OBJECTIVE:Previous research indicates that non-Hispanic Black adults are more likely to report extremes in sleep duration and worse levels of sleep quality compared to their White counterparts. However, studies examining predictors of sleep among Black adults are limited. This study addressed this gap by examining sociodemographic and health-related factors associated with sleep duration and sleep problems among non-Hispanic Black adults. METHODS:Data from 3,367 non-Hispanic Black adults in the United States, aged ≥20 years, were obtained by combining the 2015-2016 and 2017- March 2020 cycles of the National Health and Nutrition Examination Survey. Logistic regression models were fit to examine factors associated with sleep duration and sleep problems (history of trouble sleeping or excessive daytime sleepiness). RESULTS:The prevalence of recommended (7-9 h), short (<7 h), and long sleep duration (>9 h) was 53.9%, 33.0%, and 13.1%, respectively. The prevalence of sleep problems was 40.5%. Short sleep duration was positively associated with male gender, some college education, working ≥45 h per week, and history of sleep problems, and negatively associated with unemployment. Long sleep duration was positively associated with less than a college education, a family monthly poverty level index ≤1.30, being unemployed or retired, and fair or poor self-rated health, and negatively associated with female gender, age ≥45 years, and working ≥45 h per week. Sleep problems were positively associated with unemployment, mild to severe depressive symptoms, chronic medical conditions, fair or poor self-rated health, heavy alcohol consumption, and negatively associated with male gender, age ≥45 years, being foreign-born, and having a high school education or less. CONCLUSION:This study identified several sociodemographic and health-related factors associated with sleep, which can inform future research and policy and support the development of tailored clinical and public health interventions aimed at improving sleep health among non-Hispanic Black adults.

Background As communication technology advances and the digital divide grows, a deeper understanding of the influence of different information sources on vaccine uptake by generations can inform targeted public health interventions in times of future crisis. While the COVID-19 pandemic highlighted the role of media sources on the decision to receive vaccines, no studies have focused on the impact of the type and number of information sources in a population-based sample in California. Objective In this study, we examined associations between Californians’ self-reported most relied upon COVID-19 information sources, categorized by type and measured as a count, and their COVID-19 vaccination status using data collected from the 2022 California Health Interview Survey. To address differences in information preferences and vaccine uptake by age, we also tested for potential effect modification of the relationship between relied upon COVID-19 information sources and vaccination status by generational membership (eg, Generation Z, millennials, Generation X, baby boomers, and Silent Generation). Methods We conducted a secondary analysis of cross-sectional data from the 2022 California Health Interview Survey. Vaccine status (any or none) was modeled as a function of information sources (or count) controlling for important sociodemographic and health confounding variables. Interaction terms of information sources (or count) by generational status were added to the models to test effect modification, and if significant, the models were stratified by generation. All analysis was survey-weighted to account for the complex survey sampling design. Results Compared to relying on traditional news media for COVID-19 information, relying on word of mouth (odds ratio [OR] 0.6), social media (OR 0.62), and doctors (OR 0.41) for COVID-19 information was associated with lower odds of being vaccinated for COVID-19. A dose-response relationship was identified, with each additional information source associated with 9% higher odds of being vaccinated for COVID-19. In stratified models, social media, compared to traditional news media, was associated with lower odds of vaccination for Generation X, baby boomers, and the Silent Generation. Conclusions Health information preferences, especially for traditional news media, are associated with COVID-19 vaccine uptake, and the information sources differ by generation. These findings provide information for stakeholders interested in vaccine hesitancy, health informatics, messaging strategies, health literacy, and future health information outreach programs during epidemics or pandemics. Dissemination of public health information should include multiple information sources to reach all individual preferences across different generations.

