Background: Tennessee has historically had below-average vaccination rates compared to the rest of the nation. After the Covid-19 pandemic, vaccination rates further dropped due to mistrust in vaccines, especially among the aging population.

Description: We propose an innovative model of care that utilizes nurses at the county level to identify factors associated with low vaccine uptake and to address these issues, rebuilding trust in all vaccines among the aging population. The purpose of this presentation is to introduce our public health approach to building vaccine education and trust, employing the Community Registered Nurse Navigators (CRNN) model of care implemented across the state of Tennessee post-Covid-19 pandemic.

Lessons Learned: Rebuilding trust in public health must start at the local level, and local nurse navigators are equipped to do this. The navigators serve as trusted educators, promoters, and facilitators to build trust in vaccines in the aging population.

Implications: As the most trusted profession in the nation, RNs have the unique position to impact the health of older adults. This model uses cross-sector efforts to address community well-being and embed nurse navigators into local communities. The nurse navigators’ ongoing presence shows commitment to improved health and well-being, builds trust, and can be replicated in other regions.

Background

Both medical and long-term care are essential to ensure the health of older adults. The public medical and long-term care insurance systems in Japan provide universal coverage to older adults. However, the health status and service utilization of older adults over time have not been described in detail.

Methods

We conducted a retrospective cohort study using a medical and long-term care insurance claims database in Tochigi Prefecture, covering a population of 1.5 million from 18 of the 25 municipalities. All residents aged 75–89 years as of January 2014 were identified. We evaluated their initial care-need levels based on the national certification system: support level (SL) 1–2 and care-need level (CNL) 1–5. Participants were followed for 5 years to analyze mortality, care-need levels, and medical and long-term care service utilization.

Results

We identified 153,015 individuals, with 42%, 35%, and 23% aged 75–79 years, 80–84 years, and 85–89 years, respectively. The initial long-term care status were as follows: none, 77%; SL1–2, 7%; and CNL1–5, 17%. The overall mortality rate was 59.8 per 1000 population per year. The proportion of surviving individuals with no care needs, SL1–2, and CNL1–5 at 5 years were 63%, 10%, and 28%, respectively. Of the initially independent individuals, 19% developed long-term care needs. Overall, 25% were hospitalized and 10% used nursing facility services.

Conclusions

The health status of older adults was elucidated using a population-based database, serving as a basis for future studies on this population.

Background: About 3.1 million Medicare beneficiaries receive home health care (HHC), and limited evidence has focused on the relationships between the risk of infection and neighborhood factors, which are critical for HHC patients. We examined the association between rurality and neighborhood deprivation in infection-related hospitalization rates of Medicare beneficiaries receiving HHC.

Methods: We merged 2019 OASIS, MedPAR, and MBSF datasets, defined 60-day HHC episodes and linked them with the Area Deprivation Index (ADI), and estimated logistic probability models of hospitalization (during HHC episode) due to infection (primary diagnosis), adjusting for patient, agency, and county level characteristics. The independent variable neighborhood deprivation (measured by ADI) and categorized into quintiles (Quintile 5: highest deprivation). Rurality was defined from the 2023 RUCC (large-metropolitan, metropolitan, rural-adjacent, and rural-remote).

Results: Of 3,601,372 beneficiaries from 8,131 agencies, 53.0 % lived in large-metropolitan areas, 30.6% were in metropolitan areas, 11.6% were in rural-adjacent areas, and 4.8 % were in rural-remote areas. Infection-related hospitalization rates from the patients in the highest deprivation neighborhoods were 3.3%, 4.2%, and 7.1 %, higher than large-metropolitan rates for those in metropolitan, rural-adjacent, and rural-remote areas (each p<0.05). In adjusted models, these differences were 5.0%, 5.7%, and 7.1 %, lower respectively in metropolitan, rural-adjacent, and rural-remote areas than in large-metropolitan (each p<0.05). For patients in the lowest deprivation neighborhoods, hospitalizations were 10.0%, lower in rural-adjacent areas than in large-metropolitan (p<0.05). Adjusted models showed 11.0% (p<0.05).

