bluuebunny/crossref_metadata_2025 huggingface dataset:
GRAVES’ DISEASE IS ASSOCIATED WITH INCREASED RISK OF CLINICAL ALZHEIMER’S DISEASE
Authors: Yashkin Arseniy , Nikitin Stanislav Kolpakov , Gorbunova Galina , Kravchenko Julia , Yashin Anatoliy , Akushevich Igor
Published: December 2023

Identification of modifiable risk factors for Alzheimer’s Disease (AD) onset is an important aspect of controlling the burden imposed by this disease on an increasing number of older U.S. adults. Graves’ disease (GD), the most common cause of hyperthyroidism in the U.S., has been hypothesized to be associated with increased AD risk, but there is no consensus. In this study, we explore the link between GD and risk of clinical AD. Cox and Fine-Grey models were applied to a retrospective propensity-score-matched cohort of 15,505 individuals with GD drawn from a nationally representative 5% sample of U.S. Medicare beneficiaries age 65+ over the 1991-2017 period. Results showed that the presence of GD was associated with a higher risk of AD (Hazard Ratio [HR]:1.15; 95% Confidence Interval [CI]:1.07-1.23). Magnitude of associated risk varied across subgroups: Males (HR:1.19; CI:1.01-1.41), Females (HR:1.09; CI:1.02-1.18), Whites (HR:1.13; CI:1.04-1.20), Blacks (HR:1.33; CI:1.04-1.20). Competing risk estimates were consistent with these findings. A potential mechanism connecting GD and AD may involve shared etiological factors between the two diseases. Although replication of our findings is needed, they suggest that GD prevention and treatment may contribute to reducing the burden of AD in U.S. older adults.
SUPPORTING PERSONS LIVING ALONE WITH DEMENTIA: FINDINGS FROM A PILOT STUDY
Authors: Gibson Allison , Pope Natalie , Hossain Mohammad
Published: December 2023

Older adults living alone with suspected cognitive impairment often have little-to-no support for conducting daily activities and may be more isolated from formal sources of support and healthcare services. As a result, many individuals living alone may receive delayed diagnosis of dementia compared to those that reside with others. The purpose of this study was to explore an innovative pilot program of case management services, Services to Age in Your Home (STAY Home), with local paramedicine services (interdisciplinary team of social work, law enforcement, and paramedics) that links this population to healthcare and social services through case management services in an urban area. While many participants were willing to engage in the pilot program, access to healthcare and social services remained challenging due to social service program waitlists, discomfort using formal services, distrust of losing autonomy, and limited financial resources contributed to barriers in pilot implementation. A biopsychosocial survey identified individuals needing cognitive testing (88.9%), support in managing medications and medication adherence (88.9%), unmet financial needs (77.8%), unmet healthcare needs (77.8%), difficulty managing finances (66.7%), challenges accessing transportation (55.6%), and unmet assistance needs for their ADLs (44.4%). Most individuals also reported limited social supports (i.e., neighbors, out-of-town relatives) with most relying on local formal services to address emergency needs. This presentation will include a discussion of ethical challenges for both conducting research as well as providing services to this low-resource population.
ENGAGEMENT OF NURSING HOME COMMUNITY EXPERTS TO MODIFY THE DIGNITY INTERVENTION
Authors: Behrens Liza , Kowalchik Kalei , Boltz Marie , Kraschnewski Jennifer
Published: December 2023

Voices of Nursing Home (NH) residents, family caregivers, staff and leaders (community experts) are underrepresented in research development but integral when developing interventions for implementation these complex organizations. This study aimed to explore opinions of NH community experts in the development of a novel person-centered risk management intervention for residents with dementia. Community engagement studios (CES) engaged 62 community experts to gain their perspectives on the DIGNITY (Decision-making in aging and dementia for autonomy) study procedures and instruments. CESs (N=4) were led by an experienced moderator and co-moderator, recorded, and transcribed verbatim. Content analysis was used to summarize responses in a rapid feedback loop. Descriptive statistics of standard measures describe community experts’ ratings of acceptability, appropriateness, and feasibility of DIGNITY intervention. Most community experts identified as female (85%), ranging from 22 - 86 years. Participants were residents with dementia (n=4); family caregivers (n=4); NH administrators (n=16), care manager/ supervisors (n=10), direct-care workers (n=6) licensed healthcare providers (n=6), other NH staff (n=8), ombudsman (n=4) and state surveyors (n=4). Community experts provided suggestions to adapt the study instruments and delivery methods. The study team made changes to all six intervention elements based on expert feedback. Most experts agreed that the DIGNITY intervention was acceptable (M=17.7, SD= 2.08), appropriate (M= 17.24, SD= 2), and feasible (M=16.91, SD= 2.22) to implement in the NH community. Results support practical modifications to the DIGNITY intervention to make it feasible to implement in an upcoming pilot clinical trial.
DAILY WORRY, RUMINATION, AND SLEEP IN LATE LIFE
Authors: Zhou Zexi , Birditt Kira , Leger Kate , Fingerman Karen
Published: December 2023

