Number Of Older Adults Research Articles

EHealth literacy in older adults with cancer

ObjectiveRecent advances in health monitoring technology have coincided with increases in the number of older adults with cancer, many of whom report difficulty using health information technology (HIT). Previous studies have identified lower electronic health (eHealth) literacy among older adults (≥65 years) compared to younger adults (<65), but studies in older adults with cancer are limited. The goal of this study was to examine age differences in eHealth literacy and use of technology devices/HIT in patients with cancer, and characterize receptivity towards using home-based HIT to communicate with the oncology care team. Materials and MethodsPatients (n = 198) in a Radiation Oncology clinic were offered an anonymous written questionnaire assessing demographics, eHealth literacy (eHealth Literacy Scale), current use of HIT, and interest in using home-based HIT. Results and ConclusionCompared to younger patients, older patients had significantly lower eHealth literacy (p < .01), and were less likely to feel confident evaluating health resources on the Internet (p < .01) or knowing how to use the health information found on the Internet to help them (p < .01) or answer health questions (p = .01). Older patients were also less likely than younger patients to have an email address (p = .04), own a smartphone (p < .01), or use the online patient portal (p = .03). Regardless of age, most patients were not opposed to using home-based HIT to communicate with their oncology care team. Future studies on HIT use in older adults with cancer should further evaluate barriers to using HIT and ways to maximize implementation and accessibility.

Role of bioengineering and laborers in integration of farmland resources toward to improve dimension of sustainable agriculture in China

ABSTRACT Farmland transfer is one of the essential approaches for achieving large-scale farming and its management affects productive efficiency, environment pollution and food sustainable security supply. Present study was carried out investigation based representative agricultural development area Guanzhong Plain of Shaanxi, aimed at explore the role of biotechnology and laborers in integration of farmland toward to improve sustainable agriculture in rural China by employed the profit and Tobit models evaluation. The conclusion demonstrated that labor’s and agricultural management model as main stay, intensive farming has positive effect-based economic and environmental benefits than fragmentation management, female laborers have weaker effect on farmland renting-out behavior among smallholders while male laborers were superior promoters in increasing the area of rented-in farmland and farm scale. Finally, bioengineering development and agricultural intensification management as a rational choice that has great potential value for large-scale cultivation that contributing a promising future for achieving cleaner production, environment and human health further providing huge economic and social and environmental benefits in sustainability agriculture. Additionally, government policies require intensive intervention to accelerate large-scale management and biotechnology implementation. Abbreviation: Aaflf: Average age of female labor force; Incom(log): Log of annual household income; Noflf: Number of women in the labor force; Nooaf: Number of old adults in family; NTFs: non-transfer families; OLS: ordinary least square; Palff: Proportion of agricultural laborers in the female labor force; Palmf: Proportion of agricultural laborers in the male labor force; RIFs: rented-in families; ROFs: rented-out families; Whhf: Whether the household head is female

Neural Network-Based Alzheimer’s Patient Localization for Wireless Sensor Network in an Indoor Environment

The number of older adults with Alzheimer's disease is increasing every year. The associated memory problems cause many difficulties for Alzheimer's patients and their caretakers; patients may even become lost in familiar surroundings. In this article, a proposed localization system based on a wireless sensor network (WSN) and backpropagation based artificial neural network (BP-ANN) was practically implemented to detect and determine the position of an Alzheimer's patient in an indoor environment. The proposed system consisted of four ZigBee-based XBee S2C anchor nodes and one mobile node carried by the Alzheimer's patient. The received signal strength indicator (RSSI) of the anchor nodes was collected by the mobile node using a laptop supported by X-CTU software. The obtained RSSI values were used as input for training, testing, and validation processes of the BP-ANN, while two-dimension (2D) locations (x and y) were used as the output of the ANN. The results showed that the obtained mean localization errors were 0.964 and 0.921m for validation and testing phases, respectively, after applying the ANN. Based on a comparison with state-of-the-art technology, we deduced that the proposed ANN method outperformed other techniques in previous studies in terms of mean localization error.