Conclusions: We found urban-rural differences in infection-related hospitalization rates among Medicare beneficiaries depending on neighborhood deprivation and rurality.

Background
Approximately one in ten older adults experience elder abuse each year, but research suggests this is an underestimate. One challenge in capturing the breadth of this public health concern is differences in the laws and reporting of maltreatment across states, which may obscure our understanding of inequities in elder abuse and health across place.

Methods
We constructed a database by coding details of Adult Protective Services and elder abuse state statutes and reporting laws as provided by the American Bar Association. State population estimates from the American Community Survey were added to compare across age and rurality.

Results
Our policy analysis finds similarities and differences in the level of detailed types of elder abuse across states’ Adult Protective Services statutes. We also find differences in who is listed as a mandated reporter of elder abuse, when and how one must report, and reporting modes by state. Our findings also highlight how laws differ across other social contexts such as the proportion of older adults in a state and the proportion of older adults residing in rural areas as well.

Conclusions
This policy analysis yields insights on the social context, via state laws and policies, that frame how, when, and by whom elder abuse is reported across each state. Our findings can be used to assess how these laws may differentially impact older adults’ health, safety, and well-being not only across states, but across places with higher populations of older adults and in rural areas.

The current environment has reduced resources for older adults, a population already highly physically and psychologically vulnerable. Consequently, gaps ensue that have highlighted increased social isolation, lack of resources, feelings of marginalization, and overall distrust in the public health system (NIH).

HSS created an Aging with Dignity Initiative aimed at older adults with the goal of empowering them, providing coping mechanisms, increasing social connectivity, providing education and support and increasing confidence in the healthcare system. These include weekly support groups and creative programs led by specialists both in-person at partnership senior centers in underserved areas of New York City and via Zoom, Programs were evaluated through qualitative and anecdotal feedback.

Since 2021, we’ve reached 4105 participants, majority aged 60+ years (88%) and identifying as female (89%). Themes included stress reduction “[it] was stress relieving...it was nice to explore a different way to relieve stress”; improved ability to cope and reflect “[I] learned a lot about emotional coping mechanisms that I could use to deal with the negative emotions that come from my disorder”; and desire to connect with others “I forget about my problems, at least for a little while, and I feel connected”.

It is essential to offer programming that can address the unique challenges faced by older adults so that they can better trust the public health system and not feel marginalized. We must bridge gaps to build better trust, create effective change in social connectivity, stress and joy in order to enhance older adult quality of life.

Background

Dementia Friendly Oklahoma (DFO) is a statewide awareness and education program for Alzheimer’s disease and related dementias (ADRD) that supports those living with dementia and their care partners. Oklahoma is a member of the Dementia Friendly America® Network.

Description

The DFO recognition program started in June 2023. We work with our Oklahoma Healthy Brain Initiative members to promote and present the Dementia Friendly Work@Health presentation Work@Health presentations are the first step in becoming a DFO Partner. These presentations are offered in-person and virtually.

Lessons Learned

We quickly learned that a train the trainer is needed to have the best reach across the state. We recruited 2 new volunteers to assist in giving the presentation in 2024, but more are needed specifically in rural areas. We also learned that guides and tip sheets are of assistance to potential partners and current partners so they can be successful.

Implications

The Oklahoma Healthy Brain Program is growing the DFO recognition program and increasing awareness and education of ADRD one business at a time. We hope to increase our DFO Partners by 5% every year. The more DFO Partners we have the more supportive and inclusive Oklahoma becomes for those facing this disease. Since June 2023, we have 30 Dementia Friendly Oklahoma Partners in the state and in in 22 of our 77 counties. 18 DFO partners are County Health Departments (CHD). Before September 29, 2024, we hope to have all CHDs in OK trained and listed as Partners (63 sites).

Background: Cognitive decline causes an increasing burden on patients, caregivers, and society. Identifying childhood adversities and social determinants of health can be an important step in mitigating the increasing burden of cognitive decline and promoting healthy aging. This study investigates the causal relationship between adverse childhood events and social determinants of health and cognitive functioning.

