Promoting Sustainability in Housing with Services: Insights From the Right Care, Right Place, Right Time Program.

Despite the widely-acknowledged potential of housing with services for improving the lives of low-income older adults, ensuring their financial sustainability has been challenging. This study aimed to address this issue, drawing on 31 key informant interviews and three focus groups with payers, housing providers, and community partners involved in the Boston-area Right Care, Right Place, Right Time Program, which enrolled about 400 older adults. Transcripts were qualitatively analyzed using thematic coding. Participants agreed on the program's value, but there was little consensus on mechanisms for securing ongoing funding. The broadly distributed responsibility for individuals in housing sites, which involves health insurers, hospitals, and community service providers, provides little incentive for investment by these entities. Findings suggest that governmental mechanisms, probably at the federal level, are needed to channel funding toward these supportive services. Without such reliable funding sources, replication of supportive housing models for low-income older people will prove difficult.

Widowhood and bereavement in late life.

Bereavement is a common and often challenging experience in late life. Evidence shows that while many older adults manage to adjust well and demonstrate resilience in response to the death of a close person, bereavement puts a substantial minority at risk of adverse mental and physical health impacts including mortality. Current research further indicates that 1) this is the case across different countries and cultures across the globe; 2) that the COVID-19 pandemic posed unprecedented challenges for coping with late-life bereavement; 3) that loneliness and social isolation among bereaved older adults tend to be prevalent and harmful, particularly under pandemic but also in nonpandemic circumstances; and, recently, 4) that bereavement may be a risk factor for cognitive decline in this population.

What do Family Caregivers Want? Payment for Providing Care.

Although the primary goal of self-directed programs providing long term services and supports (LTSS) is to maximize choice and control for service recipients, such programs may also benefit family caregivers by compensating them for providing supportive services. This study draws on qualitative data from research supporting the RAISE Family Caregiver Advisory Council, finding that family caregivers themselves see the expansion of self-directed programs as a policy priority due to their need for financial security. The request for compensation was the strongest finding, with respondents highlighting the incompatibility of work with caregiving and their inability to rely on the existing paid workforce due to supply and quality issues; the consequences of this loss of earned income were reported as severe. Ultimately, respondents saw payment for providing care as an issue of fairness. This evidence supports the policy case for expanding access to self-directed programs that permit the employment of family caregivers.

Policies to Sustain Employment Among Family Caregivers: The Family Caregiver Perspective.

The work of caregiving can make it difficult to sustain employment. This study aimed to clarify what family caregivers themselves think is important in remaining employed, as part of work mandated under the Recognize, Assist, Include, Support, and Engage (RAISE) Family Caregivers Act of 2018. Data came from a Request for Information promulgated by the Administration for Community Living, resulting in 1147 family caregiver responses, and 12 focus groups. Findings support many goals identified by caregiver-advocates, such as expanding the Family and Medical Leave Act, and access to paid time off and sick leave; caregivers also value flexible work arrangements. However, the study further revealed a need for supportive work environments that protect caregivers against workplace discrimination and negative attitudes held by both managers and colleagues, and thus for employer education about the caregiving experience as well as caregivers' needs for workplace supports and benefits, and possibly anti-discrimination legislation.

The Town-Level Prevalence of Chronic Lung Conditions and Death From COVID-19 Among Older Adults in Connecticut and Rhode Island.

INTRODUCTION: As of November 2021, older adults (aged ≥65 y) accounted for 81% of all deaths from COVID-19 in the US. Chronic lung diseases increase the risk for severe COVID-19 illness and death. The aim of this research was to examine the association between town-level rates of asthma and chronic obstructive pulmonary disease (COPD) and deaths from COVID-19 in 208 towns in Connecticut and Rhode Island. METHODS: We conducted a multistep analysis to examine the association between town-level chronic lung conditions and death from COVID-19. Pairwise correlations were estimated and bivariate maps were created to assess the relationship between COVID-19 deaths per 100,000 people and 1) asthma prevalence and 2) COPD prevalence among adults aged 65 years or older. We used multiple linear regression models to examine whether chronic lung conditions and other town-level factors were associated with COVID-19 death rates in Connecticut and Rhode Island. RESULTS: Initial bivariate correlation and mapping analyses suggested positive correlations between asthma and COPD prevalence and COVID-19 death rates. However, after controlling for town-level factors associated with chronic lung conditions and COVID-19 death rates, multiple linear regression models did not support an association, but town-level factors (African American race and Hispanic ethnicity, age ≥65 y, and low educational attainment) were significant predictors of COVID-19 death rates. CONCLUSION: We found significant associations between town-level factors and COVID-19, adding to the current understanding of the impact of social determinants of health on outcomes.