Perseverative thinking, including worry and rumination, is a common response induced by stress, and can be detrimental to well-being and health especially for older adults. Sleep may represent an important mechanism by which preservative thoughts affect health. Yet, limited research has investigated links between worry and rumination and their implications for sleep in late life. This study examines the associations between older adults’ everyday worry, rumination, and sleep. We leveraged the daily diary data over 5 to 6 days from the Daily Experiences and Well-being Study (N = 271, Mage = 73.62). Every evening, older adults reported worry and rumination they experienced that day. Every morning, they indicated how worried they were about something that might happen that day, and sleep the prior night (e.g., duration, quality, disturbances). Multilevel models showed that greater evening rumination was associated with fewer sleep disturbances. More hours of sleep, higher sleep quality, and fewer sleep disturbances were associated with less worry the next morning. Greater evening worry and rumination were both associated with greater next morning’s worry, but more hours of sleep buffered the lingering of worry over the night. These results suggest that worry and rumination may tend to persist in older adults’ daily life, and highlight the protective role that better sleep may play in reducing older adults’ everyday perseverative thinking.
RECOMMENDATIONS REGARDING THE DESIGN OF PAIN ASSESSMENT AND MANAGEMENT TOOL FOR OLDER ADULTS WITH HEART FAILURE
Authors: Kang Youjeong , Choi Yong Kyung , Oh Seung-Eun
Published: December 2023

Nearly 80% of all patients with heart failure (HF) are older adults (≥65 years of age) who are at high risk for frequent hospitalizations. Older adults with HF may delay in responses to pain that could trigger the burden of HF symptoms such as dyspnea due to the increased cardiovascular workload and oxygen demands. However, there is a concern that healthcare providers may be poorly prepared to assess and manage pain when reported by specific populations. This qualitative secondary analysis examined the design recommendations of HF providers for a comprehensive home-based pain assessment and management tool for older adults with HF. The study used in-depth interviews with 20 healthcare providers specializing in HF across different states. Participants provided various recommendations, including a checklist of questions about the patient’s past experience with pain, their living environment, and any activities that trigger pain. While some participants preferred electronic tools, such as an mHealth app, for data collection and analysis, they acknowledged the limitations of using technology for older adults. The tool should be straightforward, easy to navigate, and involve patients in the design process to ensure their motivation and buy-in. The tool should also consider the caregiver’s input. In conclusion, this study highlights the importance of a comprehensive assessment of pain symptoms and daily activities to provide personalized care for older adults with HF. The design recommendations provided by healthcare providers can aid in the development of a unique home-based pain assessment and management tool for older adults with HF.
BS GSA AND AGE JOINT SYMPOSIUM
Authors: Rogina Blanka , Anderson Rozalyn
Published: December 2023

Since 2020, BS GSA and American Aging Association (AGE) recognized the opportunity to present a joint session regularly at each organization’s national meeting. Given our unique positions in the field of aging research, we recognize the opportunity to advance each other’s missions and strengthen the ecosystem to advance translation of aging research into practice and policy. This symposium has been a resounding success and an ideal forum for early-stage investigators who seek to develop a program at the interface of basic and clinical research.
THE CELL “SURFACEOME”: A STRATEGY TO TARGET SENESCENT CELLS IN VIVO
Authors: Banarjee Reema , Dey Amit , Nyunt Thedoe , Gregg Jordan , Tsitsipatis Dimitrios , Herman Allison , Gorospe Myriam , Basisty Nathan
Published: December 2023

Senescent cell accumulation drives aging and related pathologies including metabolic disorders and neurodegeneration, and their selective elimination is a promising therapeutic approach to treat multiple diseases of aging in humans. However, developing drugs to eliminate senescent cells requires specific biomarkers to selectively identify and target these cells in vivo. In this study, we have performed a comprehensive and quantitative proteomic profiling of surface proteomes (surfaceomes) of senescent cells to identify potential senescence biomarker candidates in human tissues. We induced senescence using ionizing radiation in a variety of cell types including lung fibroblasts, monocytes, vascular smooth muscle cells, aortic endothelial cells and preadipocytes. Senescence was validated using a panel of canonical markers including reduced proliferation, increased senescence-associated β-galactosidase activity, and increased expression of p21, p16, IL6, and others. The cell surface proteome was enriched using an optimized surface biotinylation approach (Glyco-cell surface capture) followed by data-independent acquisition (DIA) LC-MS/MS analysis on a Q-Exactive HF Orbitrap mass spectrometer. Our analysis revealed novel cell surface targets that were further validated by flow cytometry and immunohistochemistry. These results provide clinically useful information for establishing biomarkers and therapeutic targets to aid in the translation of senescence-targeted therapies to treat age-associated diseases.
A PILOT STUDY OF EPIGENETIC AGING IN THE CONTEXT OF AN INTENSIVE LIFESTYLE INTERVENTION: THE LOOK AHEAD STUDY
Authors: Reynolds Lindsay , Espeland Mark , Howard Timothy , Langefeld Carl , Vitolins Mara , Wagenknecht Lynne
Published: December 2023

