bluuebunny/crossref_metadata_2025 huggingface dataset:
ADDRESSING DISPARITIES IN ADRD PREVALENCE AND MORTALITY RATES BETWEEN RURAL AND URBAN COMMUNITIES
Authors: Ferdows Nasim
Published: January 2025

Rising life expectancy has led to an increase in age-related diseases, such as Alzheimer’s disease and related dementia (ADRD). The rapid growth of the rural older population may result in higher rates of dementia in these communities. However, rural residents face disparities in healthcare access, potentially leading to an underestimation of ADRD prevalence in claims-based studies requiring medical assessment. This study employs two approaches to examine rural and urban differences in ADRD prevalence and mortality rates. First, analyzing national county-level data from the CDC Wonder database from 2010 to 2021, we found higher ADRD mortality rates in rural areas, though not statistically significant. Second, using Health and Retirement Study data, a nationally representative sample of US older adults, and a 20% sample of Medicare claims, we observed higher dementia prevalence in rural areas based on cognitive tests in the HRS, which are free from clinical assessment. This contrasts with lower prevalence rates based on diagnosis codes in claims data for rural areas. The decline in prevalence rates based on diagnosis codes was also more pronounced in urban areas. The decline in prevalence rates based on diagnosis codes was also sharper in urban areas. These findings suggest that claims-based studies may underestimate dementia rates in rural areas due to limited healthcare access. Addressing these disparities is critical for providing adequate care and support to individuals with ADRD in rural communities.
RURALITY AND RACE IN WYOMING AND MISSISSIPPI: THE INTERSECTION OF PLACE AND RACE-BASED DISPARITIES
Authors: Jansen Taylor
Published: January 2025

Across the US, rural populations tend to be “older, poorer, and sicker” than their urban counterparts as they report higher morbidity, mortality, and greater risk of death due to unintentional injuries. In an already disadvantaged population, rural minorities tend to report even worse health outcomes. This study aims to examine the health disparities faced by rural populations by examining county-level 65+ outcomes in the predominately rural states of Wyoming (WY) and Mississippi (MS). Data from the 2023 WY Healthy Aging Data Report (HADR) and MS HADR was utilized to conduct bivariate statistical analyses and mapping to compare rural/frontier, and urban counties in WY and MS. Findings suggest rurality is protective of health in WY, where 21 of 23 counties are classified as rural or frontier, as these counties reported lower morbidity, despite lower access to primary care physicians (PCPs) [Rural: Mean(SD)=46.19(32.67); Urban: M(SD)=245(38.18)] and hospitals [Rural: Mean(SD)=1.1(0.44); Urban: M(SD)=2(1.41)]. Conversely, bivariate analyses found the two frontier counties with a Native American reservation reported the lowest life expectancy [M(SD)=77.7(1.7); WY: M(SD)=80.34(2.26)] and highest homicide rates [M(SD)=4.54(6.42); WY: M(SD)=0.83(2.31)] and COVID-19 mortality [M(SD)=476.64(52.43); WY: M(SD)=356.61(139.24)]. Similarly, predominately Black, rural counties in MS reported worse rates for 26 of 28 indicators of health and lowest access to care [PCPs: M(SD)= 18.52(20.56); Hospitals: M=1.06(0.65)] compared to rural, predominately White counties [PCPs: M(SD)= 23.88(19.92); Hospitals: M(SD)= 1.11(0.64)], and MS state averages [PCPs: M(SD)= 43.54(93.45); Hospitals: M(SD)= 1.23(1.10)]. These findings speak to the unique health disparities rural populations face at the intersection of place and race.
INDIGENOUS RESILIENCY AGAINST THE SOCIAL, BEHAVIORAL, AND MENTAL DETERMINANTS OF HEALTH DURING COVID-19 PANDEMIC
Authors: Kaapu Kristi , McKinley Catherine , Johnson-Jennings Michelle
Published: January 2025

U.S. Indigenous people have been disproportionately impacted by the COVID-19 pandemic, experiencing higher rates of infection and hospitalization, being vulnerable to mental health symptoms, including psychological stress and emotional health, and experiencing higher rates of loss and death. Structural inequities have contributed to these negative COVID-19 health outcomes; however, consistent with the Framework of Historical Oppression, Resilience, and Transcendence (FHORT), Indigenous people offset these disparities through positive coping, adaptation, and resiliency interwoven between individual, family and community ecological levels. This research assessed interconnections of structural inequality and associated disruptions in relation to Indigenous wholistic wellness, primarily around healthcare discrimination, medical mistrust, mental health, and loss and death. Thirty-one head-of-household women participated in community-based, critical ethnographic interviews to assess disparities associated with COVID-19. All participants were in caregiving roles and ranged in age from 29-56 years old. The following themes emerged: (a) negative medical and healthcare experiences; (b) connections between physical and mental health; (c) worry and depression; (d) loss of structure and self; (e) disrupted burial rituals; (f) death, grief, and extensive losses; and (g) resiliency. Results indicate disparities associated with the pandemic emerged in large part from systemic inequity; however, Native American women demonstrated resiliency by advocating for themselves, problem solving, self-coping, and upholding Indigenous values. With lower life expectancy of Indigenous peoples, this study informs both future generations and interventions, promoting traditional and cultural protective factors to offset the impact of historical trauma and oppression, including healing across all ecological domains including physical, mental, emotional, and spiritual aspects.
UNDERSTANDING THE ROLE OF SOCIAL CAPITAL IN FORMAL SERVICE USE AMONG OLDER ADULTS: A SCOPING REVIEW
Authors: De Fries Carson , Wang Kaipeng , Hasche Leslie
Published: January 2025

