Generational Bias: Another Form of Ageism.

Ageism includes discrimination toward both younger and older individuals. Discrimination based on generational cohorts can serve as a proxy for discrimination based on age and, therefore, can be argued as a form of ageism. This study examined the occurrence of generational ageism and its relationship to internalized and relational ageism. This cross-sectional study surveyed 913 individuals recruited through ResearchMatch. Analyses found that those in the Millennial and Gen Z groups reported experiencing the highest levels of discrimination based on generational cohort and reported feeling that their generational groups were viewed as less capable, more opinionated, and more selfish than other generations. Millennial and Gen Z groups also reported experiencing higher internalized and relational ageing anxiety levels than older cohorts. As our collective understanding of the manifestation and perpetuation of ageism grows, it is imperative to explore the impact and consequences of generational bias as a form of ageism.

Special Focus Facilities vs Special Focus Facility Candidates: What is the Difference?

OBJECTIVES: This study compares Special Focus Facilities (SFFs) and Special Focus Facility Candidate Facilities (SFFcs) on organizational traits and quality outcomes to evaluate the effectiveness of the SFF program as a quality improvement intervention and inform potential areas for program reform. DESIGN: This is a retrospective analysis. SETTINGS AND PARTICIPANTS: Using data from the Centers for Medicare and Medicaid Services archives for 2020, this retrospective study analyzed 247 nursing facilities (50 SFFs and 197 SFFcs). METHODS: Variables of interest were staffing, profit status, facility size, certification status, number of residents, and complaint citations: t tests, χ2, Fisher's Exact test, and multivariate analysis of variance were used to compare the 2 groups. RESULTS: From an organizational perspective, SFFs and SFFcs are minimally different. Both groups had similar facility size, profit status, hospital affiliation, continuing care retirement community status, and Medicare/Medicaid certification. Large and for-profit facilities were overrepresented in both groups. SFFs and SFFcs exhibited statistical differences in the number of complaint deficiencies. The groups had no significant difference in staffing levels, category, severity of complaints, or incident reports. CONCLUSIONS AND IMPLICATION: The study's findings suggest that the SFF program, while resource-intensive, is minimally impactful. The similarities between SFFs and SFFcs raise questions about the program's effectiveness in improving nursing facility care. Previous adjustments to the program may not have successfully achieved the desired quality improvements. This research highlights the need to further evaluate the SFF program's effectiveness as a quality improvement intervention. It also underscores the importance of addressing biases and subjectivity in state survey agency processes, which affect the enrollment of nursing facilities. The study underscores the flaws within the nursing home monitoring system and the 5-star quality rating system, especially when comparing small samples between states.

The Next Critical Turn for Ageism Research: The Intersections of Ageism and Ableism.

BACKGROUND AND OBJECTIVES: Aging includes multidimensional and multidirectional changes in biology, psychology, and social roles. With aging, individuals experience physiological changes that affect ability, stamina, and reserve capacity. Given the natural occurrence of physical decline accompanying aging, it is essential to understand if fear and prejudice toward disability (ableism) intersect and influence fear and anxiety about aging (ageism). RESEARCH DESIGN AND METHODS: A cross-sectional survey study was conducted using ResearchMatch for study recruitment, 913 individuals responded to questions regarding 3 types of ageism, including affinity for older people, internalized ageism, and relational ageism, as well as internalized and relational ableism. RESULTS: Internalized ageism was significantly associated with relational ageism, fear of physical disability, fear of cognitive disability, and affinity for older people. Relational ageism was associated with internalized ageism, relational ableism, fear of physical disability, fear of sensory disability, fear of cognitive disability, and affinity for older people. DISCUSSION AND IMPLICATIONS: Examining the intersection of ageism and ableism represents the next pivotal juncture to developing effective anti-ageism interventions that address the root anxieties influencing negative attitudes about aging and fears of growing older. Public policy initiatives to address community-level interventions and targeted training to inform discourse that addresses the intersection between ageism and ableism are critical to addressing these issues and promoting age and ability inclusivity.

