bluuebunny/crossref_metadata_2025 huggingface dataset:
ADVERSE MUSCLE COMPOSITION IS LINKED TO LOWER MITOCHONDRIAL RESPIRATION AND SLOWER WALKING SPEED
Authors: Ramos Sofhia , Glockner Katherine , Distefano Giovanna , Cawthon Peggy , Linge Jennifer , Leinhard Olof Dahlqvist , Goodpaster Bret , Coen Paul
Published: January 2025

Low muscle mass and fat infiltration are core features of sarcopenic obesity. We examined skeletal muscle mitochondrial respiration and walking speed in older adults with normal muscle composition (NMC), only low muscle volume (LMV), only high fat infiltration (HFI) and the combination of LMV and HFI, (adverse muscle composition (AMC)). Muscle composition was determined by whole body MRI and high resolution respirometry was performed on muscle biopsies from N=828 participants (76.3 ± 5.0 years old, 59.4% female) in the Study of Muscle, Mobility and Aging (SOMMA). We found that mitochondrial respiration was significantly lower in individuals with LMV (-10%), HFI (-9%) and AMC (-8%), compared to those with NMC. In multivariate regression models, 4m and 400m walking speeds were significantly slower in LMV (400m: β=-0.10 4m: β=-0.07, both p< 0.05), HFI (400m: β=-0.14, 4m: β=-0.13, both p< 0.01) and AMC (400m: β=-0.19, 4m: β=-0.16, both, p< 0.01) groups, compared to NMC (400m: 1.11m/s, 4m:1.10m/s). Compared to NMC, mitochondrial respiration explained ~20% of the variance in 400m walking speed in LMV, ~64% in HFI, and ~47% in AMC, while all three groups remained significantly slower. Compared to those with NMC, mitochondrial respiration explained ~29%, and ~77% of the variance in 4m walking speed in LMV and HFI respectively, abolishing group differences in 4m walking speed, while mitochondrial respiration explained ~50% of the variance in ACM. In conclusion, low muscle volume, high fat infiltration and AMC phenotypes are linked to lower mitochondrial respiration and slower walking speed in older adults.
MENOPAUSE HISTORY AND COGNITIVE FUNCTION IN THE IGNITE TRIAL
Authors: Watts Amber , Donofry Shannon , Ripperger Hayley , Eklund Nicole , Wan Lu , Kang Chaeryon , Erickson Kirk
Published: January 2025

Lifetime exposure to estrogen, a neuroprotectant, is associated with cognitive aging and dementia. Surgically induced menopause (ovariectomy) is associated with poorer cognitive performance, while use of hormone therapy (e.g., birth control, menopausal hormone therapy) has shown mixed associations with cognitive performance. We investigated these associations in IGNITE, a 12-month, multi-site, randomized exercise trial. We measured cognition via the Montreal Cognitive Assessment (MoCA), and factor analysis-derived composite scores for episodic memory, processing speed, working memory, attentional control, and visuospatial processing. In 461 female participants, we estimated relationships between ovariectomy, hormone-use, and baseline cognitive performance accounting for age, education, APOE ε4 carrier status, and race. Ovariectomy predicted worse MoCA scores (B=0.22, p=.038), but was unrelated to cognitive composite scores. African American race accounted for the largest proportion of variance in this model (R2Change=.09). Menopausal hormone therapy was associated with better performance on episodic memory (B=.109, p=.018) and working memory (B=.101, p=.021). Birth control use predicted better performance on MoCA (B=.090, p=.033), working memory (B=.094, p=.017), and attentional control (B=.099, p=.015). The association of ovariectomy with MoCA and not with other domains may indicate an association with dementia, not with typical cognitive aging. Meanwhile menopausal hormone therapy was associated with higher order cognitive performance, not the dementia screener. Birth control was associated with both. Our results validate prior evidence that lifetime exposure to estrogen is an important predictor of older women’s cognitive health and indicate further investigation is needed to clarify differential associations of menopause history and cognitive performance in African American women.
DYNAMIC BALANCE PERFORMANCE WAS ASSOCIATED WITH BETTER COGNITION IN COMMUNITY-DWELLING LOW-INCOME OLDER ADULTS
Authors: Thiamwong Ladda , Komalasari Renata
Published: January 2025

Objectives

We cross-sectionally examined the relationships of dynamic and static balance performance, and handgrip strength, with cognitive performance in community-dwelling low-income older adults in Orlando, Florida.

Methods

This study was drawn from a sample of 92 older adults (90.2% females, Mage = 72.63, SD±6.82). Dynamic balance was measured by the Short Physical Performance Battery, static balance by BTrackS scores, handgrips by three handgrip trials, and cognitive performance by the Rowland Universal Dementia Assessment Scale.

Results

Across the participants, 71.7% were African American, 62% completed high school, and 57.6% were just enough financially. The multiple regression analysis indicated that the model explained 10.2% of the variance (R2=.319, F (3,88) = 3.33, p =.023). Dynamic balance (B =.075, p-value =.047) was significantly associated with cognitive performance, but static balance (B =-.023, p-value =.081) and handgrip strength were not (B =.002, p-value =.855), accounting for current depressive symptoms (B =.057, p-value =.374). Independent t-test showed that older adults with normal cognition (RUDAS scores ≥23) scored higher in dynamic balance (Mdifference= 27.845, p=.018) than those with possible cognitive impairment (RUDAS scores < 23). Older adults who are cognitively healthy performed better than those with possible cognitive impairment in dynamic balance performance.

