"I just can't go back": Challenging Places for Older Americans since the COVID-19 Pandemic Onset.

During the pandemic, many older adults felt 'out of place' in their home, work, and community spaces with potentially long-term consequences for health and wellbeing. Using national data from the COVID-19 Coping Study, thematic analysis of online long-answer responses (n = 1171; mean age 68 years; 71% female; 93% non-Hispanic White; 86% with at least a 4-year college degree; data collected April-June 2022) identified four themes regarding why particular places are challenging since the pandemic onset: (1) viral exposure fears, (2) frustrating regulations, (3) uncomfortable and hostile social dynamics, and (4) 'out of place' negative emotions. Participants also shared how they continuously address or adapt to place-based challenges through lifestyle adjustments and coping strategies. Novel findings may inform multi-scalar policymaking and interventions to support wellbeing in later life in times of stress and instability.

Anti-Asian Hate and the Health of Older Asian Individuals.

This qualitative study assesses the association of anti-Asian hate with older Asian individuals' health and the clinician's role in addressing hate incidents.

"Hate has chipped away at my sense of security": A survey study of the impacts of anti-Asian hate on the health of older Asians.

BACKGROUND: Since the beginning of the COVID-19 pandemic, older Asians have experienced a rise in racism and discrimination based on their race and ethnicity. This study examines how anti-Asian hate impacts older Asians' mental, social, and physical health. METHODS: From March 18, 2022 to January 24, 2023, we conducted a cross-sectional survey study of community-dwelling Asian/Asian American adults aged ≥50 years from the San Francisco Bay Area. Measures included perceptions of anti-Asian hate; direct encounters with hate incidents; indirect experiences with hate incidents (e.g. knowing a friend who was a victim); reports of anxiety, depression, loneliness, and changes in daily activities; ways to address these issues; and discussions with clinicians about hate incidents. RESULTS: Of the 293 older Asians, 158 (54%) were Vietnamese and 97 (33%) Chinese. Eighty-five (29%) participants were direct victims of anti-Asian hate, 112 (38%) reported anxiety, 105 (36%) reported depression, 161 (55%) reported loneliness, and 142 (48%) reported decreased daily activities. Compared with those who were "not-at-all" to "moderately" worried about hate incidents, participants who were "very" to "extremely" worried experienced heightened anxiety (42% versus 16%), loneliness (30% versus 14%), and changes in daily activities (66% versus 31%), p < 0.01 for all. Most participants (72%) felt comfortable discussing hate incidents with clinicians; however, only 31 (11%) reported that a clinician had talked with them about these incidents. CONCLUSION: Both directly and indirectly, anti-Asian hate negatively impacts older Asians' mental, social, and physical health. Clinicians have a role in addressing the health impacts of anti-Asian hate.

Building Back Better: Going Big with Emancipatory Sciences.

This commentary argues that precarity and inequity across the life course and aging has accelerated via the COVID-19 pandemic. President Biden's vaccination efforts, $1.9 trillion American Rescue Plan Act, and Build Back Better framework reflect a paradigm shift to restore faith and trust in government that boldly confronts entrenched austerity ideologues. We offer emancipatory sciences as a conceptual framework to analyze and promote social structural change and epic theory development. Emancipatory sciences aim to advance knowledge and the realization of dignity, access, equity, respect, healing, social justice, and social change through individual and collective agency and social institutions. Epic theory development moves beyond isolated incidents as single events and, instead, grasps and advances theory through attempts to change the world itself by demanding attention to inequality, power, and action. Gerontology with an emancipatory science lens offers a framework and vocabulary to understand the individual and collective consequences of the institutional and policy forces that shape aging and generations within and across the life course. It locates an ethical and moral philosophy engaged in the Biden Administration's approach, which proposes redistributing - from bottom-up - material and symbolic resources via family, public, community, and environmental benefits.

Enhancing Dementia Knowledge and Self-Efficacy of In-Home Supportive Services Caregivers Through Online Training.

California's In-Home Supportive Services (IHSS) program provides vital home care to low-income consumers, some of whom live with Alzheimer's disease or related dementias (ADRD). Yet, most IHSS caregivers receive little or no training in dementia care. We present preliminary descriptive results of the IHSS + ADRD Training Project, a 10-week, competency-based, dementia training program, delivered online, for IHSS caregivers, in Alameda County. Increase in dementia knowledge and self-efficacy at training completion supports the importance of continuing and expanding this work.

Engagement and Advocacy of Community-Based Organizations Serving Older Adults in Native American, Rural, and Homeless Communities During the COVID-19 Pandemic.

