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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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, Rita
The 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.
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.
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.
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, Anita
The 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.
Limited family diversity in Japan
(Taylor & Francis, 2023-05-03) Yamashita, Takashi
The 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.
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, Alexander
Music 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.
CARE COMPARE STAR RATINGS AND FAMILY SATISFACTION IN MARYLAND NURSING FACILITIES
(Oxford University Press, 2023-12-21) Millar, Roberto; Diehl, Christin; Kusmaul, Nancy; Stockwell, Ian
Nursing 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.
Relationship between Event Prevalence Rate and Gini Coefficient of Predictive Model
(Canadian Center of Science and Education, 2022-02) Han, Fei; Stockwell, Ian
Predictive 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.
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, Darren
Internationally 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.
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, Ian
BACKGROUND 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.
”Kinlessness” and Aging w/ Dr. Christine Mair
(UMBC Center for Social Science Research, 2023-10-30) Anson, Ian; Mair, Christine A. ; Yamashita, Takashi
On 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)
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 Evan
Background 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.
Gerontological education: a pathway towards advancing the rights of older people
(Taylor & Francis, 2023-07-12) Stoeckel, Kimberly; Eyers, Ingrid; Fitzgerald, Kelly G.
Following the UN Human Rights Declaration in 1948, much effort has been undertaken to formalize the rights of older people. This article aims to highlight the role of education in advancing the rights of older people. Raising awareness and sharing knowledge about the rights of older people through rights-based education can empower students, when entering their field of work, to be advocates for rights within their employment settings and local communities. The effectiveness of a rights-based educational training for organizations working with refugees in Jordan, which took place in Amman in January 2020, is analyzed using the participant-focused Transformative Human Rights Education (THRED) as a framing structure. Our analysis found that training participants became active in promoting the rights of older people in their workplaces. The rights of older people need to be more than a conversation, and transformational change that promotes rights can occur when people feel empowered to undertake action-oriented advocacy. The case study analysis provides an example of how influential participant-centered pedagogy, such as THRED, can be to help students in gerontology programs become active agents in promoting rights of older people in their workplaces, communities, and ultimately influencing the international dialogue.
Measuring the Early Moments
(UMBC Magazine, 2018-05-22) Duque, Catalina Sofia Dansberger
The Social Science of Recreation and Aging w/ Dr. Candace Brown
(UMBC Center for Social Science Research, 2022-12-12) Anson, Ian; Brown, Candace; Hamidi, Foad
On this episode we hear a rebroadcast of the 2021 UMBC Social Sciences Forum Erickson School Lecture, organized by the Erickson School of Aging and cosponsored by the Center for Social Science Scholarship. The lecture, which took place in the Spring of 2021, featured the work of Dr. Candace Brown, Assistant Professor of Gerontology and Member of the Gerontology Executive Committee at the University of North Carolina-Charlotte. Check out the following links for more information on UMBC, CS3, and our host: The UMBC Center for the Social Sciences Scholarship The University of Maryland, Baltimore County Ian G. Anson, Ph.D. On Campus Connections, we hear about a recent co-authored paper by Dr. Foad Hamidi of the Information Systems Department at UMBC. Physiological Computing as a Facilitator for the Promotion of Physical Activity in People with Functional Diversity
Assessing performance of ZCTA-level and Census Tract-level social and environmental risk factors in a model predicting hospital events
(Elsevier, 2023-06) Goetschius, Leigh G.; Henderson, Morgan; Han, Fei; Mahmoudi, Dillon; Perman, Chad; Haft, Howard; Stockwell, Ian
Predictive analytics are used in primary care to efficiently direct health care resources to high-risk patients to prevent unnecessary health care utilization and improve health. Social determinants of health (SDOH) are important features in these models, but they are poorly measured in administrative claims data. Area-level SDOH can be proxies for unavailable individual-level indicators, but the extent to which the granularity of risk factors impacts predictive models is unclear. We examined whether increasing the granularity of area-based SDOH features from ZIP code tabulation area (ZCTA) to Census Tract strengthened an existing clinical prediction model for avoidable hospitalizations (AH events) in Maryland Medicare fee-for-service beneficiaries. We created a person-month dataset for 465,749 beneficiaries (59.4% female; 69.8% White; 22.7% Black) with 144 features indexing medical history and demographics using Medicare claims (September 2018 through July 2021). Claims data were linked with 37 SDOH features associated with AH events from 11 publicly-available sources (e.g., American Community Survey) based on the beneficiaries’ ZCTA and Census Tract of residence. Individual AH risk was estimated using six discrete time survival models with different combinations of demographic, condition/utilization, and SDOH features. Each model used stepwise variable selection to retain only meaningful predictors. We compared model fit, predictive performance, and interpretation across models. Results showed that increasing the granularity of area-based risk factors did not dramatically improve model fit or predictive performance. However, it did affect model interpretation by altering which SDOH features were retained during variable selection. Further, the inclusion of SDOH at either granularity level meaningfully reduced the risk that was attributed to demographic predictors (e.g., race, dual-eligibility for Medicaid). Differences in interpretation are critical given that this model is used by primary care staff to inform the allocation of care management resources, including those available to address drivers of health beyond the bounds of traditional health care.
