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Presentations at GSA

benjamin rose institute on aging Presentations at GSA

Contact: Jeanne Hoban, 216.373.1686, jhoban@benrose.org

November 8, 2016

Experts from the Benjamin Rose Institute on Aging will present 15 papers, posters and symposia at the 2016 Annual Scientific Meeting of the Gerontological Society of America in New Orleans, Louisiana, November 16-20.
Among the topics Benjamin Rose presenters will address are: elder abuse prevention, care preferences of individuals with dementia and the Heart Health Program.

Complete schedule of presentations by Benjamin Rose researchers appears below. Benjamin Rose presenters are highlighted in bold italic.

THURSDAY, NOVEMBER 17, 2016

8:30am - Galerie 1 (M) (Marriott)
Elder Abuse Prevention: Lessons From the Texas Adult Protective Services and WellMed Collaboration
Symposium Chair: Farida K. Ejaz
Discussant: Georgia Anetzberger, Case Western Reserve University

Intervening to Prevent Elder Abuse Among Patients in Primary Care Settings
Carol Zernial, WellMed Medical Management, and Farida K. Ejaz
Focuses on the components of an innovative intervention developed by Texas Adult Protective Services (APS) and WellMed Medical Management Inc. (WMMI) to prevent elder abuse among patients in primary care settings. Key components of the four-year collaborative intervention are to: 1) Embed two APS workers in WMMI; 2) Train clinicians in primary care clinics to identify and report victims of abuse, neglect and exploitation to APS; 3) Incorporate the Elder Abuse Screening Index (EASI) in the assessment process within the electronic medical record, and follow appropriate clinical protocols; and 4) Distribute educational materials to patients and family members. During the intervention period, 826 clinicians from 63 clinics were trained; 12,687 EASIs were completed; and educational materials were distributed. Successes and challenges of the collaboration, and planned sustainability efforts after grant funding ends, provide lessons learned for abuse prevention in health care systems.

Adult Protective Service Workers in a Healthcare Setting: New Opportunities and Challenges
Farida K. Ejaz, Miriam Rose, Amanda McLaughlin and Lauren Borato
Researchers conducted separate, semi-structured telephone interviews with two Adult Protective Services (APS) workers embedded in a health care system. The common themes included APS workers: 1) serving as educators to clinicians; 2) acting as liaisons between APS and the health care system; 3) documenting 300 cases of abuse; and 4) feeling respected despite some tensions. The findings have implications for how APS can play a role in new types of settings to prevent elder abuse.

Training Clinicians in Primary Care Settings in Texas on Preventing Abuse Among Older Patients
Miriam Rose, Farida K. Ejaz
and Lauren Borato

Texas Adult Protective Services (APS) partnered with WellMed Medical Management, Inc. (WMMI) to prevent abuse among older, primary care patients. Training on abuse, neglect and exploitation was provided to WMMI clinicians in 63 Texas primary care clinics. Trainers included 2 APS workers. Pre- and post-training surveys were completed by 532 clinicians at sessions in 2014-2015, and 200 completed follow-up surveys on a staggered basis about a year later. Preliminary analyses of responses over time were conducted using repeated measures ANOVA for interval-level data, and related-samples Cochran's Q for categorical variables. Findings indicated that significant improvements in knowledge immediately after training were not sustained at the same levels at follow-up in areas such as recognizing indicators of abuse (F=62.98, p<.001) and familiarity with clinical protocols for reporting victims to APS (test-statistic=100.00, p<.001). Findings underscore the need for ongoing training of clinicians who can play a key role in abuse prevention.

8:30am - Grand Ballroom B (Sheraton)
Should I? Change in Perceptions on the Desire to Place Persons With Dementia into a Nursing Home
Justin Johnson and Heather L. Menne
This presentation examines whether PWD and caregiver characteristics, utilization of services, or engagement in an evidence-based intervention led to any change in caregivers' perceptions of placing their loved ones in a nursing home. This analysis is based on reports from 216 caregivers who were enrolled in the Ohio replication of the Reducing Disability in Alzheimer's Disease (RDAD) program for one year. Caregivers reported their perceptions of desire to place PWDs at T1 (baseline) and again at T4 (one year). At T1, 59.7% of caregivers reported "yes"that they considered or thought about nursing home placement for the PWD. At T4 the percent reporting "yes" was 49.1%. Logistic regression analysis was conducted to measure the change in caregivers' perceptions from T1. Results indicate that caregivers with higher educational attainment (O.R. = 1.30, p < .05), caring for PWDs with more cognitive impairment (O.R. = 1.05; p < .05), and reporting greater emotional strain (O.R. = 1.21, p < .05) were more likely to have considered placing the PWD in to a nursing home after one year in the program. These results may help illustrate the stresses experienced by caregivers, and help facilitate dialogue/discussion on ways to assist people caring for persons with dementia keep them in the home.