Discussion

Simple dynamic balance performance tests, comprising balance, gait speed, and chair stand tests, could serve as a valuable cognitive assessment tool in community-dwelling low-income older adults. Keywords: dynamic balance performance, static balance performance, handgrip strength, cognitive performance, Rowland Universal Dementia Assessment Scale, aging
CULTIVATING TRUST IN RESEARCH PARTNERSHIPS WITH OLDER ADULTS ACROSS THE COMMUNITY ENGAGEMENT CONTINUUM
Authors: Brothers Allyson , Behrens LIza , Leach Carrie
Published: January 2025

Community-engaged research is essential for identifying and supporting the needs of an aging society and ensuring effective translation of research findings. While not a new idea to the field of gerontology, engaged research models and frameworks are expanding, and researchers are seeing increased access to initiatives for building and sustaining community-engaged research programs. This symposium will feature emerging and established projects across multiple levels of the continuum of engagement, from informing, consulting, involving, collaborating, and ultimately to co-creating. Kim et al. will describe efforts to co-create programming and educational materials with and for Alaska Native caregivers, focusing on decolonizing methodologies. Halvorsen will showcase an ongoing academic-organizational partnership created to increase the research and evaluation capacity of a national nonprofit organization and its grantees. Gan will describe how diverse community members were engaged to understand and meet gaps in cognitive health promotion, resulting in the pilot of a mindful discussion program. Guest et al. will present on the formation and fruitful efforts of a resident advisory board at the University Based Retirement Community, sharing best practices for sustaining engagement. Mahmood et al. will report on a community-based participatory effort evaluating the role of built environment on mobility access across five cities in the Vancouver area. These exemplars will launch the symposium into a discussion about the utility of engaging older adults across the continuum, illustrating effective strategies for establishing trusted academic-community partnerships. We invite attendees to consider the value of this heuristic framework to plan and design fit-for-purpose community-engaged research projects. Community Engaged Research Interest Group Sponsored Symposium
CO-CREATING EVIDENCE-BASED PROGRAMMING AND EDUCATIONAL MATERIALS FOR ALASKA NATIVE CAREGIVERS
Authors: Kim Steffi , Lewis Jordan , Thompson Lena
Published: January 2025

Alaska Native Elders are rarely involved in creating educational and outreach materials. Over and over, Elders share that available educational and informative materials do not include their cultural understandings, programs do not meet their needs, and resource developers rarely attend to incorporate the specific and unique Alaska Native context. We will share our expereinces about outreach, recruitment, and establishment of an Alaska Native Community-engaged Aging Collaborative to engage community members, caregivers, and local organizations to create culturally appropriate and context-specific educational materials and programming that support Alaska Native Elders. Establishing this collaboration is the foundation for implementing research and programs driven by community needs and cultural understandings in conjunction with Western evidence-based approaches. Decolonizing strategies such as community member involvement, building trust, and sustainable relationships are not just steps but integral components of conducting Indigenous-driven research that benefits communities. These approaches not only sustain Elder participation in research related to aging well and dementia but also underscore the value and importance of their contributions. Indigenous research paradigms are gaining traction and hold immense potential in involving Indigenous older adults in research endeavors. Building these collaborations not only gives Elders a voice but also offers researchers a promising direction and invaluable insight into the specific needs of these communities, fostering a sense of hope and optimism for the future of research.
OLDER ADULTS WITH DISABILITIES AS CORESEARCHERS IN COMMUNITY-ENGAGED RESEARCH ON MOBILITY AND ACCESS
Authors: Mahmood Atiya , Hedayati Niloofar , Nasiri Rojan , Hosseini Sogol Haji , Pandsheno Sepehr
Published: January 2025

Neighbourhood access and participation opportunity significantly impacts the health, social inclusion, and overall wellbeing of older adults especially those with mobility, sensory and cognitive disabilities. Stakeholders Walkability/Wheelability Audit in Neighbourhoods (SWAN) is a community engaged mixed method project where user-led audits are conducted in neighbourhoods complemented by semi-structured interviews to evaluate the role of built environment on mobility, access and participation of older adults and people with disabilities across five cities within Metro Vancouver, Canada. Using a community engaged lens starting from initial engagement to more advanced collaboration, this project involves various community stakeholders in different capacities fostering a two-way exchange of information between researchers and community members. Study participants as coresearchers participate in research tool adaptation, data collection, analysis and knowledge mobilization. Additionally, city staff members partner with the research team to identify key areas in cities for data collection, collaborate in knowledge mobilization activities and the development of complementary implementation projects. The SWAN project is part of a larger partnership project titled, “Mobility, Access and Participation” (MAP). Preliminary findings from this project underscores neighbourhood accessibility as it relates to functionality, safety, appearance, supportive features and social engagement opportunities for older adults with disabilities while highlighting some distinct challenges across different types of disabilities. Insights from the SWAN project has the potential inform both academic scholarship and local government policy around mobility, access and social. Findings underscores the importance of community engaged research in informing programmatic and policy changes using a social equity lens.
GLOBAL ASSESSMENTS OF END-OF-LIFE CARE: HOW ARE THESE CARE MEASURES PATTERNED BY PROXY RELATIONSHIP TO DECEDENT?
Authors: Mahmoud Kafayat , Carr Deborah , Ekerdt David
Published: January 2025