As individuals age, they may encounter new or persistent challenges that affect their need for and access to formal services. Social capital theory, which views relationships as a source of support, a bridge to needed resources and information, and a buffer against challenges that individuals may face, serves as a useful framework in addressing barriers to service utilization among this population. This scoping review aimed to identify how an older adult’s social capital influences their use of formal services, with a focus on the differences between intergenerational and peer (i.e., non-intergenerational) relationships. The search, conducted in January of 2023, originally yielded 2,645 articles. Following duplication removal and eligibility screening, 57 articles were included for analysis. In reviewing the methodologies of these articles, 75.4% (n=43) used quantitative methods, 9.5% (n=5) utilized qualitative methods, 3.8% (n=2) conducted a systematic or scoping review, one used mixed methods, and one was a conceptual paper on the topic. Results demonstrate nuanced differences in how certain types of relationships may support older adults’ access to formal services. Bonding social capital, operationalized as peer relationships, often provided more therapeutic support, which may have reduced the need for formal services. Bridging social capital, operationalized as intergenerational relationships, often resulted in more instrumental support, providing older adults with information about diverse resources and services. Findings also highlighted methodological gaps in assessing older adults’ social relationships and underscored the need to further explore the mechanisms through which different relationship types influence older adults’ access to needed care.
RURAL FAMILY CAREGIVING: PROMOTING SELF-CARE AND WELL-BEING OF RURAL FEMALE CAREGIVERS OF FRAIL OLDER FAMILY MEMBERS
Authors: Lalani Nasreen , Katare Bhagyashree , Wagle Sampada , Yang Siqi
Published: January 2025

Caring for frail older adults in rural areas is often more challenging due to several disparities. Informal caregivers, mostly females carry the higher burden of caregiving for their older family members. They experience physical, psychological, and economic strains causing poor well-being and caregiver outcomes. Our study aims to examine the self-care practices of rural female caregivers and determine socio-ecological-cultural factors contributing to their resilience and subjective well-being. Using a sequential mixed-method design, 160 Qualtrics-based surveys were collected followed by 20 in-depth interviews from female rural caregivers of older adults from twelve rural counties in the north-central region of the Midwest, US. Multiple linear regressions were done to measure the associations among the study variables whereas thematic analysis was done to analyze the qualitative data. Preliminary findings suggest higher involvement in self-care practices was associated with greater subjective well-being (β=0.575, p< 0.001), and reduced depression (β=0.406, p=0.017) among the rural female caregivers. Social support positively influenced subjective well-being (β=0.588, p=0.010). Initial themes generated from the qualitative data included increased burnout, mental exhaustion, loneliness, and no time for self-care. Meaning-making and faith were the motivating factors toward caregiving roles, self-care, and well-being. Caregiver support and well-being is our social responsibility to improve social, mental, and economic outcomes and prevent rural disparities. Community-based caregiver support programs and policies should be designed using gender equity and cultural lens to improve the overall health, coping, and well-being of caregivers from a rural context.
THE INFLUENCE OF THE COVID-19 PANDEMIC ON DOMESTIC ELDER ABUSE IN JAPAN
Authors: Wada Tadashi , Suda Hitoshi , Uehara Tamiko , Sato Kana
Published: January 2025

We are very interested in the influence of COVID-19 pandemic on elder abuse, especially its effects on the incidence. We investigated its incidence per population of validated domestic elder abuse cases in Matsudo City, Chiba, Japan, and in all over Japan. The Act of the Prevention of Elder Abuse, Support for Caregivers of Elderly Persons and Other Related Matters was enforced in 2004. We have the statistics of numbers of elder abuse cases validated according to the definition of elder abuse described in the act of each annual year in Matsudo City and Japan from 2004 to 2022. The numbers of validated domestic elder abuse cases per 100,000 people between annual 2004 and 2019 were 81.8 in Matsudo City and 49.8 in Japan. The numbers per 100,000 people between annual 2020 and 2022 were in 84.1 in Matsudo City and 46.4 in Japan. Therefore, the number of domestic elder abuse cases may be slightly increased under the COVID-19 pandemic in Matsudo City, on the contrary, it may be slightly decreased in Japan. There are many reports that the COVID-19 pandemic had negative effects on dynamics of family members and increased domestic abuses, however, we have often experienced to see positive effects of the COVID-19 pandemic on family members in home-care settings. I would like to discuss about the influence of the COVID-19 pandemic on the number of domestic elder abuse cases in Matsudo City and in Japan, and its positive and negative effects on family dynamics at home.
REALITIES AND CHALLENGES OF ELDER ABUSE REPORTED TO THE POLICE
Authors: Suda Hitoshi , Wada Tadashi , Satoh Kana , Uehara Tamiko
Published: January 2025

