bluuebunny/crossref_metadata_2025 huggingface dataset:
WHAT WORKS AND WHAT IS MISSING: A PRECEPTOR AND AGENCY PERSPECTIVE
Authors: Greenberg Phyllis , Danielson Jodi
Published: December 2023

As has been discussed, the population of older adults is growing at a rapid pace and the need for staff in residential environments has grown to a crisis situation. Agencies are in dire need of staff at all levels from CNAs to nurses, social workers and administrators. There is an opportunity for agencies to help train the new generation of age savvy staff by working with universities to provide hands-on experience such as internships, practicum, and field work. This presentation examines the preceptor and community agency perspective of working with students interested in aging. We explore how to achieve a win/win/win/win experience (student, preceptor-agency/university/older adult). The presenters represent a agency preceptor and a preceptor-faculty member. Key areas for consideration include: 1) Experience/education of students; 2) Time commitment for preceptors/ agencies; 3) Agency and university support for preceptors; 4) Support for students from preceptors, agencies and the university; 5) Flexibility in responsibilities and scheduling between agencies, preceptors, and students; and 6) Ensuring that the experience is valuable to both students and agencies. Presenters will discuss strategies for meeting the needs of students and agencies while at the same time meeting the requirements of the university. These strategies include student involvement in day-to-day activities, as well as projects, teaching moments, providing support to preceptors as well as on-going communication and feedback. The goal is to provide an environment (both agency and university) that fosters growing an age savvy workforce.
TRADITIONAL AND NONTRADITIONAL INTERNSHIPS: A GERONTOLOGY STUDENT’S PERSPECTIVE
Authors: VanderWerf Jessica
Published: December 2023

Today’s gerontology students are more diverse than ever. Some come to the classroom with little to no experience working with older adults, while others are looking for further education and/or credentials to add to their employment and career opportunities. Both traditional (e.g., nursing homes, senior centers) and non-traditional internship settings (e.g., research, teaching) are examined in regard to providing students with experiences that will enhance their knowledge, career development, and/or future academic goals. As both an undergraduate minor and a Master’s level gerontology student, the presenter discusses their own non-traditional internship experiences that helped them to reach their goal of pursuing a doctoral degree in aging studies. Feedback gathered from other students in a variety of internship types is also presented. Finally, lessons learned, finding the right fit, and the overall value of internships and similar experiences is discussed from a student perspective.
READY OR NOT: A DRAMA THERAPY STUDENT’S PERSPECTIVE ON WORKING WITH OLDER ADULTS
Authors: Hafner Camryn
Published: December 2023

Drama therapy has the potential to positively influence the lives of older adults in many facets, i.e., improving self-perceptions of aging (Dokter & Sajnani, 2023), attention, depressive symptoms, and overall quality of life (Lin et al., 2022). But drama therapists may also inadvertently cause harm, reenacting narratives of infantilization and indignity, or reinforcing the socially prescribed roles available to older adults (Dokter & Sajnani, 2023). Training and education may minimize harm and maximize positive outcomes; however, despite growing numbers of drama therapists and drama therapy interns working with older populations, the training of drama therapists minimally reflects this shift. Currently, a total of 800 internship hours, representing work with at least two distinct populations, are required to graduate from New York University with a Master of Arts in Drama Therapy and to qualify for a provisional license. While older adults may represent one of these populations, no courses in aging are required. One elective course, Drama Therapy and Aging: From Midlife to Elderhood, is offered once every two years. In a two-year program, this course may only become available after a student has begun their fieldwork. In this presenter’s case, the aging elective was taken concurrently with the start of her fieldwork at an assisted living facility working with persons living with dementia on a secured unit. Benefits and limitations of this student’s preparation to provide successful therapeutic experiences for individuals in this environment are considered, as well as the perceived implications for their future career as a drama therapist.
GETTING OLDER ADULTS INVOLVED IN CLIMATE CHANGE INITIATIVES: REFRAMING AGING AS A POTENTIAL APPROACH
Authors: Diehl Manfred
Published: December 2023

In the context of climate change, older adults are often solely portrayed in terms of vulnerability and victimization. Although older adults’ vulnerability to the growing effects of climate change and natural disasters is an important topic, this presentation focuses on how to get older adults involved in climate change initiatives and as advocates for the adoption of climate-friendly behavior. The presentation argues that getting the growing population of older adults actively involved in issues of climate change requires moving away from a deficit- and loss-focused view of later adulthood. Instead, a new narrative about aging needs to be adopted, recognizing the many contributions older adults can make to addressing the global climate crisis. These contributions arise out of concerns for the health and well-being of the next generations and draw on older adults’ legacy thinking, lifelong experiences, professional expertise, and ability to work in multigenerational contexts. Such a new narrative recognizes and supports older adults as a “natural resource” and important “human capital.” The presentation will conclude with a discussion of the challenges to get older adults involved in climate change initiatives and with a description of several exemplary programs that have already generated foundational knowledge in this domain.
SLEEP AND FREQUENT HOSPITALIZATIONS AT THE END OF LIFE FOR INDIVIDUALS WITH DEMENTIA
Authors: Klingman Karen , Sullivan Suzanne
Published: December 2023