Type 2 diabetes and obesity increase the rate of accumulation of age-related health deficits and accelerate biological aging. An intervention promoting weight loss among adults with these conditions, the Action for Health in Diabetes (Look AHEAD) Intensive Lifestyle Intervention (ILI), attenuated health deficit accumulation measured by a frailty index, through a variety of diet and exercise strategies and optional weight loss medications to achieve and maintain ≥7% weight loss. To better understand the long-term effects of the Look AHEAD ILI on aging biology, we leveraged biospecimens from 62 women aged 60-71 years who participated in the Look AHEAD randomized clinical trial of ILI (n=32) and diabetes support and education (control condition, n=30), and tested for associations of ILI vs control condition on the rate of epigenetic aging. Five DNA methylation-based aging measures were generated from blood collected at baseline and 14 years later. Unexpectedly, the intervention was associated with a long-term increase in AgeAccelPheno compared to the control condition (t-test, p< 0.05). ILI was not associated with a change in other epigenetic measures over 14 years (AgeAccelHannum, AgeAccelHorvath, AgeAccelGrim and DunedinPACE), or a change in a frailty index reflecting accumulation of 38 health deficits. Overall, the average change in frailty index was higher among participants with advanced epigenetic age at baseline (AgeAccelHannum>0 and AgeAccelGrim>0,p < 0.05), suggesting that epigenetic aging markers may be useful predictors of frailty risk. Well-powered studies are needed to better understand the long-term impact of intensive lifestyle interventions on epigenetic aging in adults with diabetes and obesity.
BIOLOGICAL AGE REDUCTION AND LIFESPAN EXTENSION UPON YOUTHFUL CIRCULATION EXPOSURE
Authors: Zhang Bohan
Published: December 2023

We performed extended (3-month) Heterochronic Parabiosis (HPB), followed by a 2-month detachment period of anastomosed pairs. Old detached mice exhibited improved physiological parameters and lived longer than control isochronic mice. HPB drastically reduced the biological age of blood and liver based on epigenetic analyses across several clock models using multiple independent platforms; remarkably, this rejuvenation effect persisted even after 2 months of detachment. Transcriptomic and epigenomic profiles of anastomosed mice showed an intermediate phenotype between old and young, suggesting a global multi-omic rejuvenation effect. In addition, old HPB mice showed gene expression changes opposite to aging, but akin to several lifespan-extending interventions. Altogether, we reveal that long-term Heterochronic Parabiosis can decrease the biological age of mice, in part through long-lasting epigenetic and transcriptome remodeling, culminating in the extension of lifespan and healthspan.
CONDUCTING COMMUNITY-BASED GERONTOLOGY PROJECTS IN UNDERGRADUATE CLASSROOMS: CAPSTONE CASE STUDIES
Authors: Berkowsky Ronald
Published: December 2023

Collaborations between university-level students and community-based organizations have long shown to be mutually beneficial in that they can address pressing community needs, advance the mission of the organization, and enhance the learning of students. In this presentation, I describe project collaborations between a non-profit volunteer caregiving organization based in Ventura County (“Caregivers”) and Health Science undergraduate students (N = 76) enrolled in Capstone courses at California State University Channel Islands between 2022-2023. Projects were designed utilizing a community-based approach wherein the community partner (“Caregivers”) played an active and central role in determining project goals and outcomes. Four projects, each addressing and/or serving a specific need, were completed by different Capstone sections: (1) the creation of an online governance training program to educate high school and university students on the basics of leadership in nonprofits which serve older adults; (2) the creation of a series of videos to educate on and advocate for volunteer caregiving; (3) the analysis of quantitative and qualitative survey data to evaluate the experiences and satisfaction levels of local volunteer caregivers and care recipients; and (4) the creation of a toolkit to be used by volunteer caregiving organizations implementing community meal delivery programs for older adults. In this presentation, I detail each project along with their major successes and challenges as assessed through personal observation, feedback provided by the community partner, and student reflections. I conclude with discussing best practices in implementing community-based projects in undergraduate settings and describe the value of such projects across all stakeholders.
DEVELOPMENT AND VALIDATION OF PERSON-CENTERED MEALTIME CARE KNOWLEDGE AND SELF-EFFICACY ASSESSMENTS
Authors: Liu Wen , Suh Heather , Lee Kyu Ri , Coates Cameron , Buckwalter Kathleen
Published: December 2023

Person-centered mealtime care is individually tailored and directly delivered care that engages individuals in mealtime activities and addresses their needs and preferences. Person-centered mealtime care is associated with positive mealtime behaviors and outcomes in older adults with dementia. Existing tools that assess caregiver knowledge and self-efficacy of mealtime care have low psychometric quality, and few tools focus on person-centered mealtime care. This study developed and tested the Person-Centered Mealtime Care Knowledge and Self-Efficacy Assessments. The 20-item Knowledge Assessment (total score = 0-20, higher score = better knowledge) and 15-item Self-Efficacy Assessment (items are scored from 1 = strongly disagree to 5 = strongly agree; total score = 15 - 75; higher score = better self-efficacy) were developed based on literature and expert reviews and finalized based on content validity. Seventy-two nursing home direct care staff (n=72, age = 45±12.1 years; 8.5% male; 12.3% non-white; 93% provided dementia mealtime care; 89% experienced challenges during mealtime) completed the assessments. The two assessments showed adequate content validity (Scale-CVI = 0.95-1.00; item-CVI = 0.83-1.00) and acceptable-to-good internal consistency (Cronbach’s Alpha = .651 and .984 for Knowledge and Self-Efficacy Assessments, respectively). There was a weak and significant correlation between Knowledge and Self-Efficacy Assessments (rs = .262, p = .026). Findings provide preliminary psychometric evidence of the two assessments to measure caregivers’ knowledge and self-efficacy in providing person-centered mealtime care. Future validity testing and item-level testing using Item Response Theory is needed among larger populations of diverse caregivers to accumulate rigorous psychometric evidence.
EARLY DETECTION AND MANAGEMENT OF COGNITIVE IMPAIRMENT PRACTICES AMONG PRIMARY CARE PROVIDERS
Authors: Omura John , Patel Roshni , Olivari Benjamin , McGuire Lisa
Published: December 2023

