bluuebunny/crossref_metadata_2025 huggingface dataset:
THE ROLE OF COMMUNITY-BASED ORGANIZATIONS IN SUPPORTING HEALTHY AGING
Authors: White Rebecca , Sixsmith Andrew , Fang mei
Published: January 2025

Maintaining a healthy and balanced lifestyle is crucial for healthy aging and has a significant positive impact on brain health. Community-based organizations play an important role in many countries in promoting healthy lifestyles, particularly among those with the greatest social and economic need, through the provision of social, recreational, and informational programming. This presentation draws on research carried out in Vancouver, Canada, to understand the role of community-based organizations in enhancing the physical, social, and emotional well-being of older people. Using an institutional ethnographic case study approach guided by principles of community-based participatory research, the research focuses on the role of community-based organizations in enhancing older people’s well-being at multiple levels and contextualizes such organizations within a broader healthcare ecosystem. Results demonstrate the multi-faceted role community-based organizations play in supporting health and well-being among older people. The shift towards integrated healthcare models with a more holistic approach to health presents opportunities for community-based organizations to assume a more prominent role in empowering older people to self-manage their health and promote healthy lifestyles. Yet, such organizations face a multitude of challenges, particularly securing sustainable operational funding and widening their appeal to a changing demographic. The research highlights how community assets may be mobilized to better support the health and well-being of aging communities. More research is needed to understand how community-based organizations can better communicate their value and impact and enhance their capacity to respond effectively to emerging opportunities.
EXAMINING LGBT OLDER ADULT CHOSEN FAMILIES USING THE CONVOY MODEL OF SOCIAL RELATIONS
Authors: Breder Kelseanne , Bockting Walter
Published: January 2025

Sexual and gender minority (LGBT) older adults experience heightened levels of social discrimination and minority stress throughout their lives due to their minority identities. Older LGBT adults experienced unique external, systemic barriers to social acceptance, including bans on same-sex marriage, discrimination and negligence during the HIV epidemic, and police brutality during demonstrations such as the Stonewall Riots. LGBT older adults are also more likely to live alone and more likely to be estranged from their families of origin. Taken together, these discriminatory social experiences increase stress exposure and create a demand for an adaptive and protective social network to serve as a counterbalance to minority stress. Many LGBT older adults have developed “chosen families” or social networks composed of non-biological relatives who care for one another as if they are family. The LGBT chosen family is a resilience strategy that has not been examined thoroughly by a theoretical framework. The purpose of this paper is to apply the Convoy Model of Social Relations to examine the LGBT chosen family experience. The convoy metaphor succinctly captures the value of the LGBT chosen family, which functions not only to support members within the chosen family unit, but also to offset exposure to external threats and buffer internalized and externalized homophobia in a heteronormative society. The paper identifies points of convergence and departure between the model and LGBT chosen families and includes an analysis of the role of technology in LGBT older adult social networks. Modifications to the model are proposed.
WHAT ABOUT THE HANDS? EXAMINING OLDER ADULTS’ ATTITUDES, PERCEPTIONS, AND CLINICAL INTERACTIONS OF HAND FUNCTION
Authors: Cook Rachel Logue , Brown Susan
Published: January 2025

Age-related hand impairments are common yet receive little attention, thus often go undiagnosed until they have become severe. While it has been suggested that attitudes, perceptions, and clinical interactions play an important role in seeking care for physical limitations, the degree to which this extends to hand impairments is unknown. We developed an online survey which asked older adults (≥65) about their perceptions of hand function compared to other health areas, clinical interactions related to hand function, and barriers to accessing hand-related care. Five hundred and ninety-five older adults (mean age: 71.8 ± 5.5y) completed the survey. While 85% of respondents agreed that hand function is important for their daily life, only 40% expressed concern about losing function and only 2% ranked hand function as most important. Responses also indicated that hand function is rarely discussed (21%) or measured (52%) in the primary care setting. In addition, 34% of respondents said they have considered seeking care for a limitation but chose not to because they did not think their function was poor enough (33%), thought function would improve on its own (17%), or thought losing function is part of getting older (16%). Our results demonstrate that, although older adults understand the importance of hand function for completing activities, it is not prioritized by individuals or in the primary care setting. Such findings highlight a critical need to increase awareness of hand function in order to better identify impairments before they impede daily life and functional independence.
CAN OLDER INPATIENTS WITH MOBILITY LIMITATION BENEFIT FROM MULTIDISCIPLINARY INTERVENTIONS: M-MOBILE STUDY
Authors: Ma Lina
Published: January 2025

Objective

Mobility limitation, the loss of exercise capacity or independent living ability, is a common geriatric syndrome. As a reversible precursor to disability, it is crucial to comprehensively assess the factors of mobility limitation and administer individualized multidisciplinary team (MDT) treatment. We hypothesized that MDT can improve mobility in older adults with mobility limitation methods: We conducted a study titled “A Multidisciplinary-team approach for management of Mobility Limitation in Elderly (M-MobiLE)”, which is a multicenter, randomized, and controlled trial. A total of 442 older inpatients with mobility limitation from five hospitals were recruited. Mobility limitation was defined as Short-Physical Performance Battery (SPPB) ≤9. Activities of Daily Living (ADL) and intrinsic capacity were assessed. The intervention group received an exercise-centered individualized MDT treatment, including exercise, educational, nutritional, and medical interventions; while the control group received routine medical treatment. All patients were followed up for six months. Adverse events such as falls, fracture, stroke, cardiovascular events and death were recorded.