Smart Speaker and ICT Use in Relationship With Social Connectedness During the Pandemic: Loneliness and Social Isolation Found in Older Adults in Low-Income Housing.

BACKGROUND AND OBJECTIVES: Social well-being of older adults living in low-income housing was disproportionately affected by the coronavirus disease 2019 pandemic. We explored low-income residents' experiences of social isolation and loneliness and strategies to remain socially connected during the pandemic. RESEARCH DESIGN AND METHODS: As part of a larger, 3-phase user-centered design study, we conducted a qualitative study using focus groups to gain insights into social isolation experiences and the role of information and communication technologies (ICTs), including smart speakers, in social connectedness (N = 25, 76% African American). We also collected survey data to describe social isolation, loneliness, and current ICT use in the sample. Participants included both smart speaker users and nonusers. RESULTS: Experiences of social isolation and loneliness varied by participants' sociodemographic characteristics and previous experiences with smart speakers. Qualitative analysis showed participants demonstrated coping strategies developed during the pandemic to adapt to new norms of connecting with others, including technology-enabled social interactions. Participants expressed a strong desire to build community together in their facilities and highlighted the potential role of smart speakers in making meaningful social connections, encompassing safety checks to have a means for emergencies, and providing a virtual companion. Access, digital literacy, training, security, and privacy issues were discussed as factors affecting their adoption of new ICT for enhanced social connectedness. DISCUSSION AND IMPLICATIONS: This study highlights the importance of understanding the unique social isolation experience, demographics, and social determinants of health of low-income residents to develop ICT-based interventions for social connectedness.

Internalized ageism as a risk factor for suicidal ideation in later life.

OBJECTIVES: We examined the influence of ageism on suicidal ideation using the framework of the Interpersonal Theory of Suicide among a sample of older adults in the United States. METHOD: Using Research Match, volunteers 65 and older in the United States were recruited to participate in an online survey. Demographics, perceived burdensomeness, thwarted belongingness and self-directed ageism (internalized and relational ageism) were examined. Data were analyzed using hierarchical logistic regression analysis. RESULTS: A total of 454 individuals from over 30 states participated in the study. Twelve percent of respondents reported that they had experienced suicidal ideation in the past month. Results from the logistic regression demonstrated that older adults with higher age and higher internalized ageism had a higher risk of suicidal ideation. CONCLUSION: Findings present implications for understanding an association between ageism and suicidal ideation. Results speak to the importance of recognizing and understanding the impact of ageism. Examining the development clinical guidelines and policies that address ageism as a risk factor for suicide is warranted.

Cultivating Relationships as a Community-Based Recruitment Strategy in Transdisciplinary Aging Research: Lessons From an Academic-Community Partnership.

Participation of Black American older adults in community-engaged research remains challenging in health sciences. The objectives of this study were to describe the specific efforts, successes, and challenges in recruiting Black American older adults in research led by the Health and Wellness in Aging Across the Lifespan core, part of the Virginia Commonwealth University Institute for Inclusion, Inquiry, and Innovation (iCubed). We conducted a cross-case analysis of 6 community-engaged research projects using the community-engaged research continuum model. Successful recruitment strategies comprised a multifaceted approach to community-based collaboration, including a wellness program with a long standing relationship with the community, engaging key stakeholders and a community advisory board, and building a community-based coalition of stakeholders. Posting flyers and modest monetary compensation remain standard recruitment strategies. The cross-case analysis offered critical lessons on the community's nature and level of engagement in research. Relationship building based on trust and respect is essential to solving complex aging issues in the community.

"I like being young, active, alive": first-year medical students' attitudes to their own aging.