Methods: Using the R software program, we conducted structural equation modeling from the 2022 Behavioral Risk Factor Surveillance (n = 755) dataset to analyze the role of social determinants of health (income, health insurance, food insecurity, access to a doctor, transportation, and education) and adverse childhood experiences (dysfunctional households, parental abuse, and sexual abuse) on cognitive functioning (memory loss to engage in social activities, daily activities, and assistance with these activities) in adults above the age of 45.

Results: Our results suggest that early experiences of living with incarcerated parents and parents with drug use were the highest predictors of dysfunctional households (p<0.05). The early experiences of being sexually touched and forced to have sex were the strongest predictors of sexual abuse (p<0.001). SEM revealed that dysfunctional households, sexual abuse, and higher social determinants of health were associated with low cognitive functioning (-0.160, P < 0.05; -0.167, P<0.001; 0.437, P < 0.001).

Conclusion: Providing early childhood interventions can benefit society by lowering the burden of cognitive impairment among the aging population. Public health providers and policymakers should consider implementing targeted interventions such as promoting resilience, providing social support for families, and increasing access to healthcare.

Background: Food insecurity is an adverse social condition that is rising in prevalence among older adults in the U.S and is associated with several barriers to healthy aging. However, little is known about long-term trajectories of food insecurity or how longitudinal exposures vary across older adults with different racial and ethnic identities.

Methods: Using data from the 2010-2018 waves of the Health and Retirement Study (HRS), Group-based Trajectory Modeling was used to identify food insecurity trajectories in adults ages 50 and older with incomes below 300 percent of the Federal Poverty Level. Separate trajectories were also estimated for NH Black, Hispanic, and NH White participants and Poisson regression was used to estimate associations between trajectories and participant-reported chronic conditions.

Results: Models predicted three longitudinal trajectories in the full sample and each of the NH Black and Hispanic subsamples, and two trajectories in the NH White subsample. NH Black participants were more likely than NH White participants to follow a trajectory of persistently high probabilities of food insecurity over an eight-year period (Incident Rate Ratio [IRR] = 1.72, 95% Confidence Interval [CI]: 1.09 - 1.24). Additionally, following a persistently high-risk trajectory was associated with higher cumulative chronic conditions in each subsample (IRR_{NH Black} = 1.31, 95% CI: 1.12 - 1.53; IRR_Hispanic = 1.32, 95% CI: 1.03 -1.70; IRR_{NH White} = 1.16, 95% CI: 1.09 - 1.24).

Conclusion: Public policy and population health management strategies should prioritize prevention of race- and ethnicity-based disparities in repeated exposures to food insecurity.

Rooted in the principles of prevention, protection, and promotion, nurses are at the forefront of safeguarding public health. They are the foundational support for ensuring public trust in healthcare, as such, rebuilding trust is directly related to strengthening the nursing workforce thus improving patient outcomes at local, national, and international levels.

Global partnerships have emerged as mechanisms for supporting the vision of enhancing trust in healthcare. As such, the collaboration between Northwell Health, NY and Georgetown Public Hospital, Guyana was established in 2019. In 2021, this partnership was formalized by a five-year Memorandum of Understanding between the Ministry of Health in Guyana and Northwell Health.

The nursing component of the partnership plays a key factor in supporting public trust. It focuses on strengthening nursing leadership, enhancing clinical skills, and building sustainable healthcare infrastructure. Key initiatives include Leadership Mentoring Programs, which trained 21 nurse leaders in strategic planning in 2020, held a subsequent leadership retreat, and hosted a comprehensive Nursing Leadership Program supported by the Tom Hall Grant, benefiting 68 nurses across Guyana.

Additionally, the formation of a cross-national nursing advisory council identified skill gaps and implemented quality performance metrics. Aa a result, a performance dashboard was established in 2022.

Innovative recruitment and retention strategies were implemented to address workforce challenges and enhance retention and engagement, including the launch of a nursing mentor program in 2024 and introduction of the DAISY Award in 2022.

Overall, these interventions aim to strengthen healthcare systems, enhance patient outcomes, and rebuild trust in public health.