OBJECTIVES:Advance care planning (ACP) supports communication and medical decision-making and is best conceptualized as part of the care planning continuum. Black older adults have lower ACP engagement and poorer quality of care in serious illness. Surrogates are essential to effective ACP but are rarely integrated in care planning. Our objective was to describe readiness, barriers, and facilitators of ACP among seriously ill Black older adults and their surrogates. METHODS:We used an explanatory sequential mixed methods study design. The setting was 2 ambulatory specialty clinics of an academic medical center and 1 community church in Northern California, USA. Participants included older adults and surrogates. Older adults were aged 60+, self-identified as Black, and had received care at 1 of the 2 clinics or were a member of the church congregation. Surrogates were aged 18+ and could potentially make medical decisions for the older adult. The validated ACP engagement survey was used to assess confidence and readiness for ACP. What "matters most" and barriers and facilitators to ACP employed questions from established ACP materials and trials. Semi-structured interviews were conducted after surveys to further explain survey results. RESULTS:Older adults (N = 30) and surrogates (N = 12) were confident that they could engage in ACP (4.1 and 4.7 out of 5), but many were not ready for these conversations (3.1 and 3.9 out of 5). A framework with 4 themes - illness experience, social connections, interaction with health providers, burden - supports identification of barriers and facilitators to ACP engagement. SIGNIFICANCE OF RESULTS:We identified barriers and facilitators and present a framework to support ACP engagement. Future research can assess the impact of this framework on communication and decision-making.

PURPOSE:To describe characteristics and outcomes of family caregivers for persons with Parkinson's disease and Lewy body dementia (PD/LBD) and compare them to those of other family caregivers. METHOD:Using a California statewide database, we examined caregiver characteristics and outcomes (strain, loneliness, worse health, and depressive symptoms) and compared them by care recipient diagnosis (PD/LBD, Alzheimer's disease and related dementias, or other chronic conditions) using descriptive statistics and multivariable logistic regression. RESULTS:PD/LBD caregivers were more likely to identify as female, married, and college-educated; engage in high-intensity caregiving; and report their care recipient wakes them or others up at night. In multivariable models, PD/LBD caregiving was associated with worse health. Among PD/LBD caregivers, performing medical/nursing tasks was associated with higher odds of strain, loneliness, worse health, and depressive symptoms. CONCLUSION:PD/LBD caregivers are a distinct group who often experience high-demand caregiving. Tailored support can help address the unique needs of this population.

Background: No studies examine associations between acculturation and physical activity (PA) in California's foreign-born Black population, even though rates of PA are lower in Black populations, lower PA rates are a risk for cardiovascular disease, and this population is growing. Further, despite differences in CVD and PA by sex and mental health status; no studies have examined whether these factors modify associations between acculturation and PA. Methods: We used the California Health Interview Survey (2012–2017) and fully adjusted, survey-weighted regression models to examine associations between time in the US as a proxy for acculturation (i.e., foreign-born <10 years in the US, foreign-born ≥10 years in the US) and walking for PA [leisure time (LTPA) and transportation-related (TRPA)] among Black Californians (n = 5,952). We also tested effect modification by sex and mental health status. Results: About 7 % in the sample were foreign-born. In the adjusted model of TRPA, the odds of walking for PA were significantly higher in the foreign-born group living <10 years in the US (OR = 8.63; 95 %CI: 2.49, 29.86; p < 0.01) and no different in the foreign-born group living ≥10 years in the US (OR = 1.05; 95 % CI: 0.62, 1.75; p = 0.85), compared to US-born Black Californians. We found no effect modification of the associations by sex or mental health, except by frequency of feeling depressed. Conclusion: Some foreign-born Black Californians have higher odds of walking for PA related to transportation than their US-born counterparts. Future research is needed to examine the role of mental health status on PA levels of this immigrant group.