Older adults near end-of-life (EOL) are at risk for experiencing non-beneficial hospitalizations, negatively impacting their quality of life. Reasons for frequent hospitalizations include poorly managed symptoms of progressing chronic illnesses, many of which are exacerbated by poor sleep, and may differ depending on presence of dementia. This study characterized sleep for groups with and without frequent (two-or-more) hospitalizations in the final year of life using the National Health and Aging Trends Study. A subgroup of persons living with dementia (PLWD) was also explored. Means for difficulty falling asleep, trouble falling back to sleep, and use of sleep medications were compared for groups with and without frequent hospitalizations via one-tailed t-tests. Association between dementia and frequent hospitalizations was explored via Pearson Chi-Square. Individuals at EOL (n=529, 56% female, 68% white non-Hispanic, average age 80-85, 57% PLWD) were included, and 22% had frequent hospitalizations. Among the entire sample, those with frequent hospitalizations had worse sleep (more trouble falling back to sleep, p=.032, Cohens-d=.2). Sleep was also worse for those without dementia, but with frequent hospitalizations (difficulty falling back to sleep, Cohens-d=.3, p=.02) compared to those without frequent hospitalizations. There was no association between frequent hospitalization and presence of dementia (chi-square=.868 p=.352). However, the PLWD subgroup had worse sleep than those without dementia (difficulty falling asleep Cohens-d=.15, p=.04; use of sleep medications Cohens-d=.26, p=.002), yet sleep did not differ depending on frequent hospitalizations. These results indicate that further investigation into the relationship between dementia, sleep, and frequent hospitalizations at EOL is warranted.
“NO FEAR, ALL FAITH”: RELIGIOUS COPING AND COVID-19 VACCINE HESITANCY AMONG OLDER AFRICAN AMERICANS
Authors: Skipper Antonius
Published: December 2023

While COVID-19 had a devasting impact on many groups across the globe, older African Americans were especially affected by the disproportionate rates of morbidity and mortality associated with the virus. Faced with “double jeopardy” - the nature of being both old and Black - older African Americans were at an increased risk of COVID-19-related infection and death due to their age and factors associated with ethnicity (e.g., access to resources, distrust of healthcare). These risks led many health professionals to prioritize COVID-19 vaccine uptake for older African Americans. However, historically and contemporaneously, African Americans report some of the highest levels of vaccine hesitancy in comparison to other ethnic groups. Many older African Americans use religious coping as a source to alleviate the stress of health threats. Yet, the novelty of COVID-19 contributed to a limited understanding of how and why vaccine hesitant older African Americans used religious coping in response to the pandemic. The present study gathered qualitative data from 22 vaccine hesitant older African Americans to describe the role of religious coping in vaccine hesitancy. Data were analyzed using thematic analysis and inductive coding methods. Analyses identified several salient themes relative to religious coping and COVID-19 vaccine hesitancy, including (1) No Fear, All Faith, (2) Prayer Protects my Peace, and 3) My Faith Justifies my Hesitance. As vaccine uptake remains important for both older adults and African Americans, implications from this study highlight important considerations for navigating the nexus of religion and health with highly religious populations.
AGING AND HEALTH IN THE CARIBBEAN REGION: AN OVERVIEW OF THE STATE OF RESEARCH
Authors: Quashie Nekehia Tamara
Published: December 2023

The Caribbean region is undergoing rapid population aging. While there is diversity in the pace of population aging among countries within the region, there are some shared population health challenges including the increasing prevalence of chronic non-communicable diseases and the inequalities therein. Relatedly, many Caribbean countries do not have well-established long-term care systems. Therefore, older adults primarily rely on informal care and support mainly from family members, which has implications for the health of older adults and their caregivers. Although Caribbean populations are understudied within gerontology, there is a growing body of research. This presentation provides an overview of the existing state of research on the social determinants of health among older adults within Caribbean societies and discusses directions for future research.
EXPLORING AI ELDERS’ CULTURAL PERCEPTIONS OF DISASTERS AND THE ROLE OF GENERATIVITY IN PREPARING FUTURE GENERATIONS
Authors: Thompson Lena , Buch Elana , Ashida Sato
Published: December 2023

Natural and man-made disasters have a great impact on human health, especially for AI Elders. As keepers of cultural and community knowledge, AIAN Elders also serve as guides on how to best support their communities. This study focuses on a Midwestern Tribe’s cultural perceptions of disaster management, specifically being generative, or passing down disaster management knowledge and practices to future generations. In-person semi-structured interviews were conducted with eighteen Elders from the Midwestern Tribe. Recordings were transcribed, de-identified, and coded thematically using an interpretive phenomenological analysis approach. The study received approval from the Tribe’s Department of Emergency Management and the interview guide was reviewed and approved by a Community Advisory Board of six individuals. Elders described past experiences with natural and man-made disasters, including what they did before, during, and after disasters. Elders also explained how people cared for one another, including the importance of interconnectedness with all beings, caring for grandchildren, and the role of the Tribal Government in disaster management. Elders also described how culture shaped disaster management practices, such as traditional practices to follow during a storm, and the important role of Elders in teaching communities what to do when disasters happen. Exploring the role of generativity in passing on disaster-related information is one way to learn how Elders’ knowledge is valued by the community. Findings suggest that Elders can provide important guidance to Tribal governments and public health systems to determine effective disaster management strategies for AIAN communities.
BUILDING BRIDGES TO CONNECT BETWEEN NEEDS, RESOURCES, AND RURAL RESIDENTS
Authors: Karlin Nancy , Wiese Lisa Ann , Ford Cassandra
Published: December 2023