Electronically controlled cooling pads can improve litter growth performance and indirect measures of milk production in heat-stressed lactating sows.

Heat stress (HS) decreases lactation output in sows due to an attempt to reduce metabolic heat production. However, this negatively affects litter growth performance. Therefore, the study objective was to determine whether electronically controlled cooling pads (ECP) would improve indirect measures of lactation output (e.g., total heat production [THP]) and litter growth performance in HS exposed sows. Over two repetitions, 12 multiparous (2.69 ± 0.85) lactating sows (265.4 ± 26.1 kg body weight [BW]) and litters were assigned to either an ECP (n = 3/repetition) or a non-functional ECP (NECP; n = 3/repetition) and placed into farrowing crates within indirect calorimeters from days 3.7 ± 0.5 to 18.7 ± 0.5 of lactation. Litters were standardized across all sows (11.4 ± 0.7 piglets/litter), and sows were provided ad libitum feed and water. All sows were exposed to cyclical HS (28.27 ± 0.26 °C nighttime to 33.09 ± 0.19°C daytime). On days 4, 8, 14, and 18 of lactation, indirect calorimetry was performed on each individual sow and litter to determine THP and THP/kg BW0.75. Body temperature (TB) was measured hourly using vaginal implants, and respiration rate (RR; breaths per minute [bpm]) was measured daily at 0700, 1100, 1300, 1500, and 1900 h. Sow feed intake (FI) was assessed daily. Litter weights were obtained at birth, on days 4, 8, 14, and 18 of lactation, and at weaning. Data were analyzed using PROC GLIMMIX with sow and/or litter as the experimental unit. An overall decrease (P < 0.01; 25 bpm) in RR and maximum daily TB (P = 0.02; 0.40 °C) was observed in ECP vs. NECP sows. An increase in THP (P < 0.01; 20.4%) and THP/kg BW0.75 (P < 0.01; 23.1%) was observed for ECP when compared with NECP sows and litters. Litter average daily gain and weaning weight were increased (P < 0.05; 25.0 and 19.2%, respectively) for ECP vs. NECP litters. No FI differences were observed (P = 0.40) when comparing ECP (5.66 ± 0.31 kg/d) and NECP (5.28 ± 0.31 kg/d) sows. In summary, ECPs improve litter growth, thermoregulatory measures, and bioenergetic parameters associated with greater milk production in lactating sows exposed to cyclical HS.

Lactating sows are heat stress sensitive due to greater feed intake and metabolic heat production to support milk production. Therefore, heat-stressed lactating sows reduce their feed intake and undergo physiological changes that prioritize survival over productivity which reduces milk production. Reduced milk production has negative downstream effects on the litter and can decrease litter growth performance and health status. The negative effects of heat stress on lactating sows may be ameliorated by using electronically controlled cooling pads. Electronically controlled cooling pads improve the ability of lactating sows to maintain a normal body temperature under heat stress conditions. However, it is unknown whether these pads can improve lactating sow feed intake, milk production, and subsequently litter performance under heat stress conditions. It was determined that electronically controlled cooling pads were effective in increasing piglet body weight gain and weaning weight and increasing indirect measures of sow milk production independent of greater sow feed intake. In addition, the electronically controlled cooling pads allowed sows to maintain a normal body temperature under heat stress conditions. These data suggest that electronically controlled cooling pads can be an effective technology to improve lactating sow and litter performance under heat stress conditions.

Assessing Age Inclusivity in Higher Education: Introducing the Age-Friendly Inventory and Campus Climate Survey.