Nationwide, the number of elder abuse reports made to the police has increased. However, it was unclear if these reports resulted in an increase in cases substantiated as actual “elder abuse” by the police? This study used data from fiscal year 2019 in Matsudo City, analyzing a total of 171 elder abuse cases for this study. Among these, 73 cases were reported by the police, accounting for 42.7% of the total cases, and the perpetrators lived with the victims, indicating children were the most common perpetrators of 35 cases (47.9%), followed by spouse of 31 cases (42.5%), and others of 7 cases (9.6%). Out of the police-reported 73 cases, 60 cases (82.2%) were not substantiated as elder abuse under the Act on Prevention of Elder Abuse, and only 13 cases (17.8%) were substantiated as elder abuse. This outcome led us to the conclusion that the increase in police reports does not necessarily indicate an increase in the cases substantiated as “elder abuse,” and highlighted the limited scope of definitions of Elder Abuse in the Act. For example, despite cohabitation, the elder abuse cases where even actual elder violence occurs and requires hospitalization, are not considered as “elder abuse” if there is no caregiving relationship and many of such elder violence cases become to be called “situation-based violence”. It is strongly suggested that the definition of elder abuse of cohabitants with no caregiver relationships should be also included as “elder abuse” in accordance with WHO guidelines.
DOCUMENTING THE VULNERABILITIES OF SELF-EMPLOYED OLDER ADULTS: AN EXAMPLE FROM THE PANDEMIC
Authors: Halvorsen Cal , Matz Christina , Lopez Bruna
Published: January 2025

A defining factor of self-employment in later life is its autonomy and flexibility, enabling older workers to be their own bosses, set their own schedules, and determine where and how they work. Although self-employment has been linked with both positive (higher quality of life and health) and negative (lower take-home pay and workplace-provided benefits) outcomes, little research has considered how self-employed older workers fared during the COVID-19 pandemic. In response, we analyzed data from more than 9,000 Americans ages 50 and older from the 2020 Health and Retirement Study (HRS) and the 2021 HRS Perspectives on the Pandemic mail-in survey. We assessed how work status in 2020 (working for someone else, self-employed, both working for someone else and self-employed, or not working) related to financial difficulties and experiencing health problems due to missed or delayed healthcare outcomes in 2021. While controlling for sociodemographic and health variables, our two multivariable logistic regressions found that self-employment was significantly associated with worse outcomes. Specifically, those who were self-employed or self-employed and working for someone else had significantly higher odds of facing financial difficulties and health problems due to delayed or missed care during the pandemic than those working for someone else only. (Those not working had similar odds of experiencing these issues as those in wage-and-salary work.) This study highlights the vulnerabilities faced by many self-employed older adults while encouraging a discussion on how to better support their health and well-being.
PERSON-CENTERED CARE PLANNING FOR PERSONS WITH MCC: LESSONS FROM PARTNER ROUNDTABLE DISCUSSIONS
Authors: King Anne , Schrager Sarina , Jackson Christie , Michaels LeAnn , Dorr David
Published: January 2025

The Partner Roundtable utilizes successive discussions with policymakers and health care leaders to identify barriers, facilitators, and strategies to improve person-centered care planning (PCCP) design and implementation in health systems, including primary and specialty care. The objectives are to: (1) identify organizational, policy, payment, technology, cost/resource, research, or other requirements for development and implementation of PCCP models across diverse health systems and settings, highlighting specific requirements, for persons living with, or at risk for, MCC; (2) identify challenges to implementation of PCCP; (3) recommend proven, potential, or innovative solutions or facilitators for implementation challenges; and (4) assist in dissemination of project findings. The Roundtable includes a diverse group of 25-30 individuals with influential leadership roles in making, shaping, and informing decisions related to PCCP implementation. Participants are decision-makers from health systems; local, state and federal health policy; health information technology; quality improvement and quality measurement; research; and patient associations or care recipients including family members or caregivers. Roundtable participants are representative of U.S. healthcare, including geographic spread, community health center leadership, payers, clinicians, and implementation and evaluation of innovative care models. Federal partners focused on improving care delivery for this population including care planning are invited participants. Roundtable expertise and recommendations, including environmental scan information, will inform future recommendations for promising models of PCCP.
APPRECIATIVE INQUIRY WORKSHOP TO DEVELOP A DYADIC INTERVENTION FOR PARENTS AND ADULT CHILDREN COPING WITH DEMENTIA
Authors: Monin Joan , Gil Heidi , Weiss Jenna , Moses Ellen Sue , Rosenblatt Lucy
Published: January 2025

Including the voices of people with lived experience should be a requisite step in designing dyadic intervention studies to ensure that study design and measures are acceptable, feasible, and suitable. I will discuss my experience as a researcher participating in a LiveWell Institute Appreciative Inquiry Workshop with the Empowering Partnership Network (EPN), a diverse group of partners that connect and influence dementia research and innovation, advocacy and awareness, and the design and development of systems and spaces intended for people living with dementia. The EPN consists of people living with dementia, care partners, and other partners (researchers, policy makers, practitioners). The goal of the workshop was to begin to develop an attachment-based communication intervention for adult children and their parents coping with dementia. First, we took time to meet each other and identify each other’s strengths. Second, we set guiding principles to help each other be at our best (e.g. not speaking on anyone’s behalf; giving enough time to speak). Third, in the discovery phase, I shared why this work is important and what we know about the science of Attachment theory, dementia, and parent-child relationships. I described my Stage 0 findings and provided examples of other evidenced-based interventions on which we could build. Fourth, in the dream phase, the group shared their hopes about the ideal intervention. Fifth, in the design phase, the group suggested ways of recruiting, what the materials were and what the experience should be. Finally, in the destiny phase, we established the next action steps.
SEX-SPECIFIC ALTERATIONS IN CIRCULATING LIPIDOME DURING MOUSE AGING
Authors: Xu Ziying , Bhattacharjee Anindita , Han Xianlin
Published: January 2025