The association between fear of falling and functional tests in older adults with diabetes mellitus

Background: The number of older adults with diabetes mellitus (DM) is increasing. Falling during walking and the fear of it are prevalent in older adults with DM. Objective: This study aimed to examine the association between fear of falling (FoF) and functional tests in older adults with DM and to determine other factors affecting functional tests in these people. Methods: A cross-sectional study was conducted on 134 older adults with DM who had referred to the diabetes clinic of Matini Hospital in Kashan, Iran. The participants were selected through sequential sampling and then were categorized into two groups of “with” and “without FoF.” In addition to responding to a demographic questionnaire, the participants were assessed by the Mini-Mental State Examination, Diabetic Neuropathy Symptom Score, and Falls Efficacy Scale-International version. Walking performance of the participants was also measured using the Timed Up-and-Go, 5-Sit-to-Stand, and 50-Foot Timed Walk tests. Data were analyzed using the Chi-square, t-, and Mann–Whitney U-tests and linear regressions analysis. Results: Significant associations were found between FoF and education level, body mass index, waist-to-hip ratio, and having neuropathy (P

Hospitalizations for Inflammatory Bowel Disease Among Medicare Fee-for-Service Beneficiaries - United States, 1999-2017.

Crohn's disease and ulcerative colitis, collectively referred to as inflammatory bowel disease (IBD), are conditions characterized by chronic inflammation of the gastrointestinal tract. The incidence and prevalence of IBD is increasing globally, and although the disease has little impact on mortality, the number of older adults with IBD is expected to increase as the U.S. population ages (1). Older adults with IBD have worse hospitalization outcomes than do their younger counterparts (2). CDC analyzed Medicare Provider Analysis and Review (MedPAR) data to estimate IBD-related hospitalization rates and hospitalization outcomes in 2017 among Medicare fee-for-service beneficiaries aged ≥65 years, by selected demographics and trends in hospitalization rates and by race/ethnicity during 1999-2017. In 2017, the age-adjusted hospitalization rate for Crohn's disease was 15.5 per 100,000 Medicare enrollees, and the IBD-associated surgery rate was 17.4 per 100 hospital stays. The age-adjusted hospitalization rate for ulcerative colitis was 16.2 per 100,000 Medicare enrollees, and the surgery rate was 11.2 per 100 stays. During 1999-2017, the hospitalization rate for both Crohn's disease and ulcerative colitis decreased among non-Hispanic white (white) beneficiaries, but not among non-Hispanic black (black) beneficiaries. Health care utilization assessment is needed among black beneficiaries with IBD. Disease management for older adults with IBD could focus on increasing preventive care and preventing emergency surgeries that might result in further complications.

Highland Games as serious leisure: becoming a Masters athlete

ABSTRACTIn a context of successful ageing discourse, a growing number of older adults are turning to competitive sport. The phenomenon known as Masters sport is a form of serious leisure that challenges stereotypes of ageing. Contemporary research has explored how individuals become Masters athletes in a variety of sports, focusing upon on the mainstream sports of running, swimming and tennis. Research has yet to explore how people become involved in activities that have less universal appeal. This article begins filling this gap by examining how Masters athletes became involved in the Highland Games, a sport contextualised by its links to Scotland and its diaspora. A pragmatic theoretical approach lending from three existing models is used to make sense of how people enter the Games. Drawing on semi-structured life history interviews with 19 Masters athletes, this case study details two pathways to the Highland Games. The article describes how, unlike previous research, most athletes enter the sport later in life and are either drawn to competition through an emergent identification with Scotland or a diversification of bodily dispositions that existed before Games participation. The article concludes that theoretical flexibility is required to understand better the socio-cultural factors that influence Masters sport participation.

Variations in Prevalence and Number of Older Adults With Self-reported Hearing Trouble by Audiometric Hearing Loss and Sociodemographic Characteristics

This cross-sectional study evaluates 2613 participants 60 years or older in the NHANES study (2001-2012) for variations in self-reported hearing trouble by audiometric hearing loss and sociodemographic characteristics.