Results

Preliminary data analysis showed that compared to the routine medical treatment, the exercise-centered individualized MDT treatment reduces adverse events at 6 months (6.3% vs 13.0%, p=0.036). However, there was no statistical difference in ADL, length of stay, and hospital costs between the two groups at 6 months after discharge.

Conclusion

This study developed a multidisciplinary decision-making clinical pathway for older inpatients with mobility limitation, which had potential clinical benefits such as reducing short-term adverse events in older inpatients with mobility limitation in preliminary data analysis. Further analysis is ongoing.
LENGTH OF STAY IN REHABILITATION HOSPITALS AS WELL AS HOSPITAL ADMISSION IS ASSOCIATED WITH SACRAL ULCER DEVELOPMENT
Authors: Yin Cheng , Mpofu Elias , Brock Kaye
Published: January 2025

Introduction

Sacral ulcers (SUs) pose a significant risk of mortality for older adults when admitted to rehabilitation hospitals. Previous research has underscored the influence of various factors including comorbidities, lifestyle, and personal factors on sacral ulcer development (SUD) in these settings. However, the impact of hospital admission and the mediating role of length of stay (LoS) on SUD remains unclear. Thus, this study aimed to determine the association between hospital admission and SUD in older adult patients in rehabilitation hospitals, and whether LoS mediated this association.

Methods

Cross-sectional data were obtained from the Texas Inpatient Discharge Database (2021; N = 38,916 patients aged over 60 years in rehabilitation hospitals). Binary logistic regression was used to determine the association between hospital admission and SUD, mediation was then investigated.

Results

Hospital admission increased the likelihood of SUD through mediation by LoS (b=0.30, 95% CI 0.26, 0.35). Accounting for covariates revealed hospital admission was associated with 1.58 times the odds of SUD (AOR = 1.58; 95% CI = 1.38-1.81), while LoS was linked to 1.06 times the odds of SUD (AOR = 1.06; 95% CI = 1.05-1.06).

Conclusion

Our study extends previous findings, demonstrating hospital admission’s connection to increased odds of SUD, through prolonged LoS in rehabilitation hospitals. The results highlight the importance of categorizing the source of admission in vulnerable populations to mitigate potential risks of hospital-acquired infections and excessive mortality associated with SUs.
PHYSIOLOGICAL AGING AND ITS USE AS A MARKER OF INEQUALITIES IN HEALTH: CROSS-NATIONAL PERSPECTIVES
Authors: Bloomberg Mikaela
Published: January 2025

Given substantial heterogeneity in health status between older adults, there have been many efforts to develop metrics of biological and physiological ageing that explain variability in health outcomes better than chronological age alone. Physiological age based on clinical indicators may explain variation in health outcomes better than epigenetic or telomere-based biological clocks because clinical indicators capture downstream physiological changes more closely related to health outcomes. In this symposium, we examine physiological age as a holistic marker of ageing and how we can use different measures of physiological age to examine disparities in health across the UK, US, and Ireland. The first and second abstracts examine physiological ageing in different organ systems and associations with health outcomes in the US-based Health and Retirement Study (HRS) and the Irish Longitudinal Study on Ageing (TILDA). The third abstract explores gender and educational inequalities in physiological ageing in the English Longitudinal Study of Ageing (ELSA). The fourth examines racial differences in the returns to education for physiological ageing. Finally, the fifth abstract investigates associations of cumulative stress exposure and neighbourhood context with inflammation in HRS. We demonstrate physiological age as a powerful tool for revealing inequalities in health during ageing across national contexts.
CUMULATIVE STRESS EXPOSURE, NEIGHBORHOOD ENVIRONMENTS, AND INFLAMMATION IN ADULTHOOD
Authors: Choi Jean , Farina Mateo , Munoz Elizabeth
Published: January 2025

Cumulative stress exposure, or the total stress exposure occurring across childhood and adulthood, is related to elevated inflammation, a key factor underlying physiological aging. Neighborhood contexts represent important sources of risk or resilience that may interact with stress to influence inflammation. Using data from the Health and Retirement Study, we assessed whether cumulative stress exposure would be associated with greater inflammation, and if this link is shaped by adult neighborhood cohesion and disorder (n = 5,625; age: 56 – 107). We constructed a continuous latent variable of systemic inflammation from six measured indicators (CRP, IL6, IL10, IL-1Ra, sTNFR1, IGF-1). Higher cumulative stress exposure was associated with elevated inflammation (b = 0.02, SE = 0.01, p =.032), but neighborhood contexts did not moderate this link. Sensitivity analyses revealed a significant interaction effect whereby greater neighborhood cohesion buffered the negative effect of cumulative stress exposure on IL-1Ra (b = -8.01, SE = 2.76, p =.004), and IGF-1 (b = -0.49, SE = 0.20, p =.014). Additionally, higher cumulative stress exposure was associated with elevated IL-1Ra in the context of greater neighborhood disorder (b = 4.43, SE = 2.24, p =.047). Results indicate that neighborhood cohesion and disorder are integral dimensions of the neighborhood environment that may modify the impact of cumulative stress exposure on markers of inflammation. These findings emphasize the need for additional research to consider an integrated multi-level approach to understand the effects of cumulative stress on inflammation.
STRENGTHENING BRAIN HEALTH AND DEMENTIA RESOURCES FOR OUR RELATIVES OF NORTHWEST TRIBES
Authors: Wilson Chandra
Published: January 2025