8:30am-10:00am - Rhythms 3 (S) (Sheraton)
The Care Preferences of Persons With Dementia: Working Together to Create a Balanced Plan of Care
Chair: Carol Whitlatch
Discussant: Karen Lyons, Oregon Health and Science University

"Who do you prefer help you with...": The SHARE Model for Assessing Care Preferences
Sarah Szabo, Carol Whitlatch, and Silvia Orsulic-Jeras
The SHARE Program (Support, Health Activities, Resources, and Education) is a psychosocial intervention designed for persons with early-stage dementia and their family care partners. Intervening in the early stages provides families with the opportunity to discuss care values and preferences of the person with dementia in order to create a mutual plan of care for the future. This presentation will provide an overview of the SHARE Program and its development, with a focus on the Preferences for Care Tasks scale. This scale is used to help participants understand one another's preferences for who will provide care as the illness progresses (i.e., the family care partner, other family and friends, and/or service providers). Discussion will highlight the ability of persons with dementia to answer questions about care preferences and how these responses are the basis of initial discussions for developing a realistic plan of care.

"I Know What You Want, but I Can't Do It All": How Share Helps Families Create a Balanced Care Plan
Carol Whitlatch, Sarah Szabo, and Silvia Orsulic-Jeras
Psychosocial interventions targeting persons with early-stage dementia (PWDs) and their care partners have a unique opportunity to engage both participants in discussions about preferences for current and future care. The Preferences for Care Tasks (PCT) scale assesses the PWD's preferences for who (the care partner, family/friends, and service providers) will provide assistance with PADLs and IADLs (e.g., eating, bathing, transportation), and the care partner's perception of the PWD's preferences. Results of research with over 200 families indicate: 1) PWDs prefer their care partner to help with the majority of care tasks, and 2) care partners are aware of the PWDs' preferences. This imbalance of care provision can be very burdensome for care partners. This presentation describes results using the PCT Circles Diagrams and how the SHARE intervention helps families identify additional sources of support so that the care partner is not over burdened with providing nearly all the PWD's care.

Opening the Door to Plan B: The Role of Care Preferences in Early-Stage Dementia Care Planning
Silvia Orsulic-Jeras, Carol Whitlatch,
and Sarah Szabo
Early-stage care planning for families living with dementia involves gaining insight into the person with dementia's (PWD's) preferences regarding future care. The SHARE Program takes these insights to the next level by also assessing the caregiver's perceptions of the PWD's preferences. Care dyads initially prefer the caregiver handle most care tasks and may be resistant to consider other options. The SHARE Care Circles create a visual picture of care preferences that are used to highlight imbalances and incongruences. Although discussions about personal needs, home care, and nursing home placement can be difficult, SHARE carefully breaks down barriers and helps open the door to alternate care options. This paper describes how SHARE Counselors move families toward a more realistic care picture. Case examples highlight how building rapport creates a safe and trusting environment to: 1) begin the process of making complex care-related decisions, and 2) address resistances and barriers.

The Impact of Discordant Care Preferences on Persons With Dementia and Their Care Partner
Evan Shelton
In the early stages of dementia, the practical demands of the caregiving process are typically most salient for the caregiver (CG) whereas persons with dementia (PWDs) are often more concerned with maintaining a sense of independence and well-being. Based on these concerns, both care partners likely will develop preferences for the provision of the PWD's care that may or may not be shared by their care partner. Using baseline data from the SHARE study, we measured the IADL, PADL, and socioemotional care-related preferences of the CG and the PWD. Results indicated that incongruence on socioemotional preferences significantly predicted greater relationship strain and negative mood (as rated by both the CG and the PWD) for the PWD, but not for the CG. Discussion will focus on the important findings for incongruence of PADL and IADL care preferences and the importance of socioemotional care-related content in the care planning process.

