UMBC Erickson School of Aging Studies
Permanent URI for this collectionhttp://hdl.handle.net/11603/13006
The Erickson School @ UMBC began with a vision to educate the next generation of aging services professionals. The program – the only one of its kind in the country to combine business management, public policy and the study of human aging – was designed to meet the real-world demand for educated, innovative leaders in the longevity market.
Our mission is to prepare a community of leaders who will use their education to improve society by enhancing the lives of older adults.
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Item Digital skills use profiles among older workers in the United States: a person-centered approach(Taylor & Francis, 2024-12-22) Yamashita, Takashi; Narine, Donnette; Ojomo, Adeola; Chidebe, Runcie C. W.; Cummins, Phyllis A.; Kramer, Jenna W.; Karam, Rita; Smith, Thomas J.Considering the digitalisation of the workplace and increasingly crucial digital skill proficiency in the technology-rich labour market, the objectives of the present study are to develop digital skill use profiles and to identify specific individual characteristics that are linked with digital skill use patterns among older workers in the United States. However, relatively little is known about older workers’ digital skill use patterns and skill use opportunity structures. Data of the U.S. older workers (age 50 years and older; n = 1,670) were obtained from the 2012/2014/2017 International Assessment of the Adult Competencies (PIAAC). Latent class analysis – a form of person-centred approach that identifies subgroups based on distinctive digital skill use patterns, showed that there were two underlying subgroups of older workers, including more frequent and less frequent digital skill users. More frequent users practiced a greater variety of digital skills both at work and outside of work than their counterparts. Also, logistic regression analysis showed that higher digital skill proficiency and full-time employment (vs. part-time) were associated with belonging to the more frequent digital skill use subgroup. The digital skill use profiles of U.S. older workers, subgroup characteristics, and implications for adult education and labour policies are evaluated.Item Nursing Facility Characteristics Are Differentially Associated With Family Satisfaction and Regulatory Star Ratings(Southern Gerontological Society, 2025-01-08) Millar, Roberto J.; Diehl, Christin; Kusmaul, Nancy; Stockwell, IanResearch suggests that nursing facility structural characteristics are important contributors toward residents’ quality of care. We use 2021 data from 220 Maryland nursing facilities to examine associations between two different quality-of-care metrics: family satisfaction and Care Compare five-star quality ratings. We used descriptive statistics to explore differences in quality metrics across facility ownership (for-profit vs. non-profit), geographic location (urban vs. rural), and resident census (1–60, 61–120, and 121+). Relationships were examined across overall ratings, as well as across subdomains of the two frameworks (e.g., staffing). Family members of residents in non-profit, rural, and low-census facilities rated facilities higher. Non-profit and low-resident census facilities were more likely to be rated four or five stars, while no significant association was observed across geographic location, or interactions across structural factors. Findings emphasize the need for comprehensive quality-of-care frameworks that explore quality care across stakeholders and types of facilities.Item Adult Literacy Skills and Risk of Job Automation Among Middle-Aged and Older Workers in the United States(2024-12-13) Narine, Donnette; Yamashita, Takashi; Chidebe, Runcie C. W.; Cummins, Phyllis A.; Kramer, Jenna W.; Karam, RitaJob automation can undermine economic security for workers in general, and older workers, in particular. In this respect, consistently updating one’s knowledge and skills is essential for being competitive in a technology-driven labor market. Older workers with lower adult literacy skills experience difficulties with continuous education and skills development, which can contribute to their economic uncertainty. Therefore, this study aimed to examine the correlation between adult literacy skills and job automation risk. We analyzed a nationally representative sample of middle-aged and older workers (age 50+ years; n = 1,880) from the 2012/2014/2017 Program for the International Assessment of Adult Competencies (PIAAC) dataset. The survey-weighted linear regression results showed that lower job automation risks (0%–100%) were a function of higher adult literacy skills (score 0–500 points: b = −.052, p < .05), after adjusting for relevant covariates (R-squared = .19).Item Family Care Partners and Paid Caregivers: National