The Sequential Flamsa-Bu Conditioning Regimen Does Not Improve Outcome in Patients Allografted for High Risk Acute Myeloid and Myelodysplasia Irrespective of Pre-Transplant MRD Status: Results of the UK NCRI Figaro Trial

INTRODUCTION: Allogeneic stem cell transplantation (allo-SCT) is an important curative strategy in adults with high risk acute myeloid leukemia (AML) and myelodysplasia (MDS). Disease relapse represents the major cause of treatment failure and whilst retrospective analyses have identified that pre-transplant measurable residual disease (MRD) is an important predictor of transplant outcome this has never been examined prospectively. The advent of reduced intensity conditioning (RIC) regimens has substantially increased the number of older adults eligible for allo-SCT but the optimal RIC regimen in high risk AML remains unknown. Registry data have demonstrated improved outcomes using a sequential transplant regimen utilizing cytosine arabinoside (araC)/amsacrine (AMSA) cytoreduction followed by a fludarabine (Flu)/busulfan (Bu) based RIC regimen (FLAMSA-Bu). However, although the FLAMSA-Bu regimen is now widely used in adults with high risk AML and MDS its benefit has not been evaluated in a randomized trial. We report the results of a randomized trial evaluating the FLAMSA-Bu regimen compared with standard RIC regimens which also represents the first prospective evaluation of the impact of pre-transplant MRD levels on transplant outcome. PATIENTS AND METHODS: 244 patients (median age 59 yrs) with high risk AML (n=164) or high risk myelodysplasia (n=80) were randomized 1:1 to a control arm determined by investigator's choice of either Flu/B2/ATG (Flu, Bu 3.2 mg/kg x 2 days, ATG 2.5 mg/kg x 2 days); Flu/Mel/Alemtuzumab (A) (Flu, Mel 140 mg/m2, A 50 mg) or Flu/Bu2/A (Flu, Bu 3.2 mg/kg x 2 days, A 50 mg) versus an experimental arm of FLAMSA-Bu (Flu, araC 2g/m2 x 4 days, AMSA 100mg/m2 x 4 days, Bu -total dose 11.2 mg/kg). Patients over the age of 60 received an adjusted FLAMSA-Bu regimen utilising a reduced dose of araC (1mg/m2 x 4 days) and a total Bu dose of 6.4 mg/kg. Patients were transplanted using either an HLA identical sibling (n=49) or matched (10/10 or 9/10) unrelated donor (n=195). All patients received cyclosporine GVHD prophylaxis. 155 patients with AML were in CR1 or CR2 at the time of transplant and 9 had primary refractory disease. MRD was monitored by flow cytometry (applying different-from-normal analysis when no diagnostic/relapse leukemic aberrant immunophenotype was available). Pre-transplant MRD levels were measured up to four weeks prior to transplantation in 201 patients (MRD positive = 80 (40%), MRD negative = 94 (47%), inadequate sample = 27 (13%)). MRD results were not reported to clinicians. The primary outcome was overall survival. RESULTS: Baseline characteristics including CR1/CR2 status, adverse cytogenetics and MRD levels were similar between regimens. Median follow up was 35 months. Transplant outcomes were comparable between patients allografted in the control and FLAMSA-Bu arms. 2 yr overall survival (OS) and cumulative incidence of relapse (CIR) were 61% and 30% respectively in the control arm vs 62% and 26% for the FLAMSA-Bu arm. Transplant related mortality at 100 days was 3.0% in patients allografted using the control regimen vs 14% in patients allografted using the FLAMSA-Bu regimen and 17% vs 21% at 1 year. In the study cohort pre-transplant MRD positivity was associated with both an increased CIR compared to patients testing MRD negative (2 yr CIR 42% vs 19%, p=0.009) and decreased OS (2 yr OS 52% vs 71%, p=0.048). The FLAMSA-Bu regimen failed to improve OS or reduce CIR in either MRD positive or MRD negative patients. CONCLUSIONS: This trial, the largest randomized trial of RIC regimens in AML to date, did not detect any benefit of intensification of the conditioning regimen in adults with high risk AML or MDS. Specifically, the FLAMSA-Bu regimen was not associated with improved transplant outcome in patients who were MRD positive pre-transplant. These data include the first demonstration in a prospective analysis that the presence of pre-transplant MRD measured in real time is associated with reduced OS consequent upon an increased risk of disease relapse. Further randomized studies of novel conditioning regimens in adult AML, crucially with integrated MRD studies, are now required but these results support exploration of alternative strategies, such as pre or post-transplant pharmacological intervention, as the most promising strategy to reduce the risk of disease relapse post allograft. Disclosures Russell: Jazz: Consultancy, Honoraria, Speakers Bureau; DSI: Consultancy, Honoraria, Speakers Bureau; Pfizer Inc: Consultancy, Honoraria, Speakers Bureau; Astellas: Consultancy, Honoraria, Speakers Bureau. Freeman:Jazz Pharmaceuticals: Speakers Bureau. OffLabel Disclosure: We report data using the combination of fludarabine, busulphan, amsacrine and cytosine arabinsoide as a conditioning regimen in patients allografted for high risk acute myeloid leukemia