A “good death” is one in which the patient’s physical, emotional, and spiritual needs are met, they are treated with dignity and respect by health care providers, and treatment preferences are honored. Despite policies to help improve death quality, including support for doctor-patient end-of-life consultations as part of the Affordable Care Act, it is unclear whether death quality has improved, nor whether particular people are vulnerable to poor quality deaths. Researchers rely heavily on proxy-reported measures of end-of-life, however it is unclear whether these reports differ by one’s relationship to the decedent. We use 13 waves of the National Health and Aging Trends Study (NHATS), and polychoric factor analysis and multinomial and logistic regressions to identify the contributions of 10 specific dimensions of end-of-life care to overall quality of care evaluations, and how these assessments are affected by the proxy’s relationship to the decedent, after controlling for socio-demographic and health characteristics of decedents. Overall care ratings are highly correlated with perceptions of personal care needs met, respectful treatment, being informed about care, and care coordination. Physical and emotional symptoms, care wantedness, and decisions made without patient input have weaker associations with the overall care assessment. Paid caregiver proxies give more positive assessments of care relative to spouses and children of decedents. Adult children proxies offer more positive assessments of care decisions and wantedness, whereas spouse proxies report better management of physical and emotional symptoms. We discuss the implications for data collection as well as health care practice.
OLDER AGE PREDICTS POSITIVITY IN HOSPICE FAMILY CAREGIVER AUDIO DIARIES: IMPLICATIONS FOR ASSESSMENT INNOVATION
Authors: Cloyes Kristin , Hebdon Megan Thomas , Ellington Lee
Published: January 2025

The likelihood of becoming a caregiver of someone with a serious illness increases with age, and those 55 years of age and older are more likely to be end-of-life caregivers of family and friends. Older adults may also use more emotional coping skills, which can have a protective effect depending on perceived stress and gender. We asked in-home hospice family caregivers of cancer patients (n=58) to record daily, open-ended audio diaries about their experiences. We examined whether age and gender predicted the amount of affect-related content and overall emotional tone (positivity/negativity). Caregivers recorded audio diaries up to 5 minutes via an IVR system (n=984 entries). We transcribed diaries and used LIWC software to quantify the proportion of affect-related content and positive/negative tone, and mixed-effects regression modeling to analyze the effects of age and gender on these indicators. Our sample (M age=60.72, SD=13.12, range=30-86) was mostly white (84.5%) non-Hispanic (86.2%) women (74.1%) caring for their spouse (44.8%). Age predicted positivity, with each additional year of age predicting a slight increase (β=0.426, p=0.028). Age did not predict affect (β=0.032, p=0.251). Gender did not predict tone (β=2.622, p=0.619), but trended towards predicting less affect expression in men (β= -1.482, p=0.062). Hospice family caregiving is challenging and often isolating, affording few opportunities for processing experiences. Our findings suggest an interplay of age and gender in caregiver self-expression. Understanding how caregivers’ self-expression aligns with underlying coping and unmet needs is important for developing audio diaries as a low-cost assessment of coping and well-being.
ESTABLISHING SHORT-TERM STUDY ABROAD OPPORTUNITIES IN GERONTOLOGY
Authors: Johansson Linda
Published: January 2025

Beginning in 1995, the College of Health and Welfare at Jönköping University has hosted college and university students from the United States in a short-term (10-14 days) study abroad experience in “Healthcare and Social Services across the Lifespan.” Students from multiple U.S. universities have participated, including Pennsylvania State University, Utah State University, and Indiana University Southeast. U.S. students participate with Swedish students in the campus week experiences of an existing course offered by the College of Health and Welfare as part of the primarily online course: “Aging in a Welfare State.” Students from other countries (Finland, Scotland, Spain, Turkey, UK, and Vietnam) have also participated, allowing for comparison of experiences of aging and support for older adults across countries. Symposium presentations will address: Development and content of the study abroad course (Elizabeth Fauth), Facilitators and barriers to establishing a study abroad course at a U.S. university (Carla Hermann), Challenges and benefits of hosting U.S. study abroad students at the College of Health and Welfare (Therése Bielsten), and History of a sustained and successful model of international gerontological education (Steven Zarit). Course outcomes and measures of student satisfaction and success will be presented, as well as feedback from students and faculty and how that shaped the development of the course over time. Plans for future iterations will be addressed. This course model can be replicated by others aiming to promote engaging gerontological education experiences for both U.S. and international students, as well as international research collaborations.
UPDATED SYSTEMATIC REVIEW TO IDENTIFY INTERVENTIONS TO COMBAT ELDER NEGLECT TARGETING CAREGIVERS
Authors: Park Sophie , Costantini Helena , Shaw Amy , Elman Alyssa , Rosen Tony , Czaja Sara
Published: January 2025

