Background: Learning health systems (LHSs) iteratively generate evidence that can

Background and Objectives: Long-term services and supports in the U.S. are increasingly

The number of sexual and gender minority (SGM) older adults utilizing residential long-term supports and services (LTSS) will increase in the forthcoming decades. Paradoxically, while requiring more LTSS services than their non-SGM counterparts, SGM older adults are less likely to access these services, partly due to fears of discrimination. Furthermore, SGM older adults living with Alzheimer’s disease and related dementias (AD/ADRD) present unique challenges and opportunities for LTSS facilities. This article provides a scoping review on the intersection between experiences of SGM older adults with AD/ADRD who use residential LTSS. This review identified three themes: (1) the experiences of discrimination among SGM residents in LTSS facilities, (2) the need for comprehensive staff training in residential LTSS to ensure proper care of SGM populations, and (3) the crucial role of inclusive facility policies. As the number of SGM older adults is expected to increase, further research is necessary.

Policymakers are interested in the long-term services and supports (LTSS) needs of people living with dementia. The National Core Indicators-Aging and Disability (NCI-AD) survey is conducted to eva...

Interdisciplinary collaborations and team science are essential in advancing research across the aging continuum. This involves bringing together experts from different disciplines to work together to address complex topics related to aging. Yet, despite the value of building interdisciplinary collaborations, multiple barriers often exist, that include finding the time to connect, developing shared goals by faculty dispersed across different departments, and developing a commitment to learning from each other and having open communication. This symposium will review multi-pronged strategies to build interdisciplinary collaboration in aging as part of the Center for Healthy Aging and Innovation at the University of Minnesota. In particular, we will discuss the formation of Special Interest groups (SIGs), which have become one key way to encourage interdisciplinary collaborations. SIGs are member driven and are meant to encourage collaboration via joint publications, presentations and grant applications as well as other shared initiatives agreed upon by the group (e.g., resource identifications, book club). Each special group has its own sense of community and draws on members from different disciplines. The symposium will include presentations from four of the seven SIG chairs, focused on the Financial Decision Making SIG, Alzheimer’s Disease and Related Dementias SIG, Transportation SIG, and Aging and Chronic Disease Management SIG. Importantly, the symposium includes perspectives from faculty at different career ranks as well as PhD students.

Long-Term Services and Supports (LTSS) include medical, social, and personal care services that people may need to perform activities of daily living due to physical or cognitive impairments. Measuring the quality of LTSS is essential for improving the care and outcomes of people with disabilities and older adults and ensuring that services meet consumer needs. Several frameworks have been developed to measure LTSS quality, including the National Quality Forum’s LTSS Framework. Yet, few data sources are available to measure person-reported quality in HCBS. This symposium will provide an overview of National Core Indicators (NCI) as a unique data source to address this gap. It also includes presentations from researchers from organizations in two states who utilize NCI data – Minnesota and Massachusetts – who will share their perspectives about the value of the data, results from empirical analyses, and how they use and plan to use the data to inform policy. Researchers from the Lurie Institute for Disability Policy will present findings on the association between person-centered planning and key person-reported outcomes in Medicaid HCBS. Researchers from the University of Minnesota School of Public Health and Brown University will share findings from national NCI data on unmet needs among older adults by dementia status and race/ethnicity. They will also share results of analyses in MN, linking person-reported HCBS plan quality and healthcare utilization, using claims data. Collectively, this symposium will address the gap in measurement of HCBS quality nationally and identify key directions for policy and future research.