Primary care providers (PCPs) play a critical role in the early detection and management of cognitive impairment and dementia. Understanding their current practice patterns can help identify potential areas of need for additional support. Using 2022 DocStyles survey data (n=1,182), this study assessed US PCPs’ confidence levels in identifying symptoms of cognitive impairment and the actions they take when identifying a patient with cognitive impairment. In terms of their ability to identify symptoms of cognitive impairment, 22.3% of PCPs reported being very confident, 53.2% somewhat confident, 18.3% slightly confident, and 6.2% not at all confident or did not know. PCPs reported taking a variety of actions when they identify a patient with symptoms of cognitive impairment: 70.1% assess for potential underlying causes, 69.4% review medications, 65.7% conduct a cognitive assessment or test, 59.7% refer to a neurologist or other specialist, 43.3% coordinate with a care team, and 20.9% refer to community resources. Compared to PCPs who were very or somewhat confident, those who were slightly or not at all confident were less likely to report taking each action (e.g., 35.1% vs. 75.4% conduct a cognitive assessment or test, respectively), except for being more likely to refer to a neurologist or other specialist (68.8% vs. 56.9%) (p< 0.001). PCP practices in early detection and management of cognitive impairment vary by their confidence level. Findings can inform the development of resources to help increase PCPs’ confidence and support their practices in early detection and management of cognitive impairment and dementia.
DIFFERENTIAL ASSOCIATIONS OF HAND GRIP STRENGTH AND CHAIR STAND TIME WITH INDOOR AND OUTDOOR FALLS AMONG OLDER ADULTS
Authors: Li Wenjun
Published: December 2023

Hand grip strength and chair stand time are physical performance measures that are predictive of frailty and muscle strengths in older age. We examined their associations with indoor and outdoor falls among older adults. The Healthy Aging and Neighborhood Study enrolled 397 community-dwelling older adults aged 65-95 years old in Central Massachusetts (2018-2020). Hand grip strength (in kilograms) and chair stand time (in seconds) were measured at baseline by trained research staff. Falls were reported on monthly falls calendar, and when a fall was reported, the circumstances were collected via telephone interview. Negative binomial regression models were used to estimate the associations of hand grip strength and chair stand time with both indoor and outdoor falls, separately. Models were adjusting for sex, age, BMI, bodily pain, comorbidities, ADL and IADL as appropriate. Overall, annual rates (95% CI) of indoor and outdoor falls were 40.2 (33.7-47.6) and 45.3 (38.4-53.1) per 100 person-years respectively. Stronger hand grip strength was associated with lower rate of indoor falls (IRR (95% CI): 0.94 (0.91-0.98) per kilogram). Longer chair stand time was associated with higher rate of indoor falls (IRR (95% CI): 1.06 (1.03-1.09) per second). There was no significant association of outdoor falls with grip strength (p=0.504) or chair stand time (p=0.430). In conclusion, hand grip strength and chair stand time were predictive of indoor falls but not outdoor falls. Future studies should examine the underlying mechanisms of such differential associations indoor vs. outdoor falls.
TRENDS IN DEPRESSION AND ANXIETY AMONG OLDER ADULTS ACROSS COVID-19 PANDEMIC PHASES
Authors: Hughes Tiffany , Wang Yueting , Song Ruopu , Jacobsen Erin , Chang Chung-Chou , Ganguli Mary
Published: December 2023

The effect of the COVID-19 pandemic on older adults’ mental health is especially salient given their increased vulnerability to the pathologic and social effects of both the disease and also the associated mitigation strategies. The purpose of this research is to examine trends in symptoms of depression and anxiety among older adults during two phases of the pandemic (pre- and post-vaccine in study region) compared to before the pandemic began. Data were from a longitudinal cohort study of adults aged 65 and older spanning 26 months prior to the pandemic (phase 1) through 17 months after the pandemic began (9 months pre-vaccine (phase 2) and 8 months post-vaccine (phase 3)). Interrupted time series analyses were used to test for differences in trends over time in depressive symptoms (log-mCES-D) and anxiety symptoms (log-GAD-7) during these phases. Trends in both depressive symptoms and anxiety significantly increased in phase 2 compared to phase 1, then significantly decreased in phase 3 compared to phase 2. The trend for depressive symptoms and anxiety in phase 3 was not significantly different than phase 1. These findings suggest that older adults’ mental health significantly worsened during the phase of the pandemic when a vaccine was unavailable, but returned to pre-pandemic estimates after a vaccine was available. Future studies are needed to unpack the contribution of vaccine availability and other factors to changes in mental health observed among older adults during the pandemic.
TRENDS IN DESPAIR-RELATED CONDITIONS: A LOSS OF MENTAL HEALTH AND HOPE IN THE US 1995–2014
Authors: Bardo Anthony , Yamashita Takashi
Published: December 2023

