Background/significance: Menopausal transition results in decreases in estrogen and other complications that negatively influence midlife women’s cognitive functions. Also, multiple factors including immigration transition could influence their cognitive functions. However, the findings on the relationships between immigration and cognitive symptoms are inconsistent. Some reported that immigrants had poorer cognitive functions compared with non-immigrants while others reported better cognitive functions among immigrants. Also, there were studies reporting no relationship between immigration and cognitive functions.

Objective/Purpose: The purpose of this secondary analysis was to determine the relationships between immigration and cognitive symptoms among midlife women from multi-racial/ethnic groups in the U.S.

Methods: Only the data among 1,054 midlife women from two national Internet surveys were used for this secondary analysis. The original studies included multiple questions on immigration transition, health and menopausal status, and the Cognitive Symptom Index for Midlife Women. The data were analyzed using descriptive and inferential statistics including hierarchical multiple regression analyses.

Results: There existed significant differences in cognitive symptoms between immigrants and non-immigrants (p<.001). Non-immigrant women had significantly larger numbers and higher severity scores of cognitive symptoms than immigrant women (p<.001). Immigration status (immigrants versus non-immigrants) explained about 1.28% of the total variances in the total numbers of cognitive symptoms and 1.46% of the total variances in the total severity scores of cognitive symptoms (p<.001).

Conclusions: The findings supported the theories on “positive effects of immigration on health”; immigrants are healthier than non-immigrants.

This study analyzed post-discharge 30-day mortality and readmissions among African American Medicare beneficiaries in Prince George’s (PG) County Maryland and the Mississippi Delta (Delta).

African Americans, ≥65 years, with FIPs county code for PG or the Delta (Bolivar, Carroll, Coahoma, Desoto, Holmes, Humphreys, Issaquena, Leflore, Panola, Quitman, Sharkey, Sunflower, Tallahatchie, Tate, Tunica, Warren, Washington, Yazoo) were identified in the 2016 Medicare Limited Data Set. Inpatient claims after December 1, 2016, or with a “discharge” code of death, hospital transfer, against medical advice, or still hospitalized, were excluded. Hospitalization, readmission, and mortality rates were calculated per 1000 beneficiaries. Odds of 30-day mortality and readmission were estimated using logistic regression and adjusted for demographic and clinical characteristics, and prior hospitalization for myocardial infarction (MI), heart failure (HF), pneumonia, chronic obstructive pulmonary disease (COPD), and hip/knee replacements/revisions.

6528 beneficiaries in PG and 3646 in the Delta were included (mean age, 75 years; 59% female). Prevalence of diabetes, hypertension, and end stage renal disease were similar. Delta beneficiaries had a higher prevalence of MI, HF, and COPD diagnoses, and dual Medicare-Medicaid eligibles (66% versus 19%). Rates of hospitalization (Delta, 292.44; PG, 200.17), 30-day mortality (Delta, 77.49; PG, 65.26) and 30-day readmission/mortality (Delta, 268.27; PG, 229.52) were higher in the Delta than PG; as were odds of 30-day mortality (1.16 [95% CI: 0.99, 1.36]) and 30-day mortality/readmission (1.15 [1.03, 1.28]).

Hospitalization, readmission, and mortality rates were higher among beneficiaries in the Delta than PG County, likely driven by limited access to care and socioeconomic differences.

Studies in immigrant health have documented an health paradox that foreign-born older Americans have health advantages in certain health outcomes over their native-born counterparts, despite their lower socioeconomic status. However, relatively few studies have explored whether there is immigrant advantage specific to oral health. In this study we compare the association between edentulism (as a proxy for oral health) and nativity among the participants of the Health and Retirement Study (HRS).

Data were from the HRS participants of aged 50 or older in 2012 (N=19,765). Edentulism was measured by the question, “have you lost all of your upper and lower permanent teeth?” Nativity, along with respondents’ chronological age, gender, years of schooling, dental insurance coverage, and diabetes status were entered into logistic regression models to explore the association.

A total of 3,233 (16.4%) respondents were edentulous and the foreign-born HRS respondents were significantly less likely to be edentulous (Odds Ratio= 2.33, p<.001), when compared to their US-born counterparts. No significant gender difference was found in edentulism. However, respondents who were older, had less formal education, were diabetic, or had no dental care coverage were significant predictors of edentulism.

Oral health has been linked to nutritional status and quality of life among older populations. Using edentulism as an indicator for oral health, our preliminary cross-sectional findings showed that foreign-born older Americans seemed to have another advantage in oral health (less likely to be edentulous), when compared to their native-born counterparts. Longitudinal analyses are needed to further clarify the relationship.

The aging LGBT community has distinct healthcare needs and faces well-documented healthcare disparities. As this population grows to exceed 5 million by 2060, allied health professionals, including Recreation Therapists, will be increasingly likely to interact with LGBT older adults and must be prepared to provide culturally competent quality care. The purpose of this descriptive study was to examine Certified Therapeutic Recreation Specialists’ (CTRSs) perspectives on their training and education, as well as their comfortability and competency, to serve the aging LGBT population. Following institutional review board approval, CTRSs with at least 1 year of work experience were recruited to participate in an anonymous electronic survey (N=216). Based on an extensive review of the literature, the researchers developed a 42-item survey instrument. Descriptive statistics were used to analyze the survey data. The majority of the participants were female, White/Caucasian, and between 25 to 45 years old. Participants reported receiving more formal training and education related to geriatric patients and were very comfortable (68%) and competent (60%) with serving them compared to LGB (63%; 34% respectively) and transgender (50%; 22% respectively) patients. Results suggest that although CTRSs lack substantial formal training and education on the aging LGBT population, their professional experience may increase their reported comfortability and competency. Gaps in knowledge, however, can impact the consistency of high quality and culturally sensitive care. Legislation and policies should be established to require health education and training for all allied health professionals on the growing needs of diverse LGBT older adults.

