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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Introduction to Correlation and Regression Analysis
(SAS Institute, 2008) Stockwell, Ian
SAS® has many tools that can be used for data analysis. From Freqs and Means to Tabulates and Univariates, SAS can present a synopsis of data values relatively easily. However, there is a difference between what the data are, and what the data mean. In order to take this next step, I would like to go beyond the basics and introduce correlation and hypothesis testing using regression models. A brief statistical background will be included, along with coding examples for correlation and linear regression.
Estimating the Costs to Mississippi Medicaid Attributable to Tobacco Using Paid Amounts to Providers for Tobacco-Related Illnesses
(The Hilltop Institute, 2019-06-03) Woodcock, Cynthia; Stockwell, Ian; Middleton, Alice; Idala, David; Betley, Charles
Research Objective: Estimating the costs of tobacco-related illness incurred by...
Cost-Effective Care Coordination for People With Dementia at Home
(Oxford University Press, 2020-05-01) Willink, Amber; Davis, Karen; Johnston, Deirdre M.; Black, Betty; Reuland, Melissa; Stockwell, Ian; Amjad, Halima; Lyketsos, Constantine G.; Samus, Quincy M.
People with dementia (PWD) represent some of the highest-need and highest-cost individuals living in the community. Maximizing Independence (MIND) at Home is a potentially cost-effective and scalable home-based dementia care coordination program that uses trained, nonclinical community workers as the primary contact between the PWD and their care partner, supported by a multidisciplinary clinical team with expertise in dementia care.Cost of care management services based on actual time spent by care management personnel over first 12 months of MIND at Home intervention was calculated for 342 MIND at Home recipients from Baltimore, Maryland and surrounding areas participating in a Centers for Medicare and Medicaid Services (CMS) funded Health Care Innovation Award demonstration project. Difference-in-differences analysis of claims-based Medicaid spending of 120 dually-eligible MIND at Home participants with their propensity score matched comparison group (n = 360).The average cost per enrollee per month was $110, or $1,320 per annum. Medicaid expenditures of dually-eligible participants grew 1.12 percentage points per quarter more slowly than that of the matched comparison group. Most savings came from slower growth in inpatient and long-term nursing home use. Net of the cost of the 5-year MIND at Home intervention, 5-year Medicaid savings are estimated at $7,052 per beneficiary, a 1.12-fold return on investment.Managed care plans with the flexibility to engage community health workers could benefit from a low-cost, high-touch intervention to meet the needs of enrollees with dementia. Limitations for using and reimbursing community health workers exist in Medicare fee-for-service, which CMS should address to maximize benefit for PWD.
Exploring the Relationship Between Nursing Staff and Family Members' Appraisal of Resident Care in Nursing Homes: The Role of Facility Ownership
(MDPI, 45699) Millar, Roberto; Diehl, Christin; Kusmaul, Nancy; Stockwell, Ian
Background/Objectives: To address long-standing staffing challenges and elevating care standards in the United States, new legislation will require a minimum of 0.55 h per resident day (HPRD) of registered nurse (RN) care, 2.45 HPRD of certified nursing aide (CNA) care, and a combined total of 3.48 HPRD across any combination of nursing staff. We examine differences in family members? views of care quality between facilities meeting the minimum staffing requirements and those that do not and whether there is any difference in those associations by facility ownership. Methods: This cross-sectional study utilized public data from 218 Medicare and Medicaid-certified nursing facilities in Maryland, collected in 2023. We used regression analyses to examine the association between staffing requirements and quality of care ratings, considering facility ownership status as a potential moderator. Results: Compared to facilities with CNA staffing levels below the cut off, facilities that met the CNA staffing requirement were rated more favorably by family members in overall quality and across the subdomains of staffing, care, activities, and security. In contrast, meeting the RN 0.55 cut off was not associated with family ratings across any quality domain. A facility for-profit status did not moderate the relationship between staffing and family ratings. Conclusions: These results suggest that CNA staff time is a significant driver of care quality and that non-profit facilities may already be closer to meeting new federal requirements. These findings highlight the need for regulations that support the minimum nursing staffing requirements to enhance care quality. Future research should identify the specific factors contributing to higher quality care in non-profit facilities and explore ways to implement these practices in for-profit settings.
Assessing the Incremental Health Care Utilization and Expenditures Associated With Serious Psychological Distress by Living Arrangements Among Older Adults
(Sage, 2025-02-26) Chu, Jun; Mair, Christine A.; Yamashita, Takashi; Chen, Jie
Older adults suffering from serious psychological distress (SPD) have higher health care utilization and expenditures. However, it is unknown whether living alone might further amplify differences in health care usage and costs among older adults with SPD. Using pooled data from 2007-2019 Medical Expenditure Panel Survey, we estimated the incremental care expenditures and utilization associated with SPD among older adults living alone and living with others. The results show that in both living arrangements, having SPD is associated with increases in emergency department visits, hospital admissions, and prescription fill-ups, which leads to higher total prescription expenditures. However, the incremental differences of SPD-related incremental usage and expenditures between older adults living alone and living with others were similar. Our findings call for targeted community programs for older adults that go beyond eliminating physical loneliness, and innovative care coordination strategies that prioritize mental health and preventative care among older adults.