The Deaths of Despair (DoD) narrative posits that increased prevalence of pain, psychological distress, and drug/alcohol misuse are linked to increased mortality rates among poor non-Hispanic whites in midlife. While data limitations prevent empirically linking these conditions with DoD mortalities, understanding whether period shifts in mental health and/or hope underly their increased prevalence is needed to inform program and policy directives. The present study used two waves (1995-1996 and 2011-2014) of the Midlife in the United States (MIDUS) study to examine trends in the association between these despair-related conditions with mental health and hope by age, race/ethnicity, and socioeconomic status (SES). Mental health was measured by the Complete Mental Health Continuum, and the negative end of this spectrum (i.e., languishing) was used as a proxy for “despair.” SES was based on an innovative index that is comparable across waves. Logit models with a despair x hope interaction term were used to identify demographic-group-specific period shifts. Results show that increased prevalence in these despair-related conditions is concentrated among low-SES groups, and standard decomposition techniques show that the largest drivers of an increased prevalence among these low-SES groups differs by race/ethnicity: among non-Hispanic whites it was a combination of despair and hopelessness, but hopelessness was the primary driver among racial/ethnic minorities. Findings are useful for targeting vulnerable groups in midlife and informing programs and policies to combat rising levels of pain, psychological distress, drug/alcohol misuse and related premature deaths.
WHICH MEASURES OF STRESS ARE ASSOCIATED WITH ACCELERATED BIOLOGICAL AGING?
Authors: Bourassa Kyle , Caspi Avshalom , Moffitt Terrie
Published: December 2023

Stress and stressful events are associated with poorer health. There are multiple approaches to measure stress—from assessing subjective perceptions of stress to assessing the development of posttraumatic stress disorder (PTSD)—and multiple periods that can be assessed across the lifespan. How might stress result in poorer health? One plausible physiological mechanism is accelerated biological aging, which precedes many poor health outcomes. Our study tested which measures of stress were associated with accelerated biological aging in adulthood using 955 participants from the Dunedin Longitudinal Study. The measures of stress included perceived stress, stressful life events, adverse childhood experiences (ACEs), and PTSD assessed between ages 32 to 45 years and accelerated biological aging in midlife was measured using the Pace of Aging. Higher levels of all four stress measures were significantly associated with accelerated aging in separate models (all βs > 0.14, all ps < .001). In a combined model, more perceived stress and more stressful life events remained associated with faster aging and together the four stress measures accounted for 7% of the variance in biological aging. The magnitudes of the associations between the four measures of stress and biological aging were comparable to associations for smoking and low education, two established risk factors for accelerated aging. Assessing stress, particularly perceived stress, could help identify people at risk of accelerated aging. Stress perceptions could be a potentially modifiable treatment target to slow the rate at which people are aging, with the goal of improving health as people age.
MITOCHONDRIAL DNA COPY NUMBER IS ASSOCIATED WITH PHYSICAL FUNCTION
Authors: Tian Qu , Zweibaum David , Qian Yong , Oppong Richard , Ding Jun , Ferrucci Luigi
Published: December 2023

Mitochondria generate the energy required by cells to maintain functionality and muscle health. They may play a key role in age-related physical function decline. Skeletal muscle mitochondrial function is associated with gait speed and muscle strength. Blood-derived mitochondrial DNA copy number (mtDNAcn) is a biomarker of mitochondrial health, but its association with physical function is unclear. We examined cross-sectional associations of mtDNAcn estimated by whole genome sequencing with gait speed and grip strength in participants aged 50+ from two population-based studies: Baltimore Longitudinal Study of Aging(BLSA,n=688) and UK Biobank(n=150,448). Gait speed was measured using 6-meter walk in BLSA and self-reported walking pace in UK Biobank. Handgrip strength was measured using a hand dynamometer. We additionally tested sex differences because of known sex differences in gait speed and grip strength. We found that higher mtDNAcn was associated with faster gait speed and greater grip strength, after adjustment for age,sex,race,and autosomal coverage. Specifically, each standard deviation increase in mtDNAcn was associated with a 0.05 m/sec faster in gait speed and a 19% lower odds of reporting slow walking pace(both p< 0.0001). There was no significant sex-by-mtDNAcn interaction for gait (both p>0.05). There was a significant sex-by-mtDNAcn interaction for grip strength. In sex-stratified analysis, the association with grip strength was stronger in men (β=0.129,p=0.002;β=0.032,p< 2e-16,respectively) than in women (β=0.007,p=0.784;β=0.015,p< 2e-16,respectively). These findings suggest that blood-based estimate of mitochondrial function is related to physical function in community-dwelling middle-aged and older adults. Further research is needed to understand its relationship with physical function decline and underlying mechanisms.
RACE AND PLACE: PHYSICAL PERFORMANCE DECLINES IN BLACK AND WHITE OLDER ADULTS IN FOUR US COMMUNITIES
Authors: Windham B Gwen , Windham William , Sylvester Hunter , Sharrett A Richey , Skow Laura , Palta Priya , Kucharska-Newton Anna , Griswold Michael
Published: December 2023