Health-related quality of life in South Korean community-dwelling older adults with multimorbidity: a convergent parallel mixed-methods approach.

Alongside population aging, the rapid increase in the number of older adults with multimorbidity-the existence of two or more chronic conditions-has been noteworthy. However, in South Korea, studies taking a comprehensive approach to the factors associated with health-related quality of life (HRQoL) and disease-related problems experienced by older adults with multimorbidity have been rare. This study examined the associations of several variables with HRQoL and explored disease-related life experiences of community-dwelling older adults with multimorbidity in South Korea. A convergent parallel mixed-methods approach was used with survey data from 310 community-dwelling older adults aged over 65 diagnosed with two or more chronic diseases and who regularly received treatment. Qualitative data were collected from 3 focus group interviews with 15 participants. Factors correlated with HRQoL were analyzed using multiple regression, and NVivo Pro 12.0 was used for content analysis. In the multiple regression analyses, depression had the most significant association with HRQoL. Depression, activities of daily living, instrumental activities of daily living, support from friends, number of medications, and subjective health status explained 41.0% of the variance in HRQoL. Content analysis revealed 5 major health-related themes in the participants' lives: reduced physical function, anxious mental state, changes in the importance of the social support structure, limitations of disease management, and acceptance and endurance. Based on the results, community-based programs and health promotion projects that consider psychological states (e.g., depression) are needed to boost the HRQoL of individuals with multimorbidity.

Malnutrition in older adults: Correlations with social, diet-related, and neuropsychological factors.

The number of older adults is increasing rapidly. Malnutrition is a major problem in this age group, which may adversely affect health and quality of life. Several physiological, socioeconomic, and neuropsychological factors can lead to malnutrition. The aim of this study was to evaluate the nutritional status of community-dwelling older adults, and explore the associations of malnutrition risk with physiological, socioeconomic, and neuropsychological characteristics. This study is part of the Hellenic Longitudinal Investigation of Aging and Diet study, a cross-sectional observational study in Greece, and study participants were 1831 urban-dwelling elderly individuals (mean age: 73.1 ± 5.9 y; 40.8% men). Risk for malnutrition was assessed with the Determine Your Nutritional Health checklist. Data on age, sex, level of education, marital status, depression, cognitive performance, body mass index, total energy intake, and adherence to the Mediterranean diet were recorded. Correlations and multivariate analyses were performed between these variables and risk for malnutrition. The estimated prevalence of moderate and high nutritional risks was 34.8% and 29.4%, respectively. Risk for malnutrition was associated with marital status (unmarried), increased body mass index, male sex, lower level of education, lower cognitive performance, and lower adherence to the Mediterranean diet (P < 0.05). Nutritional screening should be performed frequently in all community-dwelling older adults. Health experts should perform nutritional screening in all community-dwelling older adults as part of secondary prevention, and nutrition counselling and support should be offered in those at risk for malnutrition.