Estimates of Role-Sharing in Home Care(Oxford University Press, 2024-12-09) Fabius, Chanee D.; Gallo, Joseph J.; Burgdorf, Julia; Samus, Quincy M.; Skehan, Maureen; Stockwell, Ian; Wolff, Jennifer L.We describe “role-sharing” in home care, defined as family care partners and paid caregivers assisting with the same task(s).We studied 440 participants in the 2015 National Health and Aging Trends Study (NHATS) receiving paid help with self-care, mobility, or medical care. We describe patterns in receiving paid help only, help from care partners only, and role-sharing. We examine whether sole reliance on paid help or role-sharing differs by Medicaid-enrollment and dementia status.Half (52.9%) of care networks involved role-sharing. Care networks involving role-sharing more often occurred among older adults with dementia (48.7% vs. 25.6%, p<0.001) and less often for those who were Medicaid-enrolled (32.1% vs. 49.4%, p<0.01). Those living with dementia more often experienced role-sharing in eating (OR 3.9 [95% CI 1.20, 8.50]), bathing (OR 2.7, [95% CI 1.50, 4.96]), dressing (OR 2.1 [95% CI 1.14, 3.86]), toileting (OR 2.9 [95% CI 1.23, 6.74]), and indoor mobility (OR 2.8 [95% CI 1.42, 5.56]), and less often received help solely from paid helpers with medication administration (OR 0.24, [95% CI 0.12, 0.46]). Medicaid-enrollees more often received paid help only in dressing (OR 2.0 [95% CI 1.12, 3.74]), outdoor (OR 2.4 [95% CI 1.28, 4.36]) and indoor mobility (OR 4.3 [95% CI 2.41, 7.62]), and with doctor visits (OR 2.8 [95% CI 1.29, 5.94]).Role-sharing is common, especially among older adults living with dementia who are not Medicaid-enrolled. Strategies supporting information sharing and collaboration in home-based care merit investigation.Item Care Compare Star Ratings and Family Satisfaction in Maryland Nursing Facilities: A Comparison by Facility Structure(2024-02-22) Millar, Roberto; Diehl, Christin; Kusmaul, Nancy; Stockwell, IanThese findings were presented at the Gerontological Society of America’s (GSA) 2023 meeting in Tampa, Florida. Part of a Center and Institute Departmentally-Engaged Research (CIDER) award, this is part of several studies focused on examining quality of care in Maryland nursing facilities.Item Nurse Staffing in Nursing Facilities and Family Members' Appraisal of Resident Care(2024-06-29) Millar, Roberto; Diehl, Christin; Cannon-Jones, Stephanie; Kusmaul, Nancy; Stockwell, IanItem Multiple Chronic Condition Patterns among Full-Benefit Maryland Medicaid Enrollees(2024-06-29) Han, Fei; Gill, Christine; Blake, Elizabeth; Stockwell, IanItem Association Between Prehip Fracture Antidepressant Use and Posthip Fracture Length of Hospital Stay in Medicare Beneficiaries and Assessing Sex Differences(Elsevier, 2024-11-14) Mehta, Rhea; Falvey, Jason R.; Chen, Chixiang; Dong, Yu; Shardell, Michelle D.; Yamashita, Takashi; Orwig, Denise L.ObjectiveAntidepressants are the first-line treatment for depression among older adults. While antidepressants are associated with increased risk of falls and fractures in older adults, their effect on outcomes after fall-related injuries such as hip fracture, and whether these effects differ by sex, is unknown. Thus, the purpose of this study was to examine the association between prefracture antidepressant use and hospital length of stay (LOS) among hip fracture survivors, and related sex differences.MethodsParticipants included 17,936 community-dwelling Medicare fee-for-service beneficiaries with depression and hospitalization claim for hip fracture surgery between 2010 and 2017. Ordinal logistic regression estimated the association between prefracture antidepressant use and hospital LOS in days, categorized into three groups (1-4, 5-8, and 8+ days) during the 30-day postfracture period, adjusting for demographic, medical, facility, and geographic factors. A sex-by-antidepressant use interaction term was included to examine effect heterogeneity by sex.ResultsPrefracture antidepressant users (47%, n = 8,350) were more likely to be younger, White females. The adjusted ordinal logistic regression showed beneficiaries who used antidepressants had 8% higher odds of being in a shorter hospital LOS category compared to non-users (OR = 1.08; 95% CI = 1.02, 1.14; p=0.01). The sex-by-antidepressant use interaction was not statistically significant (p=0.92).ConclusionsAmong older adults with depression who subsequently experienced a hip fracture, antidepressant use of >30 days in the 6 months prior to fracture was associated with a shorter hospital LOS. These findings indicate that use of antidepressants does not prolong early recovery from hip fracture and may be protective.Item A Look at External Political Efficacy and the Role of Digital Skills in the Adults U.S. Population(Sage, 2024-07-23) Punksungka, Wonmai; Yamashita, Takashi; Narine, Donnette; Helsinger, Abigail; Cummins, Phyllis