Studies suggest disparities in physical function between Black and White adults, but most lack longitudinal, objective functional measures across race and geographic regions. We examined Short Physical Performance Battery (SPPB) changes among 5,836 Black and White older adults (>65 years, 22% Black, 41% men) with up to three SPPB assessments. Exams were conducted in the Atherosclerosis Risk in Communities Study (Visit 5 (2011-13)-Visit 7 (2017-19), median follow-up 5.8 years (max 8.4)) in four US communities: North Carolina (n=1248; 7% Black), Mississippi (n=1179, 100% Black), Maryland (n=1618; 0.9% Black) and Minnesota (N=1791; n=0.5% Black). A difference of 0.5 SPPB points (scored 0-12) is clinically meaningful. SPPB declines were estimated using marginal standardization following GEE (with log-links, negative binomial distributions, exchangeable covariance, robust SE, adjusting for demographics, BMI, diabetes, hypertension, smoking, drinking status, heart failure, heart disease, and stroke). SPPB declines were 3.4 times greater among Black versus White participants overall; -1.99 versus -0.59 points; absolute difference=-1.41 (95% CI: -1.67,-1.14), relative difference=3.40 (2.65, 4.15). However, some within-race, between-site differences were similar; Maryland-White SPPB declines were 3.8 (2.3, 6.3) times greater than North Carolina-White SPPB declines, and Mississippi-Black declines were 2.5 (1.10, 5.90) times greater than North Carolina-Black declines. Furthermore, between-race (Black versus White) differences were less supported statistically within the same site; SPPB declines were 2.2 (0.85, 5.80) greater in Black than White participants in North Carolina. This suggests that regional variations in physical function declines may be at least as strong as differences attributed to race; both are important to consider.
GENETIC EPIDEMIOLOGY OF ANKLE BRACHIAL INDEX IN THE LONG LIFE FAMILY STUDY
Authors: Ressler Deidra , Cvejkus Ryan , Daw Warwick , Feitosa Mary , Murabito Joanne , Minster Ryan , Zmuda Joseph , Kuipers Allison
Published: December 2023

The genetic influence on peripheral vascular health in exceptional aging has not been well-studied. Thus, we performed heritability, genome-wide linkage analyses (GWLA) and genome-wide association studies (GWAS) of ankle-brachial index (ABI) and peripheral artery disease (PAD) in 3006 individuals from the Long Life Family Study (LLFS). The LLFS is a longitudinal, family-based study including long-lived siblings and their families. ABI was measured in-home, and the minimum from both sides was used, with exclusions for ABI≥1.4 or non-compressible arteries. PAD was defined as ABI<0.9. We performed heritability and GWLA using SOLAR and GWAS using R accounting for familial relationships. Our full model was adjusted for age, sex, site, significant PCs, blood pressure, and relevant risk factors including smoking, body size, and lipids. We considered significance at a LOD≥3.0 for GWLA and at a p<5x10-8 for GWAS. The proband generation was 53.2% female, aged 88.7 and had a mean ABI of 1.06. The offspring generation was 60.1% female, aged 60.1 and had a mean ABI of 1.19. 18.2% of probands and 1.0% of offspring had PAD (7.4% overall). Residual genetic heritability was 0.12 (p=8.7x10-4) for ABI and 0.23 for PAD (p=0.0662). We found linkage with chromosome 15q12 (LOD=3.65) for ABI and association on chromosome 4q25 (rs12512857; p=6.25x10-8; ANK2; maf=0.021) for PAD. ANK2 is a gene that has been implicated in cardiac dysfunction though there have been no previous associations with ABI or PAD. This suggests that unique genetic variation is associated with peripheral vascular health in long-lived families.
ALL-CAUSE MORTALITY AND CAUSE OF DEATH IN US LONG-LIVED SIBLINGS: DATA FROM THE LONG LIFE FAMILY STUDY
Authors: Yao Shanshan , Boudreau Robert , Galvin Angéline , Murabito Joanne , Honig Lawrence , Christensen Kaare , Newman Anne
Published: December 2023

This study compared the mortality risk of long-lived siblings with the general population in the US and investigated the leading causes of death and the correspondence in age at death and causes of death between long-lived siblings. In the Long Life Family Study (LLFS), 1,264 siblings (Mean age 90.1, SD 6.4) were recruited from the US and followed over 12 years. Their survival function, based on the Kaplan-Meier estimator, was compared with an age-, race-, and sex-matched sample from US census data. To examine underlying and contributing causes, we examined in detail 338 deaths with complete death adjudication using death certificates, family interview, hospital and nursing home records at the Pittsburgh field center through the year 2018. Concordance between siblings was examined using correlation coefficients, Bland-Altman plots, percent agreement, and Kappa statistics. The LLFS proband siblings had better survival compared with US general population matched on birth cohort and age at enrollment. Age at death ranged from 75-104, mean 91.4 (SD 4.8). The leading causes of death were cardiovascular disease (33.1%), dementia (22.2%), and cancer (10.7%). In addition, we did not find significant correspondence in the age at death, the underlying cause of death, or conditions directly contributing to death between siblings. Our findings demonstrate further exceptional longevity in the LLFS proband generation compared to the general population, but do not show significant correspondence in age at death and causes of death between siblings.
EFFECT OF A HOME-BASED EXERCISE PROGRAM ON SUBSEQUENT FALLS IN OLDER ADULTS WITH COGNITIVE FRAILTY
Authors: Liu-Ambrose Teresa , Falck Ryan , Davis Jennifer , Khan Karim , Madden Kenneth
Published: December 2023

