Examining the Impact of Individual and Shared Biological Risks on Health among Older Married Couples

Abstract Relationship research has suggested that health among spouses is interdependent and should be considered jointly. Using data from the 2008/2010 and 2016/2018 waves of the Health and Retirement Study (3858 qualified couples; age=67.0±9.6), we investigated the joint influence of married partners’ individual and shared cumulative biological risk on future health outcomes. Two risk indicators were constructed to indicate biological health in different domains. Individual grip strength, walk speed, lung function, and cystatin-C were biomarkers selected to construct frailty risk whereas blood pressure, pulse, waist circumference, C-reactive protein, glycohemoglobin, high-density lipoprotein cholesterol, and total cholesterol were biomarkers used to construct cardiometabolic risk. Shared risk was calculated as the number of risks the partners shared. We employed multilevel Poisson regression models to nest partners within couples and examine the effects of individual and shared cumulative risks on future functional limitations. Heckman correction was performed to correct potential selection bias. Our unadjusted models showed individual (frailty: b=0.22, p<.001; cardiometabolic: b=0.10, p<.001) and shared (frailty: b=0.17, p<.001; cardiometabolic: b=0.08, p<.01) risks are associated with greater future functional limitations. Further, shared cardiometabolic risk moderated the effect of individual risk (b=-0.01, p<.05). In the adjusted models, the direct associations between shared risks and future functional limitations were explained by indicators of partner selection and shared experiences. In the fully adjusted model, the cross-level interaction for frailty risk became statistically significant. The unique set of dynamics shown in our study offered new insights into understanding how couples influence one another in the context of multisystem biological health.

the goal of preventing serious health problems associated with loneliness and social isolation, allowing residents to age in place.

EXAMINING THE IMPACT OF INDIVIDUAL AND SHARED BIOLOGICAL RISKS ON HEALTH AMONG OLDER MARRIED COUPLES
Tai-Te Su, 1 Shannon Meija, 2 and Richard Gonzalez, 3 1.University of Illinois at Urbana-Champaign, United States, 2. University of Illinois,Champaign,Illinois,United States,3. University of Michigan,Ann Arbor,Michigan,United States Relationship research has suggested that health among spouses is interdependent and should be considered jointly.Using data from the 2008/2010 and 2016/2018 waves of the Health and Retirement Study (3858 qualified couples; age=67.0±9.6), we investigated the joint influence of married partners' individual and shared cumulative biological risk on future health outcomes.Two risk indicators were constructed to indicate biological health in different domains.Individual grip strength, walk speed, lung function, and cystatin-C were biomarkers selected to construct frailty risk whereas blood pressure, pulse, waist circumference, C-reactive protein, glycohemoglobin, high-density lipoprotein cholesterol, and total cholesterol were biomarkers used to construct cardiometabolic risk.Shared risk was calculated as the number of risks the partners shared.We employed multilevel Poisson regression models to nest partners within couples and examine the effects of individual and shared cumulative risks on future functional limitations.Heckman correction was performed to correct potential selection bias.Our unadjusted models showed individual (frailty: b=0.22,p<.001; cardiometabolic: b=0.10, p<.001) and shared (frailty: b=0.17, p<.001; cardiometabolic: b=0.08, p<.01) risks are associated with greater future functional limitations.Further, shared cardiometabolic risk moderated the effect of individual risk (b=-0.01,p<.05).In the adjusted models, the direct associations between shared risks and future functional limitations were explained by indicators of partner selection and shared experiences.In the fully adjusted model, the cross-level interaction for frailty risk became statistically significant.The unique set of dynamics shown in our study offered new insights into understanding how couples influence one another in the context of multisystem biological health.