Immigrants and their communities face unique challenges that exacerbate their risk for psychological distress. For long-term immigrants, these challenges may intensify over time, leading to feelings of isolation, frustration, and marginalization, contributing to higher levels of stress. Neighborhood programs that support community-building and connection may be an effective solution, however, evidence to inform such interventions is sparse. The aim of this study was to examine associations between neighborhood characteristics and the levels of psychological distress among long-term California immigrants. Using data from the biannual 2021-2022 California Health Interview Survey, we conducted a secondary analysis of responses from 4,595 immigrant participants who had lived in the U.S. for 15 years or longer. The primary outcome was psychological distress, as measured by scores on the Kessler 6 Psychological Distress Scale. We used Wilcoxon rank sum tests and separate simple linear regressions to test unadjusted associations between perceptions of four neighborhood-level characteristics (support, trust, safety, and getting along) and Kessler 6 scores. In a final multivariable linear regression model, we examined associations between all the neighborhood characteristics and Kessler 6 scores while controlling for relevant covariates. In the final fully adjusted model, perceptions of neighborhood trustworthiness (β = -1.13; 95

BACKGROUND AND OBJECTIVES:Large population-based surveys are often used in caregiver research and to support policy, while caregivers seeking help and resources-key targets of the 2022 National Strategy to Support Family Caregivers-have not been fully described. We describe and compare caregiver attributes in a California-wide population seeking support to those in state and national surveys. RESEARCH DESIGN AND METHODS:This descriptive comparative study harmonized and compared variables across four data sources (2020-2022): Caregiving in the US (CGUS; n = 1,089); National Study of Caregiving (NSOC; n = 1,885); California Health Interview Survey (CHIS; n = 2,159); and CareNav, a web-based application supporting services in California-based Caregiver Resource Centers (CRC; n = 5,967). RESULTS:More CRC caregivers were female, older, married or partnered, and caring for someone with Alzheimer's disease or dementia. They were more likely to provide care for ≥40 hr/week (74% vs 10% CHIS; 22% CGUS; 16% NSOC); support activities of daily living (94% vs 68% CGUS), perform medical/nursing tasks (83% vs 59% CGUS; 10% NSOC); and provide high-intensity care (90% vs 40% CGUS). More CRC caregivers reported fair/poor health (34% vs 18% CHIS; 18% CGUS; 21% NSOC), loneliness (21% vs 2% CHIS), and worse health due to caregiving (31% vs 15% CHIS; 21% NSOC). DISCUSSION AND IMPLICATIONS:Caregivers seeking help and resources provide more full-time, high intensity care with more impact on well-being compared to caregivers in large probabilistic samples. Reliance solely on population-based surveys to set targets to support caregivers, monitor progress, or allocate resources may miss the caregivers that need help the most.

Abstract More than 56 million family caregivers provided unpaid care to a family member in the last year. This group is increasing in number and diversity, while providing more intense and complex care, as more older adults are living longer with chronic and serious illness. We used assessment and service data from a large statewide database (CareNavTM) collected by 11 California Caregiver Resources Centers statewide to describe the caregiving demands, unmet needs and resource gaps of diverse family caregivers seeking help from the centers. Almost half of the caregivers identified as Black non-Hispanic, Hispanic/Latino, Asian American/Pacific Islander, Native American/Alaska Native or multi-racial/other. Older caregivers and those with low income were more likely to provide ≥40 hours of care weekly and to provide high intensity care (measured with the number of personal care activities supported and weekly hours of care). Younger caregivers, those in racial/ethnic groups other than White non-Hispanic, and those with low income were more likely to perform medical/nursing tasks. These groups of caregivers were also the least likely to have paid or unpaid help and the most likely to report adverse outcomes including fair or poor health status, worsening health and moderate or severe depressive symptoms. Taken together, these findings inform the California Department ofn Aging efforts to develop an equity plan for caregivers and are useful to other states seeking to develop policy to assure that all family caregivers have a range of high-quality services and supports that promote their physical, emotional, and financial wellbeing.

Abstract Last year, more than 56 million family caregivers provided unpaid care to a family member, a number that will grow along population aging and increased prevalence of chronic and serious illness. The demands, resources and outcomes of family caregiving are shaped by the social and environmental context and the particular demands associated with the condition of the care recipient. In 2021, California adopted a Master Plan on Aging, including two investments to strengthen community-based supports for caregivers: Improving caregiver resource centers and adult day programs. This mixed method symposium highlights the fortitude of family caregivers and community-based organizations. We focus on specific health conditions in understudied family caregiver populations as well as the interface with formal services. The first paper examines experiences of caregiving and home care among caregivers of persons with Amyotrophic Lateral Sclerosis. The second paper compares caregiving activities and outcomes among caregivers of individuals with Parkinson’s Disease/Lewy Body Dementia to those with Alzheimer’s Disease and related dementia and other chronic conditions. The third paper examines building family capacity through family and nurse collaboration during acute illness. The fourth presentation describes the impact of adult day care services from the perspectives of family caregivers of persons with dementia. The final presentation, using a large statewide database, describes caregiving demands, unmet needs and resource gaps of diverse family caregivers to inform a caregiving equity plan for the State of California. Together, these papers reflect complexity, diversity and fortitude in family caregiving.