Cognitive frailty is characterized by concurrent physical frailty and mild cognitive impairment. and increases the risk for falls. Whether exercise can reduce falls in older adults with cognitive frailty is unknown. We examined the effects of a home-based exercise intervention on subsequent falls among community-dwelling older adults with cognitive frailty and a history of falls. A secondary of a 12-month randomized controlled trial among older adults aged ≥70 years with a fall in the last 12 months. Participants were randomized to either 12 months of home-based exercise (EX; n=172) or usual care (UC; n=172). For this analysis, we only included participants who were classified as cognitively frail based on a Short Physical Performance Battery (SPPB) score ≤ 9/12 and a Montreal Cognitive Assessment score < 26/30. Our primary analysis examined the effect of EX on self-reported falls over 12 months. The secondary analysis examined whether higher exercise adherence, or dose, benefits physical frailty among the EX participants. At baseline, 192 participants were classified as cognitively frail (EX=93; UC=99). Falls rates were lower in EX participants vs. UC participants (IRR=0.65; p=0.042). At 12 months, in the EX group, SPPB score was significantly higher among participants with high adherence vs. those with low adherence (estimated mean difference: 1.22; p=0.004). Exercise is a promising strategy for reducing subsequent falls in older adults with cognitive frailty and a history of falls. Greater exercise adherence, or dose, may reduce physical frailty in this population at high risk for disability.
EFFECTS OF INTERPERSONAL AND INTRAPERSONAL PROMOTION STRATEGIES ON FALLS: A PHYSICAL ACTIVITY TRIAL
Authors: McMahon Siobhan , Wyman Jean , Guan Weihua , Choma Elizabeth , Hayes Shannon , Wang Qi , Rothman Alexander , Lewis Beth
Published: December 2023

Although fall-reducing physical activity (PA) interventions have promising effects on falls, little is known about the relative effects of different PA promotion strategies within such interventions. This trial assessed the effects of two promotion components within a PA intervention on participants’ falls 12 months post-intervention. The components included interpersonally-oriented (e.g., social support, social comparison) or intrapersonally-oriented (e.g., goal-setting, action planning) behavior change strategies informed by empirical evidence and theory. In this 2x2 factorial trial (Ready-Steady3 [RS3]),309 community-dwelling older adults (mean age 77+/-5) with > 1 fall risk factor were randomized to 1 of 4 intervention conditions. Factors represented random assignment (No, Yes) to interpersonal or intrapersonal components. All intervention conditions included the Otago Exercise Program adapted for small groups and a PA monitor (Fitbit) and were delivered in community settings over 8 weekly meetings, 90 minutes each. We assessed fall rates using participants’ documentation of falls on prospective monthly calendars. The main and interaction effects of interpersonal and intrapersonal components on fall rates were examined using negative binomial regression. The estimated fall incidence rates among participants assigned vs. those not assigned to the interpersonal component or the intrapersonal components, respectively, were:1.0 (+/-1.4) and 0.9 (+/-1.3), and 1.1 (+/-1.6) and 0.9 (+/-1.1) per person-year. Neither the main nor the interaction effects of either component were statistically significant, suggesting that interpersonal and intrapersonal components in RS3 PA interventions did not affect fall rates. Further investigation is warranted to identify which promotion strategies and dosages reduce falls and injuries in community-dwelling older adults.
AGE-BASED ENTITLEMENT: AN AGEIST PRACTICE OR A TOOL FOR COMBATTING AGEISM?
Authors: Harnett Tove , Jönson Håkan
Published: December 2023

Researchers in gerontology have addressed the way age-based arrangements may communicate stereotypical and devaluing images of older people, thereby linking high age to frailty and dependence. The present article considers proposed reforms to the Swedish eldercare system designed to guarantee people over 85 the right to move into a nursing home regardless of their needs. The purpose of the article is to investigate older people’s views on age-based entitlement in light of this proposal. What might the consequences of implementing the proposal be? Does it communicate devaluing images? Do the respondents consider it a case of ageism? The data consists of 11 peer group interviews with 34 older individuals. Bradshaw’s taxonomy of needs was used to code and analyze data. Four positions on the proposed guarantee were identified: care should be arranged: (1) according to needs, not age; (2) according to age as a proxy for needs; (3) according to age, as a right; and (4) according to age, to combat “fourth ageism”, meaning ageism directed towards frail older persons with care needs, i.e. persons in the fourth age . The notion that such a guarantee might constitute ageism was dismissed as irrelevant, while difficulties in getting access to care were presented as the real discrimination. It is theorized that some forms of ageism posited as theoretically relevant may not be experienced as such by older people themselves.
RETIRING TO POVERTY: VETERANS’ PROTESTS FOR NONPAYMENT OF PENSIONS IN NIGERIA
Authors: Chidebe Runcie , Agha Agha A , Ugwu Ejike , Narine Donnette , Yamashita Takashi , Cummins Phyllis
Published: December 2023

The lack of satisfactory retirement plans coupled with poor retirees’ well-being has led to the introduction of different pension and social security policies in Nigeria. Of all the public servants impacted by the weak pension system, Nigerian veterans are the most vulnerable. Veterans spent their youthful years serving the nation and defending its territory; however, when they retire, they retire to poverty. Since 2015, Nigerian veterans have been staging protests and blocking access roads for non-payment of pensions, gratuities, and other allowances. We adopted a qualitative research approach and used content analysis to examine 45 news articles (2015-2022) related to veterans’ protests for non-payment of pensions in Nigeria. A semi-structured interview was conducted with ten veterans. Our findings show the protests were perceived as the last resort to ‘save their lives’ from poverty and ill health. Non-payment of pensions to veterans in Nigeria has a negative socio-psychological impact on the veterans, their families, and the country. Some of the protest placards read: “We have sacrificed our youthful years fighting for Nigeria, we should be celebrated’, “When we remember the dead, we should also remember the living”. Some quotes from the interviews are: “We’re here, alongside our wives and children, and the widows of late military personnel and veterans who died in service, some of whom died fighting Boko Haram terrorists. We’ll be sleeping over at this place until they…accede to our demands.” Veterans organize themselves in diverse groups. Our findings provide evidence to support improved pensions for veterans in Nigeria.
THE SPILLOVER EFFECTS OF COMPREHENSIVE CARE FOR JOINT REPLACEMENT (CJR) MODEL: A STUDY FROM CALIFORNIA
Authors: Kim Narae , Jacobson Mireille
Published: December 2023

