of COVID-19 Mitigation Measures During the COVID-19 Pandemic

Social Isolation of Older Adults in Long Term Care as a Result of COVID-19 Mitigation Measures During the COVID-19 Pandemic

Improving perioperative brain health: an expert consensus review of key actions for the perioperative care team

Delirium and postoperative neurocognitive disorder are the commonest perioperative complications in patients more than 65 yr of age. However, data suggest that we often fail to screen patients for preoperative cognitive impairment, to warn patients and families of risk, and to take preventive measures to reduce the incidence of perioperative neurocognitive disorders. As part of the American Society of Anesthesiologists (ASA) Perioperative Brain Health Initiative, an international group of experts was invited to review published best practice statements and guidelines. The expert group aimed to achieve consensus on a small number of practical recommendations that could be implemented by anaesthetists and their partners to reduce the incidence of perioperative neurocognitive disorders. Six statements were selected based not only on the strength of the evidence, but also on the potential for impact and the feasibility of widespread implementation. The actions focus on education, cognitive and delirium screening, non-pharmacologic interventions, pain control, and avoidance of antipsychotics. Strategies for effective implementation are discussed. Anaesthetists should be key members of multidisciplinary perioperative care teams to implement these recommendations.

Architecture of a Smart Home for Aging in Place

The United States Department of Health and Human Services (2017) estimates that there are 65 million people age 60+ residing across the fifty states. A national survey conducted by the American Association of Retired Persons (AARP) indicates that 76% of people ages 55+ prefer to age-in-place and live independently (2018). The Census Bureau American Community Survey (2015) estimates that 13 million adults have difficulties living independently, 80% of which receive assistance in their private homes. However, only 50% of these homes meet the physical needs of people who choose to age-in-place (AARP, 2018). Recent advancements in technology have led to the development of smart homes. Technology can support aging-in-place and independent living by offering necessary tools for building systems that identify behavioral patterns and offer automated decision-making. However, not all older adults are customed to using technology or comfortable with being monitored with artificial intelligence (Wang et al., 2019). In response to this concern, the current study used grounded theory framework to analyze 62 interviews of people ages 55-93 to indicate if and how older adults prefer to utilize technology in their homes. The results of the study presented that while some older adults felt they might be too old to learn and use technology, nearly 85% of the interviewers agreed that incorporating technology in the built environment could benefit them. They are especially willing to learn and use technology in their homes when the benefits are related to their health, social and emotional connection, entertainment, safety, and daily chores.

Bring School Nursing Out of the Shadows: Advocacy for the Future of Nursing 2030.

School nursing is part of America's hidden healthcare system. Recently, the Institute of Medicine commissioned the Robert Wood Johnson Foundation and the AARP (formerly the American Association of Retired Persons) to review progress on its Future of Nursing 2010 study. Additionally, the AARP and the Future of Nursing Campaign for Action held town halls that focused on school nursing. This article is a summary of the testimony offered to the Future of Nursing and Campaign for Action leaders about the value that school nursing brings to the health of our nation and the recommendations for action.

Case Study: Competitive Advantage at All Costs - An Inside Look at Five Pharmaceutical Industry Practices Which Undermined Customer Relationships

This study attempts to answer the question: Over the past 35 years, what competitive business practices instituted by the pharmaceutical industry intended to drive increased competitiveness and business efficiencies had the unintended results of increasing the publics’ general distrust and dissatisfaction with the industry? This paper takes a unique perspective by analyzing five apparently disparate business practices designed to improve business performance but which also increased customer distrust and dissatisfaction of the industry. Specifically the five business practices were:Reliance on pharmaceutical marketers with MBAs but limited or no practical pharmaceutical selling experience.The loss of independent pharmacies and pharmacists as customers due to the rise in national pharmacy chains.Purchase and use of physician-specific prescribing dataUse of direct to consumer advertising for prescription drugsDelaying generic competition and providing industry support for the Affordable Healthcare Act in exchange for U. S. government prohibition against the importation of low cost prescription drugs into the U.S. and prohibiting negotiated Medicare drug prices.The paper uses a case study methodology. The results section details the practices reviewed in this case study and suggests they did improve competitiveness and efficiencies, but also contributed to erosion in customer confidence which includes key customer groups: physicians, pharmacists, patients and payers. Consumer groups such as American Association of Retired Persons (AARP) are focusing both financial resources and membership efforts to advocate for changes in pharmaceutical industry pricing and marketing practices. To see if this phenomenon has occurred in other industries, it was observed that the airlines, fast food and information technology industries also pursued greater business efficiencies. The discussion section suggests they too experienced and continue to experience significant customer relationship issues resulting from the drive for greater efficiencies, including government intervention to address customer concerns. The conclusions review some of the limitations of this study and suggest areas for additional research.