Lipids serve as pivotal elements in biological systems, fulfilling diverse roles ranging from cellular structure components to signaling molecules and energy reserves. They encompass a variety of classes including structural membrane lipids (e.g., cholesterol, phosphatidylcholine, phosphatidylethanolamine), energy-storing lipids (e.g., triglycerides, fatty acids), and bioactive lipids (e.g., lyso-phospholipids, ceramides). Increasing evidence shows associations between lipids and age-related diseases (e.g., atherosclerosis, cancer, diabetes, and neurodegenerative diseases), indicating lipid metabolism is involved with health and longevity. In this study, we applied multi-dimensional mass spectrometry-based shotgun lipidomics to quantitatively measure the plasma lipidome alterations across different ages in C57BL/6 mice. We systematically collected plasma samples from both sexes across 7 adult-to-old-age timepoints (8 to 32 months, in 4-month increments, with 8-10 mice per sex at each age). Our data revealed a sex-dependent regulation within the circulating lipidome in which males demonstrated higher concentrations across nearly all lipid classes at each timepoint compared to females. Notably, with advanced ages, males exhibited a decline in major phospholipids and an accumulation of cholesteryl ester—suggestive of an age-related shift in lipoprotein composition. An age-associated increase in phosphatidylserine, previously linked to apoptotic signaling, was exclusive to males. Conversely, females showed a consistent plasma lipid profile throughout their lifespan. The only shared change between sexes is plasmalogen decreasing with age, which could imply increasing oxidative stress. Our findings illuminate sex-specific regulatory mechanisms in lipid metabolism during aging in mice, with potential implications for understanding sex differences in the aging process.
BETA-HYDROXYBUTYRATE IS A METABOLIC REGULATOR OF PROTEOSTASIS IN THE AGING BRAIN
Authors: Madhavan Sidharth , Diaz Stephanie Roa , Nomura Mitsunori , King Christina , Garcia Thelma , Schilling Birgit , Chaudhuri Asish , Newman John
Published: January 2025

Loss of proteostasis is a hallmark of aging and Alzheimer disease (AD). Here, we identify beta-hydroxybutyrate (BHB), a ketone body, as a molecular chaperone which regulates protein solubility in the brain. BHB is a small molecule metabolite which primarily provides an oxidative substrate for ATP during hypoglycemic conditions, and also regulates other cellular processes through covalent and noncovalent protein interactions. We demonstrate BHB-chaperone activity across in vitro, ex vivo, and in vivo mouse systems. This activity is shared by select structurally similar metabolites, is not dependent on covalent protein modification, pH, or solute load, and is observable in mouse brain in vivo after delivery of a ketone ester. Furthermore, this phenotype is selective for pathological proteins such as amyloid-beta (Ab), and exogenous BHB ameliorates pathology in nematode models of Ab aggregation toxicity. We have generated a comprehensive atlas of the BHB-induced protein insolublome ex vivo and in vivo using mass spectrometry proteomics, and have identified common protein domains within BHB target sequences. Finally, we show enrichment of neurodegeneration-related proteins among BHB targets and the clearance of these targets from mouse brain, likely via BHB-induced autophagy. Overall, these data indicate a new metabolically regulated mechanism of proteostasis relevant to aging and AD.
SERUM FACTORS DRIVE DIFFERENCES IN MITOCHONDRIAL BIOENERGETICS ASSOCIATED WITH HUMAN AGING
Authors: Heimler Stephanie , Chen Brian , Tanaka Toshiko , Moore Ann Zenobia , Bergstrom Jaclyn , Ferrucci Luigi , Molina Anthony
Published: January 2025

Heterochronic parabiosis studies in mice have demonstrated that circulating factors in blood drive multiple features of aging, including mitochondrial bioenergetic decline. To determine if circulating factors in human blood can drive age-related bioenergetic decline, we treated fibroblasts from younger (33y.o.) and older (72y.o.) adult donors with diluted serum samples representing the adult human life-course (22-92y.o). The GESTALT (Genetic and Epigenetic Signatures of Translational Aging Laboratory Testing) study provided serum samples from 88 healthy participants free from major chronic conditions. We show that the maximal bioenergetic capacity of both younger and older fibroblasts treated with serum for 24 hours negatively correlates with the chronological age of the serum donor (R=-0.28, P=0.01; R=-0.25, P=0.02, respectively). To test the hypothesis that the bioenergetic effects of serum are more closely associated with biological age than chronological age, we used DNA methylation data to calculate first and second generation epigenetic clocks (Horvath, Hannum, PhenoAge, and GrimAge). Our results indicate that the bioenergetic effects of serum are most closely related to second generation clocks, which are trained to capture age-related phenotypes and mortality risk. For example, the effects of serum on fibroblasts derived from younger and older individuals were most closely related to GrimAge (R=-0.36, P< 0.01; R=-0.31, P< 0.01, respectively). These results suggest that the bioenergetic effects of circulating factors may explain the heterogeneity of biological aging among participants of the same chronological age. Ongoing studies are pairing our high-throughput respirometric analyses with multi-omic data to identify molecules that directly impact mitochondrial bioenergetic decline with advancing age.
COMMUNITY-ENGAGED AGING RESEARCH IN GHANA
Authors: Washington Tiffany , Epps Fayron
Published: January 2025