In 2016, Medicare implemented the Comprehensive Care for Joint Replacement (CJR) program to test whether paying hospitals a bundled payment for 90 days of an episode of care for lower extremity joint replacement (LEJR), the most common surgery for Medicare beneficiaries, can improve care coordination and quality in traditional Medicare (TM). Unlike most Medicare alternative payment models, CJR participation was randomly assigned across Metropolitan Statistical Areas (MSAs). Hospitals in selected MSAs were required to participate in the program, while hospitals in other MSAs were paid in the usual fee-for-service manner. Taking advantage of this random assignment, we examined CJR’s direct effects on TM patients and spillover effects on Medicare Advantage (MA) and non-Medicare patients in California. Using California’s Patient Discharge Data (PDD) from 2014 to 2017and event study and difference-in-differences models, we studied changes in adjusted length of stay and home discharge rates before and after program implementation in hospitals in treated versus control MSAs. We found that the CJR program affected not only TM patients, but also untargeted MA and non-Medicare patients. Both TM and non-Medicare patients in treated hospitals experienced shortened length of stay (-3.9% & -1.3%, p<0.05) and increased likelihood of discharge home (3.4%, 2.3%, p< 0.001) relative to those in untreated hospitals after program implementation. MA patients experienced an increase in not only home discharge rates (4.7%, p< 0.001) but also length of stay (2.5%, p< 0.01). Programs designed to affect Medicare costs have the potential to affect the care of patients not covered by the program.
DEVELOPMENT OF A CULTURALLY TAILORED COST MANAGEMENT INTERVENTION INFORMED BY CAREGIVER VOICES
Authors: Benton Donna , Mage Susanna , Wilber Kathleen , Meyer Kylie
Published: December 2023

Caregivers spend an average of 20% of their annual household income on out-of-pocket caregiving costs. Yet, no evidence-based interventions help family caregivers manage these expenses and financial stressors. Responses to financial strain must be culturally tailored to Latino family caregivers, whose out-of-pocket care costs comprise nearly half their annual household income. This presentation describes the development of the CONFIDENCE Financial Education Intervention, a 5-week psychoeducational intervention informed by the Resourcefulness and Quality of Life Theory and made to address the needs of Latino family caregivers. To ensure CONFIDENCE was responsive to the needs of Latino caregivers, the investigators 1) conducted 11 qualitative in-depth interviews with caregivers to learn about their experiences managing care costs and 2) convened a community advisory council of Latino family caregivers to guide intervention components, content, and delivery. Council recommendations guided multiple intervention modifications. For example, based on these recommendations from the council, the investigator team expanded the intervention’s target audience from focusing on women to including caregivers of all genders so families could participate together (familialism). Findings from the interviews and the council overlapped. During interviews, caregivers reported feeling worried about the growth of future caregiving costs increasing; similarly, the council described the importance of helping caregivers understand how costs would change throughout the disease trajectory. Caregiver interviews and the advisory council also emphasized the importance of addressing the needs of middle-income caregivers to prevent future financial adversity. By integrating the caregiver voices, we developed an intervention tailored to meet the needs of Latino families.
PRELIMINARY RESULTS OF THE CONFIDENCE FINANCIAL INTERVENTION FOR CAREGIVERS TO PERSONS LIVING WITH DEMENTIA
Authors: Meyer Kylie , Zauszniewski Jaclene , Song Lixin , Benton Donna
Published: December 2023

Family caregivers to persons living with dementia experience high out-of-pocket costs of care that contribute to material and psychological hardship and can undermine current and future financial security. Latino/Hispanic family caregivers pay nearly double the out-of-pocket costs relative to non-Latino/Hispanic caregivers. CONFIDENCE is a 5-week psychoeducational intervention designed to help caregivers manage out-of-pocket caregiving costs and psychological strain by equipping caregivers with resourcefulness skills and building their self-efficacy in managing care costs. The intervention is culturally tailored to meet the needs of Latino/Hispanic family caregivers. The investigators are conducting a single-arm pre-and post-test trial to determine the preliminary efficacy of the CONFIDENCE intervention among Latino/Hispanic family caregivers to persons living with dementia (NCT05292248). Preliminary results from the first ten study participants, completed as a part of planned interim analyses, indicate a positive change in the hypothesized direction for each study outcome from baseline survey to follow-up surveys, completed within two weeks of program completion. Caregivers who participated in CONFIDENCE reported increased levels of resourcefulness (M=85.1[SD=7.0] vs. M=97.5[SD=5.6], p-value=0.02). We also observed higher levels of caregiver self-efficacy post-intervention (M=40.4[SD=6.0] vs. M=57.2[SD=6.6], p-value<0.001). Lastly, preliminary analyses suggest reduced levels of psychological financial strain following intervention (M=18.3[SD=4.2] vs. M=8.6[SD=2.7], p-value=0.04). Initial results suggest that psychoeducational intervention may prepare caregivers to manage high out-of-pocket care costs. After completing data collection, the study team will examine how intervention participation may affect out-of-pocket caregiving costs. In future studies, we will consider the potential mediating roles of resourcefulness and self-efficacy on study outcomes.