The Northwest Tribal Elders Project (NTEP) will manage the resources and provide space for the current tribal dementia relatives to gather and share intertribal stories of our traditional ways of health and wellness to address Alzheimer’s disease and related dementia (ADRD) among I/T/U (Indian Health Services, Tribal and Urban Indian) clinics. The aim of the project is to provide technical assistance, training, and resources within our 43-member tribes’ elder programs and tribal programs supporting older adults. NTEP collaborates with all 43-member tribes and provides ADRD resources that may be tailored to the health and wellness practices within each tribal community. A tribal coalition will provide input on the implementation of our ADRD Strategic plan to promote risk reduction and intervention priorities, early detection screenings and assessments and education and awareness of ADRD. Through this relationship powerful and impactful things are going to happen, the hope is there will be an increase of discussions happening with our member tribes to discuss ADRD, mild cognitive impairment, memory care and caregiving. The tribe’s input on training and technical assistance needs is the medicine for our loved ones whom are being cared for.
DEMENTIA CAREGIVER SUPPORT IN THE RURAL, FRONTIER, AND TRIBAL AREAS OF UTAH
Authors: Nederostek Kate , Russell Kristy
Published: January 2025

More than three million people call the Beehive state home. Rapid growth (40% in the last 20 years) and Utah’s unique landscape present challenges when it comes to coordination of services. Made up of 29 counties covering 84,000 square miles, Utah is the 13th largest state by area. Approximately three-fourths of Utah’s population lives in five contiguous counties, often referred to as the Wasatch Front. However, 12 of Utah’s counties are considered rural (six to 100 persons per square mile) and 12 counties are considered frontier (six or fewer persons per square mile). Utah’s statewide dementia efforts are funded by the state legislature (~$430,000/year) and currently receive no additional federal funds. Historically, the federally supported organizations that serve frontier and rural communities in Utah receive less funding due to their lower population density. To better serve their communities, the Alzheimer’s Disease and Related Dementias (ADRD) Program and Family Caregiver Support Program, offered through the Area Agencies on Aging (AAAs), have combined forces. The ADRD Program assists each AAA in providing education, support, materials, and programming to those living with dementia and their caregivers. This collaboration has allowed an extension of programs statewide, providing an opportunity for those in rural and frontier areas to participate. Relationships and collaborative interest are growing with the Utah Indian Health Advisory Board. Utah’s ADRD Program continues to work through barriers and to tailor educational opportunities to the needs of each tribal area.
STRENGTHENING CAREGIVER SUPPORT: ASSESSING AND ADDRESSING CAREGIVERS’ MENTAL HEALTH NEEDS
Authors: Gould Christine , Humber Marika , Trivedi Ranak
Published: January 2025

Family caregivers (typically patients’ unpaid relatives/friends) are vital to patient care, but their mental health needs are often overlooked. This may be exacerbated by the fact that the caregiving role can be isolating, stressful, and time-consuming. This symposium highlights promising findings related to the identification of caregiver mental health and well-being needs and potential interventions in the community and Veterans’ Health Administration (VHA). First, Dr. Moo will present findings from a national survey of caregivers of older Veterans that shows the impact of care responsibilities, health care navigation, and environment on caregiver quality of life. Second, Dr. Van Orden will describe her investigation of suicide ideation, perceived burden, and social connection among caregivers of persons with dementia. Third, Dr. Humber will describe the impact of a tele-geriatric psychiatry service in two VHA regions on caregivers of rural-dwelling older Veterans with neurocognitive and or psychiatric disorders. Last, Dr. VanPutten will discuss adaptations of Dialectical Behavior Therapy (DBT) for caregivers in high-conflict caregiving situations with persons with neurocognitive disorders. She will describe adaptations made to a DBT skills training group related to the influence of caregiver physical health problems on detecting and applying core DBT skills. Dr. Ranak Trivedi, the national Training Director of the Elizabeth Dole National Center of Excellence for Veteran and Caregiver Research and member of the Research Collaborative of the National Alliance of Caregiving, will close with discussion of the presentations and will highlight opportunities for future caregiver mental health research.
INFLUENCES ON CAREGIVERS OF OLDER VETERANS’ PERCEPTIONS OF THEIR QUALITY OF LIFE: A NATIONAL SURVEY
Authors: Moo Lauren , Chamberlin Elizabeth , Ngo Victoria , Shirk Steven
Published: January 2025

