Vulnerability Of Older Adults Research Articles

American Older Adults in COVID-19 Times: Vulnerability Types, Aging Attitudes, and Emotional Responses.

The Coronavirus Disease (COVID) pandemic has aroused challenges to emotional well-being of the individuals. With 1,582 respondents from the Health and Retirement Survey (HRS), this study investigates the heterogeneity in older adults' vulnerability and examines the relationship between vulnerability types, aging attitudes, and emotional responses. International Positive and Negative Affect Schedule Short-form (I-PANAS-SF) and Attitudes toward own aging (ATOT) were used to assess the emotional experiences and aging attitudes, and 14 kinds of pandemic-related deprivations evaluated vulnerability of individuals. Latent class analysis (LCA) was used to explore the vulnerability types, and weighted linear regressions examined the relationship between vulnerability, aging attitudes, and emotional responses. The results showed that the proportion for individuals with mild vulnerability (MV), healthcare use vulnerability (HV), and dual vulnerability in healthcare use and financial sustainment (DVs) was 67, 22, and 11%, respectively. Older adults aged below 65, Hispanics and non-Hispanic Blacks, and those not eligible for Medicaid were more likely to have HV or DVs. The relationship between vulnerability and positive emotions (PAs) was non-significant, yet individuals with HV (beta = 0.10, standard error [SE] = 0.16) or DVs (beta = 0.09, SE = 0.28) were likely to have more negative emotions (NAs) than their mildly vulnerable counterparts. Furthermore, aging attitudes moderated the relationship between vulnerability and emotions. The salutary effect of positive aging attitudes on emotional well-being was more significant among people with DVs than those with MV (beta = 0.20, SE = 0.04 for positive responses; beta = −0.15, SE = 0.04 for negative responses). Thus, we urge more attention for vulnerable older adults in a pandemic context. Meanwhile, encouraging positive aging attitudes might be helpful for older adults to have better emotional well-being, especially for those with DVs.

Implementation of an integrated home internet of things system for vulnerable older adults using a frailty-centered approach

Although integrated home internet of things (IoT) services can be beneficial, especially for vulnerable older adults, the hurdle of usability hinders implementation of the technology. This study aimed to evaluate the practical usability of home IoT services in older adults, by frailty status, and to determine the potential obstacles. From August 2019 to July 2020, we randomly selected 20 vulnerable older adults (prefrailty group [n = 11], and frailty group [n = 9]) who had already been identified as needing home IoT services in a community-based prospective cohort study, the Aging Study of the Pyeongchang Rural Area. Integrated home IoT services were provided for 1 year, and a face-to-face survey evaluating usability and satisfaction of each service was conducted. The usability of the integrated home IoT services declined gradually throughout the study. However, prefrail participants showed higher usability than frail older adults (difference-in-difference = − 19.431, p = 0.012). According to the frailty status, the change in usability for each service type also showed a different pattern. During the 12-month study period, the service with the highest satisfaction converged from various service needs to light control by remote control (77.8%) in the prefrailty group and automatic gas circuit breaker (72.7%) in the frailty group. For wider implementation of home IoT services, organizing services expected to have high usability and satisfaction based on user’s frailty status is crucial. Also, providing education before service implementation might help older adults coping with digital literacy.

Support Received and Provided by Older Adults who Lost a Child: A Qualitative Content Analysis.

Despite the vulnerability of older adults and the importance of social support following the death of a child, little research has been conducted on the Iranian older population. This study aimed to explore perceived support among older adults after the death of a child. This study was carried out in Iran in 2020-2021 using a qualitative content analysis method. Semi-structured interviews with older adults who had experienced child death were used to collect data. To ensure the data's trustworthiness, Guba and Lincoln's criteria were applied. The Graneheim and Lundman method was used to analyze the data. The participants' mean age was 70.41 years. The findings were organized into one theme, two main categories, and five subcategories based on 352 initial codes. Two main categories emerged from the participants' experiences: "supporting networks" and "giving support to others" with the theme of "healing emotional pain." Following the death of a child, the older parents perceived support as recuperation from their hurt feelings. Receiving support from family, entourages, and society, as well as providing support to the family and parents with the same experience were protective factors against the effects of child death among older parents. To reduce the consequences of child death, older parents' health should be monitored through home care provided by nurses.