BACKGROUND AND OBJECTIVES: Senior Mentoring programs have been developed to expose students to older adults, increase knowledge of geriatrics, and prepare them to provide patient-centered care. However, even while participating in a senior mentoring program, health professions students demonstrate discriminatory language toward older adults and the aging process. In fact, research suggests ageist practices occur, intentionally or not, among all health professionals and within all healthcare settings. Senior mentoring programs have primarily focused on improving attitudes about older people. The current study evaluated a different approach to anti-ageism by examining medical students' perceptions of their own aging. RESEARCH DESIGN AND METHODS: This qualitative, descriptive study explored medical students' beliefs about their own aging at the beginning of their medical education using an open-ended prompt immediately before beginning a Senior Mentoring program. RESULTS: Thematic analysis identified six themes: Biological, Psychological, Social, Spiritual, Neutrality and Ageism. Responses suggest that students enter medical school with a complex view of aging that goes beyond biological considerations. DISCUSSION AND IMPLICATIONS: Understanding that students enter medical school with a multi-faceted view of aging provides an opportunity for future work to explore senior mentoring programs as a way to tap into this complex view of aging by changing the way students think not just about older patients but about aging more broadly, and specifically about themselves as aging individuals.

Anti-Ageism for Gerontologists.

We argue that gerontologists are products of our ageist culture and that we both perpetuate ageism and suffer from internalized ageism ourselves. We make ageist comments, deny our own age, fail to teach students to recognize and confront ageism, and use language that otherizes and categorizes older people. Gerontologists are in ideal positions to confront ageism through our scholarly work, teaching, and community engagement. However, we suggest that, despite our deep gerontological knowledge, we do not have enough awareness, knowledge, and skills for taking anti-ageism actions in these arenas of our professional lives. We offer some suggestions for confronting ageism, including self-study, increasing content on ageism in the classroom and beyond, pointing out ageist language and behaviors to colleagues and students, working with diversity, equity and inclusion offices on campus, and giving careful consideration to our research approaches and academic writing. To go forward, we must increase awareness about ageism and gain skills in promoting anti-ageism.

Stress, strength, and respect: Viewing direct care staff experiences through a trauma-informed lens.

Trauma-informed approaches may promote the well-being of CNAs and disrupt organizational practices that perpetuate inequities. There is a dearth of literature addressing evidence-based, trauma-informed training for direct care staff, yet CMS now requires trauma-informed care in nursing homes. Five focus groups exploring trauma and resilience-related concepts were conducted using an expressive-collaborative model with 18 CNAs at four nursing homes. A thematic analysis was conducted and themes were identified related to identity, relationships with residents, organizational values, and personal wellness. CNAs voiced frustration at limited time and support to implement well-being or stress management practices. Relationships with residents were sources of strength and, conversely, sources of emotional injury due to disrespect, disregard, and hostile behavior directed at CNAs. Central to health and well-being, CNAs called for change within facility cultures experienced as disrespectful, inequitable, and contrary to work-life balance. Trauma-informed training can be used to give particular attention to direct care staff. Administrators would benefit from learning about trauma and resilience among CNAs and precipitating organizational factors such as reasonable care ratios, equitable benefits, and peer support that impact CNA well-being, job satisfaction, and quality of care. The development and implementation of a trauma-informed training curriculum for CNAs are warranted.

Introduction to the JPIC issue, Aging in older adulthood: Community-level intervention programming and partnerships providing older adults with community health promotion opportunities.

Community-level health promotion programs offer opportunities to improve the lives of older adults and improve the cultural narrative about aging. However, age-discrimination, ageism, and negative attitudes about aging, across the systematic ecological community levels have undermined older adult health. While the longevity of a society is a marker for success worldwide, age-discrimination and ageism, seen through limited community-level health advancement opportunities, have thwarted progress toward societal elderhood, even in the most developed and advanced nations. As a society, we need to continue to push for community-level prevention and intervention across the older age spectrum, to continue human advancement through late life.

Ageism Interventions: The Need for An Ecological Perspective.