Abstract Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease that profoundly impacts the lives of people with the condition and their family caregivers. Little is known about the experiences of care at home among individuals with ALS and their family caregivers. This qualitative study explored these experiences in 14 in-depth interviews that included seven persons with ALS and 13 family caregivers. The findings were organized based on the Salutogenic Model of Health. The main sources of stress reported included the overwhelming nature of getting an ALS diagnosis, inadequacy of health care teams in providing emotional support and promoting shared decision-making in regard to the management of ALS, high level of illness acuity, the intense nature of caregiving involved in ALS, high cost of treatments and equipment, difficulties navigating the healthcare system, unavailability of suitable medical equipment, scarcity of paid caregivers competent in managing ALS, and lack of adequate training for family caregivers. Perspectives on positive coping included mental toughness, maintaining a positive outlook about life and the future, being proactive in seeking support to maintain function and quality of life, proactively communicating with care teams, advanced care planning, having a sense of control over ALS management plan of care, and taking a break from caregiving. Instrumental and emotional support from family, friends, community organizations, and healthcare teams, as well as sufficient insurance and financial coverage for ALS treatments, facilitated better coping. Future research and policies should focus on identifying effective multisectoral strategies for supporting people with ALS and their caregivers.

Background In 2022, the US Department of Health and Human Services released the first National Strategy to Support Family Caregivers, identifying actions for both government and the private sector. One of the major goals is to expand data, research, and evidence-based practices to support family caregivers. While IT tools are widely deployed in health care settings, they are rarely available at scale in community agencies. In 2019, the state of California recognized the importance of a statewide database and a platform to serve caregivers remotely by enhancing existing service supports and investing in a web-based platform, CareNav. Implementation commenced in early 2020 across all 11 California Caregiver Resource Centers. Objective This paper describes the implementation strategies and outcomes of the statewide implementation of CareNav, a web-based platform to support family caregivers. Methods The Consolidated Framework for Implementation Research (CFIR), including a recent addendum, guided this mixed methods evaluation. Two major approaches were used to evaluate the implementation process: in-depth qualitative interviews with key informants (n=82) and surveys of staff members (n=112) and caregivers (n=2229). We analyzed the interview transcripts using qualitative descriptive methods; subsequently, we identified subthemes and relationships among the ideas, mapping the findings to the CFIR addendum. For the surveys, we used descriptive statistics. Results We present our findings about implementation strategies, implementation outcomes (ie, adoption, fidelity, and sustainment), and the impact on population health (organizational effectiveness and equity, as well as caregiver satisfaction, health, and well-being). The platform was fully adopted within 18 months, and the system is advancing toward sustainment through statewide collaboration. The deployment has augmented organizational effectiveness and quality, enhanced equity, and improved caregiver health and well-being. Conclusions This study provides a use case for technological implementation across a multisite system with diverse community-based agencies. Future research can expand the understanding of the barriers and facilitators to achieving relevant outcomes and population impact.

Older adults were disproportionately affected by COVID-19. The purpose of this study was to explore experiences of sudden-onset social isolation and factors that influenced it among social isolation in two groups of older adults. A qualitative thematic study with a survey component was conducted comparing 18 older adults in two groups: 12 reporting physical health challenges and 6 reporting no physical health challenges. Three qualitative themes describe experiences of (a) avoiding risk to personal health as the reason to postpone healthcare, (b) grieving church and church friends as a lost social connection, and (c) compound stress due to converging factors related to personal health, public health, racial justice movement and critical national events. Those with physical health challenges were less able to postpone seeking healthcare, suffered from compound stress, and were more likely to feel isolated when unable to participate in church activities. Religious, faith, or spiritual supports may be important buffers against social isolation during public health emergencies, especially for older adults with physical health challenges and when there is concurrent social unrest.