Review of washing machine-related deaths in South Korea

We reviewed data on washing machine-related deaths between 2008 and 2020 in South Korea to analyze the case characteristics, manners of death, and causes of death. Washing machine-related deaths are very rare, and only 23 incidents were identified over the study period. Of these cases, 19 (82.6%) were related to general pulsator-type top load washing machines; the other 4 (17.4%) were related to front-load washing machines. The pulsator-type top load washing machine-related deaths occurred in people aged between 40 and 93 years (mean age, 68 years), including 9 men (47.4%) and 10 women (52.6%). The manners of death among the incidents were suicide in 12 cases (63.2%), accident in 6 cases (31.6%), and unknown in 1 case (5.3%). A Medline search of the English literature currently does not yield results for washing machine-related suicidal deaths in adults. Of the 12 suicide cases, 4 were autopsied; suicidal death was determined by postmortem investigation or based on suicide notes. Washing machine-related suicidal deaths are presumed to have characteristics similar to those of bathtub suicidal deaths. The front-load washing machine-related deaths involved boys aged between 6 and 8 years, and all cases were concluded as accidents. The cause of death was hypoxia resulting from the children being accidentally trapped inside the washing machine while playing. Greater attention to vulnerable groups, especially children and older adults, is required to reduce the rate of washing machine-related accidental or suicidal deaths.

Delirium Associated Adverse Events And Resource Use After Infrainguinal Lower Extremity Bypass

INTRODUCTION AND OBJECTIVES Delirium is common yet often underdiagnosed following vascular surgery. Infrainguinal bypass surgery patients are at particular risk for delirium, yet delirium's burden on other perioperative outcomes and resource utilization remains unclear. This study's objective was to identify delirium predictors and associated resource utilization. METHODS This single center retrospective analysis included all infrainguinal bypass cases from 2012-2020. The primary outcome was delirium development and severity. Secondary outcomes included length of stay, non-home discharge, readmission at 30 and 90 days, and survival. Regression analysis evaluated delirium risk factors and delirium's association with 2 year survival. RESULTS Overall, 420 patients underwent infrainguinal bypass of whom 115 (26%) developed postoperative delirium. Individuals with delirium were older, more likely to be women and have non-elective surgery (all P<0.05). On multivariable analysis, independent delirium predictors included age, CLTI, and non-elective procedure (Table 1). Consultations were performed in 25 cases (23%), 13 (52%) being to pharmacists, and only 4 (16%) resulted in recommendations. The average length of stay for the delirium group was higher (17 days vs 9 days; P<.001). Delirium was associated with increased non-home discharge (61.8% vs 22.1%; P<.001) and 90-day mortality (7.6% vs 2.9%; P=.033). Survival at 2 years was lower in those with delirium (89% vs 75%; P<.001). On cox multivariable analysis over 2 years, delirium was independently associated with poor survival (HR=2.0; 95% CI=1.15-3.38; P=0.014). CONCLUSIONS Delirium is associated with adverse post-operative outcomes and increased resource utilization, including increased hospital length of stay, non-home discharge, and 2-year mortality. Future studies should evaluate the role of routine multidisciplinary care for high-risk patients to improve perioperative outcomes for vulnerable older adults undergoing lower extremity infrainguinal bypass. Delirium is common yet often underdiagnosed following vascular surgery. Infrainguinal bypass surgery patients are at particular risk for delirium, yet delirium's burden on other perioperative outcomes and resource utilization remains unclear. This study's objective was to identify delirium predictors and associated resource utilization. This single center retrospective analysis included all infrainguinal bypass cases from 2012-2020. The primary outcome was delirium development and severity. Secondary outcomes included length of stay, non-home discharge, readmission at 30 and 90 days, and survival. Regression analysis evaluated delirium risk factors and delirium's association with 2 year survival. Overall, 420 patients underwent infrainguinal bypass of whom 115 (26%) developed postoperative delirium. Individuals with delirium were older, more likely to be women and have non-elective surgery (all P<0.05). On multivariable analysis, independent delirium predictors included age, CLTI, and non-elective procedure (Table 1). Consultations were performed in 25 cases (23%), 13 (52%) being to pharmacists, and only 4 (16%) resulted in recommendations. The average length of stay for the delirium group was higher (17 days vs 9 days; P<.001). Delirium was associated with increased non-home discharge (61.8% vs 22.1%; P<.001) and 90-day mortality (7.6% vs 2.9%; P=.033). Survival at 2 years was lower in those with delirium (89% vs 75%; P<.001). On cox multivariable analysis over 2 years, delirium was independently associated with poor survival (HR=2.0; 95% CI=1.15-3.38; P=0.014). Delirium is associated with adverse post-operative outcomes and increased resource utilization, including increased hospital length of stay, non-home discharge, and 2-year mortality. Future studies should evaluate the role of routine multidisciplinary care for high-risk patients to improve perioperative outcomes for vulnerable older adults undergoing lower extremity infrainguinal bypass.