Elder neglect is a subtype of elder mistreatment that is associated with serious medical and social consequences including mortality. Elder neglect by a caregiver is common among older adults receiving assistance from informal caregivers. Few interventions that target informal caregivers have focused on mitigating elder neglect. We updated an existing 2018 systematic review of elder mistreatment interventions, focusing specifically on interventions addressing elder neglect and targeting caregivers. The goal was to examine methods of intervention strategies to guide the development of a new caregiver intervention. The existing and updated review followed PRISMA guidelines and included 6 databases. Across both reviews, only 20 programs focused on elder neglect and targeted informal caregivers. Most programs used psychoeducation/therapy/counseling (65%) and/or education (30%), and 25% were multi-component interventions. Only one program was found to be very likely and two programs likely to be implementable in a low-resource environment. A formal program evaluation was included in 70% of the programs; only 15% were rated as having a high-quality study design. These findings suggest that few programs have been developed to address the important issue of caregiver elder neglect. The design of future interventions should focus on programs that are feasible to implement in low-resource environments and that contain rigorous evaluation strategies. The study findings also suggest that important areas of intervention focus include enhancing caregiver preparedness and reducing caregiver burden. Overall, there is a clear need for caregiver elder neglect interventions, especially those that can be implemented in low resource environments.
INNOVATING FOR EQUITABLE HOME HEALTH CARE: REDUCING BARRIERS TO SOCIAL AND END-OF-LIFE CARE FOR OLDER ADULTS
Authors: Murali Komal , Burgdorf Julia , Mroz Tracy
Published: January 2025

This symposium will focus on equity in home healthcare (HHC), operationalized as equitable access to, and receipt of, high quality HHC that is attuned to the unique needs of specific social and clinical subgroups, including minoritized racial/ethnic groups, those with chronic and serious illness such as dementia, and those at end-of-life. Topics include racial and ethnic disparities in hospice use and barriers to care, factors that impact individuals’ access to social work services, reasons for why palliative care is declined among individuals with lower levels of education, and disparities in access to high quality HHC for people living with dementia and their care partners. Abstracts present analyses from varied methodological and theoretical perspectives that all aim to better understand existing disparities and offer foundational evidence to support development of innovative models of care. The researchers and studies convened by this symposium are dedicated to equitable improvements in home health access and quality for the millions of diverse older adults who receive HHC each year in the United States. In sum, the robust findings of these impactful studies, each conducted in an interdisciplinary fashion and rooted in health-equity principles, present informative evidence for future work endeavoring to improve equitable access to and receipt of the full gamut of HHC services from early stages of illness and social care to end-of-life care. Hospice, Palliative and End-of-Life Care Interest Group Sponsored Symposium
PALLIATIVE CARE KNOWLEDGE, HEALTH CONCERNS, AND EDUCATIONAL STATUS IN DECLINING COMMUNITY-BASED PALLIATIVE CARE
Authors: Luth Elizabeth , Amponsah Abigail
Published: January 2025

Palliative care in community settings can support seriously ill individuals to reduce symptoms and maintain quality of life. However, many individuals decline palliative care, even when they are concerned about their health. Differences in understanding how palliative care can help manage serious illness may contribute to individuals declining. This study explores the relationship between individuals’ understanding of palliative care, their health concerns, and education levels (a proxy for health literacy). We use survey responses from a validated instrument assessing palliative care knowledge and information from semi-structured interviews for 21 seriously ill individuals (n=3) and family caregivers (n=18) who were eligible for community-based palliative care services and declined. We explore the relationship between respondents’ education, understanding of palliative care, and their concerns about their or their loved one’s health. Among participants, twelve had a bachelor’s degree or higher; nine had some college or less. A higher percentage of participants with some college or less were concerned about psychological issues, stress, and managing medication side effects (67% vs 42%). All participants who did not understand palliative care could help with stress and medication side effects and were concerned about these had some college or less. One of three participants who did not understand palliative care could help with psychological issues and were concerned about these had some college or less. Assessing health concerns and explaining how palliative care can address those concerns may reduce barriers to accepting palliative care, particularly among individuals with lower levels of education.
LESSONS LEARNED AND NEXT STEPS FOR USER-CENTERED DESIGN WITH OLDER ADULTS AND CAREGIVERS
Authors: Portz Jennifer , Czaja Sara
Published: January 2025

Digital health can uniquely address various healthcare challenges, yet its’ effectiveness relies heavily on factors such as usability, acceptability, and inclusivity. In this symposium, we present findings from three pioneering projects aimed at developing and refining digital health interventions for older adults and their care partners, tailored to specific populations and healthcare needs. Each project employs a user-centered design (UCD) approach to address unique challenges and opportunities in digital health intervention development. From designing dyadic interventions for advanced dementia to improving care coordination for rural older adults and integrating social support in palliative care, these projects offer valuable insights into developing meaningful, accessible, and person-centered digital health solutions across diverse healthcare landscapes. The final presentation outlines lessons learned from four remote co-design processes for dementia care partner interventions. Co-design, involving an active contribution from older adults and partners, fosters usable, relevant solutions, yet challenges in implementing co-design warrant guidance. Lastly, our Discussant, Dr. Sara Czaja, a world-renown expert in aging-related technology, will lead a conversation highlighting the benefits of UCD, the challenges and limitations of the approach, and innovative solutions for fostering the engagement of older adults and their care partners in the digital health design process.
DESIGNING A BIOEXPERIENTIAL PROGRAM FOR SAFETY, USABILITY, AND ACCEPTABILITY WITH DYADS WITH ADVANCED DEMENTIA
Authors: Plys Evan , Rochon Elizabeth , Thacker Ayush , Sy Maimouna , Phillips Mirelle , Kuma Mischa , Ritchie Christine , Vranceanu Ana-Maria
Published: January 2025