Behavioral, Cognitive, and Functional Risk Factors for Repeat Hospital Episodes Among Medicare-Medicaid Dually Eligible Adults Receiving Long-Term Services and Supports
(Sage, 2024-09-26) Fakeye, Oludolapo; Rana, Prashant; Han, Fei; Henderson, Morgan; Stockwell, Ian
Repeat hospitalizations adversely impact the well-being of adults dually eligible for Medicare and Medicaid in the United States. This study aimed to identify behavioral, cognitive, and functional characteristics associated with the risk of a repeat hospital episode (HE) among the statewide population of dually eligible adults in Maryland receiving long-term services and supports prior to an HE between July 2018 and May 2020. The odds of experiencing a repeat HE within 30 days after an initial HE were positively associated with reporting difficulty with hearing (adjusted odds ratio, AOR: 1.10 [95% confidence interval: 1.02-1.19]), being easily distractible (AOR: 1.09 [1.00-1.18]), being self-injurious (AOR: 1.33 [1.09-1.63]), and exhibiting verbal abuse (AOR: 1.15 [1.02-1.30]). Conversely, displaying inappropriate public behavior (AOR: 0.62 [0.42-0.92]) and being dependent for eating (AOR: 0.91 [0.83-0.99]) or bathing (AOR: 0.79 [0.67-0.92]) were associated with reduced odds of a repeat HE. We also observed differences in the magnitude and direction of these associations among adults 65 years of age or older relative to younger counterparts.
Behind the Curtain: Comparing Predictive Models Performance in 2 Publicly Insured Populations
(Wolters Kluwer Health, 2024-11) Sun, Ruichen; Henderson, Morgan; Goetschius, Leigh; Han, Fei; Stockwell, Ian
Introduction: Predictive models have proliferated in the health system in recent years and have been used to predict both health services utilization and medical outcomes. Less is known, however, on how these models function and how they might adapt to different contexts. The purpose of the current study is to shed light on the inner workings of a large-scale predictive model deployed in 2 distinct populations, with a particular emphasis on adaptability issues. Methods: We compared the performance and functioning of a predictive model of avoidable hospitalization in 2 very different populations: Medicaid and Medicare enrollees in Maryland. Specifically, we assessed characteristics of the risk scores from March 2022 for the 2 populations, the predictive ability of the scores, and the driving risk factors behind the scores. In addition, we created and assessed the performance of an “unadapted” model by applying coefficients from the Medicare model to the Medicaid population. Results: The model adapted to, and performed well in, both populations, despite demographic differences in these 2 groups. However, the most salient risk factors and their relative weightings differed, sometimes dramatically, across the 2 populations. The unadapted Medicaid model displayed poor performance relative to the adapted model. Conclusions: Our findings speak to the need to “peek behind the curtain” of predictive models that may be applied to different populations, and we caution that risk prediction is not “one size fits all”: for optimal performance, models should be adapted to, and trained on, the target population.
Producing Graduates That Industry Needs: Exploring the Views of Employers, Administrators, Faculty, and Students on Foundational Skills at Community College STEM Programs
(Taylor & Francis, 2025-02-04) Chidebe, Runcie C. W.; Cummins, Phyllis A.; Karam, Rita; Kramer, Jenna; Narine, Donnette; Yamashita, Takashi
This qualitative study explored the views of community college employers, faculty, administrators, and students on the importance of foundational skills, including literacy, numeracy, and problem-solving skills, in science, technology, engineering, and math (STEM) programs of study. Participants (N = 50) were recruited, semi-structured interviews were conducted, and the data were analyzed using inductive thematic analysis. Four themes were identified: 1) foundational skills are as important as the course of study; 2) the ability to communicate technical skills is crucial; 3) leadership and supervisory skills are valuable; and 4) employers contribute to the curriculum, producing graduates that industry needs. Our findings provide policy and practice recommendations, including the need to design curricula with strong components of literacy, numeracy, and problem-solving skills, integrating supervisory and leadership skills in classroom exercises, and engagement of employers in curriculum development and instruction. Producing graduates in STEM fields with skills that employers require is important for employee advancement and for future economic growth.
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.
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, Ian
Research 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.
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, Rita
Job 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).
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.
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, Ian
These 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.
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, Ian
Multiple Chronic Condition Patterns among Full-Benefit Maryland Medicaid Enrollees
(2024-06-29) Han, Fei; Gill, Christine; Blake, Elizabeth; Stockwell, Ian
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.
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.

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