Abstract Caring for a person with dementia requires family fortitude in terms of commitment, time, energy and ability to manage a trajectory of several years. Family caregivers provide the vast majority of care for over 7 million individuals living with dementia. Many are adult children who deal with competing demands of other family members and employment. Adult Day Services (ADS) offer respite for family caregivers and meaningful support for persons with dementia. This study presents caregiver perspectives from the California Community Program for Alzheimer’s Supports and Services Pilot Program that engaged seven sites in a learning community to develop care standards and advance equity. We conducted semi-structured interviews and thematic analysis of recorded transcripts. The sample included 24 caregivers aged 25 to over 85 (12 spouses, 10 adult children and 2 other relatives). Caregivers described ADS services as life sustaining, being a vital resource that enabled them to continue in their role, balancing other demands. ADS improved mental health and physical health, reduced strain, and fostered self-care and engagement in the broader social network. The services also provided education and enhanced their skills in caring, prolonging their ability to continue. ADS services benefit both persons with dementia and caregivers. Future research could illuminate the long-range health care and societal costs and benefits of ADS for both persons with dementia and caregivers. Sustainable solutions bolster fortitude and optimize person and family-centered care.

Background: As care shifts from institutional to community settings, family caregivers are providing increasing support to older adults, including complex medical/nursing care. In the mid-late pandemic, technology advancements such as use of online patient portals present opportunities for communication and care delivery. This study aims to assess the association between caregiver medical/nursing tasks or patient portal use with contact, communication, and training of caregivers by healthcare providers.Methods: We conducted a cross-sectional analysis of caregiver data from the 2021 National Study of Caregiving (NSOC), linked to the National Health and Aging Trends Study (NHATS). NHATS is nationally-representative, annual survey of Medicare enrollees; NSOC surveys family/unpaid caregivers of NHATS participants. Logistic regression tested association between whether the caregiver does medical/nursing tasks or uses an online patient portal to contact the medical team (independent variables), and communication with or training by the medical team (dependent variables).Results: Participants were 1590 caregivers of living, community-dwelling older adults. More than half (54%) reported no contact with the care recipient's medical team in the past year. Caregivers who did medical/nursing tasks (OR = 3.10; 95% CI: 2.16, 4.46) or who used patient portals (OR = 3.28; 95% CI: 1.96, 5.51) had higher odds of contacting the older adult's medical team. Thirty percent of caregivers stated communication was either not at all or just a little helpful. Sixty-seven percent reported that providers rarely asked if they needed help managing the older adult's treatments. Just 6% of caregivers reported receiving any caregiver training in the last year.Conclusions: Both medical/nursing tasks and online patient portal use were independently associated with contact with health providers. Overall contact, communication, and training were limited or of variable value. Despite recent policy changes and technology advancement, there is still a need for improved integration of caregivers into health teams with ongoing assessment of their needs.

Background Nearly two-thirds of family caregivers of persons living with Alzheimer's disease or related dementias (AD/ADRD) provide complex care, including medical care. Family caregivers typically receive little to no training on how to provide this care. Furthermore, family caregivers simultaneously grapple with the presence of behavioral and psychological symptoms of dementia (BPSD), diminished communication abilities, and comorbidities such as diabetes. We developed Learning Skills Together (LST), a 6-week digitally delivered psychoeducational program, to facilitate family caregiver abilities to administer complex care tasks. The goal of the present study is to test the efficacy of LST and to reduce adverse outcomes associated with caregiving, such as depressive symptomology and negative appraisal of BPSD. Methods To test the efficacy of LST, we will conduct a two-arm single-site randomized controlled trial (RCT) with N = 200 family caregivers of persons living with AD/ADRD. Eligible family caregivers will be randomly assigned to participate in either the LST intervention or a structurally equivalent control condition focused on healthy living. All family caregivers will complete four surveys, including a baseline survey administered prior to randomization, a post-intervention survey, and a 3- and 6-month follow-up survey to assess change in study outcomes. Between-group comparisons of each outcome will be evaluated using generalized estimating equation models. Mediation analyses will assess family caregiver self-efficacy as the intervention's mechanism of change in depressive symptomology and BPSD. We will also examine caregiver race, ethnicity, and gender as effect modifiers of the intervention. Discussion LST findings will inform the field of AD/ADRD and caregiving regarding optimally supporting family caregivers in managing complex care tasks. If efficacious, the LST intervention will support family caregivers in preserving their own mental health while providing complex care. Trial registration Clinical Trials.gov NCT05846984. This study was registered on May 6, 2023.