The STEM Wage Premium Across the OECD
(Sage, 2023-05-11) Even, William E.; Yamashita, Takashi; Cummins, Phyllis A.
Using data from the Program for the International Assessment of Adult Competencies, this paper compares the earnings premium and employment share of jobs in Science, Technology, Engineering and Mathematics (STEM) across 11 member countries of the Organisation for Economic Co-operation and Development. The results reveal that the STEM wage premium is higher in the United States than in any of the other comparison countries, despite the fact that the U.S. has a larger share of workers in STEM jobs. We also find evidence that the premium varies significantly across STEM sub-fields and education levels, and that the premium tends to be higher in countries with lower unionization rates, less employment protection, or a larger share of employment in the public sector.
What’s Keeping Residents “Out of the Mainstream”: Challenges to Participation in the News Media for Older People Living in Residential Care
(Sage, 2022-12-04) Allen, Laura D.; Bradley, Dana Burr; Ayalon, Liat
The voices of older people living in residential care are often excluded from news articles about residential care, and thisexclusion was especially apparent during the COVID-19 pandemic. The aim of this study is to identify and understand thebarriers which may be obstructing the news media participation of older residents. Semi-structured interviews were conductedwith 7 journalists, 7 administrators, and 12 residents. Interview transcripts were analyzed using a thematic analysis, whichresulted in the following themes: (1) residents are physically separated from their communities; (2) journalists do not considerresidents to be official sources for news stories; (3) administrators feel they must manage their care home’s reputation andcontrol access to residents; and (4) journalists and administrators are not equipped to handle issues of consent and privacy. Therole of ableism and ageism in the news reporting process is discussed
Living with Dementia during COVID-19, feat. Dr. Laura Girling
(UMBC Center for Social Science Research, 2021-12-10) Anson, Ian; Girling, Laura; Majid, Tabassum
Research priorities of caregivers and individuals with dementia with Lewy bodies: An interview study
(PLOS, 2020-10-07) Armstrong, Melissa J.; Gamez, Noheli; Alliance, Slande; Majid, Tabassum; Taylor, Angela; Kurasz, Andrea M.; Patel, Bhavana; Smith, Glenn
Background Funding bodies are placing increased emphasis on patient and public involvement in research, but the research priorities of individuals and caregivers living with dementia with Lewy bodies (DLB) are unknown. Method Investigators conducted telephone interviews with individuals living with DLB and caregivers. Participants were recruited from a Lewy Body Dementia Association Research Center of Excellence. Interviews employed a semi-structured questionnaire querying research needs in different categories and then asking participants to select their top priorities. Investigators used a qualitative descriptive approach to analyze transcripts and identify themes. Results Twenty individuals with DLB and 25 caregivers participated. Seventeen from each group participated as part of a patient-caregiver dyad. Twenty-three of the caregivers were spouses, two were daughters. Individuals with DLB and caregivers identified research needs relating to focusing on awareness, determining the cause of DLB, improving diagnosis, and investigating what to expect/disease stages. Participants also highlighted DLB symptoms needing additional research, therapies to prevent, cure, or slow the progression of DLB, and research targeting daily function and quality of life, caregiving, and improving education. Conclusions These findings support the research priorities defined in the National Institutes of Health dementia care summits in addition to ADRD priority-setting summits. Research is needed across all domains of DLB. Funding should be informed by the priorities of all relevant stakeholders and support research investigating causes, natural history, biomarkers, and treatment in addition to research targeting themes regarding living with disease (e.g. independence, quality of life, caregiving, and education).

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