Ageism is a dynamic force of oppression that presents systemically within all levels of Bronfenbrenner's ecological system framework (microsystem, exosystem, mesosystem and macrosystem). Although ageism is a well-documented phenomenon with wide-reaching negative impacts, interventions to mitigate ageism's effects remain understudied. This internal evaluation conducted a deductive content analysis of 208 resources on an anti-ageism resource clearinghouse, OldSchool.info. Resources were organized using two coding schemes; to determine focal points based on the ecological systems theory and to ascertain the mechanisms of the intervention (e.g., active or passive approach). Results indicate the majority of ageism interventions are passive-oriented societal-level macrosystem approaches. Findings indicate active-oriented interventions at the personal and relational levels are lacking. Since ageism is embedded within all of the interacting levels of the ecological system, meaningful change in policy and practice will require multiple approaches to developing positive change toward building an age-inclusive society. An ecological approach to ageism can provide critical insights toward the development of policy and law to reduce or eliminate ageism, including promoting positive behaviors and attitudes at the individual level and raising awareness of anti-discrimination and human rights laws at the macrosystem level.

COVID in Context: The Lived Experience of Richmond's Low-Income Older Adults.

Taking a phenomenological approach, this qualitative study describes the lived experiences of low-income older adults during the COVID-19 pandemic. A socio-ecological model was used to organize the five identified themes describing the lived experience: socio-economic context, Black Lives Matter and the politics of race, COVID and polarized views of COVID, interpersonal context (social connections), and individual context (feelings, beliefs, and behaviors). Study findings illustrate the intersectionality of contextual influences on the experience of low-income older adults. Study participants demonstrated remarkable resilience and coping strategies developed in response to the challenges they experienced throughout their lifetime which benefited them when faced with the pandemic, social unrest, and political events that took place in 2020. This study highlights the importance of understanding the larger context of COVID-19 which has significant implications for policy makers and public health leaders.

Socioeconomic Effects on Psychosocial Factors Among Low-Income Older Adults.

OBJECTIVES: Older adults have been disproportionately affected by COVID-19. The primary goal of this study is to determine the socioeconomic effects on psychosocial factors among low-income independent-living older adults, in an urban setting, during the COVID-pandemic. METHODS: Participants were recruited through Virginia Commonwealth University's Richmond Health and Wellness Program. Telephone surveys (n=100) were conducted using the Epidemic - Pandemic Impacts Inventory Geriatric with the Racial/Ethnic Discrimination addendum. Responses were analyzed for income and education effects across seven domains: home life, social activities/isolation, economic, emotional health-wellbeing, physical health, COVID-infection history, and positive change behaviors/experiences. RESULTS: The sample population was between 51 and 87 years of age, 88% were Black, 57% reported incomes of $10,000/year or less, and 60% reported a high-school education or less. There were income effects for social activities/isolation (f = 3.69, p<.05) and positive change (f = 8.40, p<.01), and education effects for COVID History (f = 4.20, p <.04). DISCUSSION: Overall results highlight the social patterns for a diverse sample of low-income urban older adults; education and income are identified as risk factors for social losses, COVID-infection experiences, racial/ethnic discrimination during the COVID-pandemic, and positive change behaviors.

Bringing Transdisciplinary Aging Research From Theory to Practice.

There is a growing emphasis to use a transdisciplinary team approach to accelerate innovations in science to solve complex conditions associated with aging. However, the optimal organizational structure and process for how to accomplish transdisciplinary team science is unclear. In this forum, we illustrate our team's experience using transdisciplinary approaches to solve challenging and persistent problems for older adults living in urban communities. We describe our challenges and successes using the National Institutes of Health four-phase model of transdisciplinary team-based research. Using a de-identified survey, the team conducted an internal evaluation to identify features that created challenges including structural incongruities, interprofessional blind spots, group function, and group dynamics. This work resulted in the creation of the team's Transdisciplinary Conceptual Model. This model became essential to understanding the complex interplay between societal factors, community partners, and academic partners. Conducting internal evaluations of transdisciplinary team processes is integral for teams to move beyond the multi- and interdisciplinary niche and to reach true transdisciplinary success. More research is needed to develop measures that assess team transdisciplinary integration. Once the process of transdisciplinary integration can be reliably assessed, the next step would be to determine the impact of transdisciplinary team science initiatives on aging communities.

