Longitudinal Trends and Predictors of Medicaid Utilization Among Middle-Aged and Older Adults

Abstract Over fifteen million older adults in the United States rely on the means-tested Medicaid program for healthcare coverage (accounting for approximately 20% of total Medicaid beneficiaries according to the Centers for Medicare and Medicaid Services). With the older adult population growing exponentially, there has been concern that steadily rising Medicaid spending will skyrocket among this group and that there may be a need to reconfigure coverage of the program. However, few studies have longitudinally examined which factors are related to utilization of the program over time among older adults in order to better understand how any future coverage changes might impact this group. This study used the 1998 to 2014 waves of the Health and Retirement Study (N=8,162) to analyze a representative sample of those 50 and older regarding demographic, health, and economic trends associated with Medicaid utilization over a sixteen-year period. Descriptive analyses showed stable longitudinal patterns such that those who utilized Medicaid had significantly poorer health and fewer financial resources compared to those who never accessed Medicaid. Multivariate analyses further revealed those who were older, female, minority race/ethnicity, less educated, in poorer health, below the federal poverty line, and with lower net wealth had a higher proportional risk of utilizing Medicaid during the observed time period than their counterparts. The findings from this study highlight the importance of monitoring changes in the documented risk factors over time in terms of their impact on Medicaid utilization and underscore the need to consider how these factors may be interrelated.

Because the labels of OTCs are frequently the only information accessed by consumers, labels designed to communicate safety information are paramount for these products. Yet, available studies suggest that consumers do not regularly access the comprehensive information in the Drug Facts Label (DFL) when making purchase or use decisions, tending to rely on information found on the front of the package. Herein, we evaluate how four OTC label formats (standard; standard/highlight; critical warnings on front/highlighted; critical warnings on front not highlighted) affect how aging participants attend to critical information. Sixty-eight participants (65+) engaged a computer-based task answering yes/no questions that required use of labeling information about the warnings or active ingredients (AI). Results indicate that AI information is found accurately and relatively quickly compared to warning information and highlighting and placement on the front of the package had little effect. By contrast, warning information was found slowly and with low accuracy with the standard label, and highlighting and front of pack placement both significantly improved performance. These results suggest that novel labelling strategies could result in more effective, safer use of OTC medicines among older consumers and provide insights that could be used by regulators as they work to improve policy focused on improving mandates for OTC labeling. Over fifteen million older adults in the United States rely on the means-tested Medicaid program for healthcare coverage (accounting for approximately 20% of total Medicaid beneficiaries according to the Centers for Medicare and Medicaid Services). With the older adult population growing exponentially, there has been concern that steadily rising Medicaid spending will skyrocket among this group and that there may be a need to reconfigure coverage of the program.

LONGITUDINAL TRENDS AND PREDICTORS OF MEDICAID UTILIZATION AMONG MIDDLE-AGED AND OLDER ADULTS
However, few studies have longitudinally examined which factors are related to utilization of the program over time among older adults in order to better understand how any future coverage changes might impact this group. This study used the 1998 to 2014 waves of the Health and Retirement Study (N=8,162) to analyze a representative sample of those 50 and older regarding demographic, health, and economic trends associated with Medicaid utilization over a sixteenyear period. Descriptive analyses showed stable longitudinal patterns such that those who utilized Medicaid had significantly poorer health and fewer financial resources compared to those who never accessed Medicaid. Multivariate analyses further revealed those who were older, female, minority race/ ethnicity, less educated, in poorer health, below the federal poverty line, and with lower net wealth had a higher proportional risk of utilizing Medicaid during the observed time period than their counterparts. The findings from this study highlight the importance of monitoring changes in the documented risk factors over time in terms of their impact on Medicaid utilization and underscore the need to consider how these factors may be interrelated.

NARRATIVE GROUP INTERVENTIONS TO REDISCOVER LIFE WISDOM AMONG HONG KONG CHINESE OLDER ADULTS: A WAITLIST RCT STUDY
Esther Chow, 1 and Sai-fu FUNG, 2 1. City University of Hong Kong,Kowloon,China,2

. City University of Hong Kong, Kowloon Tong, China
Objectives: To recognize, and rejuvenate the life wisdom of Hong Kong Chinese older adults, a new strength-and meaning-based Narrative Therapy (NT) in practice is developed, with two objectives: to examine its effectiveness in enhancing wisdom; and to test the longer-term effects at 2 and 8 months respectively. Method: A waitlist randomised controlled trial (RCT) design was used. A total of 157 older adults were recruited, 82 of which was randomly assigned to 12 intervention groups to receive four 2-hour NT sessions using the 'Tree of Life' metaphor, to assess perceived wisdom at baseline (T1), at the end of treatment (T2), and at two (T3) and 8 months after treatment (T4). Results: Participants in the NT group showed significant improvements in the wisdom outcome measure [F(2.726, p = 0.041)]. As such, the results of latent growth curve models with time-invariant covariates for impact of NT on wisdom scores suggested significant effects two months after treatment (T3) with controlled the effects of age, gender and educational level [TML(11) = 17.306, p = 0.098, RMSEA = 0.079, CFI = 0.960]. Most improvements were sustained at 2-and 8-months post intervention. No adverse reaction was recorded in any of the cases mentioned at all study sites. Conclusion: The findings have significant theoretical contributions for professional social work practice to ground a new theory in understanding wisdom in older adulthood, develop a new clinical practice that appreciate and celebrate life wisdom, and a practice guide to be disseminated among health and social care practitioners.

OLDER AFRICAN AMERICANS' EXPERIENCE OF THE OPIOID CRISIS Sharon Rainer, Thomas Jefferson University, Moorestown, New Jersey, United States
In 2017, over 1200 Philadelphians died from opioid overdoses and an estimated 50,000 -70,000 people in the city are Innovation in Aging, 2020, Vol. 4, No. S1