Identifying vulnerable older adults at risk for functional decline in cardiac care wards: time to shift the paradigm

ABSTRACT Objective To determine whether routine screening with the Flemish version of the Triage Risk Screening Tool (fTRST) is a valid approach to determine which patients on cardiac care wards are at risk for inhospital functional decline and would benefit from geriatric expertise consultation. Methods A secondary data-analysis of the G-COACH before-cohort, describing patient profiles and routine care processes, in 189 older adults on two cardiac care wards in the University Hospitals Leuven between September 2016 and June 2017. Inhospital functional decline was defined as an increase of at least one point on the Katz Index of Activities of Daily Living or death between hospital admission and discharge. Results Nine in 10 patients had at least one geriatric syndrome and one-third developed functional decline. Based on the fTRST proposed cut-off of ≥2, 156 (82.5%) patients were at risk for functional decline (sensitivity of 95.2%, specificity of 23.8%, negative predictive value of 90.9% and Area Under the Curve of 0.60). Of the 156 ‘at risk’ patients, 43 (27.6%) received a consultation by the geriatric consultation team after a median of four hospitalization days. A positive fTRST was not significantly related to geriatric consultations (x2 = 0.57; p = 0.45). Conclusion The fTRST has a low discriminative value in identifying older cardiology patients at risk for functional decline. Given the high prevalence of geriatric syndromes, we propose a new paradigm were all older adults on cardiac care wards undergo a needs assessment upon hospital admission.

Super-Spreaders or Victims of Circumstance? Childhood in Canadian Media Reporting of the COVID-19 Pandemic: A Critical Content Analysis.

This qualitative research study, a critical content analysis, explores Canadian media reporting of childhood in Canada during the COVID-19 global pandemic. Popular media plays an important role in representing and perpetuating the dominant social discourse in highly literate societies. In Canadian media, the effects of the pandemic on children and adolescents’ health and wellbeing are overshadowed by discussions of the potential risk they pose to adults. The results of this empirical research highlight how young people in Canada have been uniquely impacted by the COVID-19 global pandemic. Two dominant narratives emerged from the data: children were presented “as a risk” to vulnerable persons and older adults and “at risk” of adverse health outcomes from contracting COVID-19 and from pandemic lockdown restrictions. This reflects how childhood was constructed in Canadian society during the pandemic, particularly how children’s experiences are described in relation to adults. Throughout the pandemic, media reports emphasized the role of young people’s compliance with public health measures to prevent the spread of COVID-19 and save the lives of older persons.