The percentage of older adults living in rural areas is predicted to rise with population aging. This impacts access to resources, creates barriers to effective aging, and promotes a unique aging experience. Consequently, demands are growing for services to support healthy aging in rural regions already experiencing healthcare disparities. This symposium will focus on location variations in resource availability, and unique interventions to promote aging in place. In the first and second presentations, researchers report on differences in current service utilization, satisfaction, and perceived future service needs/use among rural versus frontier-residing older adults in Wyoming, and in Nigeria, respectively. In the third presentation, successes and failures of an interdisciplinary approach to increase Alzheimer’s disease and related dementias (ADRD) diagnosis/treatment rates are shared. The fourth group reports the impact of an intergenerational RCT intervention of training older adults in computer literacy and online chair yoga engagement, for decreasing pain levels and cognitive risk. This is a Rural Aging Interest Group Sponsored Symposium.
BUILDING BRIDGES BETWEEN RURAL PROVIDERS AND RACIALLY/ETHNICALLY DIVERSE RETIRED FLORIDA FARM WORKERS
Authors: Wiese Lisa Ann , Tolea Magdalena , Pulido Joanne
Published: December 2023

We report results from a consortium-led randomized controlled clinical trial to optimize rural community health through interdisciplinary detection and care (ORCHID), funded by the Florida Department of Health/Moore Alzheimer’s Disease Research Foundation. This project involving providers, nursing students, office staff, community residents and caregivers, targets a health professional shortage area with a 39% poverty rate. Both the control group (56% non-White, n=11) and intervention group ((93% non-White, n=9) received training on screening tools and updated ADRD information using the Florida Department of Health ADRD Resource Guide. The intervention group is participating in an additional four hours of evening online ADRD diagnosis/treatment training geared towards primary care clinicians, available at no-cost through Washington University. Both groups are being offered in-depth cognitive assessments by Adult Gerontological Nurse Practitioners (AGNP) during home visits. Connections to under-utilized local resources are being facilitated by local nursing students. Initial results include that although pre-post total Alzheimer’s Disease Knowledge Scores (Carpenter et al., 2009) correlated strongly (r =.93; p =.003), there was no significant difference in knowledge (p =.07) in the control group. There was also no significant increase in ADRD diagnostic rates, and AGNP visits were not requested. Instead, the control group providers report the routine practice of conducting annual cognitive screening in persons over age 65, and referring patients as needed to the nearest neurology providers 30 miles away, which residents do not visit. However, connections to local resources increased by 65%. New ADRD diagnosis/treatment rates in the intervention group will be available August, 2023.
UNDERSTANDING THE CURRENT LOCATION DISPARITIES IN ADRD AND ITS DETERMINANTS IN NIGERIA
Authors: Ogidigo Oloaigbe (Joyce) , Okpalefe Okiemute , Omeje Kingsley , Anosike Chioma
Published: December 2023

Alzheimer’s disease and related dementias (ADRD) is a growing health challenge in low- and middle-income countries, particularly in sub-Saharan Africa. Evidence of geographical variation is associated with increased ADRD incidence, and current research suggests that early-life rural living further increases ADRD risk. However, the scarcity of studies conducted in resource-poor countries limits conclusions. Consequently, the awareness and response to ADRD have been limited. In Nigeria, several rural communities still associate dementia with the normal process of aging, with many patients stigmatized and abandoned in the belief that their condition is beyond any medical intervention. Thus, many of those affected delay seeking medical care and endure poor outcomes. This is exacerbated by the lack of mental health service access in rural areas. This geographic disparity and deeply rooted structural inequalities have posed additional challenges to adequately diagnose and provide care for individuals across the lifespan living in these settings. Hence, population-based data on ADRD incidence in Nigeria is required to estimate its true burden and inform the design of ADRD prevention and management strategies. We report our analysis of the current situation of ADRD in rural Nigeria while exploring future perspectives and directions. For example, heath policies to increase the ratio of mental health professionals per number of patients, mostly in rural areas, foment proactive primary care centers. Ultimately, understanding rural-urban variation in ADRD diagnostic incidence and prevalence will inform needed policies to improve timely management and access to supportive services for older adults in Nigerian and other under-resourced regions.
HIDDEN BARRIERS TO ENGAGING HOME- AND COMMUNITY-BASED SERVICES IN DEMENTIA CARE RESEARCH
Authors: Parker Lauren , Marx Katherine , Gaugler Joseph , Gitlin Laura
Published: December 2023