OLDER ADULTS AND THE WORLD CAFé APPROACH: CROSS-GENERATIONAL INITIATIVES IN RESEARCH AND EDUCATION

In Canada, numbers of older adults are considered to be increasing, and by 2036, it is expected that seniors will reach 25% of the total population. Since 2009, the Saskatchewan Population Health and Evaluation Research Unit (SPHERU) has developed an interdisciplinary approach to a community-based research program focused on rural older adults. The world café approach is recognized as collaborative and ideal for encouraging dialogue, sharing knowledge, and developing action plans. Set up like a café, four to six participants at each table engage in a series of three conversational rounds lasting approximately 20 minutes each. At the end of each round, participants move to different tables while the facilitator(s) remain at their original tables. We incorporated a world café approach in three distinct research projects, facilitating a total of five world café events. For each of these events, we also engaged with graduate and undergraduate students who were trained to serve as table facilitators. Participating students represented a variety of disciplines including social work, nursing, and gerontology. Older adults participating in the world café events reported positive experiences and appreciation for the opportunity to discuss new information. Student facilitators identified their participation as a “real life” learning and networking opportunity that enhanced their classroom experiences. Challenges identified included issues related to individual mobility, and issues related to noise and sound quality for those with hearing deficiencies. A community-based approach to research is effective when engaging with this population, and a word café event brings seniors directly into the discussion.

A SYSTEMATIC APPROACH TO SPREADING THE WORD ABOUT GERONTOLOGY TRAINING OPPORTUNITIES IN A UNIVERSITY SETTING

Training university students to work in professional gerontology settings is extremely important during an era when the number of older adults is increasing due to the Baby Boom cohort entering their later years. Efforts to reach students are critical given budget and enrollment challenges. Some university students find gerontology resources and training on their own, yet gerontology programs can do much to help students know of opportunities. In this paper, I will share methods that the gerontology program at my university has used to reach out to students and faculty across campus to encourage students to study gerontology. In the last 3 years, student enrollment in this gerontology minor has grown from 65 students housed in 3 colleges, to 275 students housed in 7 colleges. Faculty involvement has grown from a 7-faculty committee, to 61 faculty affiliates. The roles of university resources and fundraising will also be discussed.

EAST MEETS WEST: IMPROVING HEALTH AND LONG-TERM CARE FOR OLDER ADULTS IN THE U.S. AND CHINA

As the number of older adults in the U.S. and China continues to increase, promoting healthy aging is essential for individuals, family, and society. Both countries face many similar issues due to their aging populations, including prolonging healthy life expectancy and providing quality of care. However, the change in demographics brings with it unique challenges for both the U.S and China. This forum invites scholars and researchers from these two countries to share their knowledge and insights on promoting healthy aging and improving care for older adults. This forum includes five presentations and one-panel discussion. Two presentations will focus on long-term care (LTC) in China, one is to forecast the needs of LTC in the next five decades, and the other is to evaluate the current LTC needs and discuss LTC policy. Using the data from the Health and Retirement Study, the third presentation aims to re-conceptualize spousal caregiving as a dyad-level phenomenon and provides a dynamic view of the spousal caregiving experiences. The last two presentations will focus on promoting healthy aging through clinical interventions. The fourth one is to evaluate the effectiveness of adaptive computer-based cognitive training among community-dwelling older adults in China. The last presentation provides some examples of using pragmatic clinical trials to improve the care of older adults in skilled nursing facilities in the U.S. After the five presentations, the three panelists will provide feedback to the presentations and share their views on healthy aging with the audience.

USE OF A HOME SYMPTOM MANAGEMENT ZONE TOOL IN GERIATRIC PATIENTS UNDERGOING CANCER TREATMENT

Adult oncology practices are caring for a growing number of older adults with cancer. Evidence suggests that patients with cancer have higher emergency department (ED) utilization, particularly in patients 65 years of age and older and in those whose symptoms are poorly controlled. The ED is not the most appropriate nor most cost-effective option for addressing urgent care needs of patients undergoing cancer treatment. This quality improvement project is being conducted in a community medical oncology practice during usual cancer treatment education. Older adult patients starting or changing cancer treatment are presented with a zone tool (green-yellow-red) to inform decision-making at home regarding level of severity of current symptoms and recommended actions (e.g., you are stable, you need to call the office, you need to go immediately to the ED). The tool has been distributed to 28 patients with a goal of at least 30 by 9/20/19. Outcome measures include the number of ED visits in the intervention group compared to a pre-intervention sample of older adults from the same medical oncology office. Other outcome measures are acceptability of zone tool among clinical staff and patients. Preliminary data suggest suggest acceptability among staff and patients; and ease of use among clinical staff. Tracking of visits to the ED in the sample population and surveys of patients and staff are ongoing through October 2019.