Can Social Resources Explain the Limitations in the Activities of Daily Living of Older Adults Classified by the Phenotype of Physical Frailty?

The objective is to investigate the mediating roles of living alone and personal network in the relationship between physical frailty and activities of daily living (ADL) limitations among older adults. 2271 individuals were classified as vulnerable (pre-frail or frail) or robust. Mediating variables were living alone and personal network. Katz Index and Lawton-Brody scale were used to assess ADL. Mediating effects were analyzed with beta coefficients from linear regression models using the bootstrapping method. Mediation analysis showed significant mediating effects of living alone (β = .011; 95% CI = .004; .018) and personal network (β = .005; 95% CI = .001; .010) on the relationship between physical frailty and basic ADL limitations. Mediation effects of living alone and personal network on the relationship between physical frailty and instrumental ADL limitations were β = -.074 (95% CI=-.101; -.046) and β = -.044 (95% CI = -.076; -.020), respectively. Physically vulnerable older adults who lived alone or had poor personal network were more dependent on basic and instrumental ADL.

Acceptance of virtual consultations among older adults and caregivers in Malaysia: a pilot study during the COVID-19 pandemic

ABSTRACT Aim The COVID-19 pandemic has disrupted the delivery of healthcare to vulnerable older adults, prompting the expansion of telemedicine usage. This study surveyed the acceptance of virtual medical consultations among older adults and caregivers within geriatric outpatient services in a tertiary hospital during the pandemic. Methods A cross-sectional survey was conducted among caregivers and patients attending geriatric outpatient services in Kuala Lumpur, Malaysia. The survey measured the availability of equipment for virtual consultations, prior knowledge and experience of telemedicine, and willingness to consult geriatricians through virtual technology, using the Unified Theory of Acceptance and Use of Technology (UTAUT) scale. Results A total of 197 caregivers and 42 older patients with a mean age of 54.28 (±13.22) and 75.62 (±7.32) years, respectively, completed the survey. One hundred and fifty-six (79.2%) of the caregivers were adult children accompanying patients. The mean UTAUT score was 65.97 (±13.71) out of 90, with 66.64 (±13.25) for caregivers and 62.79 (±15.44) for older adults, suggesting a high acceptance of adopting virtual consultations in lieu of face-to-face care. The independent predictors of acceptance of virtual consultation were : possession of an electronic device capable of video-communication, living with someone, living in a care home, weekly online banking usage, and perceived familiarity with virtual platforms. Conclusion Caregivers and patients indicated a high level of acceptance of virtual medical consultations, which is likely facilitated by caregivers such as adult children or spouses at home or staff in care homes. To minimize the transmission of COVID-19 in a highly vulnerable group, virtual consultations are an acceptable alternative to face-to-face consultations for older people and their caregivers in our setting.

Impact of Tailored Multicomponent Exercise for Preventing Weakness and Falls on Nursing Home Residents' Functional Capacity.

We aimed to determine whether the benefits of long (24weeks) and short (4weeks) training programs persisted after short (6weeks) and long (14weeks) periods of inactivity in older adult nursing home residents with sarcopenia. Multicenter randomized trial. The Vivifrail tailored, multicomponent exercise program (http://vivifrail.com) was conducted to individually prescribe exercise for frail older adults, depending on their functional capacity. The training included 4 levels combining strength and power, balance, flexibility, and cardiovascular endurance exercises. Twenty-four institutionalized older adults (87.1 ± 7.1years, 58.3% women) diagnosed with sarcopenia were allocated into 2 groups: the Long Training-Short Detraining (LT-SD) group completed 24weeks of supervised Vivifrail training followed by 6weeks of detraining; the Short Training-Long Detraining (ST-LD) group completed 4weeks of training and 14weeks of detraining. Changes in functional capacity and strength were evaluated at baseline, and after short and long training and detraining periods. Benefits after short and long exercise interventions persisted when compared with baseline. Vivifrail training was highly effective in the short term (4weeks) in increasing functional and strength performance (effect size= 0.32-1.44, P < .044) with the exception of handgrip strength. Continued training during 24weeks produced 10% to 20% additional improvements (P < .036). Frailty status was reversed in 36% of participants, with 59% achieving high self-autonomy. Detraining resulted in a 10% to 25% loss of strength and functional capacity even after 24weeks of training (effects size= 0.24-0.92, P < .039). Intermittent strategies such as 4weeks of supervised exercise 3 times yearly with no more than 14weeks of inactivity between exercise periods appears as an efficient solution to the global challenge of maintaining functional capacity and can even reverse frailty in vulnerable institutionalized older adults.