The high prevalence of dementia in the United States has resulted in a reliance on home-and community-based services (HCBS) to assist in the provision of care for community-dwelling persons living with dementia. Partnering with HCBS organizations, like Adult Day Services (ADS), is beneficial to disseminating evidence-based dementia care interventions as it is an existing service that can be leveraged to foster relationships between research staff and clients. While benefits exist, challenges in identifying community-partner organization, ethical approval, and community-partner staffing can be unintended barriers. Using the ADS Plus Program as a case-study, this presentation will detail hidden barriers in engaging HCBS partnerships into dementia care research. Specifically, we will discuss barriers to 1) developing relationships to implement a multi-site national-trial, 2) high touch points necessary to engage sites from underrepresented populations, 3) institutional review board requirements (e.g. CiTi training, Federal Wide Assurance Forms), and 4) staff readiness to participate in research. We also offer recommendations based on lessons learned from the ADS Plus Program to enhance the pipeline from engagement with HCBS to participate in research to implementing an evidence-based interventions. Lessons learned from the ADS Plus Program demonstrates that changes are needed to improve the efficiency of the pipeline from community-based participation into dementia care research and implementation of evidence-based interventions.
THE MARGRET M. AND PAUL B. BALTES AWARD LECTURE AND PRESENTATION
Authors: Jarrott Shannon
Published: December 2023

The Margret M. and Paul B. Baltes Award Lecture will feature an address by the 2022 Baltes Award recipient, Eric S. Kim, PhD, of the University of British Columbia. This session will also include the presentation of the 2023 Margret M. and Paul B. Baltes Award to recipient Reuben Ng, PhD of the National University of Singapore. The Margret M. and Paul B. Baltes Foundation Award in Behavioral and Social Gerontology recognizes outstanding early-career contributions in behavioral and social gerontology. The award is generously funded by the Margret M. and Paul B. Baltes Foundation.
PSYCHOLOGICAL WELL-BEING AND PHYSICAL HEALTH IN THE CONTEXT OF OUR RAPIDLY AGING WORLD
Authors: Kim Eric
Published: December 2023

Our society is rapidly aging. Thus, citizens, researchers, and policymakers alike are seeking ways to re-engineer society to achieve the dual aim of helping our aging population age well and fostering new ways for older adults to deploy the abundance of strengths that accrue with age. Most public health, biomedical, and psychological efforts have focused on reducing harmful risk factors. This approach has contributed greatly to prevention and treatment programs. However, another approach to achieving this dual aim is to expand the focus and evaluate upstream dimensions of psychosocial well-being. This approach might help inform the multidisciplinary and multi-level response efforts we need. In this talk, I will describe a theoretical model, results from a series of studies evaluating associations between a sense of purpose with reduced risk of chronic conditions, and mechanistic biobehavioral processes underlying these associations. This work aims to provide new directions for building a science of resilience and providing new targets for multi-level interventions that we can weave into our daily lives via practices and systems.
HOSPITAL-IN-HOME: IMPLEMENTATIONS IN THE VA HEALTH CARE
Authors: Sullivan Jennifer , Franzosa Emily , Cooper Dayna
Published: December 2023

The Department of Veterans Affairs (VA) Hospital-In-Home (HIH) program delivers patient-centered, acute-level hospital care at home within a single-payer integrated health-care system. Compared to inpatient care, HIH has demonstrated improved patient safety, effectiveness, and patient and caregiver satisfaction. As of 2022, there were eleven HIH sites across the VA, evidence of modest adoption. This symposium presents findings from the first year of a 4-year project that aims to conduct an in-depth inquiry in to the most effective ways to implement, adapt and sustain HIH across the VA. We will present an overview of the VA HIH program, describe one HIH program in-depth, present a birds-eye-view of the national program, present comparisons of sites’ implementations in terms of structure, patient characteristics and outcomes, and conclude with an implementation-science framework to examine program adoption, adaptations, successes and challenges. National leadership will provide perspectives on management, planning and policy of Hospital-In-Home.
THE BOSTON HOSPITAL-IN-HOME PROGRAM—A LOCAL PERSPECTIVE
Authors: Jindal Shivani , Pietruszka Brittany , Meears Rachel , Parris James
Published: December 2023

The Hospital-in-Home (HIH) model provides patient centered care, may reduce complications and costs. VA Boston Healthcare System (VABHS) planned its HIH program in 2018 and enrolled its first patient in May 2019. HIH provided care to 45 patients in 2019 which grew to 185 in 2022. The team is comprised of 2 clinicians (a hospitalist physician and a physician assistant), a nurse manager, 5 registered nurses (RN), a social worker and a pharmacist. The program practices complementary HIH (admissions from inpatient care) and substitutive care (all other admissions). At this time, majority of the recruitment comes from the inpatient services, followed by heart failure and primary care clinics. The program catchment area is about 25 miles from the West Roxbury campus of VABHS. A hybrid visit approach is taken for clinician visits - initially, the veteran is seen in person or by video by the clinician on admission to the program. Subsequent visits are done with RN assessments in the home and the clinician conducting the visit by telephone or video. In FY 2021, conditions of patients treated by HIH include congestive heart failure (50%), chronic obstructive pulmonary disease (14%), wound care (6%), diabetes (2%) and other conditions (20%). In FY 2022, the average daily census was 15.9 veterans and average visits per day 4.8. The HIH program outcomes include reduction of bed days of acute care in the hospital and reduction in the use of unnecessary medications through deprescribing which may translate to cost avoidance for the medical center.
THE DEPARTMENT OF VETERANS AFFAIRS HOSPITAL-IN-HOME PROGRAM: A BIRD’S EYE VIEW
Authors: Hung William , Intrator Orna , Sullivan Jennifer , Makineni Rajesh , Li Jiejin , Cai Shubing
Published: December 2023