A.; Kramer, Jenna W.; Karam, RitaThe ability to effectively use digital technology and problem-solve are critical skills for maintaining democratic health, particularly as civil society and the modern digital landscape continuously evolve. However, information on whether individuals have the critical problem-solving skills to use digital technology and confidently affect change is yet to be further explored. Using data from the 2017 Program for International Assessment of Adult Competencies (n = 2749), we examined the associations between digital problem-solving skills and the three levels (low, neutral, high) of external political efficacy in the U.S. adult population. We used multinomial logistic regression and found a positive association between digital problem-solving skills and external political efficacy, while explanations for the three levels of efficacy are nuanced. Continuous development of digital problem-solving skills through adult education has implications for political efficacy, and ultimately for the promotion of a variety of civic engagement in the adult life stages.Item Association between pre-hip fracture depression and days at home after fracture and assessing sex differences(Wiley, 2024-07-20) Mehta, Rhea; Orwig, Denise L.; Chen, Chixiang; Dong, Yu; Shardell, Michelle D.; Yamashita, Takashi; Falvey, Jason R.Background Hip fracture and depression are important public health issues among older adults, but how pre-fracture depression impacts recovery after hip fracture is unknown, especially among males who often experience greater depression severity. Days at home (DAH), or the days spent outside a hospital or healthcare facility, is a novel, patient-centered outcome that can capture meaningful aspects of fracture recovery. How pre-fracture depression impacts DAH after fracture, and related sex differences, remains unclear. Methods Participants included 63,618 Medicare fee-for-service beneficiaries aged 65+ years, with a hospitalization claim for hip fracture surgery between 2010 and 2017. The primary exposure was a diagnosis of depression at hospital admission, and the primary outcome was total DAH over 12 months post-discharge. Longitudinal associations between pre-fracture depression and the count of DAH among beneficiaries were estimated using Poisson regression models after adjustment for covariates; sex-by-depression interactions were also assessed. Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) reflecting relative differences were estimated from these models. Results Overall, beneficiaries with depression were younger, White females, and spent 11 fewer average DAH compared to counterparts without depression when demographic factors (age and sex) (IRR = 0.91; 95% CI = 0.90, 0.92; p < 0.0001) and social determinants of health (race, Medicaid dual eligibility, and poverty) were adjusted for (IRR = 0.92; 95% CI = 0.91, 0.93; p < 0.0001), but this association attenuated after adjusting for medical complexities (IRR = 0.99; 95% CI = 0.98, 1.01; p = 0.41) and facility and geographical factors (IRR = 1.0037; 95% CI = 0.99, 1.02; p = 0.66). There was no evidence of effect modification by sex. Conclusions The comorbidity burden of preexisting depression may impact DAH among both male and female Medicare beneficiaries with hip fracture. Results suggest a holistic health approach and secondary prevention of depressive symptoms after hip fracture.Item Digital Skills, STEM Occupation, and Job Automation Risks among the Older Workers in the United States(Oxford University Press, 2024-06-05) Yamashita, Takashi; Narine, Donnette; Chidebe, Runcie C. W.; Kramer, Jenna W.; Karam, Rita; Cummins, Phyllis A.; Smith, Thomas J.Advancing automation technologies are replacing certain occupations such as those involving simple food preparation more than occupations such as those in STEM fields (e.g., engineering, health care). Older workers generally face higher job automation risks in part due to their lower levels of digital skills. A better understanding of the associations between job automation risk, digital skills, and type of occupation (e.g., STEM vs. non-STEM) can facilitate preparations for job automation and workforce population aging. We analyzed a nationally representative sample (N = 1,560) of middle-aged and older U.S. workers aged 50–74 years from the 2012/2014/2017 Program for International Assessment of Adult Competencies (PIAAC) restricted-use file. The estimated job automation risks (i.e., percentage of jobs to be automated in the next decades) were derived from the previous studies. PIAAC digital problem-solving skills proficiency (measured on a scale of 0-500 points) was assessed based on a series of practical digital tasks (e.g., finding a job research website that does not require registration). Linear regression analysis showed that greater digital skill proficiency (b = −0.04, p < .05) and