Older adults in Native American, rural, and homeless communities have been disproportionately affected by the Coronavirus Disease 2019 (COVID-19) pandemic due to structural and systemic inequities. However, community-based organizations (CBOs) serving these older adults are well positioned as frontline responders and trusted messengers to support their needs and provide vital services that enable them to stay safe. This commentary argues that CBOs are essential for engaging with and responding to community needs during a pandemic. The work of three CBOs is spotlighted to elucidate the importance of partnerships and trust in disseminating strategies for responding to and mitigating pandemic impacts.

Emancipatory Visions: Using Visual Methods to Coconstruct Knowledge with Older Adults.

This article calls for gerontologists to engage with visual methods in qualitative research as an innovative tool for community-engaged research that has potential to advance social justice in gerontology. Reflections about using visual methods from the intersectional standpoint of the authors, 3 younger women of color, are presented. In Working the Hyphen, J. Yeh shows how interpersonal dynamics are fundamental to visual methods and that attention to identity can provide new insights into aging while also reconstituting existing power dynamics that researchers must carefully consider. In Employing Elicitation Techniques With Experts, L. Reyes discusses how a colonial lens limits understandings of civic participation and erases contributions of Black, Indigenous, and People of Color (BIPOC) older adults, proposing that elicitation techniques offer opportunities for BIPOC older adults to contribute their expertise to the research process and dissemination of findings beyond an academic audience. In Pedagogy and Practicality, H. S. Versey describes promises and complexities of scaling visual methods on multiple levels-teaching future generations of researchers the philosophy and practice of photovoice; negotiating university and community relationships through a service-learning project; and navigating identity between herself, her students, and research participants. In sharing our self-narratives, we integrate reflexivity into the research process and challenge power dynamics in knowledge construction.

Age-Friendly for Whom? An Aperture to the Lived Experiences of Older San Franciscans.

BACKGROUND AND OBJECTIVES: Spatial practices and changing urban environments affecting identity, experiences, and everyday life were examined among a diverse sample of older adults as they negotiated and navigated an age-friendly city. RESEARCH DESIGN AND METHODS: Ethnographic interviews, observations, and visual methods were used to understand spatial practices and lived experiences of 4 older adults, who chronicled their lives using disposable cameras. RESULTS: Informant identities emerged in their everyday practices, reflecting varied positionalities that fundamentally shaped their notions of "age-friendly." Informants sought to sustain or improve their lives while attempting to negotiate socioenvironmental forms and forces that often threatened their identity and increased their precarity. DISCUSSION AND IMPLICATIONS: Contrast exists between "invariant" macro/meso issues all older adults face as they age and "multivariant" ways in which age is accomplished based on place, biography, and intersectionality. Age-friendly environments may simultaneously maintain the status quo and exacerbate inequalities. Gerontology must take seriously how stratified life chances can undermine seemingly universal potential benefits of age-friendly environments.

Building an advocacy model to improve the dementia-capability of health plans in California.

BACKGROUND: Given the high and growing prevalence of Alzheimer's disease and related dementias, and the intensity of this population's care needs, it is imperative that healthcare systems increase their capacity to effectively serve people living with dementia (PLwD). The Dementia Cal MediConnect (Dementia CMC) project proposes an advocacy model that may foster dementia-capable systems change. METHODS: The Dementia CMC project was a 5-year partnership (2013-2018) between local Alzheimer's organizations and 10 managed care health plans (HPs) in California's duals demonstration. It used an advocacy model with the following steps: (1) Identify dementia-capable best practices to set as systems change indicators; (2) Identify and leverage public policies in support of systems change indicators; (3) Identify and engage champions; (4) Develop and advocate for a business case to improve dementia care; (5) Identify gaps in dementia-capable practices; (6) Provide technical assistance, tools, and staff training to address the gaps in dementia-capable practices; and (7) Track systems change. Systems change data were collected through participant observation with HPs and interviews with key informants representing partnering organizations or government entities. RESULTS: Participating HPs reported making systems changes toward more dementia-capable practices such as: better pathways for detection and diagnosis; better identification, assessment, support, and engagement of caregivers; and improved systems of referral to community-based organizations (CBOs), including Alzheimer's CBOs. Some indicators of systems change were inconclusive due to flawed assumptions around HP's care coordination, and the availability of common electronic health records between HPs and providers. CONCLUSION: The application of this advocacy model in California has led to systems changes that can improve care for PLwD and their caregivers and should be replicated to expand the dementia-capability of other health systems. Continued efforts to refine indicators are needed to capture systems change in complex and changing health systems.

Improving End-of-Life Care for Persons Living With Dementia: Bereaved Caregivers' Observations and Recommendations.