Sub-Saharan Africa (SSA) countries have the fastest growing rates of older adults than other countries across the globe. In SSA countries, adults aged 60 and older will reach 161 million by 2050. Because SSA countries have under-developed economies, older adults in this region are at greater risk for a myriad of social, economic, and health conditions in comparison to their developed counterparts. For example, estimates suggest that the prevalence of dementia in the SSA region may be considerably higher than previously assumed, given the scarcity of comprehensive epidemiological data and the rapidly aging population. Addressing this knowledge gap is imperative to develop effective strategies for early detection, intervention, and support for affected individuals and their families. Therefore, the goal of this symposium is to describe efforts to better understand the experience of older adults in Ghana through community-university partnerships. Speaker one will discuss the development and implementation of a culturally adapted dementia education intervention in Ghana. Speaker two will describe nursing students’ experiences caring for older adults in acute care settings in Ghana. Speaker three will present barriers and facilitators to global community engaged dementia research using a collaboration between U.S.-based university and Ghanaian community partners as a case example. The discussant will outline steps forward in community-engaged aging research in Ghana.
ASSESSING CHANGE IN SOCIAL CONNECTION: DESIGN CONSIDERATIONS FOR CLINICAL TRIALS WITH OLDER ADULTS
Authors: Van Orden Kimberly
Published: January 2025

Social disconnection is associated with suicide ideation, attempts, and deaths in later life and is present in 70-90% of suicide deaths in older adults. However, it is not known if promoting social connection is an effective strategy to prevent suicide in later life because studies have not directly tested this mechanism. This presentation will describe the rationale and design of an ongoing clinical trial to test a brief behavioral intervention to increase social connection and thereby reduce suicide risk in older adults in senior living communities who endorse significant loneliness and recent suicide ideation. All study outcomes are measured via smartphone: two subjective indices of social connection are measured via EMA self-report (loneliness and satisfaction with social activities) as well as two objective indices of social connection (time spent outside the home [self-report via EMA, supplemented with GPS sensing] and quantity of conversations [ambient audio sensing]. Suicide ideation is assessed daily via EMA. Findings from baseline smartphone assessments will be presented, including compliance to the protocol. Currently, 5 subjects have completed the 10-day smartphone assessment protocol (2 males, 3 females), with an average age of 88 (range 77-96 years). Few studies with older adults use this methodology for outcomes assessment and no studies have used smartphone assessments to collect outcomes data for behavioral interventions for social connection, despite potential benefits of assessing social connection within real-world social contexts. Opportunities (maximizing sensitivity) and challenges (technology support) to this approach will be discussed.
DAILY MEMORY ISSUES: NATURE, CORRELATES, AND CONSEQUENCES
Authors: Hartung Johanna , Hueluer Gizem
Published: January 2025

Memory lapses are common occurrences in daily life; however, little is known about the mechanisms underlying their occurrence. The overarching goal of this project is to understand the nature, correlates, and consequences of memory lapses in everyday life. We conducted an experience-sampling study over ten days with three measurement occasions per day with 325 adults (age = 18 to 36 years). The momentary assessments included measures of memory lapses, working memory (WM) performance, activities, and mood. Participants also completed a retrospective memory lapse questionnaire. Our results show that the participants who retrospectively reported a higher number of lapses also reported a higher number of lapses across the 30 measurement occasions. Nevertheless, the frequency of momentary memory lapses was unrelated to WM, while the number of retrospectively measured lapses was associated with lower WM. The opposite pattern was found for interference/seriousness: WM was not associated with retrospective ratings of seriousness but with momentary ratings of interference. Memory lapses were more likely to occur on occasions with more cognitive activity and worse mood and individuals who reported more cognitive activity and worse mood than others also reported more memory lapses than others. The occurrence of memory lapses at a given time was unrelated to momentary working memory performance. Taken together, our findings suggest that the occurrence of memory lapses may be indicative of a cognitively active lifestyle, but not necessarily of objective performance deficits. We address the implications of our findings for theory and practice and discuss a replication with older adults.
RACIAL/ETHNIC DIFFERENCES IN LONELINESS AMONG OLDER ADULTS: THE ROLE OF INCOME AND EDUCATION AS MEDIATORS
Authors: Taylor Harry , Roy Arka , Tsuchiya Kazumi , Nguyen Ann , Chen Yu-Chih , Cudjoe Thomas , Qin Weidi
Published: January 2025