Millions of low-income older American adults without supplemental Medicare coverage receive care at Health Resources and Services Administration-funded health centers (HCs). In 2014, Medicare established a standard payment policy to adequately reimburse HCs for the higher needs of older adult patients. We examined the impact of this policy rate change on the growth of older adult patients served at HCs. We used the 2015 to 2017 Uniform Data System (HC characteristics), the 2015 Area Health Resource File (county characteristics), and the 2015 American Community Survey (HCs service area characteristics). We included 1,211 HCs that operated both years and reported serving older adult patients. We used 1) a structural equation probit regression model to measure growth in percentage of older adult patients from 2015 to 2017 and 2) an ordinary least squares regression to measure subsequent older adult population growth with HC revenues and expenditures in 2017. Most (84%) HCs showed a 22% average growth in percentage of older adult patients. HC predictors of proportional older adult growth included fewer older adult patients (-1.0% predicted probability), providing mental health care (6.4%), higher percentage of revenues from Medicaid (15.7%), and more older adult patients in service areas (0.8%) in 2015. Following the establishment of a prospective payment system methodology in 2014, HCs observed a growth in the percentage of older adult patients served from 2015 to 2017. HCs are a logical source of care and natural partner for aging networks that serve older adults given the delivery of integrated, whole person care.

Background: Despite growing interest in the health of underrepresented aged populations, little is known about the burden of disease and frailty among older adults of Native Hawaiians and Pacific Islanders ethnicity. While studies on the quality of life and health needs of these elderly have infrequently appeared in the literature, these studies typically use small, convenience samples with limited generalizability so we lack definitive information upon which to create guided public health policy. Methods: This presentation uses data from the 2014 Native Hawaiians and Pacific Islanders National Health Interview Survey (NHPI NHIS), a nationally representative household survey based upon the 2014 NHIS and fielded by the National Centers for Health Statistics. This resource, released in 2017, allows the calculation of the first descriptive statistics and age-adjusted prevalence of chronic disease and frailty for NHPI older adults 55 years and older. These results are then compared to US rates calculated with the 2014 NHIS. Results The estimated prevalence for chronic conditions and self-reported frailty was found to be markedly higher among NHPI elders when compared to the US as a whole and major ethnic groups. Significant correlates with health conditions include age, being single-race, gender and immigration status. Overall, major differences were seen between NHPI and Whites, but NHPI’s also reflected higher risks of poor health and frailty compared to African Americans and Hispanics. Conclusion: NHPI older adults are disproportionately affected by chronic diseases and disability. Research is needed to reduce this progression and persistence.

Objective: We examined factors associated with older black patients' readmission to ambulatory care within one week to two months’ discharge. Methodology: We analyzed 7619 older patients (age 50 and older) from the 2016 National Ambulatory Medical Care Survey. Logistic regression analyses were used to examine the risk factors for ambulatory readmission. Findings: Being Black or the Medicaid payment was not statistically significant to predict for readmission. However, black patients using Medicaid as the primary payment experienced higher risks of readmission (OR=2.30, 95%CI[1.33, 3.96]), after controlling for other variables. Medicare coverage (OR=1.16, 95%CI[1.01, 1.35]) and the higher facility percentage (>50%) of Medicaid patients (OR=2.40, 95%CI[1.73, 3.32]) were each associated with greater odds of readmission. Nursing home visits within the prior week increased the odds of readmission. Patients diagnosed with cancer, chronic kidney disease, depression, or currently using tobacco experienced greater odds to be readmitted. The presence of RN/LPN decreased the risk for readmission (OR=0.80, 95%CI[0.67, 0.95]). Implications: Older black patients with Medicaid payment or patients in facilities with higher percentage of Medicaid revenue experienced significantly greater odds of readmission to ambulatory care within one week to two months of discharge. Future research is called upon to exam these disparities in ambulatory care.

By 2030, the number of adults in the USA will increase to 74 million, over 22 million of them will need specialized geriatric care particularly care for those with dementia. Simultaneously, in 2025, a national shortage of medical geriatricians will be close to 27,000 full time positions. This shortage has a greater impact on oral health due to limited access and shortage of trained dentist to manage patients with special needs and with cognitive decline. Therefore, there is an urgent need for workforce enhancement nationwide. Oral health of the elderly is the most neglected area of the health care by many health providers across healthcare disciplines leading to a constant high cost Emergency departments visits for dental related emergencies.

Project ECHO (Extension for Community Healthcare Outcomes) is a telementoring guided practice model that revolutionizes health education to provide best-specialty oral care practice to reduce oral health disparities. Training oral health providers by utilizing project ECHO model is a logical response to the shortage of trained dentist for elderly with dementia. It is an excellent method of communication among oral health providers when treating elderly with other health complexities including dementia. Telementoring, (unlike telemedicine) is democratizing knowledge of specialist to primary providers to deliver proper care to the patients in their own community by moving the knowledge and not the patient. This innovation enhances workforce for delivering the right treatment, in the right time and in the right place to the most vulnerable group of elderly at lowest cost.