Being a family caregiver can negatively impact an individual’s physical and mental health, leading to caregiver burden, burnout, and lower quality of life (QoL). We explored caregiver and care recipient factors that influence caregiver QoL via a national web-based survey of 511 informal caregivers of older Veterans. We found that greater dependence of the Veteran on the caregiver for Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (iADLs) was associated with poorer QoL (p<0.001). Caregivers’ cohabitation with the Veteran was also associated with poorer QoL (p<0.001), while caring for an additional person was not. However, our results also suggest that caregivers making time for their own medical care and social needs were unique important predictors of higher caregiver QoL, and this positive benefit remains even when considering the negative impact of Veteran ADL and iADL support needs. In fact, our results suggest that making time for social activities is the strongest predictor of QoL. Thus, making time to receive medical attention and participating in social activities are important factors when considering the caregivers’ overall QoL. Cohabitating with the care recipient may be required for various reasons (e.g., amount of care needed, financial limitations) and, therefore, may be challenging to address. However, improving and supporting the amount of self-care the caregiver receives may be a feasible area to address and can still have a substantive impact on their overall QoL.
THE CANNABIS AND OLDER PERSONS STUDY: CAN WE AT LEAST DEFINE IT AS A FORM OF COMPLEMENTARY AND ALTERNATIVE MEDICINE?
Authors: Kaskie Brian
Published: January 2025

The Cannabis and Older Persons Study has examined the increasing use of cannabis among older persons since 2016. This year’s COPS symposium features panelists trained in community health, gerontology, medicine, psychology and public health, each offering latest research findings and considering cannabis as a form of complementary and alternative medicine. Annie Nguyen and her colleagues from the University of California, San Diego present a qualitative analysis of interviews completed with physicians and other clinicians affiliated with a geriatric medical clinic, focusing on their perspectives about cannabis as a form of complementary and alternative medicine. Angela Bryan and her team from the University of Colorado, Boulder identify more than 200 older persons who completed the “Cannabis and Your Health” survey and compare those who use cannabis for purposes of self-care and contrasts outcomes related to balance, mood and memory with those who do not use cannabis. Julie Bobitt from University of Illinois Chicago uses a socio-ecological framework to identify multi-level factors associated with cannabis use among 30 older women with HIV. Fadi Martinos examines more than 12,000 persons over 50 who completed the California Health Interview Survey, and compares cannabis use among those who identify as informal care givers and those who do not. Together, these studies reflect how scientific understanding of cannabis use among older persons has been informed by varied disciplinary perspectives, and whether researchers consider cannabis use among older adults as a complementary and alternative form of medicine.
THE IMPACT OF ENVIRONMENTAL EXPOSURES ON DEMENTIA, PHYSICAL, COGNITIVE, AND MENTAL HEALTH OF OLDER ADULTS
Authors: Zaninotto Paola , Prina Matthew
Published: January 2025

The proposed symposium will delve into crucial environmental factors affecting physical health, cognitive and mental health, in older populations. The first talk will explore urban environments’ impact on cognitive health, highlighting evidence gaps and concentrated areas of existing research, such as air pollution and social environment influences on dementia and Alzheimer’s disease. Another presentation will examine the association between long-term air pollution exposure and dementia risk in Denmark, identifying the most vulnerable groups based on socioeconomic status and comorbidities. The third talk will focus on the relationship between air pollution exposure over a decade and cognitive performance in older individuals in England, emphasizing the detrimental effects of industry emissions on cognition. A different study will discuss the findings on outdoor light at night and its lack of association with depressive symptoms in older adults in England. Lastly, the symposium will present research on extreme heat exposure’s effects on epigenetic aging and its potential to increase morbidity and mortality risks, underscoring the need for mitigating these biological changes.
EFFICACY OF THE RESIDENTIAL CARE TRANSITION MODULE
Authors: Gaugler Joseph , Birkeland Robyn , Albers Elizabeth , Peterson Colleen , Louwagie Katie , Baker Zachary , Mittelman Mary , Roth David
Published: January 2025

“This study aimed to evaluate the efficacy of The Residential Care Transition Module (RCTM), a six-session, psychosocial, and psychoeducational telehealth intervention for family caregivers of cognitively impaired relatives living in a residential long-term care (RLTC) setting. Eligible participants (including care recipients, regardless of time since admission) were randomized to treatment or usual care control conditions. Survey data were collected at baseline, four months, eight months, and 12 months (N = 240). Primary analytic outcomes included caregiver subjective stress (a stress process mechanism) and depressive symptoms (a measure of global well-being). Secondary analytic outcomes included secondary role strains, residential care stress, caregiver sense of competence, and self-efficacy (additional mechanisms of action). General linear models tested for the main effects of the intervention at four months and longitudinal mixed models examined the 12-month effects of the intervention. Post hoc analyses also examined the influence of moderators. There were no significant differences between the treatment and control groups for any primary analytic outcome. Caregivers in the treatment group whose relatives were admitted to RLTC in the prior three months were more likely to indicate reductions in depressive symptoms over the first four months of participation. Over the 12-month study period, caregivers in the treatment group who were employed reported increased self-efficacy over time. The heterogeneity of dementia care requires a broader consideration of key contextual factors. Aligning measures with the preferences, goals, and values of dementia caregivers may further demonstrate the benefits of interventions such as the RCTM” (Gaugler et al., in press).
PROCESS EVALUATION OF THE RESIDENTIAL CARE TRANSITION MODULE
Authors: Urbanski Dana , Birkeland Robyn , Louwagie Katie , Bailey Dionne , Baker Zachary , Gustavson Allison , Mitchell Lauren , Gaugler Joseph
Published: January 2025