Our study examines differences in loneliness by race/ethnicity among older adults in the United States and whether income and education mediate these differences. Data came from the Health and Retirement Study Leave-Behind Questionnaire, 2014-2016. Loneliness was measured by the UCLA 3-item loneliness scale. Race/ethnicity categories were White, Black, and Hispanic/Latino. The mediator variables were total household income and education. Sociodemographic covariates included gender, age, employment status, living arrangements, country region, urbanicity, and HRS LBQ Wave. Multivariable linear regression models were used to determine differences in loneliness by race/ethnicity. The KHB mediation method was used to determine if income and education mediated racial/ethnic differences in loneliness. In bivariable analyses, White and Hispanic/Latinx older adults had comparable levels of loneliness, while Black older adults had higher loneliness scores. After multivariable adjustment, Hispanic/Latinx older adults had the lowest levels of loneliness while White and Black older adults had comparable levels of loneliness. A complete mediation was found between Whites and Blacks, in that income and education completely mediated differences in loneliness between these groups. A partial mediation was found between Whites and Hispanics, and between Blacks and Hispanics. Income as a mediator accounted for greater racial/ethnic differences in loneliness compared to education. Our study is the first to explicitly determine if socioeconomic factors mediate race/ethnicity differences in loneliness among a nationally representative sample of older adults. Study findings can inform evidence-based interventions and programs to reduce loneliness among older adults.
SUCCESSFULLY “AGING ALONE”? UNEQUAL OPPORTUNITIES AND RISING RISKS IN FAMILY-BASED MODELS OF CARE CROSS-NATIONALLY
Authors: Mair Christine
Published: January 2025

For the first time in human history, older adults will outnumber children and a substantial and growing proportion will live alone and lack one or more nuclear family tie. Such unprecedented shifts require a reevaluation of existing models of “successful aging”, particularly in terms of long-term care policies. This paper draws on country-level data from multiple publicly available sources (e.g., World Bank, Organization for Economic Cooperation and Development, Our World in Data, and the World Values Survey) to examine cross-national patterns of development, health, demography, resources and policies, and cultural values in low-, middle-, and high-income countries. Although there exists substantial heterogeneity across countries, country-level patterns illustrate the economic privilege of living alone and the dominance of “successful aging” opportunities in high income countries. Cultural values about family reflect standard patterns of economic development, yet friendship emerges as a particularly consistent global value. Living alone is associated with poor health in lower income countries, yet better health in higher income countries. Aging “alone” is a risk factor in some contexts, yet a marker of privilege in others. Models of “successful aging” are largely unobtainable in lower income countries, and therefore require a thorough incorporation of global realities, or final abandonment in favor of more nuanced structural perspectives. Long-term care policies that assume the presence of family will yield increasing risk over time across all global contexts and represent a key vulnerability in the future of healthy aging policy.
FAMILY INVOLVEMENT AND SYMPTOM BURDEN IN NURSING HOME RESIDENTS WITH COGNITIVE IMPAIRMENT
Authors: Tucker Gretchen , Cagle John , Stump Timothy , Tu Wanzhu , Zhang Peiyuan , Floyd Alex , Ersek Mary , Unroe Kathleen
Published: January 2025

Research suggests that family involvement improves the quality of life of nursing home residents. Using baseline data from an on-going multisite clinical trial (UPLIFT-AD), we examined the association between family involvement and staff-reported accounts of resident symptom burden. Symptom burden was measured as a composite of frequency and intensity of symptoms, using items from the End-of-Life Dementia (EOLD) scale. Higher scores indicate greater burden. Family involvement was measured by the family-reported average weekly in-person visit frequency over the past month (range 0-7 days). Data on 198 residents were collected, 61.9% of whom were in Indiana, with the remainder (38.1%) in Maryland. Of the 198 residents, 60.3% were female. The Brief Interview for Mental Status score, which indicates cognitive impairment level, was 6.5 (SD=3.9). Most family members were an adult child (58.7%), 7.9% were spouses, and 38.8% were “other.” On average, spouses visited 5 days a week, children 2 days a week, and other family members 1.5 days a week. In 53.5% of cases, the reporting staff member knew the resident for >1 year. Linear regression analysis was used to examine the associations between the frequency of in-person family visits and EOLD scores while adjusting for resident demographics, mental status, family relationship to the resident, and facility location. Visit frequency was associated with higher EOLD scores (B=0.18, p=.037). Findings suggest family involvement may sensitize nursing home staff to the presence of a resident’s burdensome symptoms, which may become more discernible to families with increased involvement.
MOTIVATING OLDER ADULTS THROUGH IMMERSIVE VIRTUAL EXERCISE (MOTIVE)
Authors: Burch Brittany , Resnick Barbara , Reyes Jimmy
Published: January 2025