1:30pm - Bayside B (Sheraton)
Predictors of Discrepancy Between Dementia Care-Dyads on the Care-Recipients' Quality-of-Life
Heehyul Moon, Aloen Townsend, Peggye Dilworth-Anderson, Carol Whitlatch
Given that the voices of care recipients with mild-to-moderate dementia are often excluded from their caregiving process, this study explored discrepancy and its predictors between reports of family caregivers and care recipients with mild-to-moderate dementia about care recipients' quality of life (QoL). With 200 care dyads results showed that caregivers rated care recipients' QoL significantly lower than care recipients did. Greater incongruence in perceptions of care recipients' decision-making involvement (DMI) and higher level of care recipient impairment in activities of daily living were significantly related to higher absolute discrepancy between caregivers and care recipients about care recipients' QoL. When the dyad had more DMI incongruence, or caregiver reported higher relationship strain, the caregiver was more likely to report lower care recipients' QoL than care recipients reported. This study highlights the importance of including CRs with mild-to-moderate dementia in their caregiving process. It also highlights the advantages of including the absolute discrepancy and the direction of discrepancy as alternative ways of investigating discrepancies.

5:30pm - Galerie 4 (M) (Marriott)
Cross-Cultural Adaptation of Measurement Aging in Asia Special Interest Group Session: Aging in Asia Special Interest Group Session: Tools for Asian Older Adults: Methods and Challenges
Chair: Shantha Balaswamy
Discussant: Farida K. Ejaz

In order to better understand the effects of global aging, more cross-cultural research and validation of geriatric assessments tools is needed. Current measures of health, mental health, social support, and well-being have been largely developed and often used within Western populations which compromises their validity in other cultures. This symposium describes the methods and challenges used by researchers in cross-cultural validation of commonly used scales. Investigators used quantitative and qualitative research methods to test the cultural relevance of proposed constructs using careful translation and adaptation of a common measures to establish criterion and construct validity. Two presentations explore "health related" measures in China and India, one presentation tests the "social isolation" construct in elders from six countries and one presentation assesses the meaning of "social support" from elder perspectives in India.

FRIDAY, NOVEMBER 18, 2016

9:30am - Napoleon Ballroom (S) (Sheraton)
Are You Ready? The Role of Readiness in a Dyadic Care Planning Intervention for Early Dementia
Silvia Orsulic-Jeras and Evan Shelton
Evidence supports designing proactive, dyadic interventions for use in the early stages leads to more effective decision making, and provides an opportunity to document and validate the person with dementia's (PWD's) care preferences. SHARE (Support, Health, Activities, Resources, and Education) a seven-session, counseling-based intervention aims to encourage and support care dyads to have important discussions about health care preferences that are often put off or avoided until the later stages of dementia. Although having these discussions early on are critical, many care dyads are not yet ready to have them. This poster will describe how SHARE Counselors are trained to assess care dyads' readiness using an adapted, 4-stage version of the Transtheoretical Model (TTM). SHARE Counselors rated readiness of each care partner at baseline, after 6 sessions (8 weeks from baseline), and again after a final booster session (20 weeks from baseline). Findings from readiness assessments administered to 125 early-stage dementia care dyads will be used to illustrate: 1) how care partners who were less "ready" at baseline responded to discussions about future care, 2) strategies used by SHARE Counselors to engage care partners even when each started off at a different level of readiness, 3) how initial readiness levels at baseline impacted whether or not dyad completed the full intervention protocol, and 4) whether or not readiness improved over time as a result of the intervention. Discussion will highlight why understanding PWD and caregiver (CG) readiness is critical when engaging in sensitive discussions on future care needs.