Pioneering COVID-19 Pandemic Partnerships: Federally Qualified Health Centers and Geriatric Workforce Enhancement Programs Work Together to Care for Diverse Underserved Older Adults.

Background: The COVID-19 pandemic disproportionately affected populations served by Federally Qualified Health Centers (FQHCs), with high morbidity and mortality rates in ethnic minority older adults. In response to this pandemic, academic geriatric medicine teams through federally funded Geriatric Workforce Enhancement Program (GWEP) with FQHC partnership implemented new initiatives to improve the care for vulnerable older adults. Objectives: To describe how four FQHC/GWEP teams collaborated in caring for diverse communities of older adults during the pandemic. Methods: Four GWEPs have addressed pandemic response efforts with their respective FQHC partners. These collaborations to meet the increasing numbers of older adults seeking services, and the rising disparities exacerbated during the pandemic are delineated. Results: FQHC/GWEP partnerships enabled access to care, whether in-person or virtually to serve unmet needs of underserved older adults during the pandemic. Partnerships promoted COVID-19 education, testing, and vaccinations. Most FQHCs faced severe staffing shortages, and the digital divide challenged patients with barriers. GWEPs provided direct care, created educational materials, and developed telehealth programs. These partnerships addressed social determinants of health gaps caused by the pandemic. Conclusion: The findings demonstrate that strong partnerships between GWEPs and FQHCs mitigate health inequities for vulnerable ethnic minority and rural older adults during pandemic crises.

Mild Cognitive Decline Is a Risk Factor for Scam Vulnerability in Older Adults.

Research on elderly financial exploitation has mostly focused on financial abuse that occurs in families and other types of trusted relationships. As such, little is known about financial frauds and scams perpetrated by strangers. Financial fraud and scam prevention activities for older adults must be promoted, for which the correlation between the psychological, social, and cognitive characteristics of their vulnerability needs to be determined. The present study aimed to determine whether cognitive decline is a risk factor for scam vulnerability in older adults. Thus, we created a scam vulnerability scale for older adults with cognitive decline and analyzed the data to reveal the correlation between them, including inhibition and executive function. We conducted an interview survey with 50 older adults with cognitive decline (average age: 79.42 years, SD: 5.44) and 51 older adults without cognitive decline (average age: 76.12 years, SD: 5.82). The interview survey included the scam vulnerability scale, psychosocial questionnaires, and neuropsychological tests. The scale included six items with a four-point Likert scale based on a previous study. Hierarchical multiple regression analysis revealed that lower scores on the Japanese version of the Alzheimer's Disease Assessment Scale–Cognitive Subscale (ADAS-Jcog; indicating higher general cognitive function) correlated with higher scam vulnerability in the cognitive decline group (β = −0.46, p < 0.001). In addition, men were found to be more vulnerable in both groups (cognitive decline group: β = −0.29, p = 0.015, cognitive non-decline group; β = −0.32, p = 0.018). Inhibition and executive function were found not to correlate significantly with scam vulnerability. These results suggest that mild cognitive decline correlates with higher scam vulnerability, whereas moderate to severe cognitive decline correlates with lower vulnerability, possibly because it makes understanding the scam attempt itself difficult. Older adults with mild cognitive decline and their families, particularly those visiting elderly care or outpatient facilities, should be notified of the scam vulnerability of older clients using the ADAS-Jcog score as an index to help them avoid victimization.