The Impact of Performing Medical/Nursing Tasks at Home Among Caregivers of Individuals With Cognitive Impairment.

Caregiving for older adults with cognitive impairment can be more difficult as caregivers are required to perform medical/nursing tasks at home. Little is known about medical/nursing tasks and their relationship to caregivers' characteristics and their effects on caregiver burden. Secondary data analyses were conducted with 423 caregivers of individuals with cognitive impairment from the 2015 National Alliance for Caregiving (NAC) and American Association of Retired Persons (AARP) data. In terms of the caregiving context, caregivers who performed medical/nursing tasks lived with the care recipients and provided longer hours of care than caregivers who did not perform medical/nursing tasks. When caregivers delivered medical/nursing tasks, they were 2 times more likely to experience higher levels of caregiver burden. Medical/nursing tasks can exacerbate caregiver burden. Health care providers' explanations of the needs and the benefits of performing medical/nursing tasks, as well as education and training for the tasks, are needed to reduce caregiver burden.

State of the clinical science of perioperative brain health: report from the American Society of Anesthesiologists Brain Health Initiative Summit 2018

Cognitive recovery after anaesthesia and surgery is a concern for older adults, their families, and caregivers. Reports of patients who were 'never the same' prompted a scientific inquiry into the nature of what patients have experienced. In June 2018, the ASA Brain Health Initiative held a summit to discuss the state of the science on perioperative cognition, and to create an implementation plan for patients and providers leveraging the current evidence. This group included representatives from the AARP (formerly the American Association of Retired Persons), American College of Surgeons, American Heart Association, and Alzheimer's Association Perioperative Cognition and Delirium Professional Interest Area. This paper summarises the state of the relevant clinical science, including risk factors, identification and diagnosis, prognosis, disparities, outcomes, and treatment of perioperative neurocognitive disorders. Finally, we discuss gaps in current knowledge with suggestions for future directions and opportunities for clinical and translational projects.

Abstract 3331: Association of lifestyle and clinical characteristics with receipt of radiotherapy treatment among women diagnosed with DCIS in the National Institutes of Health-AARP Diet and Health Cohort Study

Abstract Introduction: The long-term risks and benefits of breast radiotherapy for the treatment of ductal carcinoma in situ (DCIS) remain unclear. A recent study using data from the Surveillance, Epidemiology and End Results (SEER) registries showed that DCIS-associated radiotherapy treatment significantly increased risks of second non-breast cancers. To help disentangle those observations and understand whether breast cancer risk factors are related to radiotherapy treatment decision making, we aimed to identify factors associated with receipt of radiotherapy treatment for DCIS. Methods: Accordingly, among 1,628 women with DCIS who participated in the large prospective National Institutes of Health (NIH)-AARP (formerly American Association of Retired Persons) Diet and Health Cohort Study, that were diagnosed between study entry and follow up (through 31st December 2011) and eligible for inclusion, we examined associations between demographic, lifestyle and clinical factors and receipt of radiotherapy treatment. Odds ratios and 95% confidence intervals (CIs) were estimated from multivariable logistic regression models, to determine associations. Results: Among women diagnosed with DCIS, 45% (n=730) received radiotherapy treatment. No relationships were observed between receipt of radiotherapy and lifestyle factors including smoking status. The strongest associations were observed for clinical factors. Receipt of radiotherapy was associated with a more recent diagnoses period (2005-2011 versus 1995-1999; OR=1.60, 95%CI: 1.14, 2.25), diagnosis within eastern (Michigan/New Jersey) versus western US states, (OR=1.44, 95%CI: 1.07, 1.93), poorly than well-differentiated tumours (OR=1.69, 95%CI: 1.16, 2.46) and receipt of endocrine therapy (OR=3.37, 95%CI: 2.56, 4.44). Discussion: Clinical characteristics of the DCIS and temporal trends in radiotherapy use were the strongest determinants of radiotherapy treatment within this population. Receipt of radiotherapy was largely unrelated to lifestyle factors suggesting that the previously observed associations in SEER between radiotherapy treatment and risk of non-breast cancers were likely not confounded by lifestyle factors including smoking status. Thus, these findings are relevant for understanding the aetiology of subsequent secondary cancers among the increasing population of DCIS survivors. The lack of association observed for breast cancer family history and prior breast biopsy suggest that these risk factors do not influence radiotherapy clinical decision making. Citation Format: Maeve Mullooly, Diana R. Withrow, Rochelle E. Curtis, Shaoqi Fan, Linda M. Liao, Ruth M. Pfeiffer, Amy Berrington de Gonzalez, Gretchen L. Gierach. Association of lifestyle and clinical characteristics with receipt of radiotherapy treatment among women diagnosed with DCIS in the National Institutes of Health-AARP Diet and Health Cohort Study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 3331.