1:00pm - Napoleon Ballroom (S) (Sheraton)
The Health Belief Model for Understanding Older Adults' Engagement in the Heart Health Program
Lauren Borato, David Bass, Heather L. Menne, Justin Johnson, and Evan Shelton
The Health Belief Model (HBM) posits five perceptions as central for understanding engagement in health behaviors: severity of health problems, susceptibility to health problems, barriers to and benefits of preventive actions/treatments, and self-efficacy in managing health. This research examines whether constructs from the HBM relate to older adults’ participation in the behavior change Heart Health Program. The 6-session program provided information, support, and participant-chosen "action steps" as behavior changes to improve/maintain heart health. This pilot study (n=25) tests whether HBM characteristics measured before beginning the program were associated with the extent of program engagement (i.e., sessions attended, number of action steps, expectations for long-term behavior change, and program satisfaction). Several findings were consistent with HBM. Participants more concerned about their health engaged in more medical, social, and stress-reducing action steps (r=-.45, p=.03). Participants who perceived more benefits to doing heart-healthy behaviors were more satisfied with the program (r=.43, p=.05), and had more exercise/nutrition action steps (r=.35, p=.10). Participants who felt more efficacious about managing their health reported a stronger commitment to sustaining behavior change (r=.45, p=.04) and greater program satisfaction (r=.40, p=.08; .41, p=.07). Those who perceived more barriers to doing health behaviors were less satisfied with the program (r=.43, p=.05). One finding contrasted with HBM; perceived susceptibility was unrelated to any program engagement measure. Although a limited sample, results suggest the HBM is a promising conceptual framework for understanding engagement in this innovative program. Additional implementations with larger samples are underway.

SATURDAY NOVEMBER 19

5:30pm - Bayside C (S) (Sheraton)
What Non-Completion of an Intervention Data Collection Can Tell Us About the Participants
Heather L. Menne and Justin Johnson
Ongoing data collection is conducted to document participant outcomes because it is expected that most participants who complete an evidence-based intervention will benefit from participation. Less talked about are the participants who do not complete follow-up data collection once the intervention is delivered. The dyadic, evidence-based Reducing Disability in Alzheimer’s Disease (RDAD) program, was replicated by Ohio's Alzheimer's Association Chapter staff who trained families on exercise and behavior management techniques. Four hundred and sixty-four (464) families completed the 12-session intervention; however, only 277 families completed the study data collection through 1 year ("stayers"). Of the 187 families who did not complete data collection at 1 year, 76 left due to placement of the person with dementia (PWD) into a residential care setting ("placers") and the remaining 111 ("others") left for various other reasons (e.g., health of caregiver, relocation). ANOVA analyses and post-hoc tests were conducted to determine whether the "stayers", "placers", and "others" differed on demographics, health, cognitive and functional ability, strain, well-being, and level of engagement in the RDAD intervention. Cognitive ability of PWDs (based on the Short Blessed Test), was significantly different between "stayers" (mean= 18.36) and "placers" (mean=21.45; p<.025); whereas PWD physical functioning was significantly different between "stayers" (mean= 46.46) and "others" (mean=36.03; p<.025). Caregiver-reported relationship strain was significantly different between "others" (mean=10.30) and "placers" (mean=12.47; p<.025). Understanding what distinguishes between those who complete and those who do not complete an intervention study can more broadly indicate the generalizability of the intervention.

5:30 PM - Rhythms 3 (S) (Sheraton)
Perceptions of the Care Values of Hospitalized Patients With Dementia
Lyndsey Miller, School of Nursing, Oregon Health & Science University (OHSU), Carol Whitlatch, Christopher S. Lee, OHSU, Jill Bennett, OHSU, and Karen Lyons, OHSU
The purpose of this study was to describe incongruence in perceptions of the care values of hospitalized persons with dementia (PWDs), and identify determinants thereof. Using multilevel modeling, we examined cross-sectional data collected from 42 dementia care dyads (PWD and family member) in the inpatient hospital setting. There was a significant amount of incongruence, on average, for all 4 subscales of the PWD's care values: autonomy = -0.33 (p < .001); avoiding being a burden = -.49 (p < .001); safety = -.26 (p < .001); maintaining social interactions = -.21 (p = .004). For all care values, the direction of incongruence was such that the family member underestimated the importance to the PWD. There was a significant amount of variability around the average amount of incongruence for the values of autonomy, burden, and safety, but not for the value of social interactions. Less decision-making involvement of PWDs was a significant determinant of the variability around the average incongruence for the values of autonomy, burden, and safety. Additionally, fewer positive dyadic interactions were a significant determinant of incongruent perceptions regarding the value of autonomy. Our findings suggest that incongruent perceptions of the PWD's values may be extensive among dementia care dyads in the hospital setting. Yet, involving PWDs in decision making and engaging in more positive interactions may mitigate such incongruence.

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