The Department of Veterans Affairs (VA) Hospital-In-Home (HIH) program offers Veterans the option to receive intensive, institutional-level acute services in their homes. This study presents characteristics of Veterans across 11 HIH programs operating between fiscal years 2021 and 2022. VHA administrative data and Medicare claims were linked to identify HIH stays from HIH visits, extending a stay over time as long as visits were no more than 7 days apart, allowing for intervening ED visits. Two types of HIH stays were identified: complementary HIH (admissions from an acute inpatient stay) and substitutive HIH (admissions from all other locations). HIH patients’ sociodemographic characteristics, health conditions, and risk factors are described as well as length of HIH stay (LOS) and discharge destination. We identified 2536 veterans (1,110 complementary and 1,426 substitutive) who had 3,599 HIH stays with 73.9% of Veterans having one stay. Compared to Veterans with complementary HIH, Veterans with substitutive stays were generally younger (67 vs. 72), more likely to be Black (20% vs. 12%), and less sick (probability of 1-year mortality 14% vs 24%). Heart failure, Chronic Obstructive Pulmonary Disease, and COVID were the most frequent admission conditions for both HIH types. Average HIH LOS was 17.3 and 25.8 days for substitutive and complementary models, respectively. About 4% of substitutive and 18% of complementary stays ended in inpatient admission. In the unique VA single-payer, integrated-care system implementations may vary and comparisons of patient characteristics and outcomes can provide the basis for future implementations.
VARIATIONS ACROSS 11 DEPARTMENT OF VETERANS AFFAIRS HOSPITAL-IN-HOME PROGRAMS IN 2021–2022
Authors: Intrator Orna , Cai Shubing , Li Jiejin , Makineni Rajesh , Hung William
Published: December 2023

The Department of Veterans Affairs’ (VA) Hospital-In-Home (HIH) program provides Veterans with the option to receive acute level services in the comforts of their own homes. A total of 11 HIH programs operated between fiscal years 2021 and 2022. We examined the volume of the programs and average risk of one-year mortality (using the Care Assessment of Needs measure) among each program’s participants and characteristics of HIH stays (length-of-stay [LOS] and discharge destination) across program sites and program types (complementary- admissions from hospital and substitutive- other admissions) using VA administrative data linked with Medicare claims. The number of patients served in a year varied between 36 and 680 with 6 programs having <200 patients. Substitutive HIH was the dominant HIH type in 8 programs (>50% of patients) while only one program had clearly more complementary HIH (87%) and only 9 programs had complementary HIH. Average length-of-stay (los) in HIH was 20.5 days (SD=24.4 days, median=13 days), with averages across programs ranging between 3 - 36 days, 6 programs with average los<13 days and 5 programs with average los >19 days. Predicted risk of death within one-year varied: among substitutive HIH, 7 programs’ average risk was > 20% and 4 programs’ average risk was <15%. Among complementary HIH only one program’s risk was <15% and the rest was >20%. Substitutive HIH programs discharged 2-10% of Veterans to hospital, while complementary programs discharged 11-23% to hospital. Interviews with program staff will help elucidate reasons for differences and inform expected outcomes.
FEATURES OF THE SOCIAL AND PHYSICAL ENVIRONMENT AND ACCELEROMETRY-BASED PHYSICAL ACTIVITY AMONG OLDER ADULTS
Authors: Twardzik Erica , Freedman Vicki , Martinez-Amezcua Pablo , Schrack Jennifer
Published: December 2023

Social and physical environments shape physical activity (PA) opportunities among older adults. Whether environmental factors are associated with patterning of PA among older adults is less understood. We examined associations of the social and physical environment with accelerometry-based daily PA metrics among older adults. Cross-sectional data from 2021 National Health and Aging Trends Study respondents with non-missing data were included. Using linear regression models with analytic survey weights and adjusted for potential confounders we investigated the associations between four environmental features: social cohesion, neighborhood disorder, broken step into the home, and continuous sidewalks with PA patterns. Three accelerometry-based PA metrics were examined: total activity counts, PA fragmentation, and number of PA bouts. 633 older adults (45% female) were included in our analytic sample. Respondents with a broken step into their home, compared with those without, had lower total activity counts (♌=-170024.3, SE=81530.6, p<.05). Compared to those living in a neighborhood with no disorder, those living in a neighborhood with any disorder had more PA bouts per day (♌=10.5, SE=3.9, p<.01). All other contextual factors examined were not associated with activity counts, fragmentation, or bouts of PA. Greater physical barriers to access the neighborhood may explain why broken steps were associated with less total PA (volume and intensity). Neighborhood disorder was associated with number of PA bouts per day, which may be due to greater reliance on walking for transportation in disordered neighborhoods. Future work should investigate how the neighborhood environment is structured (e.g., walkability) to elucidate these findings.
INCREASED TEMPORAL GAIT VARIABILITY OVER TIME IS RELATED TO FUTURE DEMENTIA
Authors: Tian Qu , Resnick Susan , Simonsick Eleanor , Ferrucci Luigi
Published: December 2023