Representation of Older Adults in COVID-Related Newspaper Coverage

Based on clinical and epidemiological evidence, COVID-19 infection can occur in people of all ages; however, the media typically focuses its attention on the vulnerability of older adults and individuals with chronic illnesses. This study aims to explore the representation of older adults during the first month of the pandemic in the U.S. by comparing the narratives of older adults and younger adults in national media sources. A systematic search identified 115 articles published in four major newspapers in the U.S. included USA Today, The New York Times, Los Angeles Times, and The Washington Post between March 11 and April 10, 2020 in which older adults and younger adults were quoted on topics related to the intersection of COVID-19 and aging. Quotes were inductively reviewed using thematic content analysis. In 115 articles, there were 265 quotes from older adults (n=104, 39%) and younger adults (n=161, 61%). When comparing patterns that were common or distinctive between older and younger individuals quoted, three key themes emerged: 1) impacts of COVID-19 on older adults and resulting vulnerability, 2) debated perspectives over the value of older adults’ lives, and 3) a counternarrative of resiliency among older adults. This study provides the opportunity to understand how the pandemic may impact representations of older adults and findings emphasize the importance of voice among older adults to combat ageist messaging and promote counternarratives to assumptions of vulnerability. Also, it suggests for policymakers and practitioners to insight into how the representation of older adults is disseminated by media.

Food Insecurity in Older Adults: Gerontology Students and RSVP a Partnership that Works

A gerontology course related to policies /programs each year researches, develops and designs a service-learning project related to an issue/concern for older adults and their quality of life. Students wanted to work with vulnerable older adults and after research and discussion decided on tackling the issue of food insecurity in older adults. Food insecurity is a growing issue for older adults which has been exasperated by COVID-19. According to Meals on Wheels America (2020) there has been a 22% increase in the number of older adults needing food assistance. In addition, while the need for food banks has increased donations have declined (Next Avenue, 2020). Students partnered with RSVP, which had previously conducted a food donation project.. Students took on the responsibility for advertising, soliciting grocery stores to allow us to set up and engage shoppers in purchasing items for the project. In addition, they reached out to the university community and set up food donation stations. RSVP sent out emails to their constituents to encourage them to volunteer and do their shopping on the date of the project. Students were paired with RSVP volunteers at two stores and provided shopping lists and information about food insecurity in older adults to shoppers. Students collected 566 pounds of food. The food was distributed equally between Catholic Charities, which has a senior shopping program and the Somali Elder Community. Students sorted the food by categories and removed any foods with pork/gelatin products for the Somali Community.

Social Connectivity in the Context of COVID-19 and Long-Term Care

The COVID-19 pandemic has disproportionately impacted older adults, particularly those residing in long-term care homes (LTCHs), causing immense loss of life and resulting in overall health declines in LTCH residents. These vulnerable older adults have also experienced extreme loneliness, anxiety and depression. Social connectedness is an important contributor to well-being and quality of life of older adults in LTCHs and family members are an essential component to this. However, restrictions driven by policies to protect resident safety, have constrained family members’ access to long-term care homes and limited in-person contact between residents and their families. In their absence, health providers have been integral to supporting connections between residents and their families within LTCHs. This study aimed to understand the experiences of social connectedness between residents and family members who have been physically separated due to the current pandemic and, to examine LTCH health providers’ experiences and responses to support social connectedness. Using a qualitative descriptive design, in-depth semi-structured interviews were conducted with 21 family members and 11 healthcare providers. Emergent themes from qualitative content analysis are: (a) all-encompassing impacts of separation; (b) advocacy became my life; (c) the emotional toll of the unknown; 4) the burden of information translation; 5) precarious balance between safety and mistrust for the healthcare system; and (d) a formulaic approach impedes connectivity. A more comprehensive understanding of the experiences and support needs of LTCH residents and their family members within the context of a pandemic can inform practice approaches to support social connections going forwards.

