J Minahan’s research while affiliated with Fordham University and other places

Objectives: Alcohol and substance misuse has been under-acknowledged and underidentified in older adults. However, promising treatment approaches exist (e.g., brief interventions) that can support older adults with at-risk alcohol and substance use. Postacute rehabilitation settings of Skilled Nursing Facilities (SNFs) can offer such programs, but little is known about patient characteristics that are associated with the likelihood of participating in interventions offered in postacute rehabilitation care. Thus, the objective of this study was to identify individual patient characteristics (predisposing, enabling, and need-related factors) associated with participation in a brief alcohol and substance misuse intervention at a SNF. Methods: This cross-sectional study analyzed medical record data of postacute care patients within a SNF referred to a substance misuse intervention. Participants were 271 patients with a history of substance misuse, 177 of whom enrolled in the intervention and 94 refused. Data collected upon patient admission were used to examine predisposing, enabling, and need-related factors related to likelihood of program participation. Results: Older age and ethnic minority status were associated with a reduction in likelihood to participate, while widowhood increased the likelihood of participation. Conclusion: Upon referral to a substance misuse intervention, clinicians in SNFs should be cognizant that some patients may be more likely to refuse intervention, and additional efforts should be made to engage patients at-risk for refusal.

Ageism against older adults is a prevalent issue in the U.S. and has consistently been found to negatively impact older adults (e.g., Sargent-Cox, 2017). Research has shown that being exposed to ageism (in the form attitudes or behaviors) is related to diminished cognitive performance, psychological well-being, self-esteem, and worse self-perceptions of aging among older adults (e.g., Han & Richardson, 2015; Robertson et al., 2016). Therefore, it is important to understand what factors predict ageism. In the current study, aging anxiety, knowledge of aging, death anxiety, and intergenerational contact frequency and quality were examined as predictors of ageism in a large sample of individuals (N=419) between the ages of 18 and 86 years via an online survey. The average age of participants was 46.09 (SD= 19.28), 79.50% were female, and 85.70% were White. Using hierarchical regression analyses, we found that higher levels of aging anxiety and lower levels of knowledge of aging, frequency of contact, and quality of contact were related to higher levels of ageism beyond the influence of demographic and well-being factors (e.g., positive and negative affect, depression, life satisfaction). Although death anxiety was significantly related to ageism, the relationship was fully mediated by aging anxiety. Finally, knowledge of aging, frequency of contact, and quality of contact were examined as moderators, and we found that knowledge of aging buffered the impact of aging anxiety on ageism. Overall, these findings suggest that there are important predictors of ageism that may potentially serve as targets for intervention in the future.

The purpose of this study was to examine Long-Distance Caregiving (LDC) stressors (i.e., work and family conflict, caregiver [CG] burden) and mental health consequences (i.e., depression and anxiety), and to identify subgroup difference (i.e., by ethnicity, income adequacy, and gender). We analyzed data from the Fordham Long Distance Caregiving Study (N=286). Results showed that Blacks when compared to Whites and Latinos reported significantly lower levels of caregiving interference with other family responsibilities. Blacks when compared to Whites had significantly lower levels of CG burden. Female LDCs had significantly higher levels of depression and anxiety when compared to men. Finally, there were significant associations between lower income adequacy and higher levels of CG burden, more interference with work and family responsibilities, and higher depression and anxiety. This study paints a complex picture of stressors and consequences of LDC and highlights which LDC sub-groups may be vulnerable to stressors and negative consequences.

Using data from the Fordham Long Distance Caregiving (LDC) Study (N=286), the purpose of these analyses was to describe the formal service use and needs (e.g., support groups, geriatric care management) of LDCs and to identify subgroup differences based on caregiver and care recipient characteristics. We found that rates of service use were low with an average of 8% of participants reporting use of each type of service. Participants who used formal services were younger, female, White, reported higher caregiver burden, depression, anxiety, and had care recipients with better cognition. Regarding service needs, an average of 53% of participants reported being interested in each type of service. Participants who were more likely to be interested in services were younger, female, had lower income adequacy, reported higher caregiver burden, depression, anxiety, and had care recipients with better cognition. This study highlights discrepancies between service use and needs among LDCs.

