Using Clustering Methods to Map the Experience Profiles of Dementia Caregivers.

Background and Objectives: Caregivers of persons living with dementia report wide-ranging lived experiences, including feelings of burden and frustration but also positivity about caregiving. This study applies clustering methodology to novel survey data to explore variation in caregiving experience profiles, which could then be used to design and target caregiver interventions aimed at improving caregiver well-being. Research Design and Methods: The k-means clustering algorithm partitioned a sample of 81 caregivers from the Midwest region of the United States on the basis of 8 variables capturing caregiver emotions, attitudes, knowledge, and network perceptions (adversity: burden, anxiety, network malfeasance; network nonfeasance; positivity: positive aspects of caregiving, preparedness and confidence in community-based care, knowledge about community services for older adults, and network uplift). The experience profile of each segment is described qualitatively and then regression methods were used to examine the association between (a) experience profiles and caregiver demographic characteristics and (b) experience profiles and study attrition. Results: The clustering algorithm identified 4 segments of caregivers with distinct experience profiles: Thriving (low adversity, high positivity); Struggling with Network (high network malfeasance); Intensely Struggling (high adversity, low positivity); Detached (unprepared, disconnected, but not anxious). Experience profiles were associated with significantly different demographic profiles and attrition rates. Discussion and Implications: How caregivers respond to support interventions may be contingent on caregivers' experience profile. Research and practice should focus on identifying public health strategies tailored to fit caregiver experiences. Clinical Trial Registration: NCT03932812.

Cyclical Migration in Alaska Native Elders and Its Impact on Elders' Identity and Later Life Well-Being.

OBJECTIVES: This paper outlines the unique culturally driven cyclical migration of Alaska Native (AN) Elders, distinct from previously described migration patterns in that Elders spend extended time in more than one community. We describe this Indigenous cyclical migration of AN Elders and its influence on their identity and later life health and well-being. METHODS: Interviews with 124 AN Elders were conducted across 5 regions of Alaska: Bristol Bay, Interior, Norton Sound, Aleutian Pribilof Islands, and Southcentral. Within this sample, 87 participants engaged in cyclical migration. Thematic analysis was employed to identify themes related to Elders' cyclical migration between rural and urban communities and the impact on their identity and later life health and well-being. RESULTS: We identified 2 distinct patterns of Indigenous cyclical migration-Elders living primarily in rural communities migrating to urban communities and Elders living primarily in urban communities migrating to rural communities. Elders engaged in these 2 patterns of cyclical migration to maintain cultural practices, access social, and health care services to maintain their physical health and well-being, and continue their community roles contributing to their AN Elder identity. DISCUSSION: This study builds upon existing migration theories by introducing a cyclical pattern uniquely driven by AN identity, culture, and traditional practices. Findings illustrate how AN communities can support Elders who experience cyclical migration patterns to ensure they age successfully in both locations. Future research should explore cyclical migration patterns among other Indigenous populations with migration histories.

Social Interactions between Family and Community-Based Service Providers in Dementia Caregiving.

Objectives: This study aimed to evaluate the psychosocial experiences in community-based dementia caregiving by assessing the characteristics of social interactions between family caregivers and community-based service providers and associated psychological responses.Methods: Two independent groups of participants (family caregivers and community-based service providers) completed a one-time survey to report their social interactions and psychological states. A linear regression model was fit for each outcome (satisfaction, 10-item CES-D) while controlling for significant relevant covariates.Results: Higher perceived levels of collaboration were associated with higher job satisfaction and lower depression score among service providers, and higher satisfaction with providers among family caregivers. Higher perceived social support from the provider was associated with higher satisfaction among family caregivers.Conclusions: Participants reported varying levels of provider-family collaboration. The extent of collaborations and support exchange may have implications on the psychological well-being of those providing care to individuals with dementia including families and providers.Clinical implications: It may be beneficial to identify providers and families who perceive low levels of collaboration and implement intervention to facilitate positive social interactions. Developing organizational culture and payment systems that value high-quality social interactions may help enhance the psychological well-being of service providers and satisfaction among families who receive their services.

"I Like to Try My Hardest to Keep My Small Family Together": Housing as a Key Resource for Academic Success of Pregnant and Parenting College-Aged Students.

Pregnant and/or parenting students (PPS) face unique challenges to attending college. The prevalence of housing insecurity may be higher among college PPS. Adding to the limited research in this area, our study explores how housing could be a barrier to attending and maintaining academic success in college for PPS. We partnered with a Midwestern community college (CC) to conduct the study, which consisted of (1) an environmental scan of in-state collegiate housing programs available to PPS, (2) an online survey among PPS attending the partner CC, and (3) key informant interviews with providers at agencies serving PPS and high school PPS planning to attend college. Eight of the 18 institutions we identified from our environmental scan offered family housing. Populations most often addressed were married students (56%), families (39%), and single parents (28%). Out of 22 responses from our online survey, about a third of PPS disagreed or strongly disagreed that they felt satisfied with housing support provided by the partnering CC and that housing options offered were family friendly. PPS perceived affordability, proximity to campus and to their children's school, on-site day care, and amenities as important aspects of housing. Key informant participants (n = 9 interviews) described social support, PPS-specific housing, and access to services as important to college attendance. Community college efforts to meet the needs of PPS must consider the unique barriers PPS face to finding affordable and stable housing. Collaborating with local agencies that offer services for PPS is one approach to ensuring their academic success.

Queer in the Heartland: Cancer Risks, Screenings, and Diagnoses among Sexual and Gender Minorities in Iowa.

Little is known about the cancer experiences of sexual and gender minority (SGM) persons in Midwestern areas. In response, a statewide survey of 567 SGM adults in Iowa, a largely rural Midwestern state, assessed cancer prevalence, screening tests, and related risk factors. Skin cancer accounted for nearly half of reported cancers. Individuals assigned female sex at birth reported high levels of lifetime mammograms and Papanicolaou (Pap) tests. In contrast, there were almost no colorectal cancer screenings reported among older (age 50+) respondents, regardless of gender identity or sexual orientation. Current tobacco use was modest overall, and cisgender women were more likely to report heavy drinking than cisgender men. Cisgender men age 40 and younger were less likely to have any human papillomavirus vaccination than cisgender women. The survey identified both strengths to leverage and deficits to address, which may inform future cancer prevention efforts in Iowa and other Midwestern states.

Teaching rapid oral health deterioration risk assessment: A 5-year report.

PURPOSE/OBJECTIVES: The purpose of this study was to present a 5-year report about the outcomes of using a teaching tool that guides dental students through the thought process of the expert about how to assess the risk of rapid oral health deterioration (ROHD) among older adults and provide viable treatment alternatives. METHODS: A teaching tool was previously developed using ROHD risk factors identified in the literature and the steps that experts apply in their treatment decision making, summarized in 10 questions. During 5 years, 188 senior dental students were introduced to the teaching tool and asked to use the 10-question set to present a case they have treated during their Geriatric and Special Needs Program. Two evaluators were asked to grade the students on each question. Students were graded "G" if they answered the question and grasped the principles behind it, "A" if they only answered the question, or "M" if they missed the question. Additionally, the students were given a form to grade the importance of and comment on the exercise. RESULTS: More than 75% of the students had an A or G for most questions, agreement between the 2 evaluators was above 85%, and students' performances improved during the 5-year period. Additionally, 94.4% of the students considered the teaching tool as important or very important for the general dentist. CONCLUSION: The vast majority of the students had an A or G grade, examiner agreement was high, and the students appreciated the importance of this teaching tool for the general dentist.