BACKGROUND: Acute care hospitalization has been associated with older adult home falls after discharge, but less is known about the effects of hospital- and patient-related factors on home fall risk. OBJECTIVES: This study compares the effects of hospital length of stay, medical condition, history of falls, and home health care on period rates of home falls after discharge from acute care hospitalization. METHODS: This was a retrospective cohort study comparing period rates of home injury falls among older adults (age >= 65) occurring after discharge from an acute care hospitalization. Data were collected from state health care utilization administrative records between January 1, 2016, and December 31, 2018. We used log-linear Poisson regression to model post-discharge injury fall incidence rates as a function of days since discharge and patient-level covariates. RESULTS: A total of 736,230 older adults were included in the study cohort. Absolute risk for post-discharge home falls was 7%. Fall rates were highest the first week after discharge at 0.05 per 100 person-days, with a period incidence rate 74.29 times higher than the >90-day discharge period. Fall risk increased with age, with the highest risk in the >= 85 age group. Fall risk increased for a 2-day hospital stay but decreased for 5- to 30-day stays, compared to a 1-day length of stay. Discharge to home health care and history of falls were associated with increased risk. CONCLUSIONS: Older adults are at highest risk for a home fall the first 7 days after discharge from acute care hospitalization. These findings describe patient-related risk factors that acute care hospitals can use to develop geriatric-specific discharge guidelines intended to reduce home fall risk during the early care transition to home.

BackgroundThe COVID-19 pandemic compelled older adults to engage with technology to a greater extent given emergent public health observance and home-sheltering restrictions in the United States. This study examined subjective experiences of technology use among older adults as a result of unforeseen and widespread public health guidance catalyzing their use of technology differently, more often, or in new ways. ObjectiveThis study aimed to explore whether older adults scoring higher on the Unified Theory of Acceptance and Use of Technology questionnaire fared better in aspects of technology use, and reported better subjective experiences, in comparison with those scoring lower. MethodsA qualitative study using prevalence and thematic analyses of data from 18 older adults (mean age 79 years) in 2 groups: 9 scoring higher and 9 scoring lower on the Unified Theory of Acceptance and Use of Technology questionnaire. ResultsOlder adults were fairly competent technology users across both higher- and lower-scoring groups. The higher-scoring group noted greater use of technology in terms of telehealth and getting groceries and household items. Cognitive difficulty was described only among the lower-scoring group; they used technology less to get groceries and household items and to obtain health information. Qualitative themes depict the role of habit in technology use, enthusiasm about technology buttressed by the protective role of technology, challenges in technology use, and getting help regardless of technology mastery. ConclusionsWhereas the pandemic compelled older adults to alter or increase technology use, it did not change their global outlook on technology use. Older adults’ prepandemic habits of technology use and available help influenced the degree to which they made use of technology during the COVID-19 pandemic.