Assisted living (AL) describes long-term residential care settings that emphasize person-centered services and choice in a “home-like” environment. There is considerable variability in how AL is defined, what services are provided, and how quality is measured. Minnesota serves as a unique policy environment in which to study AL. In May 2019, Minnesota funded the development of an AL Report Card to measure and report on the quality of AL from resident and family perspectives, created in partnership with the University of Minnesota. Literature review, stakeholder feedback, and pilot testing were completed in 2020-21 and the survey was implemented statewide in 2021-22. Using 2021 AL resident quality of life (QoL) survey pilot data (N=1,392), the goal of this work was to assess the reliability and psychometric properties of the survey in measuring 7 QoL domains: food, staffing, environment, engagement, autonomy, culture, and security. The 7 domains were measured using 6, 10, 3, 6, 5, 3, and 6 items, respectively. We found acceptable internal consistency for four QoL domains: food, staff, security, and engagement (McDonald’s omega and Cronbach’s alpha ≥0.6). Confirmatory factor analysis was performed for each individual factor using diagonally weighted least squares for ordinal data. We found high interfactor correlations between the three domains with poor internal consistency (environment, culture, and autonomy). We collapsed these three domains into one overarching domain – climate – and found satisfactory data-model fit. Findings of stability and validity of QoL report card domains have important implications for adoption outside of Minnesota.

Sexual and gender minority (SGM) older adults face discrimination in long-term services and supports (LTSS). Yet, SGM older adults use LTSS disproportionately higher relative to their non-SGM count...

Objectives: To evaluate the evidence on effects of nurse staffing in nursing homes on resident outcomes. Design: Systematic review. Setting and Participants: Studies evaluating the effects of nurse staffing levels, total staffing, or skill mix on pressure ulcers, nursing home associated infections, and pain outcomes for adult residents in US nursing homes. Methods: We searched MEDLINE, Embase, CINAHL, and the Cochrane Database for English-language articles published between January 2000 and May 2021. We also searched for gray literature and sought expert referrals. Two reviewers participated in determination of eligibility, assessment of methodological quality, and abstraction of data. Abstracted data included study design; setting and population characteristics; and resident outcomes. We rated overall certainty of evidence (very low, low, moderate, and high) for each outcome using GRADE. Results: Of 9152 unique citations, 378 articles underwent full-text review. We identified 22 eligible studies that addressed pressure ulcers (k = 15), COVID-19 cases and/or mortality (k = 4), other infections (k = 8), and moderate-severe pain among residents (k = 7); some examined multiple outcomes. Most studies (k = 17) were rated moderate or high quality. All studies were observational. Overall, registered nurse (RN) staffing was probably associated with fewer pressure ulcers (moderate certainty) and possibly fewer COVID-19 infections/mortality (low certainty), other infections (low certainty) and lower rates of moderate-severe pain (low certainty). Higher skill mix was probably associated with fewer pressure ulcers, higher resident COVID-19 infections, fewer other infections, and lower rates of moderate-severe pain (low certainty for all outcomes). Conclusions and Implications: Higher RN staffing and skill mix may be associated with better nursing home resident outcomes, while results were mixed for total staffing. Increasing RN staffing levels and skill mix are one of a variety of approaches to improve nursing home care.

Objectives: We investigated the relationship between the cognitive status of participants’ spouses and participants’ own cognitive outcomes, controlling for mid-life factors. Methods: Participants (n = 1845; baseline age 66–90 years) from the prospective Atherosclerosis Risk in Communities Study were followed from 2011 to 2019. We used linear regression and Cox proportional hazard models to estimate whether spouses of people with MCI/dementia had lower cognitive functioning and elevated risk of incident dementia. Results: Having a spouse with MCI/dementia was associated with a deficit in cognitive function (b = −0.09 standard deviations; 95% CI = −0.18, 0.00). Adjustment for mid-life risk factors attenuated this association (b = −0.02 standard deviations; 95% CI = −0.10, 0.06). We observed no significant relationship between spousal MCI/dementia status and incident dementia (hazard ratio = 0.97; 95% CI = 0.69, 1.38). Discussion: Spousal cognitive status is not associated with poor cognitive outcomes independent of mid-life factors.