EXAMINING THE RELATIONSHIP BETWEEN HOSPICE AGENCY CHARACTERISTICS AND COMPLAINT DEFICIENCIES
Xiaochuan Wang, Susanny Beltran, Denise Gammonley, Norma Conner, and Milo Leon, University of Central Florida, Orlando, Florida, United States The U.S. hospice industry has expanded over the last decade.Similar to nursing homes, research guided by the Donabedian framework has documented quality differences in hospice based on agency characteristics, including profit status and rural status.Yet, compared to nursing homes, quality oversight and transparency in hospice remain limited.When families report substandard care, a complaint survey is launched to investigate allegations.Using publicly available regulatory oversight data (e.g., CMS QCOR, Medicare PACPUF, CAHPS HIS, Hospice Compare), and guided by the Donabedian framework, this study describes hospice agency structure and process characteristics associated with care complaint deficiencies (outcome).Of the 4,415 hospice facilities examined, 453 (or 10.3%) have had complaint survey deficiency citations between January 2018 and December 2020.Chi-square and ANOVA tests were conducted to compare facility characteristics (e.g., ownership status, percentage of Medicare beneficiaries in rural zips), nursing and social work involvement, and CAHPS scores between hospices with and without complaint survey deficiencies.Results indicated that the average proportion of beneficiaries with a rural zip for Medicare correspondence was significantly lower in hospices with deficiencies (p<.001).Finding also suggested that weekly total nursing and social work minutes were significantly higher in hospices with deficiencies.Additionally, family ratings of hospice team communication, symptom management, and overall satisfaction were higher in facilities without complaint survey deficiencies.Future research and practice implications will be discussed.This study presents findings on the impact of the COVID-19 pandemic as reported by a representative sample of Oregon assisted living communities (AL) between December 2020 and March 2021.Of the 559 AL eligible to participate, 346 completed eleven questions related to their experiences since March 2020.These questions covered topics such as access to personal protective equipment (PPE) and accurate information, communication with and support from government agencies, ability to find staff and new residents, ability to address pandemic-related concerns of residents' families and staff, use of virtual visits and telehealth for residents, and visitor restrictions.Response categories ranged from 0 (strongly disagree) to 4 (strongly agree) and we coded "agree" and "strongly agree" responses as having experienced that issue.Among responding AL, 42% were located in rural or frontier areas.We present three findings.First, most AL experienced adverse impact due to COVID-19, especially regarding issues likely to be outside of their control compared to those within their control.Second, while almost all urban-based AL reported that their residents used virtual communication technologies and tools for telemedicine/ telehealth (96%) or virtual social visits (96%), rural AL were less likely to report so (90% and 92%, respectively).Finally, rural AL experienced significantly greater staffing difficulties (75%) compared to their urban counterparts (82%).In sum, while all AL would benefit from better regulatory guidance on policies and access to PPE, rural AL might especially benefit from additional, context-specific resources.

FACTORS ASSOCIATED WITH ATTACHMENT AND CARE DECISIONS
Kimberly Cassie, University of Oklahoma, Tulsa, Oklahoma, United States It is widely accepted that remaining in the community for as long as possible is preferable to placement in a care facility.For many, this can only be realized with the support of a family caregiver.Previous research on the relationship between attachment and caregiving decisions is sparse, but tends to suggest there is a relationship between attachment and the decision to assume caregiving responsibilities, but more information is needed to better understand this unique relationship.This exploratory research seeks to address gaps in our understanding by asking is attachment related to the decision to care for a parent and what factors are associated with attachment.A convenience sample of 128 individuals caring for older parents was surveyed to answer these questions.Results indicate lower attachment related avoidance was associated with greater odds of caring for a recipient in the community rather than placing the recipient in a care facility.No relationship between attachment related anxiety and placement decisions was observed.Additionally, greater levels of attachment related avoidance were observed among caregivers reporting lower levels of filial responsibility, more adverse childhood experiences, less perceived support, and greater financial stability.Findings from this study can be used to support the development of interventions to strengthen attachment between adult children and their parents before care decisions are necessary.