Age-related brain changes affect the timing and coordination of gait. High gait variability may stem from impaired brain motor control and has been associated with compromised cognition and cognitive impairment. Whether increased gait variability over time is associated with future MCI or dementia is unknown. In the Baltimore Longitudinal Study of Aging, we used age-, sex-, and race-adjusted linear mixed-effects models to examine whether changes in gait variability were associated with future MCI or dementia in participants aged 65+. Gait characteristics were quantified by 3D motion analysis. Independent of baseline gait speed and compared to cognitively normal participants (n=387), those who developed dementia (n=24) had greater rates of increase in gait cycle time variability, stance time variability, and swing time variability (but not mean performance) before the symptom onset (all p<0.05). Further adjustment for concurrent assessment of visuospatial ability or manual dexterity attenuated these associations. Adjustments for verbal memory, psychomotor speed, attention, or executive function did not attenuate these associations. Rates of changes in these gait variability measures were not statistically different between cognitively normal participants (n=387) and those who developed MCI (n=41). Baseline gait variability measures were not different across groups. These findings suggest that longitudinal trajectories of gait variability, not one-time assessment, provide the additional predictive value of future dementia over and beyond gait speed. Mechanisms may include compromised visuospatial ability or manual dexterity. Future neuroimaging studies are warranted to understand neural substrates connecting increased gait variability and dementia risk.
A NOVEL POSTDISCHARGE TELEHEALTH INTERVENTION FOR STROKE CAREGIVERS: IMPLICATIONS FOR IMPLEMENTATION
Authors: LeLaurin Jennifer , Eliazar-Macke Nathaniel , Freytes I Magaly , Uphold Constance
Published: December 2023

This study investigated the potential for implementation of the RESCUE stroke caregiver telehealth intervention by assessing acceptability, feasibility, and cost. Family caregivers (n=174) of Veteran stroke survivors from eight medical centers were randomized to usual care or intervention. The RN-led intervention involved discharge plan review, problem-solving training, education, and support delivered via one telephone session and eight asynchronous online messaging center sessions. Acceptability was assessed using an adapted Acceptability and Enactment Survey (n=42) and qualitative interviews with a subsample of caregivers (n=16). We used retention data to assess feasibility and calculated cost per participant. Findings indicate the intervention was acceptable to caregivers. Most intervention completers found the intervention very/extremely helpful (90.5%), very/extremely easy to use (78.4%), and resolved most/all caregiving problems (64.3%). Qualitative interviews showed caregivers valued the asynchronous delivery method, personalized nature of the intervention, and ability of the RN to answer medical questions and provide education. More intervention caregivers dropped out compared to usual care (50.0% vs.19.3%, p< 0.001). Intervention dropout was predicted by lower education (p=0.03) and less positive views of caregiving (p=0.01). Cost was $309.98 per intervention completer. Findings support intervention acceptability and highlight the value of RN-led interventions. The relatively low cost and fully remote nature of the intervention support its suitability for widespread implementation. Multiple delivery options and flexible intervention schedules may enhance engagement. The RESCUE intervention provides a model of a low-cost post-discharge telehealth intervention for stroke caregivers that can be adapted for other conditions. Future work should test methods to augment retention.
DO PUBLIC HOME CARE CLIENTS “LOSE OUT ON SERVICES” BECAUSE THEY HAVE A FAMILY CAREGIVER?
Authors: Keefe Janice , Mitchell Lori , Poss Jeff , Mah Jasmine
Published: December 2023

The public home care (PHC) system in Canada is heavily reliant on family caregivers to enable clients to stay in the community. When caregivers are present, there are concerns formal home care aide (HCA) services are less available. Using data from the Resident Assessment Instrument for Home Care (RAI-HC), we examined caregiver and client characteristics in relation to HCA service amounts. Our cohorts were individuals aged 60+ receiving an initial RAI-HC assessment in 2011-2013, and one subsequent assessment in two provincial jurisdictions: the Winnipeg Regional Health Authority (n=5,251) and Nova Scotia Health (n=5291). We measured weekly HCA hours and constructed a predictive model for hours of care controlling for client need. To identify the most underserved client population, we calculated the ratio between predicted to actual received hours of care ascertaining the lowest client quintile. In both jurisdictions, the odds of being underserviced were higher when the client co-resided or had a spouse. Clients living alone at initial intake were least likely to be underserved. Caregiver characteristics increasing the risk of being underserved in Winnipeg included providing IADLs/ADLs support, caring more than 14 hours per week and being unable to continue. Rurality increased risk of underservice in Nova Scotia. These findings contribute to the debate: is PHC a supplement or substitution for family care? PHC as a supplement to family care was more pronounced in Winnipeg and in rural Nova Scotia. Implications for greater equity across regions is explored using an Equity, Diversity and Inclusion lens.
PATTERNS OF MARIJUANA USE IN THE US OLDER ADULT POPULATION
Authors: Ailshire Jennifer
Published: December 2023

