Older African Americans' Experience of the Opioid Crisis

Abstract In 2017, over 1200 Philadelphians died from opioid overdoses and an estimated 50,000 -70,000 people in the city are addicted to opioids. The opioid crisis is a family crisis that touches all communities affecting those using opioids, their family members, and the community. As policymakers develop responses to the opioid crisis, a multigenerational perspective is critical. With much published on the opioid crisis, there remains little understanding of older adult’s perceptions or experiences to this public health emergency. Older adults bring a unique voice. They are grandparents, parents, opioid users, and people living with chronic pain and/or addictions. Center in the Park (CIP), a nationally accredited senior center in Philadelphia, Pennsylvania sought to understand older African Americans’ perceptions of the opioid crisis and how their experiences inform senior center programming. CIP leadership sought a community partnership with Thomas Jefferson University College of Nursing to respond to what some in their community called “a domino effect” of the opioid crisis. Using a Community-Based Participatory Research Model rooted in humanistic research theory, a qualitative study was designed. Three focus groups (n29) were convened. All focus group recordings were transcribed and checked for accuracy. An iterative axial coding process was used. All transcripts were coded using the qualitative software program NVivo12. Findings suggest older adults are concerned about younger generations and addictions. In addition, older adults lack knowledge of the use and safety of opioids and have a general mistrust of the medical community to adequately limit the opioid epidemic.


LONGITUDINAL TRENDS AND PREDICTORS OF MEDICAID UTILIZATION AMONG MIDDLE-AGED AND OLDER ADULTS
Jane Tavares, 1 and Marc Cohen, 2 1. University of Massachusetts Boston,Florence,Massachusetts,United States,2. University of Massachusetts Boston,Boston,Massachusetts,United States 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 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. 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 addicted to opioids. The opioid crisis is a family crisis that touches all communities affecting those using opioids, their family members, and the community. As policymakers develop responses to the opioid crisis, a multigenerational perspective is critical. With much published on the opioid crisis, there remains little understanding of older adult's perceptions or experiences to this public health emergency. Older adults bring a unique voice. They are grandparents, parents, opioid users, and people living with chronic pain and/or addictions. Center in the Park (CIP), a nationally accredited senior center in Philadelphia, Pennsylvania sought to understand older African Americans' perceptions of the opioid crisis and how their experiences inform senior center programming. CIP leadership sought a community partnership with Thomas Jefferson University College of Nursing to respond to what some in their community called "a domino effect" of the opioid crisis. Using a Community-Based Participatory Research Model rooted in humanistic research theory, a qualitative study was designed. Three focus groups (n29) were convened. All focus group recordings were transcribed and checked for accuracy. An iterative axial coding process was used. All transcripts were coded using the qualitative software program NVivo12. Findings suggest older adults are concerned about younger generations and addictions. In addition, older adults lack knowledge of the use and safety of opioids and have a general mistrust of the medical community to adequately limit the opioid epidemic.

ORAL HEALTH DISPARITIES AMONG CHINESE OLDER ADULTS: EVIDENCE FROM CHARLS Chengming Han, Case Western Reserve University, Cleveland, Ohio, United States
This paper explored the effect of the type of health insurance on dentist visits among older adults in China. The data were drawn from the CHARLS-II (2013). The sample included older adults aged 60 and older (N= 6767, n(urban)=3272, n(rural)=3495). Multivariate logistic regression models indicated that in urban and rural places, respondents with a governmental/civil servants' insurance and those with an urban-employee insurance are more likely to visit a dentist in the survey year. Household registration status (hukou) does not play a significant role in dentist visits when insurance types are adjusted for. In other words, employment status, and the coverage of health insurance presented more significant effects on dentist visits. Differing from previous studies about urbanrural health disparities, this study disclosed substantial institutional influences on dental care access among older adults.

OUTPATIENT AND INPATIENT SERVICE USE BY CHINESE ADULTS LIVING IN RURAL LOW-INCOME HOUSEHOLDS
Peiyi Lu, 1 JUN YAO, 2 Chunyu Yang, 3 Mack Shelley, 1 and Li zhang, 4 1. Iowa State University, Ames,Iowa,United States,2. NANJING MEDICAL UNIVERSITY,NANJING,Jiangsu,China,3. Nanjing University of Information Science and Technology,NANJING,Jiangsu,China,4. Nanjing University of Chinese Medicine,NANJING,Jiangsu,China Background: This study applied the Andersen Model of Health Care Utilization to explore the variables associated with health service use among Chinese adults living in rural low-income households. Method: A survey of 2,429 adults living in 787 low-income households in Jiangsu, China was conducted. Respondents were asked the presence of outpatient service in the past one month and the amount of hospitalization in the past one year. Mixed effect logistic and negative binomial models were used to examine the relationship of individual-level and household-level characteristics with health service use. Results: Health condition was the predominant determinant of both outpatient and inpatient service use (Odds Ratio [OR] >1, p<0.001). Individuals living in a poor household were less likely to use outpatient service (OR=0.05, 95% confidence interval CI: 0.00, 0.71), and the longer in poverty status the less likely to use outpatient service (OR=0.92, CI: 0.86, 0.99). Age was associated with lower likelihood to use outpatient service (OR=0.93, CI: 0.93, 1.00), and this relationship was stronger for larger households (OR=1.01, CI: 1.00, 1.01). For inpatient service use, most householdlevel measures were insignificant. Conclusion: Rural Chinese health service use was influenced primarily by needs variables. Outpatient service use was constrained by household enabling variables. Older adults were at a disadvantage for using outpatient service when the family prioritized younger members in allocating resources. These results suggest the need for policy advocacy to expand insurance reimbursement and improve benefits for poor older adults.

PHYSICAL IMPAIRMENT, INSURANCE COVERAGE, AND HEALTHCARE UTILIZATION AMONG U.S. CHINESE OLDER ADULTS
Jonas Attilus, 1 Mengting Li, 1 Qun Le, 2 and XinQi Dong, 1 1. Rutgers University,New Brunswick,New Jersey,United States,2. Rutgers University,New Brunswick,,New Jersey,United States The relationship between physical impairment and healthcare utilization is well studied. However, few studies examined this relationship among immigrant older adults whose health insurance status may represent a barrier to healthcare use. This study aims to examine the relationship between physical impairment, health insurance, and types of healthcare utilization. The PINE Study provided data of 3,157 Chinese older adults age 60 and over. Most (70.67%) of them had insurance. Physical function was assessed by Activities of Daily Living and Instrumental Activities of Daily Living. Healthcare utilization was evaluated by the times of physician visit (PV), ER, and hospitalization, separately, in the past two years. Logistic regression was used. After adjusting for covariates, among the insured patients, every one unit increase in ADL impairment was associated with higher odds of ER visit