Unmet Needs for Information and Support Among Military Caregivers.

In the United States, there are 5.5 million military caregivers, defined as family members, friends, or other acquaintances who provide essential care and support to current or former military service members. This study describes the prevalence and predictors of unmet information and support needs in this unique group of caregivers. Until recently, little research has focused on military caregivers. In 2014, a comprehensive RAND report underscored the specific challenges experienced by military caregivers including greater physical, financial, and emotional strain when compared with civilian caregivers. Of note, compared to civilian caregivers, military caregivers provide care and support for care recipients who are more likely to have complex illness. While this recent research improved our understanding of the increased burden associated with military caregiving, it also identified gaps for future work, including the need for additional studies to better understand unmet information and support needs to inform future interventions. The current study was designed to address this gap. We examined data collected in the Caregiving in the U.S. Survey, a cross-sectional online survey fielded in 2014, by the National Alliance for Caregiving and the American Association of Retired Persons (AARP) for primary caregivers who had been in the role for at least six months. Four outcomes representing unmet caregiver needs were examined measuring caregiver report of needing more help or information to: (1) keep the care recipient safe at home; (2) manage challenging behaviors such as wandering; (3) manage their own emotional and physical stress; and (4) make end-of-life decisions. Survey-weighted logistic regression was used to test associations between military caregiver status (military/civilian) and unmet needs while controlling for key socio-demographic, caregiving and care recipient health variables, with nationally generalizable results. Compared to their civilian counterparts, military caregivers had significantly higher odds of reporting need for information or support to make end-of-life decisions (OR = 2.22; 95% CI: 1.24, 3.97; p = 0.01) and marginally higher odds of reporting need for more information or support to manage physical and emotional stress (OR = 1.64; 95% CI: 0.93, 2.88; p = 0.08). In contrast, military caregivers had significantly lower odds of reporting need for more information or support to keep the care recipient safe compared to civilian caregivers (OR = 0.54; 95% CI: 0.30, 0.95; p = 0.03). Reports of unmet needs related to managing challenging behaviors were similar between military and civilian caregivers. Needs for information and support differ for civilian and military caregivers and may reflect direct or indirect impacts on caregivers arising from differences in TRICARE and Veterans Affairs health insurance coverage and related benefits, services and systems or access to resources that address the unique needs of military populations. Future research is needed to better understand the unique concerns of military caregivers and inform interventions that support end-of-life care decision-making for military service members and their caregivers.

Factors Associated With Opinions About Hospice Among Older Adults: Race, Familiarity With Hospice, and Attitudes Matter.

Attitudes and opinions about end-of-life care among older adults are understudied. Using survey data from the American Association of Retired Persons (AARP) membership in Florida (N = 2714), this study identified predictors of opinions about hospice (OAH) among older adults. Relationships between race/ethnicity and attitudes were also examined. Results showed race of the respondent was the strongest predictor of one's OAH. Predictors of positive opinions of hospice included being of Caucasian race, non-Hispanic ethnicity, better health, greater familiarity with hospice, a high importance of pain control, the importance of fulfilling personal goals, a desire to have health-care professionals involved in one's care, and having engaged in advance care planning. These findings suggest a need for greater attention to culture-based elements in future research and practice.

The association of dietary quality with colorectal cancer among normal weight, overweight and obese men and women: a prospective longitudinal study in the USA

ObjectiveLower body mass index (BMI) and higher dietary quality reduce the risk of colorectal cancer (CRC). A full understanding of how these associations vary by sex and weight is lacking.MethodsWe...