Although still relatively uncommon in dementia care science and gerontology, process evaluations can offer substantial insight when considering the dissemination and implementation of evidence-based innovations, particularly when utilizing various types of data to examine causal assumptions of an intervention as well as pre-specified contextual moderators or mediators that may influence intervention effects. This process evaluation leveraged the extensive quantitative and qualitative data collected during the 12-month, mixed methods evaluation of the Residential Care Transition Module (RCTM), a psychoeducational telehealth (via phone or video conference) intervention. Of 120 treatment participants, 107 completed the six session intervention. Session duration averaged 81 minutes (range 18-130 minutes, SD=20.9). The 13 participants who did not finish the intervention were bereaved during the intervention. As such, intervention delivery was discontinued. One hundred and fourteen treatment group participants engaged in varied amounts and means of ad hoc communications throughout their time in the study, including 9 of the 13 aforementioned bereaved participants who chose to continue to work with their transition coach after their relative passed. Eighty-one of the 114 participants engaged in ad hoc coaching sessions via phone or video conference, averaging six ad hoc sessions (range 1-38 sessions, SD=5.7). Ad hoc session duration averaged 41 minutes (range 5-120 minutes, SD=18.4). Emotional support was the most frequently delivered content, occurring in 91% of intervention sessions and 53% of ad hoc contacts. Participants overwhelmingly valued the RCTM program via a treatment review checklist administered quarterly, indicating high perceptions of utility, acceptability, and satisfaction with the RCTM.
AN EMBEDDED MIXED METHODS EVALUATION OF THE RESIDENTIAL CARE TRANSITION MODULE
Authors: Birkeland Robyn , Gaugler Joseph , Albers Elizabeth , Peterson Colleen , Louwagie Katie , Baker Zachary , Mittelman Mary
Published: January 2025

Mixed methods designs refer to those research strategies that integrate or “mix” qualitative and quantitative research questions, sampling and data collection approaches, and analyses, so that one component builds upon and expands the inferences of the other. The Residential Care Transition Module (RCTM) evaluation relied on an “embedded” mixed methods design. In the RCTM embedded design, qualitative data collection was integrated during and following intervention delivery to ascertain components or contextual factors that may have influenced participant benefit. We relied on the robust qualitative data available from quarterly review checklists as well as purposive, post-intervention semi-structured interviews administered to RCTM treatment participants to identify and empirically test three mediators and moderators in a series of post-hoc, longitudinal quantitative analyses: unemployment, time in residential care, and bereavement status. In this presentation, we will highlight our findings for whom and under what circumstances a telehealth dementia care support intervention such as the RCTM may exert positive benefits.
INTEGRATING A FRAILTY INDEX INTO THE CMS HIERARCHICAL CONDITION CATEGORY MODEL FOR PREDICTING HEALTH CARE COSTS
Authors: Jang Jieun , McCarthy Ellen , Olivieri-Mui Brianne , Shi Sandra , Park Chan Mi , Sison Stephanie Denise , Kim Dae Hyun
Published: January 2025

The Centers for Medicare and Medicaid Services Hierarchical Condition Category (CMS-HCC) score is a standard risk adjustment tool to predict total Medicare costs. We examined whether a claims-based frailty index (CFI) could enhance the predictive capability of the CMS-HCC score. We utilized electronic health records linked with Medicare data, focusing on patients over 65, including surgical inpatients and outpatients from January 2017 to December 2018. Analyzing 1,855 surgical inpatients using logistic regression, we estimated the likelihood of incurring top 20% Medicare costs for 30 days, 90 days, and 1 year after surgery, comparing 1) the CMS-HCC score alone with 2) the CMS-HCC score combined with the CFI. Similarly, for 58,492 outpatients, we employed generalized estimating equations to estimate the likelihood of being in the top 20% of total Medicare costs for 1 year after an outpatient visit, comparing the same two models. The added value of CFI was assessed using net reclassification improvement (NRI) with 3 risk categories (0 to <10%, 10 to <20%, ≥20%) to compare the two prediction models. Including CFI with CMS-HCC score improved NRI by 7.3% for 30-day costs, 10.1% for 90-day costs, 9.8% for one-year costs in surgical inpatients, and 12.3% for annual costs in outpatients. The added contribution of CFI to CMS-HCC significantly improves the model’s ability to identify patients at high risk of incurring substantial medical costs (top 20%). Accounting for patient frailty may enable healthcare systems to more effectively allocate resources and implement targeted interventions, ultimately reducing healthcare expenditures.
ADAPTATIONS AND OUTCOMES OF A WALKING AND REMINISCENCE BRAIN HEALTH INTERVENTION FOR CAREGIVERS
Authors: Fuller Patrice , Fennell Charles , Mattek Nora , Gothard Sarah , Kaye Jeffrey , Croff Raina
Published: January 2025