Background and Objectives: Uncovering subgroups of nursing home (NH) residents sharing similar

Among nursing home (NH) residents with Alzheimer’s disease (AD) and AD-related dementias (AD/ADRD), racial/ethnic disparities in quality of care exist. However, little is known about quality of life (QoL). This study examines racial/ethnic differences in self-reported QoL among NH residents with AD/ADRD. Methods: Validated, in-person QoL surveys from 12,562 long-stay NH residents with AD/ADRD in Minnesota (2012–2015) were linked to Minimum Data Set assessments and facility characteristics. Hierarchical linear models assessed disparities in resident-reported mean QoL score (range, 0–100 points), adjusting for case-mix and facility factors. Results: Compared to White residents, racially/ethnically minoritized residents reported significantly lower total mean QoL scores (75.53 points vs. 80.34 points, p <.001). After adjustment for resident- and facility-level characteristics, significant racial/ethnic differences remained, with large disparities in food enjoyment, attention from staff, and engagement domains. Discussion: Policy changes and practice guidelines are needed to address racial/ethnic disparities in QoL of NH residents with AD/ADRD.

Research suggests a disparity in the prevalence of dementia, with Black older adults having double the risk compared to their White counterparts. African immigrants are a fast-growing segment of the U.S. Black population, but the dementia care needs and resources of this population are not fully understood. In this paper, we describe the process of working collaboratively with a community partner and project advisory board to conduct a culturally informed project. Specifically, we describe the process of developing culturally informed instruments to collect data on dementia care needs and resources among African immigrants. Working together with a diverse project advisory board, a guide was developed and used to conduct community conversations about experiences with dementia/memory loss. Transcripts from six conversations with 24 total participants were transcribed and analyzed thematically by two independent coders in Nvivo. These qualitative findings were used to inform the development of a survey for quantitative data collection that is currently ongoing. Themes (e.g., cultural attitudes, challenges, and current resources) from the community conversations that informed the survey are described briefly. Despite the challenges of conducting research during a global pandemic, having trusting relationships with a partnering community organization and project advisory board facilitated the successful development of instruments to conduct preliminary dementia care research in an underserved population. We anticipate that survey results will inform interventions that increase education, outreach, and access to dementia care and caregiving resources for this population. It may serve as a model for community–university partnerships for similar public health efforts in dementia as well as other chronic disease contexts.

Racial/ethnic composition of nursing home (NH) plays a particularly important role in NH quality. A key methodological issue is defining when an NH serves a low versus high proportion of racially/ethnically diverse residents. Using the Minimum Data Set from 2015 merged with Certification and Survey Provider Enhanced Reports, we calculated the racial/ethnic composition of U.S.-based NHs for Black or Hispanic residents specifically, and a general Black, Indigenous, and People of Color (BIPOC) grouping for long-stay residents. We examined different definitions of having a high racial/ethnic composition by varying percentile thresholds of composition, state-specific and national thresholds, and restricting composition to BIPOC residents as well as only Black and Hispanic residents. NHs with a high racial/ethnic composition have different facility characteristics than the average NH. Based on this, we make suggestions for how to identify NHs with diverse racial/ethnic resident compositions.

Objective: Little is known about sexual minority (SM) older adults’ activities of daily living (ADL) and instrumental activities of daily living (IADL) limitations and their subsequent access to lo...

Background and Objectives: Abundant evidence documents racial/ethnic disparities in

<p>Most older adults reside in low- and middle-income countries (LMICs) but most research dollars spent on interventions to improve the lives of older adults are awarded to researchers in High-Income Countries (HICs). One approach to improve implementation of evidence-based innovations for older adults in LMICs is designing interventions that are relevant to LMICs and HICs simultaneously. We propose that researchers in HICs could partner with stakeholders in an LMIC throughout the intervention design process to better position their intervention for implementation in that LMIC. We provide an example study from an adaptation of the Resources for Enhancing Caregiver Health (REACH) II in Vietnam, which did not use this strategy but may have benefited from this strategy. We then turn to several considerations that are important for researchers to contemplate when incorporating this strategy. Finally, we explore incentives for creating interventions that are relevant to both HICs and LMICs for funders, intervention designers, and intervention receivers. Although this is not the only strategy to bring interventions to LMICs, it may represent another tool in researchers’ toolboxes to help expedite implementation of efficacious interventions in LMICs.</p>