Physical activity among older adults can prevent and treat a host of chronic conditions and reduce mortality. However, people who are high-income are almost twice as likely to meet the physical activity guidelines compared to their low-income peers. Physical activity interventions are a critical approach to directly decrease health disparities among older adults who are low-income. We present pilot study results from an innovative intervention titled Motivating Older Adults Through Immersive Virtual Exercise (MOTIVE), which aimed to: 1) determine the feasibility of MOTIVE and 2) test the preliminary efficacy of MOTIVE at increasing physical activity among older adults who are low-income and living in urban environments. We randomized 10 older adults in Baltimore to the fully-immersive virtual reality exercise intervention (MOTIVE) and 10 to a physical activity education only control group. For 8 weeks, twice weekly, the participants in the MOTIVE intervention group biked through virtual naturalistic environments and smashed targets to the beat of their favorite music. To analyze the data, we performed descriptive statistics and used linear mixed models, controlling for covariates. We found that MOTIVE group participants attended an average of 15 out of the 16 sessions. During the 8 weeks, according to the Yale Physical Activity Survey Part 2, the MOTIVE participants significantly increased their physical activity (p<.001, CI=-31.3,-11.3). While the interaction of time and group was not statistically significant, the Cohen’s d (.53) indicated a moderate effect, favoring the MOTIVE intervention group. These results provide strong preliminary data to support a scaled-up study.
GAIT SPEED AS A FUNCTIONAL VITAL SIGN: FROM IMPLEMENTATION TO INTERVENTION
Authors: Baillargeon Emma , Garbin Alexander , Bean Jonathan
Published: January 2025

Older adults with impaired mobility have a greater risk of falls, hospitalization, loss of independence, and mortality. Interventions to improve mobility are effective, but because mobility limitations are under-diagnosed, patients are often not referred for treatment unless they fall or report a change in function. Walking (gait) speed is a strong predictor of overall health (a “functional vital sign”) and can identify patients who may benefit from intervention, but in most clinics is not routinely assessed like other vital signs. In this symposium, we will present four projects on using routine gait speed assessment to identify and treat mobility limitations in outpatient clinical care. The first two speakers (Baillargeon and Garbin) will present projects implementing gait speed in outpatient geriatric clinics, the factors associated with implementation, project outcomes, and strategies to integrate gait assessment into clinical workflows. The third speaker (Lo) will present on self-administered app-based walking assessments that can allow for more frequent measures of walking in various settings and how this data may inform clinical decision making. Finally, the last speaker (Brach) will discuss interventions to improve gait speed that could be used to treat mobility limitations once patients are identified. Our discussant (Bean) will lead a conversation about this work in the larger context and possible future directions for the field. Together, the talks in this symposium will provide evidence that routine, quantitative gait assessment in outpatient care is feasible and has significant potential to improve the care for older adult patients across the continuum of healthcare.
ASSESSING THE GENERALIZABILITY OF THE PEOPLE LIVING WITH HIV IN THE ALL OF US DATABASE
Authors: Plummer Narcissa , Ratnayake Aneeka , Olivieri-Mui Brianne , Cavanaugh Robert
Published: January 2025

Few large databases are representative of the US population of people living with HIV. In 2018, the All of Us (AoU) Research Program launched, with the goal of enrolling 1 million Americans under-represented in biomedical research such as PWH. This study aimed to establish the generalizability of data self-reported by PWH in AoU to U.S. Centers for Disease Control and Prevention (CDC) HIV surveillance statistics (2021). We conducted a cross-sectional descriptive analysis of AoU participants who self-reported as living with HIV. The ‘allofus’ R package extracted survey responses to the HIV-related questions with the relevant concept IDs (1384391, 43530505, 43528832, 43530347). We compared AoU demographic statistics to CDC HIV surveillance statistics using Pearson’s chi-squared tests. Of the 409,420 AoU participants 1,714 people self-reported having HIV. Most were male (n=1,282, 76.4%) and reported a non-heterosexual sexual orientation (n=1,239, 71.2%). Almost half were 55 and older (n=821, 47.9%) and the largest race/ethnicity group was non-Hispanic White (n=783, 45.7%). Compared to national surveillance data AoU was similar in gender/sex (US: 76.9% Male vs AoU: 76.4% Male, p-value 0.103), but different in age (US: 22.7% Age 45-54 vs AoU: 26.8% Age 45-54, p-value <0.001) and race/ethnicity (US: 39.8% Non-Hispanic Black vs AoU: 30.6% Non-Hispanic Black, p-value <0.001). AoU has successfully oversampled older ages, but self-reported PWH are Whiter than expected. As such, interpretations of AoU are limited in generalizability to the US HIV population. Future research is to redefine AoU HIV cohort (including health records and medication) and evaluate generalizability.
THE DEMENTIA CARE PARTNER HUB: A NOVEL RESOURCE TO SUPPORT PEOPLE LIVING WITH DEMENTIA, CARE PARTNERS, AND CARE TEAMS
Authors: Dawson Walter , Reed Jenn Hollandsworth , Gelmon Sherril
Published: January 2025

Care partners of people living with dementia (PLWD) need information and access to multiple services and programs to provide support and maintain their own wellbeing. Focus groups (n=5) and interviews (n=24) were conducted with care partners and interviews with organizations serving PLWDs in the Portland, Oregon region between July 2022 and September 2023. A review of organizational websites and relevant literature identified several US-based role model programs. Data analysis revealed community assets and unmet needs, and articulated resource priorities to inform programs/services. Dementia care partners need multiple supports for caregiving: information about dementia; navigation and coordination; psychological support; recognition of care partner burden; leisure activities; day services; transportation; legal and financial services; home health; and financial support. Feedback revealed care partner deficits in accessing information and social supports. To augment existing services and supports for care partners, a Dementia Care Partner Hub (the “Hub”) should be developed. The Hub would be the central node of a regional network of existing services. The Hub should serve all dementia care partners in its service region, with a responsive design to the specific assets and needs of historically and currently underrepresented communities. It should augment and complement current clinical, research, and social programs by connecting care partners to programs and services. Community-specific information for communities defined by geography and identity will ensure the Hub equitably serves care partners with varying needs. Key elements to achieving this equity goal include language access, culturally appropriate information, and accessibility of the Hub across the entire region.
“CULTIVA MENTE”: DESIGNING A BRAIN HEALTH CAMPAIGN FOR PROMOTING DEMENTIA-RISK REDUCTION
Authors: Aravena Jose , Castro Hugo , Poblete Ronald , Levy Becca
Published: January 2025