CONTEXT: Dementia is a terminal diagnosis that requires significant caregiving support across the trajectory of decline through to death. Experiences and perspectives from bereaved caregivers can help identify ways to improve the end-of-life care experience of persons dying with dementia. OBJECTIVES: This exploratory study sought to assess satisfaction with, and elicit recommendations for improving end-of-life care experiences of decedents with dementia from the perspective of bereaved caregivers. METHODS: A cross-sectional survey was conducted with caregivers of decedents with dementia (n = 53), from the San Francisco Bay Area, California. Multiple choice and open-ended questions were asked regarding end-of-life care discussions and decisions and respecting and honoring end-of-life needs and wishes. The Satisfaction with Care at the End of Life in Dementia instrument was adapted for the survey. RESULTS: While approximately 75% of caregivers were satisfied with their person living with dementia's (PLWD) end-of-life care, 25% felt better care was needed. Qualitative findings revealed that gaps persist regarding communication with providers about disease progression, care continuity and coordination, and honoring death in a preferred location. While most caregivers felt ready to discuss end-of-life decisions with providers when their PLWD was near death, with retrospection, the majority would recommend that providers discuss end-of-life decisions with them during earlier stages of the disease. CONCLUSION: End-of-life care for PLWD has significant room for improvement. Efforts to train healthcare providers should focus on helping them meet the complex informational, emotional, and social support needs of PLWD and their caregivers across the trajectory of decline.

Community Gerontology: A Framework for Research, Policy, and Practice on Communities and Aging.

We introduce "community gerontology" as an area of research, policy, and practice that aims to advance understanding of communities as fundamental contexts for aging and its diversity, and to leverage this understanding for change. We present a foundational framework for community gerontology in three parts. First, we discuss the mesolevel as the unifying construct for community gerontology. Second, we describe community gerontology's focus on pathways of mutual influence between the mesolevel with more micro and macro contexts over time. Third, we put forth community gerontology's emphasis on gerontologists' participation in community change processes to facilitate more optimal experiences of aging among diverse population subgroups. We conclude by describing the integrative nature of community gerontology and the ways that this framework can advance research on particular substantive areas, as well as gerontology as a whole.

"I Feel Trapped": The Tension Between Personal and Structural Factors of Social Isolation and the Desire for Social Integration Among Older Residents of a High-Crime Neighborhood.

BACKGROUND AND OBJECTIVES: The aim of this study was to examine the factors contributing to the social isolation of older residents of a high-crime neighborhood through the in-depth examination of their lived experiences. A deeper understanding of factors contributing to social isolation can allow policymakers and health care providers to create policies and programs to alleviate the social isolation of these vulnerable and understudied individuals. RESEARCH DESIGN AND METHODS: Participants were recruited through the support of the Housing Authority and Police and Fire Departments of Richmond, California, a town with a high-crime rate. Fifty-nine ethnographic interviews were conducted with 20 individuals of 58-95 years of age. Transcripts and fieldnotes were analyzed with a focus on the specific factors contributing the social isolation of participants. RESULTS: An overarching theme of tension between personal and structural factors of social isolation and desire for social integration emerged from qualitative content analysis. A tension emerged between a longing to participate in society and the immersion in a reality so dense with obstacles that made participation in society difficult to attain. Four specific themes also emerged. Three themes demonstrated underlying factors of social isolation stemming from the personal sphere and the physical and social environment. The fourth theme illustrated participants' desire for social integration. DISCUSSION AND IMPLICATIONS: Findings demonstrate the salience of interventions and programs to make neighborhoods safe and accessible to older residents. Findings also suggest a need to reframe the conceptual framework for social isolation to better measure and alleviate this public health problem.

Advancing family health through the Garden of Eatin': on-site food gardens in early childhood education.

Nutritional practices develop over the life course. Developing healthy habits at an early age can contribute to combating increasing child obesity rates. Through a range of activities that rely on the presence of an on-site food garden, North Bay Children's Center (NBCC), an early childhood education program, has enacted a "culture of health" into all aspects of the curriculum to promote healthy eating practices among children, families, teachers and staff. NBCC's garden program serves as a model in early childhood education and as a community-based intervention to improve family health and prevent child obesity.

The safe routes to school program in California: an update.

Despite efforts to combat increasing rates of childhood obesity, the problem is worsening. Safe Routes to School (SRTS), an international movement motivated by the childhood obesity epidemic, seeks to increase the number of children actively commuting (walking or biking) to school by funding projects that remove barriers preventing them from doing so. We summarize the evaluation of the first phase of an ongoing SRTS program in California and discuss ways to enhance data collection.