BARRIERS TO CARE FOR OLDER ADULTS IN MEDICATION-ASSISTED TREATMENT FOR OPIOID USE DISORDER

Over the last decade, the number of older adults (people over the age of 50) who misuse opioids doubled and continues to increase. People over the age of 50 also represent one of the fastest growing groups entering into and sustaining medication assisted treatment (MAT) (i.e., methadone and buprenorphine) for opioid use disorder (OUD). Despite increasing awareness of this growing at-risk population, significant knowledge gaps regarding their support and care needs persist. To begin to address these gaps, we conducted interviews with 20 treatment staff, focus groups with 18 patients and surveys with 100 patients over the age of 50 at eight diverse Opioid Treatment Programs (OTPs) participating in a 1-year pilot study (Bender, PI) funded by the Georgia Clinical and Translation Science Alliance supported by the National Center Advancing Translational Sciences. Patients in this study do not always disclose their use of MAT to non-OTP providers. When they do, participants reported numerous negative experiences with non-OTP providers, including perceived discrimination, stigma, and misunderstanding by providers about MAT. These negative experiences potentially contribute to an over reliance on OTP providers to manage age-related health conditions (e.g., COPD, hypertension). Providers report minimal training about aging and varied levels of confidence to manage these conditions. We present the experiences of patients and providers with suggestions for improving care coordination. We conclude with recommendations to improve communication among providers working with older adults in recovery from OUD.

CHANGES IN COGNITIVE FUNCTION AMONG SENIOR AMERICANS: TRENDS AND DIFFERENCES BY RACE

Improvements in health and increase in life expectancy have contributed to the increasing proportion of older population over the past century. It is estimated that by 2050, the number of older adults with cognitive impairments in the United States will increase by 2.5-4 fold, while age-specific rates remain constant. This paper uses data from 10 waves (1996-2014) of the Health and Retirement Study (N= 33213) to crystalize the trends in cognitive function changes and cognitive impairment rates in a nationally representative sample of older adults. OLS and logistic regressions are used to estimate the trends and determine the contribution of sociodemographic variables to decreasing trends in the prevalence of cognitive impairment over time. Results show that with the increase of age, the cognitive function of older adults decline in all races, after adjustment for age, gender, education, and other sociodemographic factors. Also, the annual decline rate of cognitive function is larger for African Americans and Hispanic Americans, while smaller for white and other races. A further investigation of the possibility of cognitive impairment reveals a different scenario: as individual ages, the Hispanic are the least likely to suffer from cognitive impairment, followed by the white, other and black. Improvements in educational level contribute to declines in cognitive impairment across all races, particular the Hispanic Americans. Race-specific findings suggest that future research need to take into account the racial diversity and possibly cultural influences when examining the cognitive functions of older adults.

STRENGTHENING AGE-FRIENDLY COMMUNITIES THROUGH CAPACITY BUILDING TO ADDRESS BEHAVIORAL HEALTH CONCERNS

The Center for Aging and Disability Education and Research at Boston University in collaboration with the Age-Friendly New Bedford received funding from Tufts Health Plan Foundation to reduce the stigma of mental illness and increase awareness of the effects of social isolation in the community. In order for older adults to be fully engaged in community life, behavioral health concerns need to be addressed with a focus on social isolation, depression, and substance use. Many Age Friendly efforts don’t address these issues even though significant numbers of older adults are impacted. Without a community-wide capacity building effort, behavioral health issues among older adults often fade into the background. We developed and implemented a 3-tiered approach to incorporating behavioral health into an Age Friendly initiative. In the first tier, we focused on increasing awareness of the impact of behavioral health concerns and stigma by creating an anti-stigma campaign in multiple languages. The second tier focused on holding workshops for older adults on behavioral health related issues. The third tier provided training to key stakeholders, including aging service providers, clergy, first responders, and resident coordinators focusing on the need to effectively identify and respond to older adults with behavioral health concerns. Using the Depression Stigma Scale, we measured perceived stigma among older adults pre and post workshop participation. We found statistically significant changes in how older adults perceive depression after participation in the workshop. Training results were also statistically significant with gains pre-post training in key competency areas.