Major Disasters’ Impacts on Long-Term Care Settings, Vulnerable Older Adults, and Care Providers

The COVID-19 pandemic has disproportionately negatively affected older adults, and has specifically devasted older adults who are minorities and those who reside in long-term care (LTC) facilities. For professionals working in LTC facilities, major stressors and challenges due to the pandemic must be navigated, sometimes in parallel with the effect that major disasters like hurricanes can have on LTC facilities. This symposium will focus on the impact major disasters, including the COVID-19 pandemic and Hurricane Irma, had on LTC settings and those who live and work there, as well as older adults who are minorities and their communities. First, Dr. Roma Hanks will present findings from a study of community members and leaders in a majority African-American community in the United States (US) about their experiences with and challenges faced related to the pandemic. Second, Dr. Lisa Brown will share experiences and perceptions of mental health clinicians from across the US who worked in LTC settings before and during the pandemic. Third, Dr. Ella Cohn-Schwartz will describe how the pandemic impacted Holocaust survivors ages 75+ in Israel compared to older adults who did not experience the Holocaust. Fourth, Dr. Lindsay Peterson will present findings from interviews with nursing home and assisted living community representatives in the US regarding vulnerabilities LTC facilities experienced related to Hurricane Irma in 2017. As a whole, these presenters will provide insights into experiences of older adults, care providers, LTC facilities, and communities as they navigated challenges associated with the COVID-19 pandemic and a major hurricane.

Vaccine access shrinks disparities between long-term care and community rates of COVID-19 mortality.

This longitudinal secondary data analysis examines differences in COVID-19 incidence and mortality among long-term care facility (LTCF) residents with those living in the community in South Carolina (SC) throughout the pandemic, including the time of vaccine availability. Data came from the SC Department of Health and Environmental Control (SCDHEC). Descriptive statistics and trends for cases of infections and deaths were calculated. Cox proportional hazards were used to compare COVID-19 mortality in LTC residents to community dwelling older adults, controlling for age, gender, race, and pre-existing chronic health conditions. Until early January of 2021, significantly greater incidence rates of infection (116.2 per 10,000 per month) and hazard of death after infection (HR=1.83, 95% CI: 1.70-1.98) were experienced among LTC residents as compared to older adults in the community even after statewide mask mandates and visitation guidance. Since vaccine availability, COVID incidence rates among LTC residents fell by half (59.5 per 10,000 per month after vaccines), and the relative hazard of death compared to older adults in the community was diminished (HR=1.44, 95% CI:1.29-1.61). Reducing the gap between LTCF and community-wide infection and mortality rates suggests that vaccination against COVID-19 is correlated with reduced disease spread in the greater community and in LTCF. Results indicate that policies and regulations addressing LTC resident and staff vaccination may effectively protect the most vulnerable older adults and the workforce providing their care while mask mandates and visitation guidance do not.

Changes In Mental Health, Social Engagement, and Physical Activities During the COVID-19 Pandemic

The current COVID-19 pandemic has profoundly changed our behaviors and health, especially vulnerable community-dwelling older adults. This symposium includes three presentations that evaluated the pandemic’s impacts on mental health, social engagement and physical activity in healthy community-living older adults and those with dementia. Dr. Wenjun Li and his team examined the pandemic impact on mental health and social engagement among relatively healthy older adults residing in suburban and rural neighborhoods in Central Massachusetts, USA. The study reported significant variations in pandemic impacts by sex, age, race, income, living arrangement, and neighborhood housing density, suggesting the pandemic has had disproportionally negative impacts on socially and economically disadvantaged vulnerable older adults. Dr. W. Quin Yow and her team evaluated the impacts of government mandated social distancing and lockdowns on older adults with dementia and their caregivers in Singapore. The study found significant increases in irritability, aggression and hallucinations among older adults with dementia, and possible deterioration of health conditions and heightened moderate level of stress. The results suggest that social distancing may have resulted in negative outcomes in this vulnerable population with dementia and their caregivers. Dr. Ladda Thiamwong reported her team’s efforts on forming an international aging research collaborative to mitigate heath consequences of COVID-19 crisis from the international perspective. The team consists of ten scholars from five countries, including Hong Kong, Nepal, Singapore, Thailand, and the United States. They collect data using combinations of online and face-to-face surveys. Their important findings will be discussed in detail in this symposium.