The purpose of this study was to examine the specific types of challenges related to distance that were reported by caregivers who participated in the Fordham Long Distance Caregiving (LDC) Study. We coded 60 open-ended responses to a question that asked about the challenges caregivers face in providing care to an older adult who lives at least two hours travel distance away. More than half of respondents reported challenges relating to distance from the care recipient (CR). The main distance-related themes that emerged included general difficulty taking care of things from afar (n=8), difficulty communicating with the CR (n=5), spending time away from family members (n=5), the toll of traveling (n=4), making time to travel to visit the CR (n=4), difficulty knowing what’s going on with the CR (n=4), and emotional strain (n=4). This study provides insight into the unique challenges that LDCs face in providing care to loved ones.

Empirical evidence for the positive effects of culture change components such as elder choice, consistent staffing, and organizational redesign is growing. We conducted a retrospective comparison of residents living in Small House communities with a matched sample of those living in traditional, legacy communities in the same nursing home. Most residents had moderate to severe cognitive loss. We found no significant changes on quality of life / care indicators from admission to six months. However, findings showed that at six months, a significantly greater proportion of Small House compared to Legacy residents fell into a lower care intensity group indicating better elder functioning and fewer care resources needed. Further, when comparing activities of daily living, we found that Small House compared to Legacy residents were more likely to have improved mobility within their environment. Findings provide some evidence that the Small House model can potentially improve function.

This paper presents recruitment experiences and sample information from the Fordham LDC Study (N=286). We initially planned to recruit LDCs from primary contacts of elders receiving residential or home care services. However, low recruitment rates lead us to research matching services, list serves, and participant and personal referrals. As a result, 46% of the sample were recruited from service agencies and 54% from non-affiliated sources. However, among the latter group, 27% of the elders were in residential care, and of those living at home, 38% were receiving home care services. LDCs were typical in being 72% women; while we found our LDCs to be highly educated (74% with college or more) and somewhat younger (mean = 57 years). While 72% were caring for parents, 28% were caring for more distant relatives and friends, suggesting that for many, LDCs step in when proximate and/or closer relatives are not available.

The demand for long-term care services will likely increase, despite the fact that on average individuals prefer to remain living in their own home. The transition to living in a long-term residential care facility can be a stressful event for older adults, and this transition has been linked to poor psychological outcomes. The current study aimed to better understand this transition process. We analyzed data from a nationally representative sample of Medicare beneficiaries aged 65 years and older of the National Health and Aging Trends Study (NHATS). We focused on a sub-sample that transitioned from community to long-term residential care, either nursing home residence (n= 107) or other non-nursing home residential care (e.g., assisted living facilities; n=158). The study assessed the relationship between several key pre-transition health, psychological, social, and sociodemographic factors, and psychological well-being (e.g., depression, anxiety, negative affect, and positive affect), after residential care transition. Overall, psychological and social factors at pre-transition did not impact psychological well-being at post-transition for either nursing home residents or residents of a residential care facility other than a nursing home. However, results revealed several influential sociodemographic factors. For instance, being Asian, Hispanic/Latino, or female was associated with worse psychological well-being after the transition to residential care facility (other than a nursing home), while income was associated with better psychological well-being after the transition to residential care facility (other than a nursing home). This study has important implications for the development of clinical guidelines regarding cultural competencies to facilitate healthy residential care transitions.

While a fair amount of research has investigated the impact of sensory impairments on the mental health of young older adults (65–79 years of age), only a few studies have focused on the associations of sensory impairments with mental health outcomes in the oldest-old (80 years and older). To close this gap, this study examined the separate and combined effects of self-reported vision and hearing impairment for depressive symptoms in a sample of oldest-old individuals, controlling for other mental health risks (e.g., functional disability, health interference, and loneliness). A sample of centenarians and near-centenarians (N = 119; average age = 99) were recruited from the community and geriatric healthcare organizations. In-person interviews were conducted at participants’ place of residence. In hierarchical regression analyses vision impairment and its interaction with hearing impairment as well as functional disability, health interference with desired activities, and loneliness were significant predictors of depressive symptoms. Hearing impairment alone was not associated with depressive symptoms, but follow-up analyses clarifying the interaction effect showed that individuals with poor vision had the highest levels of depressive symptoms, if they had a concurrent hearing impairment. Thus, a concurrent presence of poor vision and poor hearing resulted in an increased vulnerability for depressive symptoms. We conclude that given that a majority of oldest-old has sensory impairments which can result in mental health issues, it is important to facilitate this population’s access to vision and audiological treatment and rehabilitation.