THE IMPACT OF SEXUAL FLUIDITY AND SOCIAL SUPPORT ON EGO INTEGRITY IN OLDER ADULTS

The population of lesbian, gay, and bisexual (LGB) Americans is growing as the number of older adults “come out. ” While we know that “coming out” later in life impacts the experience of aging, little research has examined ways in which social support and sexual fluidity influence ego integrity in older adults. The present study investigated ego integration, changed sexual behavior, and perceived social support in adults 45 years of age and older who had been in a long-term relationship with the opposite sex prior to “coming out” as LGB. The average of participants was 61 years, sixty-eight percent (N = 43) were currently married or in a domestic partnership, and eighty-six percent (N = 54) identified as Caucasian. Individuals were recruited to participate in the survey utilizing online social media. Results (N = 63) suggested that those whose behavior was more sexually fluid were least ego integrated. Timing of “coming out” LGB, Early (44 and younger) versus Late (after the age of 45) impacted the degree of sexual fluidity and perceived social support. Results indicated those who “came out” Late were more sexually fluid and were less fearful of “coming out. ” The most significant result revealed social support from significant others to be most impactful compared to friends and family. This research expands on the challenges of those who are aging in a non-normative environment. The implications suggest that individuals who “come out” later have a more difficult time with accepting their sexual fluidity.

PALLIATIVE AND END-OF-LIFE CARE TO THE LGBT COMMUNITY

The lesbian, gay, bisexual, and transgender (LGBT) community experiences discrimination and stigma in accessing health care and social services – including palliative, hospice, and long-term care – across cultures and countries. Health care providers may fail to recognize, acknowledge or address disparities in care. Providers and institutions may be uncomfortable with gender and sexuality issues, and often fail to inquire about sexual orientation and gender identity. It is estimated that there are approximately 2.7 million LGBT adults in the U.S. age 50 and older and approximately 1.1 million age 65 and older. In the UK, an estimated 5-7% of the population identify as LGBT; there are between 600,000 and 840,000 LGBT adults aged 65+. With the projected increased number of older adults and improved treatments that extend the life of seriously ill individuals, even greater numbers of LGBT older adults, and their families, will require palliative and end-of-life in the coming years. Researchers in the US and UK have found that LGBT older adults living in the community and in long-term care facilities experience inadequate, disrespectful, and abusive care due to their sexual orientation and gender identity status. They fear being open about their identities, not receiving equal or safe treatment, and having their family of choice and designated surrogates disrespected or ignored by health care staff. This symposium will describe the experiences of LGBT individuals and their family members, and compare commonalities and differences faced by LGBT communities in the US and UK in accessing palliative and end-of-life care.

WHEN NETWORKS FAIL: ISOLATION AND INDEPENDENCE AMONG OLDER ADULTS IN PUBLIC HOUSING

In the coming decades, the population of adults over 65 in the US will increase dramatically. Many older adults live at or below the poverty level, and the growing lack of affordable housing combined with fixed incomes promises to increase the number of older adults facing combined housing and health challenges. Despite their vulnerability, little is known about the lived experiences of older adults aging in place in public housing. We conducted semi-structured qualitative interviews with 27 older adults at two public housing sites in Austin, Texas to gain an understanding of their thoughts on health, aging, home, community, and problem solving. We conducted interviews in Spanish (n=10) and English (n=17) with 16 female and 11 male interviewees with a mean age of 71.7 years (range 65-85 years). We systematically coded transcribed interviews and used grounded theory to analyze the data. Participants described feeling isolated due to language barriers, cultural perceptions about neighbors, and previous problematic experiences with neighbors leading to intentional isolation for safety. Some, however, spoke of how they acted as community connectors or responded to connectors in the community in ways that reduced their isolation. Participants framed individual problem-solving and personal choices as central to health and wellness. Our findings suggest a way forward for housing authorities, communities, and health systems working together to provide services to these adults. Incorporating their points of view and even co-creating interventions to enhance their health and well-being will make these interventions more successful and welcome.