FACTORS DRIVING HIGH-NEED HIGH-RISK VULNERABLE VETERANS USE OF OUTPATIENT HEALTHCARE
Ali Vaeli Zadeh, 1 Fei Tang, 2 Carlos Gomez, 1 Luci Leykum, 3 Orna Intrator, 4 Bruce Kinosian, 5 Willy Marcos Valencia, 6 and Stuti Dang, 7 1.Miami VA Healthcare System,Miami,Florida,United States,2. Miami Veteran Affairs Healthcare System,Miami,Florida,United States,3. South Texas Veterans Health Care System,San Antonio,Texas,United States,4. Canandaigua VA Medical Center,Canandaigua,New York,United States,5. Philadelphia VAMC,Philadelphia,Pennsylvania,United States,6. Medical University of South Carolina,Miami,Florida,United States,7. University of Miami,Miami,Florida,United States Using predictive analytic modeling, the Veterans Affairs (VA) Geriatrics and Extended Care Data Analysis Center (GECDAC) identified vulnerable "High-Need High-Risk" (HNHR) Veterans, as requiring more support and services.We sought to identify variables linked with utilization of our outpatient HNHR C4 clinic offering Comprehensive Geriatric Assessment, Care Planning, Care Coordination, and Co-management".Of 724 HNHR Veterans contacted, 531 were reached and invited to participate; 193 were not reached, 326 were reached but declined the C4 clinic, 205 attended the clinic.We compared these groups.Independent variables were organized using Anderson's behavioral model into predisposing (age, gender, race, ethnicity), enabling (drive time, service eligibility, Area Deprivation Index, marital status), and need factors (mental health cognitive condition, ambulatory care sensitive conditions, NOSOS, JFI, CAN, etc.).C4 enrollment acceptance was the outcome.Results showed that compared to patients who declined, HNHR veterans who attended C4 clinic had more chronic health conditions(p<0.01),more service eligibility(p=0.01),more driving time to the closest VA clinic(p=0.01), and more were married (p=0.01).Patients who declined C4 clinic might have greater barriers to care access.Accessing needed healthcare among HNHR older adults maybe impacted more by enabling factors that allow the individual to seek care if needed and are the resources that may facilitate access to services, rather than need factors, which include individuals' perceptions of their health and functional state, and healthcare needs assessed by professionals.More social and intermediary determinants of health should be incorporated as enabling factors into models striving to understand drivers of healthcare use.

FAMILY CAREGIVER HEALTH IN A PANDEMIC
Kimberly Cassie, University of Oklahoma, Tulsa, Oklahoma, United States Each year family caregivers provide care and services worth billions of dollars to support the needs of older Americans.Their support is invaluable to keep individuals in the community for as long as possible and to allow individuals to attain and maintain their highest practicable level of well-being.But what impact does caregiving have on one's health?Does caregiver health decline with the assumption of caregiving duties?Did caregiver health change during the pandemic?If so, how and what factors are associated with declines in caregiver health?To answer these questions, an exploratory survey was conducted among a convenience sample of 195 family caregiver.Almost a third of those sampled reported excellent or very good health, while 44% reported good health, and almost a quarter reported poor or fair health.Forty-eight percent reported their health had declined since they assumed caregiving duties and 29% reported their health had declined during the pandemic.Employed caregivers and those experiencing less depression/ anxiety reported better health.Those experiencing a decline in health with caregiving were more likely to be female, not employed, experienced more stress and more depression/ anxiety.Those experiencing a decline in health during the pandemic reported less spirituality, greater attachment related avoidance, and greater depression/anxiety.Findings from this research can be used to inform future research on the effect of the pandemic on family caregiving and to plan interventions to protect caregiver health as they provide vital services to maintain individuals in the community for as long as possible.

FEASIBILITY AND ACCEPTABILITY OF THE TECHNOLOGY-BASED FALL RISK ASSESSMENTS FOR OLDER ADULTS
Ladda Thiamwong, 1 Oscar Garcia, 2 Renoa Choudhury, 2 Joon-Hyuk Park, 2 Jeffrey Stout, 2 and Rui Xie, 2 1. College of Nursing, University of Central Florida,Orlando,Florida,United States,2. University of Central Florida,Orlando,Florida,United States Promising technologies, which are simple, portable, quick, non-invasive, and inexpensive, may open new horizons on fall risk assessments and provide important information for older adults.We used a mixed-methods approach to examine the feasibility and acceptability of technology-based fall risk assessments, including the BTrackS Balance System, Bioelectrical Impedance Analysis, and activity monitoring devices among older adults.Data were collected via a Qualtrics survey and