Food Insecurity in Older Adults: Gerontology Students and RSVP a Partnership that Works

Despite rapidly growing number of older medical cannabis users, research on them is scant. In this study, we examined medical and nonmedical cannabis users aged 50+ on health-related characteristics and cannabis use patterns and sources. Hypotheses were that compared to nonmedical users, medical users are more likely to have physical and mental health problems, use healthcare services, discuss their drug use with a healthcare professional, use cannabis more frequently, and purchase cannabis from a medical dispensary and other sources rather than obtain it as a gift, share someone else’s, or use other means. We used the 2018 and 2019 National Survey on Drug Use and Health data (N=17,685 aged 50+; male=8,030; female=9,655) and multivariable logistic regression analysis to test hypotheses. Of the sample, 8.9% reported past-year cannabis use. Of past-year users, 18.5% reported any medical use. Of medical users, 70.9% reported exclusive medical use and 29.1% reported using medically and nonmedically. A large proportion obtained cannabis from private/informal sources. Any medical use, compared to nonmedical use, was associated with lower odds of alcohol use disorder but higher odds of discussing drug use with a healthcare professional (AOR=4.18, 95% CI=2.53-6.89), more days of use (AOR=2.56, 95% CI=1.35-4.86 for 200-365 days), and purchase at a medical cannabis dispensary (AOR=4.38, 95% CI=2.47-7.76). Medical and nonmedical users did not differ on physical health, and both had high behavioral health problem rates. However, only a small portion discussed their drug use with a healthcare professional. More healthcare professional attention to older cannabis users is needed.

Effective recruitment strategies for home-living vulnerable older adults with depression into a psychotherapy RCT

Objectives: Vulnerable older adults, such as physically impaired or care-dependent individuals, are vastly underrepresented in psychotherapy research. Improving their inclusion in randomized controlled trials is necessary to determine the effectiveness of psychotherapy in this population. This study is the first to systematically evaluate strategies to recruit home-living vulnerable older adults with clinically significant depression into a large randomized controlled psychotherapy trial. Potential participants were approached directly (self-referral) or via cooperation with gatekeepers (gatekeeper-referral). Methods: The initiator of the first contact with the study team and successful recruitment strategies were recorded. Referral strategies were compared with respect to number of inquiries and inclusion rates; study personnel’s time investment; and participant characteristics (sociodemographics, functional and cognitive status, depression and anxiety scores). Results: Most of the N=197 participants were included via gatekeeper-referral (80.5%, 95%CI=[74.9%,86.1%], but time investment for gatekeeper-referrals was five times higher than for self-referral by media reports. Clinical psychologists and medical practitioners referred the largest proportion of participants (32.3% each) and referral by medical practitioners led to highest inclusion rates (55.6%; χ²(3)=8.964, p<.05). Most participants were referred from a hospital setting (50.3%), whereas referral numbers by medical practices were low (15.9%). Participants who initiated the first contact themselves had higher inclusion rates and were less functionally and cognitively impaired. Conclusions: Including home-living vulnerable older adults into psychotherapy trials requires simultaneous implementation of diverse recruitment strategies. Medical practitioners and psychologists, especially in hospitals, are the most effective recruitment strategy, but self-referral via media is most cost-efficient in terms of time investment.