The SHARP-Caregiver (SHARP-CG) study evaluated the feasibility of adapting SHARP to family caregivers of care partners with mild cognitive impairment or early-stage dementia. SHARP-CG assigned 7 triads (n=21) to Group A or B. Triads had a family caregiver (age >40), their care partner (age >40), and a support person (age >18). Caregivers and support persons were healthy or mildly cognitively impaired. Triads walked 1-mile routes with images to prompt conversational reminiscence 3x a week for 16 weeks using the SHARP walking application. Caregivers and care partners contributed weekly health update data, and (optionally) sleep and step-count data. Group A participants walked immediately. Group B participants first completed 16-weeks of observation. Ages were 35-90 (mean 69.8); most were female (52%). Mean Montreal Cognitive Assessment score for caregivers and care partners was 21.7 (SD+4.6). Eighty-six percent (n=6) of caregivers and 71% of care partners (n=5) opted to engage in digital biomarker data collection (actigraphy watch and sleep sensor). Caregivers had greater mean total daily steps (2055; SD+686) than care partners (1684; SD+979). Mean sleep hours were similar for caregivers and care partners at 6.1 (SD+1.1) and 6.5 (SD+2.5). Recruiting caregivers was difficult because many family members did not recognize what they were doing as caregiving. To improve study accessibility for caregivers, adapted eligibility criteria included reducing minimum age, allowing mobility aids, and making some components optional. Increasing accessibility, while improving enrollment, did not necessarily impact adherence. Caregiver demands and sporadic health concerns limited participation.
EFFECTIVENESS OF A TECHNOLOGICAL PLATFORM TO MANAGE FRAILTY: RESULTS FROM THE POSITIVE AND INTEGRACAM STUDIES
Authors: Rodriguez-Manas Leocadio , Grille Alba Maria Costa , Hermosilla Irene Molina , Lopez Irene Alfonso , Perez-Rodriguez Rodrigo , Peinado-Martinez Ignacio , Villalba-Mora Elena
Published: January 2025

Technologies can assist in managing frailty through home monitoring and intervention systems, though evidence of their clinical benefit is lacking. Our study had two components. A) A two-arm (Intervention vs. Control) RCT named POSITIVE (NCT04592146) with a 6-month follow-up, recruiting prefrail or frail people aged ≥70 years living at home from three European countries (N=83), and B) a validation study in usual clinical practice called INTEGRACAM, conducted in Madrid, Spain, under a quasi-experimental before-after design that mirrors the criteria of POSITIVE. Both components utilized a technological platform for comprehensive patient assessment and functional status monitoring, delivering personalized interventions including VIVIFRAIL physical exercise programs, nutritional recommendations, and medication adjustments according to STOPP-START criteria. Usability and user experience were measured using the System Usability Scale (SUS) and the User Experience Questionnaire (UEQ-S), alongside frailty (Fried criteria and FTS-5 score) and functional status (SPPB and WHODAS). Results from POSITIVE (average age 76.7 years; 76.8% female) indicated significant improvements after six months in frailty status (FTS-5: -5.43 points in the intervention group vs. usual care; p=0.008; Fried´s criteria-FFP: -0.4 in IG vs UC p=0.087), SPPB (+1.07 points; p= 0.022) and WHODAS (0.22, p= 0.09). INTEGRACAM showed similar findings with participants (n=51; mean age 78.1±5.3 years) demonstrating improvements in SPPB (+1.03±1.38; p-value <0.001), FTS5 (-3.4±4.11; p-value <0.001), and FFP (-0.4±1.03; p-value 0.028) after 6 months. Patients rated usability as 87/100, surpassing the optimal threshold value (68/100). Regarding the UEQ-S, hedonic quality improved throughout the project (2.44 vs 2.02, p=0.031), both in patients and professionals.
THE POTENTIAL FOR MIND–BODY THERAPIES AS FRAILTY INTERVENTIONS
Authors: Loewenthal Julia
Published: January 2025

Strategies to prevent and manage frailty are priorities in clinical medicine and public health. Current evidence-based interventions for frailty are multimodal in nature, with physical activity as a key element. Mind-body therapies, especially those that incorporate movement such as yoga and tai chi, include physical postures, breathing practices, meditation, and other elements. In our recent systematic review of 33 randomized controlled trials of yoga interventions in older adults (2384 participants), there was moderate-certainty evidence that yoga improved gait speed and lower extremity strength when compared to inactive control groups. Both yoga and tai chi are known to improve physical function, even in already frail populations. Emerging evidence suggests they may modulate cellular and molecular hallmarks of aging, especially inflammation. Mind-body therapies have additional benefits for cognition, mood, and sleep. They likely confer resilience by positively impacting core systems for maintaining homeostasis, including musculoskeletal, metabolic, and stress-response systems. They are not only highly adaptable for older populations, but also increasingly popular: among US adults, use of yoga alone increased from 5% in 2012 to 15.8% in 2022. They may be delivered in a group format to reduce social isolation, and are increasingly accessible via telehealth, senior centers, and other community-based organizations. In addition, there is evidence that mind-body therapies are an entry point to other types of physical activity, especially for women. They are promising frailty interventions, though more work is needed to understand optimal dose, duration, and effectiveness.
IMMUNOLOGICAL ASPECTS OF AGING
Authors: Yousefzadeh Matt
Published: January 2025