Implementing a successful campaign to promote dementia-risk reduction requires an understanding of how both older persons and healthcare providers conceptualize dementia risk as well as culturally relevant barriers and facilitating factors related to achieving brain health. Thus, this study aimed to achieve this goal through a qualitative study using a design-thinking approach with senior center participants aged 60 and older with no dementia, and healthcare professionals working at the senior centers in Chile. Ten centers, each with one focus group of senior center participants and one focus group of health professionals discussed topics related to a brain health campaign. Thematic analysis was conducted and supplemented with an analysis of previous educational campaigns. A total of 115 patients and 51 health professionals participated. Themes identified included: A) social images about dementia; B) knowledge about dementia risk factors; C) structural barriers to dementia prevention, including ageism; D) barriers and facilitating factors to dementia prevention, such as education: and E) role models of persons that worked toward brain health. Based on these results and analysis of previous initiatives, an educational campaign named ‘Cultiva mente’ (cultivate mind) was developed, referring metaphorically to nurturing minds like plants. The campaign includes posters and brochures highlighting positive images and behaviors about aging and brain health, an educational interactive website, and a training program for health professionals on dementia risk reduction strategies. This study constitutes the design of a culturally relevant campaign to promote dementia risk reduction that will be tested in a future efficacy study
NEW CONSUMER-REPORTED QUALITY INDICATORS FOR HOME AND COMMUNITY-BASED SERVICES: THE NCI-AD SURVEY
Authors: Shippee Tetyana , Shih Regina
Published: January 2025

This symposium will introduce new consumer-reported quality indicators for home and community-based services (HCBS). The HCBS Quality Measures Set released by the Centers for Medicare and Medicaid Services includes few consumer-reported measures, most of which are not psychometrically validated or widely applicable. The National Core Indicators- Aging and Disability Survey (NCI-AD) is an underutilized source of consumer-reported data for measuring HCBS quality. This symposium includes 4 presentations. [1] The first presentation provides an overview of the NCI-AD database for researchers and policy-makers, including new features/survey tools added to more recent survey waves. [2] The second presentation introduces five new quality indicators (from 22 consumer-reported survey items) developed using exploratory and confirmatory factor analyses of the NCI-AD data. These indicators include staff quality, environmental safety, community inclusion, service satisfaction, and service decision-making; each with good reliability and validity (Cronbach’s alpha, 0.78-0.89). [3] The third presentation demonstrates measurement of service-specific unmet needs as a measure of consumer-reported quality for 6 commonly used HCBS, and how these differ between consumers with versus without dementia. [4] The fourth presentation discusses state-level factors as correlates of consumer-reported service-specific unmet needs, with emphasis on a higher proportion of Medicare managed care beneficiaries in a state as a predictor of greater unmet needs for some HCBS measures. Collectively, the four projects introduce new consumer-reported quality indicators for HCBS and equip the attendees with knowledge to measure consumer-reported quality in HCBS, including for older adults with dementia.
HOW DO UNMET NEEDS VARY BETWEEN PEOPLE WITH AND WITHOUT DEMENTIA RECEIVING HOME AND COMMUNITY-BASED SERVICES
Authors: Jutkowitz Eric , Wolf Jack , Parikh Romil , Langworthy Benjamin , Shippee Tetyana
Published: January 2025

The National Core Indicators Aging and Disability (NCI-AD) survey samples home and community-based service recipients to understand their unmet HCBS needs. Using 2016-2019 NCI-AD data (N=24348), we evaluated the demographic (e.g, race), health (e.g, hearing ability), environmental (e.g., living alone) and payer (e.g., Medicaid) factors associated with reporting an unmet need among HCBS users age ≥65 with and without dementia. We defined an unmet need as reporting wanting more adult day services, caregiver support, delivered meals, homemakers, personal care assistance, or transportation services. We modeled the odds of unmet needs and tested for differences in unmet needs between people with and without dementia. Personal care assistance was the most frequently used service among people living with and without dementia (59% vs. 50%) followed by delivered meals (22% vs. 37%), homemaker services (21% vs. 25%), adult day services (12% vs. 8%), transportation (9% vs. 8%) and caregiver support (9% vs. 5%). Unmet needs among people with and without dementia respectively varied between 5% and 3.2% (adult day services) to 11% and 14% (personal care assistants). Asians compared to Whites without dementia were significantly more likely to report an unmet need for personal care and homemaker support, and less likely to report an unmet need for caregiver support, but there was little association for people with dementia. Overall health and hearing ability also had different associations with unmet needs between people living with and without dementia but the relationships were not consistent in direction.