STEM occupations (b = −17.78, p < .001) each were associated with lower job automation risks, even after adjusting for a series of demographic, socioeconomic, and civic engagement characteristics. Education and labor policy interventions to promote digital skills among older workers and non-STEM workers may better prepare an aging workforce for the dynamic labor market needs in the United States.Item SEEe Immersive Analytics System: Enhancing Data Analysis Experience within Complex Data Visualization Environments(ACM, 2024-06-07) Rajasagi, Damaruka Priya; Boot, Lee; Wilson, Lucy; King, Tristan; Zuber, James; Stockwell, Ian; Komlodi, AnitaThe current state-of-the-art 2D data visualizations fall short in capturing the intricate complexity and depth of available information crucial for integrated decision-making. In response to this limitation, the Systems Exploration and Engagement environment (SEEe) emerges as a cutting-edge virtual immersive analytics data experience. We developed this system through a user-centered design process involving an interdisciplinary design and development team. Through virtual reality, SEEe seamlessly integrates geo-referenced spatial data, abstract data visualization, and qualitative data encompassing text, images, videos, and conceptual diagrams to support sensemaking from large amounts of multiformat data and integrated decision making. We aim to redefine the experience of analyzing extensive amounts of abstract data by creating an environment that accommodates both quantitative and qualitative data for visualization and analysis. How these novel immersive analytics experiences fit into data analysis workflows in various domains have not been studied widely. We carried out a user study with 10 public health graduate students to test the usability, learnability, and utility of the SEEe experience and to explore how these immersive data visualization experiences can fit into traditional data analysis processes. While SEEe is designed to be adaptable across various domains, we evaluated its performance within the public health context. The results of the evaluation affirm that SEEe is not only usable and useful but also provides a learnable environment conducive to immersive analytics.Item Limited family diversity in Japan(Taylor & Francis, 2023-05-03) Yamashita, TakashiThe objective of this chapter is to provide an overview of family forms and functions in Japan from a sociological perspective. The brief social, cultural, and historical backgrounds on the definition of family are introduced. Then, the current welfare policy and family-related demographic data are examined. Several selected family formation topics, including same-sex marriage, adoption, and medically assisted reproduction, are also briefly depicted. Finally, the limited family diversity as well as the seemingly resistant nature of Japanese society against the emerging forms of family, in view of the possible explanations, established form, and role of the family in the Japanese tradition, stemming from the cultural norm (e.g., Confucian familism) are explored. The chapter concludes with a brief discussion of two overarching themes that emerged and recommendations for future research and family policy in Japan.Item The effects of personally preferred music on mood and behaviour in individuals with dementia: An exploratory pilot study(Queen Margaret University Edinburgh, 2024-02-26) Cairo, Stephanie; Kang, Kyurim; Izbicki, Patricia; Isinghood, Molly; Majid, Tabassum; Pantelyat, AlexanderMusic has been shown to benefit individuals with dementia. There are, however, limited studies examining how assisted living staff members use preferred music for dementia patients. This controlled pilot study aimed to determine: 1) whether preferred music is effective in improving mood and behaviour and 2) whether a person-centred approach to music-based interventions is feasible for individuals with dementia. The 20 participants (mean age (SD) = 81 (8)) listened to a preferred song or control song in random order over 6 weeks with a five-day wash out period between the exposures. Neurobehavioral Rating Scale (NRS) and Observed Emotion Rating Scale (OERS) were used to measure participants? emotions and behaviour changes. Blood pressure and heart rate were collected to understand physiological responses to music. NRS was used to measure the behavioural changes in response to a listening intervention comprised of both preferred music and control music over the course of 14 sessions administered over six weeks. We observed no changes in NRS symptoms post-intervention. OERS scores and vital signs did not differ significantly between the preferred music and the control song despite trends. Participants/staff/family expressed the importance of preferred songs to evoke specific memories and increase well-being. Thematic analysis using sentiment components