BACKGROUND AND OBJECTIVES: This study introduces a theoretical framework for assessing age inclusivity in higher education environments and describes the Age-Friendly Inventory and Campus Climate Survey (ICCS). The ICCS measures age-friendly campus practices as reported by administrators, perceptions of age-friendliness by campus constituents, and the fit between objective practices and subjective perceptions as an overall indicator of age inclusivity. RESEARCH DESIGN AND METHODS: The ICCS was administered at a public university in the northeastern United States. Administrators completed the Inventory of potential age-friendly campus practices associated with their units. Campus constituents (n = 688) completed the online Campus Climate Survey to assess subjective awareness of these practices, perceived age-friendliness, and personal beliefs about age inclusivity. RESULTS: The Inventory yielded a score of 66% of potential age-friendly practices in place as reported by administrators. The Campus Climate Survey showed low overall perceptions of age-friendliness and varied beliefs about age inclusivity on campus. Fit was measured by comparing the Inventory practices and Campus Climate Survey awareness of the existence of 47 of 73 potential practices. Convergence on this campus showed an awareness of 36% of age-friendly practices. DISCUSSION AND IMPLICATIONS: Based on the proposed theoretical framework for age inclusivity, the ICCS offers a way of assessing the age-friendliness of the objective environment across campus functions, the subjective environment across campus constituents, and the fit between subjective and objective environments on campuses. The ICCS will help higher education institutions identify strengths and challenges for advancing age inclusivity.

Assessing Age Inclusivity in Higher Education: Introducing the Age-Friendly Inventory and Campus Climate Survey (ICCS).

BACKGROUND AND OBJECTIVES: This study introduces a theoretical framework for assessing age inclusivity in higher education environments and describes the Age-Friendly Inventory and Campus Climate Survey (ICCS). The ICCS measures age-friendly campus practices as reported by administrators, perceptions of age friendliness by campus constituents, and the fit between objective practices and subjective perceptions as an overall indicator of age inclusivity. RESEARCH DESIGN AND METHODS: The ICCS was administered at a public university in the northeastern United States. Administrators completed the Inventory of potential age-friendly campus practices associated with their units. Campus constituents (n = 688) completed the online Campus Climate Survey to assess subjective awareness of these practices, perceived age-friendliness, and personal beliefs about age inclusivity. RESULTS: The Inventory yielded a score of 66% of potential age-friendly practices in place as reported by administrators. The Campus Climate Survey showed low overall perceptions of age-friendliness and varied beliefs about age inclusivity on campus. Fit was measured by comparing the Inventory practices and Campus Climate Survey awareness of the existence of 47 of 73 potential practices. Convergence on this campus showed an awareness of 36% of age-friendly practices. DISCUSSION AND IMPLICATIONS: Based on the proposed theoretical framework for age inclusivity, the ICCS offers a way of assessing the age-friendliness of the objective environment across campus functions, the subjective environment across campus constituents, and the fit between subjective and objective environments on campuses. The ICCS will help higher education institutions identify strengths and challenges for advancing age inclusivity.

Geographic and Social Factors Associated With Chronic Disease Self-Management Program Participation: Going the "Extra-Mile" for Disease Prevention.

INTRODUCTION: We examined geographic and social factors associated with participation in the Chronic Disease Self-Management Program (CDSMP) and the Diabetes Self-Management Program (DSMP) implemented at 144 sites in Illinois. METHODS: Programs were delivered by trained facilitators, once per week, during 6 weeks to 1,638 participants aged 50 or older. Of the 1,638 participants, we included in our analysis 1,295 participants with complete geographic information and baseline data on demographic characteristics, health history, and health behaviors. We assessed the following program data: program type (CDSMP or DSMP), workshop location, class size, and number of sessions attended by participants. We geocoded each participant's home address, classified the home address as rural or urban, and calculated the distance traveled from the home address to a workshop. We used linear and logistic regression analyses to examine the associations between participant and program factors with number of sessions attended and odds of program completion by whether participants lived in an urban or rural county. RESULTS: Average program attendance was 4.2 sessions; 71.1% (1,106 of 1,556) completed 4 or more sessions. Most participants enrolled in CDSMP (59.6% [954 of 1,600]), but DSMP had greater completion rates. Less than 7% (85 of 1,295) of our sample lived in a rural county; these participants had better completion rates than those living in urban counties (89.4% [76 of 85] vs 75.6% [890 of 1,178]). Traveling shorter distances to attend a workshop was significantly associated with better attendance and program completion rates among urban but not rural participants. The number of sessions attended was significantly higher when class size exceeded 16 participants. Not having a high school diploma was significantly associated with lower levels of attendance and program completion. CONCLUSION: Participation in CDSMP and DSMP was associated with distance traveled, program type, class size, and education. Increasing participation in self-management programs is critical to ensure participants' goals are met.