Dyadic psychosocial interventions that engage both persons living with dementia (PLWD) and care partners (CPs) are increasingly popular. Yet, designing dyadic interventions for advanced dementia is challenging due to mismatched abilities. Here, we describe the initial development and refinement of the Toolkit for Experiential well-beiNg in Dementia (TEND) intervention with a focus on design considerations for safety, usability, and acceptability. TEND is an online bioexperiential program (e.g., storytelling, digital art, and relaxing sounds and imagery) designed to engage PLWD and CPs together, to support positive affect, relationship satisfaction, and emotional well-being. Using a multi-phasic approach consistent with user-centered design, we conducted two focus groups with clinicians (N=10), two with PLWD-CP dyads (N=7), and one with CPs only (N=4) to inform an initial prototype. Then, we conducted eight rounds of workshops with 10 PLWD-CP dyads to inform intervention refinements. Rapid data analysis was used to analyze findings and quickly inform iterative design. Focus group participants highlighted design considerations to avoid inadvertently exacerbating behavioral and psychiatric symptoms; matching the context of use; and promoting individualization, familiar stimuli, immersion, and visual clarity of the online program. After development of an initial prototype, workshop participants informed refinements to include mixed methods of engagement (i.e., voice recognition, typing, and interactive movement); instructions, tutorials, and navigation guides; directive prompts; simplified language; and pleasant sounds. Overall, the program was perceived as safe and user feedback informed refinements to promote usability and acceptability. We highlight design elements of the TEND program that were responsive to iterative user feedback.
LESSONS LEARNED FROM A USER-CENTERED DESIGN APPROACH RURAL OLDER ADULTS USING DIGITAL HEALTH TOOLS
Authors: Lewis-Thames Marquita , Trimble Shawn , Rosen Francesca Cejtin , Seigel Zachary , Toll Kara , Horne Kensley
Published: January 2025

Increasing age and rurality are associated with decreased care coordination. There is a growing interest in the role of digital tools in improving care across the care continuum for rural and older adult groups. Still, little is known about the best practices of rural older adults and digital health tool usability. Guided by a user-centered design approach, we 1) describe multiple strategies to meaningfully engage rural older adults in the development of a digital health tool to improve telehealth navigation and 2) report best practices assessed from our multi-modal iterative design approach. We engaged key informants, including rural older adults, their caregivers, providers, healthcare administrators, and an advisory board. Our mixed methods user-centered design approach triangulated findings through semi-structured interviews, a systematic literature review, tool usability testing, and a MyChart usability analysis using eye-tracking technology. Lessons learned from our analysis reveal that rural older adults readily engage with digital technology and often sustain use after their introduction. Digital health technologies were most commonly associated with relieving access to care and transportation barriers. Reduced internet access and challenges with using the equipment were common usability barriers. Useful strategies to overcome usability barriers include in-person or telephone tutorials and knowledgeable caregivers. Tools to assist rural older adults with technology barriers were limited. As digital health technologies increasingly integrate into rural care coordination, barriers faced by rural older adults must be considered. Research that aims to elevate the voices of rural older adults in digital health tool design is imperative.
LESSONS LEARNED ENGAGING CARE PARTNERS OF PEOPLE LIVING WITH DEMENTIA IN CO-DESIGN OF DIGITAL HEALTH INTERVENTIONS
Authors: Werner Nicole
Published: January 2025

Per the NIH Stage Model of Behavioral Intervention Development, once a scientific mechanism for a possible behavioral intervention is established, the next critical step is to systematically design the intervention with the target population. If digital health intervention researchers bypass this stage, their interventions may work in ideal but not “real world” settings. Moreover, partnerships between user-centered design/engineering experts and health sciences researchers are believed to “increase the likelihood for impactful outcomes from the use of the engineering design process.” However, more work is needed to translate user-centered design approaches to digital health intervention design for older adults and care partners. Co-design in particular promotes strengths-based (vs. deficit-based) treatment of older adults and care partners. That is, rather than being the focus of a study on what is wrong, older adults and their care partners actively contribute to design and are therefore more likely to produce digital health solutions that are usable, useful, relevant, acceptable, and adaptable to current routines. However, co-design approaches can be challenging to implement, and guidance for engaging older adults and care partners in co-design is lacking. Dr. Werner will present lessons learned across four projects that implemented a remote, five-phase co-design process to co-design digital health interventions with care partners of people living with dementia. Lessons learned span co-design activities, co-design quality, and co-designer outcomes that were identified from research team and care partner interviews conducted at the end of the design process and feedback surveys conducted with care partners after each co-design session.
LIFESPAN SOCIOECONOMIC STATUS AND MORTALITY USING 1900–1940 CENSUSES: FINDINGS FROM THE NORMATIVE AGING STUDY
Authors: Marino Victoria , Ferrie Joseph , Dorame Ashley N , Graham Eileen , III Avron Spiro , Mroczek Daniel , Lee Lewina
Published: January 2025