indicated a predominance of positive sentiment in the meaningful music category and a minor occurrence of negative sentiment in the control music.Item CARE COMPARE STAR RATINGS AND FAMILY SATISFACTION IN MARYLAND NURSING FACILITIES(Oxford University Press, 2023-12-21) Millar, Roberto; Diehl, Christin; Kusmaul, Nancy; Stockwell, IanNursing facilities provide critical services and supports to individuals with long-term care needs. The quality of care in nursing facilities varies depending on facility structural characteristics. Moreover, the measurement and perceptions of what constitutes quality of care varies across stakeholders. We used publicly available data to examine the association between family satisfaction with care and the Centers for Medicare & Medicaid Services’(CMS’s) Care Compare five-star quality ratings in the context of facility characteristics. Facility-level data of family satisfaction with care were merged with CMS’s five-star star ratings of 220 Maryland nursing facilities in 2021. Using univariate and bivariate statistics, we explored differences in family ratings and five-star ratings across facility ownership (for-profit vs. non-profit), geographic location (urban vs. rural), and average resident occupancy (1-60, 61-120, and 121+). Relationships were examined across overall ratings, as well as across subdomain of the two quality rating frameworks (e.g., staffing, autonomy, health inspections). Family members of residents in non-profit, rural, and low-occupancy facilities rated facilities higher. Non-profit and low-occupancy facilities were statistically more likely to be rated four or five stars, while no significant association was observed across geographic location. The association between subdomain-specific family satisfaction and star ratings varied across facilities of different structures. Findings emphasize the need for comprehensive quality of care frameworks that consider views of quality across stakeholders and types of facilities. A clear understanding of nursing facility structure and quality of care is critical to advance data-driven decision making.Item Relationship between Event Prevalence Rate and Gini Coefficient of Predictive Model(Canadian Center of Science and Education, 2022-02) Han, Fei; Stockwell, IanPredictive models are currently used for early intervention to help identify patients with a high risk of adverse events. Assessing the accuracy of such models is a crucial part of the development process. To measure the predictive performance of a scoring model, quantitative indices such as the K-S statistic and C-statistic are used. This paper discusses the relationship between Gini coefficients and event prevalence rates. The main contribution of the paper is the theoretical proof of the relationship between the Gini coefficient and event prevalence rate.Item The Roles of Education and Literacy in the Digital Divide Among Middle-Aged Adults: Cross-National Evidence from the United States, Japan, and South Korea(ProLiteracy, 2024) Yamashita, Takashi; Kim, Giyeon; Liou, Chih-Ling; Ando, Takatoshi; Bardo, Anthony R.; Liu, DarrenInternationally representative data of middle-aged adults 45 – 65 years old [n(United States) = 2,150; n(Japan) = 2,318; n(South Korea) = 2,800] from the 2012 Program for International Assessment of Adult Competencies were analyzed to examine the roles of education and literacy in relation to the digital divide. Results from survey-weighted binary logistic regressions showed that both educational attainment and literacy were positively associated with all four measures of information and communication technology (use of the computer, email, online information and transaction) use in all three countries. The middle-aged adults in the United States benefited more from the educational attainment than those in Japan, in terms of email and online information use. The middle-aged adults with lower education and basic skills (i.e., literacy) may benefit from the educational intervention and additional information and communication technology training, and in turn, improve the digital divide in later life, regardless of differences in culture and economy.Item The actual, long-term cost of intentional injury care among a cohort of Maryland Medicaid recipients(Wolters Kluwer, 2023-03-01) Dezman, Zachary D.W.; Thurman, Paul; Stockwell, IanBACKGROUND Intentional injury (both self-harm and interpersonal) is a major cause of morbidity and mortality, yet there are little data on the per-person cost of caring for these patients. Extant data focus on hospital charges related to the initial admission but does not include actual dollars spent or follow-up outpatient care. The Affordable Care Act has made Medicaid the primary payor of intentional injury care (39%) in the United States and the ideal source of cost data for these patients. We sought to determine the total