Aging is an intricate and multifaceted phenomenon that impacts every aspect of our bodies, including the immune system. As we age, there’s a gradual decline in immune function known as immunosenescence, which reduces the body’s ability to combat pathogens effectively. Moreover, this decline in immune function plays a pivotal role in the development of various age-related chronic conditions. One significant contributor to aging is inflammaging or the production of low-grade chronic inflammation that occurs in the absence of pathogens that can drive aging. Despite significant research efforts, the intricate mechanisms behind immunosenescence and the communication of aging between the immune system and other bodily systems remain largely elusive. The aim of the symposium is to delve into recent breakthroughs in this field across different levels of research, spanning from basic science, translational studies, and potential therapeutic interventions.
PREDICTING OLDER ADULTS’ RESIDENTIAL CARE RELOCATION RISKS BASED ON CAREGIVER NETWORK CHARACTERISTICS
Authors: Nemmers Natasha , Lai Wenhua , Haldar Srabani , Tsuker Sophia , Freedman Vicki , Leggett Amanda
Published: January 2025

When older adults face increasing care needs or limited support, remaining safely and comfortably at home becomes challenging. Extant research has primarily concentrated on characteristics of the older adult or their primary caregiver on nursing home admission. This study examines the risk of older adults transitioning to residential care (e.g., assisted living, nursing home), focusing on the influence of their caregiver network or involvement of multiple caregivers. Using the National Health and Aging Trends Study, we conducted competing risk regressions following 7,085 community-dwelling older adults moving to residential care, accounting for death, across rounds 1-9 (2011 – 2019). We assessed network composition, size, shared tasks, and the number of in-network specialists or generalists, while controlling for individual sociodemographic and health factors. Individuals with caregiver networks that shared medical tasks had the highest risk of moving, followed by those sharing household tasks. Conversely, shared mobility or self-care and transportation responsibilities were associated with lower risks. Having more generalists increased the risk, while any number of specialists was non-significant. Larger networks were associated with heightened risk, though having close family like a spouse was protective. The findings underscore that caregiver network characteristics are critical to older adults’ ability to age in place. Specifically, older adults with larger caregiver networks, lacking a spouse or child, and providing complex care are at greater risk for relocating. Understanding caregiver networks can guide interventions related to care network coordination and resource allocation to help avoid or postpone a residential care move.
RELATIONSHIP CHANGES ACROSS THE CAREGIVING TRANSITION
Authors: Joiner Raquael , Nelson Niccole , Liu Qimin , Niemiec Stacey Schepens
Published: January 2025

The majority of aging individuals’ care needs are met by family caregivers (CGs), often at great costs to CGs’ well-being. There is, however, significant heterogeneity in CG outcomes, and social capital, or the quality of marital, family, and friend relationships, is widely recognized as an im-portant factor underlying individual differences in CG outcomes. Because empirical work to date largely focuses on either cross-sectional differences or changes in social capital post-caregiving on-set, it is unclear, however, whether social capital disparities across different populations are a func-tion of the transition to CG or whether such disparities exist prior to taking on a CG role. Thus, we used data from the Health and Retirement Study (N=366; 8-waves) and Bayesian multi-phase latent growth curve models to examine social capital changes across the caregiving transition. Results sug-gested that CGs, on average, do not show significant changes in their social capital across the transi-tion to caregiving. Yet, there were significant individual differences, and individual differences in pre-caregiving social capital were significantly associated with social capital changes following tak-ing on a caregiving role: CGs with higher initial levels of social capital showed less declines in rela-tionship quality leading up to caregiving onset, but steeper declines in relationship quality at caregiv-ing onset and smaller relationship quality increases in the years following caregiving onset. This suggests that the social capital of individuals with initially satisfying relationships are most impacted by caregiving. We discuss the implications of these findings for refining and developing personal-ized social support interventions for CG populations.
BUILDING COMMUNITY IN PRACTICE AND RESEARCH OF HEALTHY LONG-TERM CARE ENVIRONMENTS
Authors: Chi Peggy , Hunter Sarah , Berta Whitney
Published: January 2025

This presentation will describe an initiative based at the Institute of Health Policy, Management and Evaluation in Toronto, Canada, that aims to dismantle silos and build a community in the practice and research of aging environments. The goals and objectives are to share, synthesize, advance, and mobilize knowledge on long-term care homes—the influence of living environments on older adults and working environments on workers and their work. Three knowledge mobilization activities are the means by which our aims are achieved: 1) A series of seminars are curated for experts to disseminate knowledge to a broad audience (industry and academic leaders, decision-makers, and end-users) to connect research to practice. 2) Informal, practical discussions are created for practitioners to share current key challenges in long-term care homes with researchers to connect practice to research. 3) A Design Charrette is organized to translate knowledge to address key challenges within interdisciplinary teams comprising practitioners/ care providers, team leads, and trainees. These activities bring together individuals from industry and academia who represent diverse disciplines that have generated knowledge about these linkages based on different and complementary conceptualizations of long-term care environments but for whom there is no pre-existing forum in which to engage in integrative, synthetic discussion and application. The open-forum nature of the activities is intended to foment public discourse on the role of physical and psychosocial environments in the health of older adults and workers in long-term care homes and to demonstrate the value of evidence-based design founded on multidisciplinary knowledge.
UNDERSTANDING CAREGIVER BURDEN IN DECISION-MAKING IN ALZHEIMER’S DISEASE AND RELATED DEMENTIAS
Authors: Ginn Brandi , Arteaga Ignacia , de Jesús Alma Hernández , Abramson Corey , Dohan Daniel
Published: January 2025