Early and midlife socioeconomic status (SES) are linked to all-cause mortality, but few studies have examined their independent and joint associations using multidimensional, prospective SES measures and track mortality over extended periods. As described in the Dorame et al. presentation in this symposium, the Boston Early Adversity and Mortality Study (BEAMS) acquired prospective data on the early-life circumstances of three well-characterized male cohorts via linkage to the 1900-1940 US Federal Censuses. This study leverages BEAMS data to test the independent and joint associations of early and midlife SES with all-cause mortality in 1,303 men from a BEAMS cohort, the Normative Aging Study. Early SES, assessed at baseline (earliest available Census before age 18), was a composite combining paternal literacy (1=yes, 0=no) and z-standardized paternal occupational income. Midlife SES was a z-score composite of men’s occupational standing, education, and income at study entry (mean age=42). Mortality status was followed through December 2020 (mean follow-up since baseline: 77 years). Early SES was weakly and positively correlated with midlife SES (r=.17, p<.0001). In Cox regression, each 1-SD higher early SES was associated with 8% lower mortality risk (95%CI: 0.84, 1.00). Each 1-SD higher midlife SES was associated with 3% lower mortality risk (95%CI: 0.95,0.99), adjusted for early SES. The main effect of midlife SES weakened the association of early SES with mortality by only 2%. Early SES did not moderate the association of midlife SES with mortality. Our findings support largely independent contributions of early and midlife SES to all-cause mortality risk.
STABILITY OF COGNITIVE ABILITY AND EFFECT OF EDUCATION ACROSS 58 YEARS: A PROJECT TALENT AGING STUDY
Authors: Arpawong Thalida Em , Huh Jimi , Gruenewald Tara , Fisher Gwenith , Manly Jennifer , Seblova Dominika , Peters Kelly , Gatz Margaret
Published: January 2025

We assessed the degree to which individuals retain cognitive abilities from adolescence through older adulthood, and whether more education associates with better retention in some more than others, after adjusting for adolescent cognitive ability. We also evaluated whether benefits associated with education differ for those with lower or higher cognitive scores in adolescence, or women or men. Data came from the Project Talent Aging Study, and included measures of abstract reasoning, mathematics, visualization in two dimensions, and recognition memory in 1960 and 2018 (n=2,032; age range 71 to 79). Confirmatory factor analysis was used to fit one-factor (cognitive ability factor, CAF) at each timepoint. We then used a structural equation model to test whether the 1960 CAF predicted the 2018 CAF, with an interaction term between 1960 CAF and years of education. Multiple group models tested invariance by sex. We found high stability in CAFs assessed 58 years apart. Education predicted higher 2018 CAF (p<.001), although a significant interaction (1960 CAF*education; p<.05) showed that effects were diminished for those with higher 1960 CAF. Sex-specific analyses showed that the diminishing effect of education was evident for both women (p<.05) and men (p<.05). Additionally, the simple effect of education on 2018 CAF was significant for women (p<.001) but not for men (p=.37). Findings indicate high stability in cognitive abilities from adolescence to older adulthood, and that exposure to more education differentially benefits later age abilities depending on adolescent levels and sex.
VALIDATION OF COGNITIVE AND PSYCHOSOCIAL INSTRUMENTS FOR THE KENYAN CONTEXT: RESULTS FROM LOSHAK
Authors: Mani Sneha , Ehrlich Joshua , Ngugi Anthony , Nagarajan Niranjani , Riang’a Roselyter , Mwangi Eunice , Gross Alden
Published: January 2025

Adaptation of cognitive tests to culturally diverse and low-resource settings is essential for expanding knowledge of cognitive health in older adults beyond high-income countries. However, contextual differences in novel settings can affect reliability and validity. A significant knowledge gap remains in Sub-Saharan Africa, a region projected to be home to over 158 million older adults by 2050. The Longitudinal Study of Health and Ageing in Kenya (LOSHAK) aims to address this measurement gap. The LOSHAK pilot collected neuropsychological and psychosocial assessment data, adapted from the US Health and Retirement Survey to be relevant to the Kenyan context. For four cognitive constructs (orientation, memory, executive functioning, language/fluency) and four psychosocial constructs (depressive symptoms, loneliness, subjective well-being, and life satisfaction), internal consistency reliability was evaluated using McDonald’s omega (ω) and factor structures were evaluated using confirmatory factor analysis. McDonald’s omegas ranged from ω=0.78 to 0.95 for cognitive domains and were above 0.83 for each psychosocial domain, suggesting high reliability. Factor analyses revealed good to excellent fit for most domains (RMSEA<0.095; CFI>0.93; SRMR<0.11); patterns of factor loadings were mostly acceptable (ranging from 0.5 to 0.9), and will be used to refine instruments further. This examination reveals a successful adaptation of neuropsychological and psychosocial assessments in Kenya and provides a reference for other studies seeking to assess the efficacy of adapted instruments.
HARMONIZING COGNITIVE SCORES ACROSS WAVES IN THE CHINA HEALTH AND RETIREMENT LONGITUDINAL STUDY
Authors: Wu Yingyan , Mayeda Elizabeth Rose , Kobayashi Lindsay , Gross Alden , Zhang Yuan
Published: January 2025