and per-person long-term cost (initial event and following 24 months) of intentional injury among Maryland Medicaid recipients. METHODS Retrospective cohort study of Maryland Medicaid claims was performed. Recipients who submitted claims after receiving an intentional injury, as defined by the International Classification of Diseases, Tenth Revision, between October 2015 and October 2017, were included in this study. Subjects were followed for 24 months (last participant enrolled October 2017 and followed to October 2019). Our primary outcome was the dollars paid by Medicaid. We examined subgroups of patients who harmed themselves and those who received repeated intentional injury. RESULTS Maryland Medicaid paid $11,757,083 for the care of 12,172 recipients of intentional injuries between 2015 and 2019. The per-person, 2-year health care cost of an intentional injury was a median of $183 (SD, $5,284). These costs were highly skewed: min, $2.56; Q1 = 117.60, median, $182.80; Q3 = $480.82; and max, $332,394.20. The top 5% (≥95% percentile) required $3,000 (SD, $6,973) during the initial event and $8,403 (SD, $22,024) per served month thereafter, or 55% of the overall costs in this study. CONCLUSION The long-term, per-person cost of intentional injury can be high. Private insurers were not included and may experience different costs in other states. LEVEL OF EVIDENCE Economic and Value Based Evaluations; level III.Item ”Kinlessness” and Aging w/ Dr. Christine Mair(UMBC Center for Social Science Research, 2023-10-30) Anson, Ian; Mair, Christine A. ; Yamashita, TakashiOn this episode I speak with Dr. Christine Armstrong Mair, Associate Professor of Sociology and Gerontology and Director of the Center for Health, Equity, and Aging (CHEA) in the Department of Sociology, Anthropology, and Public Health (SAPH) at UMBC. We discuss Dr. Mair’s ongoing research into aging and older adult lifestyles across the world. Dr. Mair mentioned the following resources in our discussion: Gateway to Global Aging Data SMaRT Scholars Program National Academies of Science, Engineering, and Medicine (NASEM), Seminar on Kinlessness and Living Alone at Older Ages (Drs. Margolis, Carr, Taylor, and Mair)Item Addressing housing-related social needs for Medicaid beneficiaries: a qualitative assessment of Maryland’s Medicaid §1115 waiver program(Springer, 2023-09-18) DeGrazia Jr, Robert; Abdullahi, Abdikarin; Mood, MaryAnn; Diehl, Christin; Stockwell, Ian; Pollack, Craig EvanBackground While health care payers are increasingly considering approaches that help support stable and affordable housing for their beneficiaries, experience with these initiatives is limited. Through its §1115 HealthChoice waiver, Maryland Medicaid has begun experimenting with programs designed to pay for housing and tenancy support/case management services. This study investigates barriers and facilitators to the success of Maryland’s pilot program initiative — Assistance in Community Integration Services (ACIS). Methods The study focused on key stakeholders employed by the four Lead Entities that currently participate in the ACIS program. The stakeholders included members of each Lead Entity’s administration, direct service providers, state and local government officials, and case managers from local hospitals. The convenience sample was selected through an initial list of stakeholders and was supplemented using snowball sampling methods. Interviews were audio recorded and turned into transcripts via Otter.ai and then analyzed using NVivo by two independent reviewers. Results A total of 23 interviews were conducted between February 2022 and May 2022, representing a broad range of stakeholders across different Maryland geographies. A total of 4 themes were identified through the course of the interviews. Stakeholders identified difficulty finding housing for the target population in a tight housing market, challenges with communication within the program and with its clients, and problems with non-healthcare providers documenting services for reimbursement. At the same time, ACIS was seen as creating opportunities for organizations to work together across siloes in meeting client needs. Conclusions The findings of this study helps to highlight Medicaid §1115 waivers as a novel approach to using Medicaid funds to support tenancy-based services, such as ACIS and to improve the lives of individuals while reducing healthcare costs. Implementation of the ACIS program in Maryland has been a resounding success in helping individuals obtain and sustain stable housing. However, continued efforts to align capacity with demand, streamline billing and reimbursement and improve communication with clients and across partners will need to be prioritized. The program also highlights the growing need to address root causes of housing insecurity including the limited supply of affordable housing.