Marijuana use is increasing in the U.S. population, including among adults 50 and older, but research on population characteristics of marijuana use in middle aged and older adults is limited. We use data from the 2018-2021 Behavioral Risk Factor Surveillance System (BRFSS) surveys, which are representative of U.S. state populations, to estimate prevalence and frequency of marijuana use by age. The data are from 39 states that included the module on marijuana use in the past 30 days (n=466,469). We also examine age patterns in use by legalization status and reasons for use of marijuana. Reported marijuana use is much lower among those ages 50 and older (6.49%) than 18-49 (16.3%). Multivariable regression analyses show that marijuana use declines with age (p<.001) and is lower among women (p<.001). Marijuana use among older adults is slightly lower in states where it is illegal compared to states that have legalized (4.6% vs. 7.1%, p<.001). Use of marijuana for medical reasons increases with age; nearly two-thirds of adults 80+ who use marijuana report doing so for medical reasons. Adults 80+ also report the highest frequency of use, likely reflecting greater medical need. The most common conditions reported among adults 50+ who use marijuana for medical reasons are arthritis (61%), depression (36%), asthma (20%), and COPD (18%). Our prevalence estimates of use at older ages match those from other national surveys, but our findings suggest older adults are using marijuana largely for medical reasons.
CANNABIS USE TRENDS AND INTENTIONS AMONG OLDER PEOPLE WHO INJECT DRUGS IN LOS ANGELES, CA, AND DENVER, CO, 2021–2022
Authors: Bluthenthal Ricky , Cohen Jonathan
Published: December 2023

One potential benefit of drug legalization is that it might lead to substitution of legal products for criminalized substances. This is particularly true in the case of legal cannabis use by the subpopulation of people who inject drugs (PWID) and thus face substantial risk of physical harm, infectious diseases transmission, and even death especially in criminalized environments. Should substitution occur among older PWID, where other comorbid conditions are more common, the benefits could be even greater. To describe substance use patterns among older people who inject drugs and to examine if older PWID are more likely to use cannabis as a substitute for other substances. We analyze data from quantitative, health surveys collected from 429 community-recruited PWID during 2021/22. Descriptive statistics were used to characterize the drug use patterns among older (50 years of age or more) PWID and multivariate regression to examine if older participants were more likely to substitute cannabis for any other substance.

Results: Among the 429 participants, 110 (or 26%) were 50 years of age or older. Older participants reported being significantly less likely than younger participants to use of methamphetamine, fentanyl and cannabis. In terms of cannabis substitution, older participants were significantly more likely to report using cannabis to reduce alcohol use. Risk and benefits of cannabis use vary among subpopulations. Older PWID might benefit from improved access to cannabis when trying to reduce alcohol use. Given the negative consequences of alcohol use, cannabis substitution might have additional benefits for this subpopulation.
CARE PARTNERS OF PERSONS WITH DEMENTIA USE OF SHARED ACCESS TO THE PATIENT PORTAL
Authors: Gleason Kelly
Published: December 2023

The patient portal plays a significant and growing role in health system navigation, and most patient portals offer shared access for care partners. Care partners are at the forefront of dementia care, yet little is known about their use of the portal through shared access. We conducted an observational cohort study of patient portal utilization for a 5-year period (10/3/2017-10/2/2022) at an academic health system. The cohort consisted of 49,382 patients ages 65+ with 2+ visits in 24 months. More than half (57.34%) of the cohort was female and white (67.19%) and the average age was 76.56 (SD 8.60). We operationalized diagnosed dementia from ICD10 codes and problem lists. Shared access use was defined as activity happening through “proxy” credentials. We operationalized the patient portal activity metric as the ratio of portal sessions in relation to number of clinical encounters. Older adults with (versus without) diagnosed dementia were similarly likely to be registered for the patient portal (71.20% versus 71.51%, p=0.16) but more likely to have a shared access user (10.41% vs. 3.31%; p<0.001). Among patients with dementia, those who had a shared access user, compared to those who did not, had 341.32 versus 164.33 patient portal sessions, sent 47.56 versus 27.42 messages, and had a 19.22 versus 11.22 patient portal activity metric over the 5-year period (p<0.001 all contrasts). Policy initiatives and organizational efforts that encourage use of shared access may benefit care quality of persons with dementia and their care partners.
MUSCLE UP: WHAT AGING LOOKS LIKE FROM THE INSIDE OUT
Authors: Simonsick Eleanor , Ferrucci Luigi
Published: December 2023