The China Health and Retirement Longitudinal Study (CHARLS) administered a word recall test to assess memory function across five study waves from 2011 to 2020. Since 2018, the word recall test has differed from prior waves in the difficulty of word lists used and number of immediate recall trials given, posing challenges for longitudinal analyses of cognitive change. We thus leveraged weighted equipercentile equating for immediate and delayed recall scores to address nonequivalence in the test across study waves. We created a calibration sample that balanced age, gender, and education to ensure the same underlying test ability across waves. Within the calibration sample, we used equipercentile equating to crosswalk percentile ranks between the scores in the 2015 and 2018 waves and 2015 and 2020 waves, then applied the crosswalk to the full study sample. In the full study sample, the mean original delayed word recall scores were higher in 2018 (4.3 words) and 2020 (5.1 words) versus 2015 (3.2 words). Within the 2018 and 2020 waves, mean original delayed scores were higher than mean original immediate scores (2018: 4.3 vs 3.2, 2020: 5.1 vs. 3.6 words). After applying equipercentile equating, the mean 2018 and 2020 wave immediate and delayed word recall scores were comparable to previous waves (immediate: 2015: 4.1, 2018: 3.7, 2020: 3.8; delayed: 2015: 3.2, 2018: 2.5, 2020: 2.8 words). Equipercentile equating can be used to generate comparable scores to facilitate longitudinal analysis when cognitive test administration procedures change over time.
CONSIDERATIONS FOR CROSS-NATIONAL APPROACHES TO ESTIMATING PREVALENCE OF DEMENTIA
Authors: Cai Wenjie , Jones Richard , Gross Alden
Published: January 2025

Comparing dementia prevalence across countries and contexts is crucial for effective public health planning. The Harmonized Cognitive Assessment Protocol Project (HCAP) is a global effort to characterize dementia risk using population-representative samples. Using the HCAP studies from the US, England, and India, we evaluated variations of a classification algorithm based on neuropsychological norms. Variations of the algorithm included variables used to define a robust normative sample (e.g., depression, stroke history, previous diagnosis of dementia, basic and instrumental activities of daily living), characteristics adjusted for when standardizing cognition in the normative sample (e.g., age, sex, education, race/ethnicity, literacy), numbers and types of cognitive domains, and the choice of cut-offs of the components in classification algorithm such as cognitive scores, self-rated memory, and informant-rated impairment. Across each country, we varied these parameters. The overall prevalence of dementia ranged from 8% (India) to 9% (US, England). As expected, using a more liberal 1.0 standard deviation (SD) cutoff on cognitive tests rather than 1.5 SD led to higher dementia prevalence by 3-7%. Excluding orientation to time/place from the cognitive domains resulted in lower prevalence of dementia by 2-3% across countries but a markedly lower prevalence of Mild Cognitive Impairment (by 10% or more), whereas less restrictive criteria for defining a normative sample resulted in slightly lower prevalence of dementia (by 1-2%). This study underscores the importance of consistent methodologies for cross-national dementia prevalence estimates, and also informs the relative importance of certain modifications to criteria.
DETERMINANTS OF RECOVERY IN THE US MEDICARE MINIMUM DATA SET: HANDLING INFORMATIVE OBSERVATION TIMES
Authors: Shardell Michelle , Chen Chixiang , Falvey Jason
Published: January 2025

Patients with Alzheimer’s Disease (AD) who experience a hip fracture are heterogeneous and understudied; thus, factors that influence these patients’ physical recovery are unknown. Moreover, identifying these factors can help inform personalized care for this population. To fill this gap, we use the US Minimum Data Set (MDS), a federally mandated standardized clinical assessment tool administered by the United States Centers for Medicare and Medicaid Services to facilitate care management for residents in Medicare and Medicaid certified nursing homes. Longitudinal assessments in these real-world data are irregular, and their timing is likely informative, which leads to bias if ignored. Therefore, we introduce and apply a novel joint model for longitudinal outcomes and observation times that includes a shared random effect. Data include 9,545 older adults (76.8% female, 55.7% aged 86+ years, 21.8% Medicaid eligible) in the MDS living with AD who were discharged from the hospital after hip fracture to Medicare and Medicaid certified nursing homes between 2017 and 2022. Barthel Index, a measure of physical function in activities of daily living, was the outcome (range: 0 to 90, higher scores indicate better function). Participants underwent 35,794 assessments over 100 days. Medicaid eligibility and lower cognition measured using the Brief Interview for Mental Status were more strongly associated with worse physical function in the proposed method than in a competing method (p<.05). Findings highlight 1) potential roles of socioeconomic status and heterogeneous cognition in AD in hip fracture recovery, and 2) importance of addressing informative observation times in the MDS.
A NEW ANALYTICAL METHOD FOR RISK FACTOR IDENTIFICATION IN ANALYZING LONGITUDINAL POSTFRACTURE RECOVERY OUTCOMES
Authors: Chen Chixiang , Shardell Michelle , Falvey Jason
Published: January 2025