Alzheimer’s disease and related dementias (ADRD) are chronic conditions that involve changes or loss of cognitive and social function. People living with dementia (PLWD) undergo a gradual expansion in caregiving needs, and many ultimately spend a portion of their lives in institutional settings, including nursing homes or assisted living facilities. This study uses a comparative ethnographic approach to examine how PLWD and their caregivers make sense of and navigate transitions from home to institutional care. It combines three years of detailed field observations and 84 in-depth interviews in California and Maine. Our data illustrate how socioeconomic inequality, disparate neighborhood contexts, and shared understandings of aging shape tensions caregivers experience as they navigate whether, how, and when to relocate PLWD for whom they care. Our results show cultural narratives encouraging independence and non-institutionalization of older adults intersect with caregivers’ desires, structural positions, and local institutional resources – creating tensions and are mentioned alongside the feeling of being burdened. These experiences and feelings emerge gradually as the health of PLWD declines and caregivers become aware of unmet needs and their own resource constraints. We unpack how diverse caregivers make sense of the burden they feel, define the thresholds to make decisions, map community resources, and experience a range of emotions such as frustration, guilt, and grief throughout the process. This contextualized analysis of how caregivers navigate ADRD decision-making offers insights into the affective nature of the process and the caregivers’ fortitude.
EXAMINING THE IMPACT OF RIDE-HAILING ON THE TRAVEL BEHAVIOR OF OLDER ADULTS ACROSS THREE CITIES
Authors: Song Minju
Published: January 2025

Due to age-related physical and cognitive changes, older drivers may eventually find themselves unable to continue driving, when finding alternative transportation modes becomes a major concern. Ride-hailing services like Uber and Lyft have emerged as potential solutions to this issue. Nevertheless, given the dearth of available data and the recently introduced transportation systems, limited research exists on ride-hailing usage of older adults. This paper aims to examine the factors influencing ride-hailing adoption among older adults by comparing different age groups across three metropolitan areas: Chicago, Minneapolis, and Seattle area. Using regional survey data collected in 2019, we estimate logistic regression models by age groups to examine notable characteristics of older adults utilizing ride-hailing. In follow-up, we use a multilevel logistic regression model to explore the hierarchical relationships between regional, household, and individual levels. Findings show that ride-hailing services are more used by younger adults (18-64) compared to individuals over 65 years, indicating a potential technological familiarity gap between age groups. The built environment has a significant association with ride-hailing adoption, particularly in urban areas with transit infrastructure and higher population density. While ride-hailing has the potential to enhance the social inclusion and independence of older people who stop driving, ride-hailing is not accessible for older people as much as other age groups. Thus, this study underscores the importance of continued investment and research in ride-hailing services, advocating for policymakers and service providers to consider older adults’ needs in transportation planning.
SIBLING-TO-SIBLING DEMENTIA CARE: UNDERSTANDING MOTIVATIONS, CHALLENGES, AND EXPERIENCES
Authors: Savla Jyoti , Roberto Karen
Published: January 2025

Caregiving research has traditionally focused on older adult siblings’ involvement in shared social activities and emotional support, while offering limited exploration of instrumental help provided by siblings when their brothers/sisters face a health-related event or long-term illness. Moreover, there is a notable gap in understanding how siblings navigate the complexities of caring for their community-dwelling sibling living with dementia (SLwD). We begin to address this gap by examining determinants of sibling dementia caregiving roles, individual and family challenges older adult sibling caregivers encounter, and factors that facilitate their provision of care. From a mixed-methods analysis of interviews with 25 sibling caregivers, comprised of 12 sisters caring for sisters, 10 sisters caring for brothers, and 2 brothers caring for brothers (Mage = 68.03 years, R = 52-83; 48% African American; 52% co-residing), several key insights emerged. Motivations for assuming the caregiving role included shared life experiences, availability due to non-employment, personal or professional caregiving experience, and the absence or limited involvement of the SLwD immediate family. Early-life relationship conflicts, challenges in managing dementia-related symptoms, and divided family loyalties added complexity to the caregiving role. Sibling caregivers who received support from other family members and paid caregivers in caring for SLwD reported lower role captivity and caregiver burden. Caregiving experiences intersected with birth order, race, and socioeconomic status. Discussion focuses on when and why siblings take on the caregiving role for their SLwD, nuanced differences on how they manage their caregiving responsibilities, and implications for extended family caregiving practices and support.