The Longitudinal Studies Section of the Translational Gerontology Branch of the National Institute on Aging Intramural Research Program has the mission and opportunity to examine aging physiology from the cellular to the full body functional level in model systems and human populations. This symposium presents ongoing research that targets pathologic and normative change in muscle with aging and the significance of these changes for understanding the aging process. Data come from the Baltimore Longitudinal Study of Aging (BLSA) and the Genetic and Epigenetic Signatures of Translational Aging Laboratory Testing (GESTALT) study. In nearly 500 BLSA participants aged 50+, Zenobia Moore evaluates the association between multiple epigenetic age metrics and change over 6 years in mid-femur areas of muscle and subcutaneous and intramuscular fat derived from computed tomography. Qu (Teresa) Tian investigates the relationship between skeletal muscle mitochondrial function and risk of MCI or dementia over 3.3 years in 460 initially cognitively normal BLSA participants and PET and blood biomarkers of AD in available subsamples. In 82 men and women from GESTALT, Stefano Donega examines relationships between physical activity, peak oxygen consumption and muscle oxidative capacity using p31 MR spectroscopy and gene expression, transcript usage and splicing events derived from vastus lateralis biopsies. Using volumetric Focused Ion Beam Scanning Electron Microscopy, Lisa Hartnell shares 3D images of muscle samples at the level of the mitochondrial reticulum and sarcomere from young and old healthy and frail GESTALT participants. Together, these findings highlight the value of muscle as a window on aging.
STRATEGIES FOR ENGAGING LOW-INCOME SENIOR HOUSING RESIDENTS IN INTERDISCIPLINARY WELLNESS CLINICS
Authors: Holmes Sarah , Klinedinst Jennifer , Brandt Nicole , Resnick Barbara
Published: December 2023

Engaging residents in low-income senior housing communities in health and wellness services can be challenging. Despite the significant healthcare needs of residents in senior housing communities, numerous barriers to engaging residents exist including the mistrust of academic or healthcare institutions, stigma about health conditions and treatment, and lack of awareness about services available. To successfully implement Interdisciplinary Wellness Clinics, a participatory approach was used through engagement of stakeholders in the housing communities. The Interdisciplinary Wellness Clinic team worked closely with the Senior Program Manager and the community and regional property managers to establish a plan for implementation. The needs of the communities, day and timing of the clinics that would fit with their schedules, and a plan for ways to invite and engage the residents was developed. Flyers were made by the interdisciplinary team for visits at each community and sign-up sheets for the services provided on any given month. The flyers were posted on bulletin boards within the communities or in a central location for residents to access them by the community property managers. Intermittently, associated with holidays for example, we also held raffles for gifts for anyone who attended the clinic. Regular meetings were held with the property managers at each of the senior housing communities to solicit their input and brainstorm strategies for continued engagement of residents and identify new approaches to increase engagement in wellness clinic services.
OPTIMIZING GSA STUDENT CHAPTER NETWORKING ACROSS CAMPUS AND THE WORLD
Authors: Bouchard Lauren
Published: December 2023

The Portland State University (PSU) Gerontological Society of America Student Chapter was formed as a new student organization in 2022. Due to student interest and enthusiasm, this chapter was eager to invest in connections within PSU departments (e.g., public health, social work, and urban affairs) across Portland area campuses (e.g., Oregon Health and Science University) and between other student chapters internationally. Initially, this chapter focused on relationships between undergraduate and graduate students invested in aging research and education on PSU’s campus. Once a core group was formed, the chapter recruited members across campus, created an Aging 101 Service event to reach all students, and developed connections with professionals in the regional area. With guidance from the faculty advisor, this chapter reached out to the chapter at the University of Porto, the University of Aveiro in Porto, Portugal, to create a dual chapter networking event with colleagues in Portugal. This presentation will explain the chapter networking and provide suggestions to create regional, national, and international connections.
CHILDHOOD INTERPERSONAL TRAUMA AND DEPRESSION OF CHINESE IN MID LATER LIFE: MEDIATION EFFECT OF SOCIAL INTEGRATION
Authors: Zhou Jiajia , Zhou Shuai
Published: December 2023

Objectives

This study investigates the long-term associations between five types of childhood interpersonal trauma (i.e., physical neglect, emotional neglect, physical abuse, being bullied, exposure to interparental violence) and depression in mid-later life. The mediation roles of social integration in the family (i.e., satisfaction with marriage and children) and broader social contexts (i.e., social participation and perceived social support) are examined in the associations.

Methods

This study used two waves (2014 and 2015) of data from the China Health and Retirement Longitudinal Study. The analytical sample included 12,486 participants aged 45 years and older.

Results

People who was bullied, physically abused, and witnessed interparental violence during childhood are more likely to develop depression in mid-later years, controlling for socio-demographic characteristics, childhood family socio-economic status, and childhood parental mental health. However, childhood physical neglect and emotional neglect are not directly related to depression in mid- and late-adulthood. The associations between childhood interpersonal trauma and depression were mediated by the satisfaction with marriage, satisfaction with children, and perceived social support, but not social engagement.

Discussion

This study calls for attention on the long-term consequences of multiple types of childhood interpersonal trauma on mental health among middle-aged and older adults. It provides a comprehensive understanding of the mechanisms of social integration in bridging early-life interpersonal trauma and depression in mid-later life.