Moderation: S. Zank, Köln; J. Bauer, Heidelberg
Discrimination affects ethnic minority groups on a daily basis in the United States. This study focuses on Chinese older adults living in the US and examines: (1) psychosocial factors related to their report of discrimination, and (2) the association between self-reported discrimination and depressive symptoms controlling for potential confounders including personality traits and ethnic enclave residence. We conducted cross-sectional analysis of data collected from adults (age 60+) of Chinese origin residing in the Greater Chicago Area (N=3009). Self-reported discrimination was assessed by a 9-item measure, and was dichotomized (yes vs. no self-reported discrimination) due to skewed distribution. Depressive symptoms were measured by the 9-item Patient Health Questionnaire (PHQ9). Logistic regression of self-reported discrimination and negative binominal regression of depressive symptoms were conducted, and robust standard errors were applied to adjust for clustering of individuals by neighborhoods. The analysis shows that about 21.5% of the sample reported having experienced discrimination. Those who are younger, male, have higher education and income, are more acculturated, have higher levels of neuroticism, and reside out of Chinatown are more likely to report discrimination. Self-reported discrimination is significantly and positively associated with depressive symptoms (b=.16, 95% CI=.04 to .28, p=.007), even after controlling for age, gender, marital status, education, income, acculturation levels, years living in US, neuroticism and Chinatown residence. The findings suggest that even though Chinese are portrayed as a ‘model minority’ in the US, they are not spared of discrimination, and that discrimination experience undermines mental health of Chinese older adults in the US.
Introduction: Global increases in older adult populations and the paucity or decrease in geriatricians in many countries, makes it essential for all practitioners to be trained in older adult patient care. Yet these patients are viewed negatively. “Admitting” medical trainees into nursing homes for an extended period to live the life of a resident provides a life altering learning environment and establishes the need for new models of care.
Methods: Learning-by-Living utilizes qualitative ethnographic/biographic research design, whereby a “culture” is observed by the researcher (medical trainee) living within an environment (nursing home). Trainee volunteers (N=33) were “admitted” into 10 nursing homes (2006-14) to live the life of an elder resident 24/7 for 2 weeks; complete with medical diagnoses and “standard” procedures of care (toileting, transferring, bathing, and feeding). Field Notes (data) reported observations, experiences, and resident encounters. Data were analyzed by thematic categorization and coding by manual and QSR-N-Vivo Research Software standard protocols.
Results: Data stages included nursing home arrival, first days, daily life, and leaving. Salient themes included dependence, routine, respect, and waiting. Trainee skill attainment included communication using voice tone/cadence, body language, word choices, touch, and eye contact. Age disparities, disease, and frailty were non-issues in forming interpersonal relationships.
Conclusion: Learning-by-Living challenges stereotypes about aging and nursing homes, and expands trainees’ doctoring attitudes, skills and knowledge. Admitting medical trainees into nursing homes to live the life of an elder resident increases their desire to work with older adults.
- Understand the utility of immersion learning in augmenting intergenerational connections within the nursing home environment
- Apply immersion learning with medical trainees to enhance empathy and understanding
This presentation focuses on two training programs targeting healthcare professionals to identify, screen and report abuse, neglect and exploitation among adult patients. In one project funded by the U.S. Administration on Community Living (ACL), a healthcare provider collaborated with Adult Protective Services (APS) to train clinicians in 63 primary care clinics across Texas. Two APS workers were embedded in the healthcare system and helped conduct on-site training of 826 clinicians. Of these, 711 clinicians were invited to participate in pre-post training surveys and 532 completed both. These clinicians also received a one-year follow-up survey. Although 300 elders were reported to APS, survey findings indicated that significant improvements in knowledge immediately after training were not sustained at follow-up in areas such as recognizing indicators of abuse and protocols for reporting victims to APS.
The other is a three-module, online training program developed in Ohio with funding from ACL. The three modules are each one-hour long, include pre-post training surveys and focus on: background on abuse; screening; and reporting. The training targets care managers in managed care organizations involved in a demonstration to coordinate care for the dually eligible Medicare and Medicaid population. A year after its release, 453 care managers enrolled and 211 completed all three modules. Findings revealed significant improvements in knowledge in areas such as understanding the criteria for reporting victims to APS, but not in other areas.
Both the Texas and Ohio projects have implications for abuse prevention by training healthcare professionals on identification, screening and reporting abuse.
Objectives After attending this session, participants will be able to:
- Describe findings from an in-person training conducted with clinicians in primary care settings in Texas to identify and screen for abuse among older and vulnerable patients.
- Describe findings from an online training program on abuse, neglect and exploitation offered to care managers participating in a demonstration to coordinate care for the dually eligible Medicare and Medicaid population in Ohio.
- Discuss successes and limitations of abuse training programs conducted in Texas and Ohio, and their implications for practice and policy.
Sarcopenia is a geriatric syndrome encompassing the loss of muscle mass and strength or physical performance with age. The term osteosarcopenia has been used to describe those frailer subjects suffering from both osteopenia/osteoporosis and sarcopenia. Osteosarcopenia is associated with poor outcomes in older persons, which include impaired mobility, higher incidence of falls and fractures, reduced quality of life, greater social and healthcare needs, and increased morbidity and mortality. Analysis of the pathophysiology of sarcopenia and osteoporosis reveal several overlapping features. These conditions are age-related, both are multifactorial processes and both are characterized by progressive loss of tissue mass. Additionally, physical inactivity, vitamin D deficiency and poor nutrition accelerate the progression of both conditions. Despite these similarities, most interventions to date target these conditions separately. In this session we will review the current state of knowledge about osteosarcopenia and will analyze preventive measures and therapeutic interventions that can benefit both conditions simultaneously. We intend to go over the translational aspects of sarcopenia and osteoporosis research and highlight expected outcomes from different interventions for both conditions. We will initially review the biological mechanisms contributing to sarcopenia and osteoporosis including metabolic and cell signaling changes. Next, we will discuss the benefits and limitations of current diagnostic schemes for both conditions. For instance, the benefits and limitations of dual energy X-ray absorptiometry (DXA) as a diagnostic and research tool will be analyzed. Then, we will discuss evidence-based diagnostic and therapeutic interventions that pose promising opportunities for both conditions, which include the review of nutritional, physical activity and pharmacologic interventions. Finally we will translate this information into practical approaches that can improve older adult care.