Hip fracture is a highly disabling event experienced disproportionately by older adults with Alzheimer’s disease or related dementias (ADRD). Older adults with ADRD are up to three times more likely than cognitively intact older adults to sustain a hip fracture, have worse functional outcomes, and spend more than 50 fewer days at home (DAH) in the year after fracture. Given the significant consequences of hip fracture among older adults, improving recovery for those with ADRD is a crucial national priority. However, the population of patients with ADRD is highly heterogeneous, hindering our ability to risk stratify patients and focus interventions on those at highest risk and with greatest likelihood of benefit. We develop a new data science approach to unbiasedly detect high-dimensional patient-level risk factors associated with less DAH, while existing toolboxes may fail to address potential biases from unmeasured hospital-level confounders, informative hospital size, and loss to follow-up in analyzing Medicare claims. Analysis of 16562 Medicare beneficiaries with ADRD, aged 65 or above, and experienced a hip fracture between 2017 and 2019 demonstrated that older age, longer length of stay in the hospital, heavier comorbidity burden, and less days at home before fracture are significantly associated less days spent at home in the 12-month period after hip fracture (p<.05), while existing methods fail to detect some effects. Findings demonstrate that the proposed method can overcome bias in using Medicare data and can lead to findings that may inform target for intervention to promote healthy aging.
STRESS PROCESSES IN AGING: CONSIDERING SOCIAL CONTEXT AND SELF-PERCEPTIONS
Authors: Hill Kyrsten
Published: January 2025

How individuals perceive, appraise, and cope with their stressors holds dramatic influence on whether they experience positive aging trajectories. However, stress-related processes are inherently contextual, reflecting an interaction between the person and the environment. The current series of talks considers how individuals deal with stress across different time scales. The first two talks will consider stress in a social context, evaluating the roles of daily loneliness and interpersonal stressors. First, Kang will describe findings from an EMA study suggesting a reciprocal relationship between momentary loneliness and cognitive performance. Second, Ong will report on an EMA study examining the relationship between self-perceptions of aging and daily social interactions. The final two talks will consider adults’ perceptions of their ability to deal with stressors, considering control beliefs and coping processes over the short- and long-term. Third, Neupert will discuss how daily stressors and daily control beliefs are associated with the perceived rate at which people feel that they are aging. Finally, Kurth will discuss how coping strategies change longitudinally over 10 years and how the rate and direction of change depends on age. Together, this symposium highlights how stress processes influence aging across individuals, time courses, and contexts.
SELF-PERCEPTIONS OF AGING AND DAILY SOCIAL INTERACTIONS
Authors: Ong Lydia , Klaiber Patrick , Stuart Nicole , DeLongis Anita , Sin Nancy
Published: January 2025

Age stereotypes can become internalized across the lifespan to influence one’s self-perceptions of aging (SPA). Stereotype embodiment theory suggests behavioral and stress response pathways through which SPA influence downstream health outcomes. Previous research has shown negative SPA predict lower social engagement, but little is known about whether this mechanism is evident at the daily level. Thus, the current study uses ecological momentary assessment over 14 days to investigate whether more negative SPA are associated with fewer interpersonal stressors and positive social interactions, and whether SPA attenuate differences in positive and negative affect on moments with versus without these events. Participants were 224 adults from British Columbia, Canada (ages 25-89, M = 46, 71% women). Multiple regression and three-level multilevel models controlled for demographic factors, depressive symptoms, and health conditions. Results showed that SPA did not predict exposure to interpersonal stressors and positive social interactions. People with more negative SPA had larger differences in negative affect on moments with versus without interpersonal stressors (simple slope for -1 SD SPA: b =.99, SE =.13, p <.001), compared to those with less negative SPA (simple slope for +1 SD SPA: b =.60, SE =.14, p <.001). SPA did not moderate associations between interpersonal stressors and positive affect, or between positive social interactions and positive and negative affect. Findings indicate that people with more negative SPA do not show a lack of daily social engagement but display greater negative affective stress responses, which have implications for downstream health.
DAILY STRESSORS AND DAILY CONTROL BELIEFS ARE ASSOCIATED WITH DAILY ACCELERATED AGING
Authors: Neupert Shevaun , Swaim Kathryn
Published: January 2025

Exposure to daily stressors is consistently associated with reduced health and well-being, including feeling subjectively older. Experiencing increases in daily perceptions of control, however, are typically associated with increased health and well-being and feeling subjectively younger. The current study focuses on subjective accelerated aging from a daily perspective, capturing day-to-day fluctuations in the perceived rate at which people feel that they are aging. The goal of the current study was to bring together daily stressors and daily perceptions of control to test their independent contributions to the understanding of daily accelerated aging. A sample of 440 U.S. adults aged 50-85 participated in a 14-day daily diary study, reporting on their perceived rate of aging, exposure to daily stressors, and perceptions of daily control beliefs each day. All variables demonstrated significant within-person variability, with ICCs ranging from.60 (rate of aging) to.78 (control beliefs). Daily stressors and daily control beliefs were each uniquely predictive of daily accelerated aging, where daily stressors were positively associated and daily control beliefs were negatively associated with daily accelerated aging. These findings underscore the dynamic and contextual nature of subjective aging metrics and document the within-person coupling between events and beliefs.