Alumni survey of a combined doctor of pharmacy/graduate certificate in aging studies program.

INTRODUCTION: The Certificate in Aging Studies at Virginia Commonwealth University allows students to study gerontology while completing their doctor of pharmacy (PharmD) or graduate pharmaceutical sciences degree concurrently. The objective of the study was to evaluate alumni satisfaction with the Certificate in Aging Studies program, its application, and its perceived usefulness. METHODS: Alumni of the program (n = 49) were emailed an anonymous electronic survey about their perceptions of the program. The survey was emailed three times. Responses to eight multiple choice questions were summarized using descriptive statistics. Two free response questions were qualitatively analyzed for themes by two investigators. RESULTS: The response rate to the survey was 59.2% (n = 29). Most respondents practice in hospital settings (24.1%) and did not undertake additional postgraduate clinical training (44.8%) or earn additional geriatric certifications (69%). The majority (65.5%) reported using the dual program in their career and would recommend the Certificate in Aging Studies to others (96.6%). Most (59%) alumni indicated that the best part of the program was the interprofessional interaction, and 69% suggested no further areas of improvement for the program. CONCLUSIONS: A PharmD-Gerontology dual program is one way to enhance the workforce to care for the growing older population. This partnership approach should be considered by schools of pharmacy that also offer degree programs in gerontology.

Over-the-counter medication use in residents of senior living communities: A survey study.

BACKGROUND: Self-medication with over-the-counter (OTC) products is common among older adults. Although OTC self-medication is a convenient way to manage some health issues, older persons may be at higher risk of experiencing medication-related problems. This study examines the prevalence, practices, and preferences associated with OTC medication use in older adult residents of senior living communities. OBJECTIVES: The study aimed to examine the characteristics of OTC medication users and to quantify the prevalence, attitudes, perceptions, preferences, and practices regarding OTC medication use and decision-making in 2 senior living communities in central Virginia. METHODS: The study used survey methodology. A 51-item semistructured questionnaire was designed by the research team of geriatrics specialists, and mixed-methods and evaluation researchers. The questionnaire was administered in-person to participants (N = 88). Descriptive analyses were conducted using SAS 9.4. Characteristics of those using OTC medications as directed by a health professional were compared with those of whom were self-medicating with OTC medications. RESULTS: Most of the sample were women (55%), black (61%) and had less than or equal to a high school education (55%). Analgesics were the most (76%) prevalent OTC therapeutic category used, and aspirin was the most (65%) prevalent OTC medication. A greater (82%) proportion of respondents reported self-recommended OTC medication use (self-medication with OTC medications) rather than physician recommended use (18%). A high (41%) prevalence of inappropriate use of OTC medications was observed in this sample of older adults. Most (80%) considered OTC medications safe and effective. The pharmacy was the most (93%) commonly reported purchase location to buy an OTC medication. Physicians were the most (90%) commonly reported information source for OTC medications. CONCLUSION: Considering the high percentage of self-reported self-medication, inappropriate use, and experiences of adverse effects, steps should be taken to develop consumer education and relationships with pharmacists to encourage the responsible use of OTC medications in this population.

The efficacy of a video-based intervention to reduce ageism among long-term services and supports staff.