Abstract This study examined the impact of the COVID-19 pandemic on social relationships of older adults in two groups: eleven who were part of a caregiving dyad and seven who were not (mean age=79; 12 White, 5 Black, 1 More Than One Race). Semi-structured qualitative interviews were combined with the Lubben Social Network Scale (six-item version, LSNS-6). Those in dyads and not in dyads reported comparable extent of social connections on average with family (9 monthly social engagements vs. 9.5 on LSNS-6, respectively). Those in dyads reported greater social engagement on average with non-family individuals than those not in dyads (8.5 vs. 7 on LSNS-6). Older adults in both groups had greater social connections with family than non-family members. Qualitative themes such as seeking, losing and keeping ties represent the range of social connection experiences: all in dyads (vs. five not in dyads) referred to family members as key persons during the pandemic, five (vs. one) reported social isolation from family members specifically, zero (vs. three) identified a spouse or partner as most protective, five (vs. three) described supportive relationships, and four (vs. one) described relationships needing adjustments as a result of the pandemic’s impact. Six older adults in dyads (vs. two not in dyads) described non-family contacts as key, eight (vs. three) described the loss of connection with friends, and three (vs. zero) identified friends or hobbies as most protective. Type of dyadic relationships (spouses vs. parent-child vs. friends) and relationship quality may influence older adults’ social connections differently.

Abstract Parkinson’s Disease (PD) and Lewy Body Dementia (LBD) are related progressive neurodegenerative disorders that primarily affect older adults. Many individuals with PD/LBD require support from a family caregiver. However, caregivers of individuals with PD/LBD are infrequently studied. We extracted data from 2019-2022 in CareNavTM, a statewide electronic platform with data from caregivers served by the eleven California Caregiver Resource Centers, to compare caregiver sociodemographic characteristics, caregiving activities, and outcomes among caregivers of individuals with PD/LBD to those of individuals with Alzheimer’s Disease and related dementia (ADRD) and other chronic conditions (OCC). Care recipient condition was examined as a predictor of caregiving outcomes (e.g., loneliness, depressive symptoms, strain, and worsening health) using multivariable logistic regression models. There were a total of n=13,649 caregivers, with a majority caring for someone with ADRD (66%), followed by OCC (23%), and PD/LBD (10%). PD/LBD caregivers were more likely to be older, female, white, college-educated, and retired. PD/LBD caregivers were more likely to care for a spouse, spend >40hrs/wk on caregiving, assist with more personal care, and experience problems with the care recipient waking others up at night. In multivariable models, PD/LBD caregiving was independently associated with caregiving strain (OR 1.2; 95% CI [1.0-1.4], p= 0.01) and worsening health (OR 1.2; 95% I [1.1-1.4], p< 0.01), but not with depressive symptoms or loneliness. PD/LBD caregivers are a unique subset of family caregivers engaged in intense and complex care. Services and supports tailored to this condition and related needs may be warranted to optimize caregiver wellbeing.

Abstract There is growing evidence of the economic impact of unpaid family caregiving on physical, mental, social and financial wellbeing. The financial burden of caregiving has not however been fully examined nationally by generation. To address this gap, we examined relationships between generation and selected measures of financial fortitude among caregivers. This cross-sectional study used the 2020 Caregiving in the U.S. Survey to examine any reported impact of caregiving on savings, debt, and bills among adult caregivers who cared for an older adult. The primary independent variable was generation categorized as millennial, Gen X, and Baby Boomer. Survey-weighted logistic regression was used to model outcomes as functions of generation, controlling for socio-demographic and caregiving variables. Compared to Baby Boomers, millennials had higher odds of reporting impact on savings (OR=1.8; p=.006; 95%CI [1.17, 2.70]), debt (OR=2.2; p< 0.01; 95%CI [1.45, 3.40]), and bills (OR=2.6; < 0.01; 95%CI [1.69, 4.24]). Generation X also had higher odds of reporting impact on savings (OR=1.6; p=.006; 95%CI [1.15, 2.3]) and debt (OR=1.4; p=.03; 95%CI [1.02, 2.17]). Caregivers with higher incomes reported lower odds of impacts on all outcomes while those supporting more activities of daily living and caregiving for longer hours had higher odds. Additionally, caregivers with college degrees reported lower odds of impacts on bills. These findings highlight the role of generational status, socio-demographic and caregiving factors on financial outcomes, emphasizing the need for targeted interventions and policies that provide financial support to younger caregivers.