Research has shown that ageism can act as a barrier to both quality of life and quality of care delivery within the continuum of residential care settings. Anti-ageism interventions have the hefty task of improving attitudes and behaviors toward aging and older adults. The purpose of this study was to examine whether a one-hour video-based intervention designed to address ageism could decrease self-reported ageist attitudes and behaviors among staff members of long-term service and support settings. This cross-sectional study used data collected from 265 staff members of aging services organizations. The study examined ageist attitudes and behaviors at pre-intervention, and at two follow-up points: immediately after the intervention and three-month post-intervention. Results demonstrated that internalized aging anxiety significantly decreased from pre-intervention to the immediate follow-up and stayed stable at the 2nd follow-up. Results showed that ageist behaviors significantly decreased over the three-month study period and that participants were able to identify specific actions they had taken as a result of the video intervention. The study suggests that a low-cost, short video-based intervention on ageism can improve ageism-related attitudes and behaviors among staff in long-term services and supports settings.

GPS Tracking Technologies to Measure Mobility-Related Behaviors in Community-Dwelling Older Adults: A Systematic Review.

Global positioning system (GPS) technology has been increasingly used in aging research as a tool for reliably capturing the level and patterns of mobility among older adults. This article aims to systematically review the current state of GPS-based mobility research with community-dwelling older adults. Twenty-nine studies from 2008 to 2019 are included. Included studies examined various forms of temporal and spatial mobility measures. This review provides a synthesis of the current evidence on the risk factors or correlates of GPS-driven mobility limitations, such as demographic, cognitive, physical, psychological, and environmental factors. There is variability in types of GPS technology and GPS-derived mobility measures, GPS recording methods, data processing, and correlates of mobility limitation across studies. Future research should focus on identifying meaningful GPS-derived mobility measures and developing standardized protocols for GPS administration and data analytics for comparison across studies.

Development of the Relational Ageism Scale: Confirmatory Test on Survey Data.

The objective of the study is to test a refined measure of attitudes about aging as a multidimensional construct reflective of a relational process that includes personal identity (i.e., beliefs about oneself), social identity (i.e., self-conception based on group membership), and collective identity (i.e., self-conception based on comparison of groups) as well as capturing awareness of ageism and its impact. Researchers refined the Aging Anxiety Scale and recruited a convenience sample of 329 participants via a social media platform. A principal component factor analysis revealed the specification of three latent factors: personal, relational, and collective aging anxiety. Awareness of ageism as a problem in society was lower than awareness of other forms of discrimination, and awareness of the negative impacts of ageism was low. The findings support the incorporation of this new measure of relational aging anxiety as a by-product of social identity and construction in future ageism studies.

A qualitative study to understand over-the-counter medication use and decision-making among residents of senior-living communities.

INTRODUCTION: OTC medications are generally considered safe and convenient to use without requiring a prescription. However, the safety of an OTC medication and the final health outcome depends in part upon consumers' perceptions, beliefs, and their decision-making about OTC medication use. This study uses a qualitative approach to explore the knowledge, beliefs, and practices associated with OTC medication use and decision-making in adults aged 65 years and older. METHODS: A set of focus groups (N = 10) were conducted in a sample of independently living older adult residents of senior apartment buildings (N = 80) using purposeful sampling. All focus groups were recorded, transcribed verbatim, and analyzed qualitatively. RESULTS: Most participants considered OTC medications safe and effective to use if following the drug label instructions appropriately. Brand name products were perceived as equally or more effective compared to generic products by participants. Two approaches to OTC treatment decision-making were observed: 1) a decision to treat their symptoms by themselves (self-recommended) or 2) a decision to ask and/or follow their physician's recommendation (physician-recommended). Each of these treatment approaches may lead to the other depending on the person's financial and healthcare resources, the severity of the symptoms, experiences with the medication, and relationship with the physician. Maximum and fast relief was mentioned as the most important attribute in the final OTC purchase decision, followed by the lower cost, and easy to swallow dosage forms. Aspirin and ibuprofen were the two most frequently reported OTC medications associated with adverse effects and inappropriate use. CONCLUSIONS: Older adults, in general, feel positive about OTC medications and are satisfied with using them. Considering the self-reported malpractices and side effects associated with OTC medications, older adults should be encouraged to make safe and responsible decisions about self-medication.