bluuebunny/crossref_metadata_2025 huggingface dataset:
IMPLEMENTATION OF A VIRTUAL FALL PREVENTION PROGRAM IN OLDER VETERANS
Authors: Ritchey Katherine
Published: January 2025

Though virtual platforms have increased in popularity few studies have explored the implementation and benefit of a virtually-based fall prevention program. MOVing FREEly (Multicomponent Otago Virtual Falls Reduction Exercise and Education program) is a VA-based fall prevention program delivered entirely over a virtual care platform. The MOVing FREEly program is six-weeks long and includes both education in fall-risk reduction and evidence-based fall prevention exercises. Process measures captured implementation considerations, feasibility and effectiveness of the program. 27 participants who were older (mean 75 years), mostly male (89.0%), white (85.2%) and moderate or high risk of falling completed the program. 70% were new to the virtual platform. Attendance for education and exercise classes was > 80% with little attrition. There was improvement in the Falls Efficacy Scale-International short form and statistically significant improvement in 30 second sit-to-stand and single leg balance tests. Process measures indicated that 40% of participants needed extra help at the start of each class to sign-on to the virtual visit, which was provided by program facilitators. By the fourth class, all participants were self-sufficient in their ability to navigate the virtual platform. Additional considerations such as electronic health record documentation and coding; clinic setup, referral management and virtual appointment scheduling; patient privacy and health emergency planning were necessary for the start-up and sustainability of the program. Virtual fall prevention programs are feasible and effective but require careful logistical planning and considerations. Implementation considerations from this program can guide future telerehabilitation research and clinical efforts.
CURRICULUM FOR PRACTICE AND LEADERSHIP IN NURSING HOMES: THE US RESPONSE
Authors: Kolanowski Ann , Reifsnyder JoAnne , Dunbar-Jacob Jacqueline
Published: January 2025

The Teaching Nursing Home (TNH), which began in the 1980s under the leadership of Dr. Mathy Mezey, was a visionary approach to improving the lives of older adults in nursing homes through the efforts of the interdisciplinary healthcare team. The project had extraordinary outcomes, but for a host of political and economic reasons was never brought to full realization. Forty years and a pandemic later, the need for improving quality care in our nations’ nursing homes took center stage. Dr. Terry Fulmer (John A Hartford Foundation) and Nancy Zionts (Jewish Healthcare Foundation) provided extraordinary leadership to address what is now widely regarded as a devastating gap in the US healthcare system. With over $5 million in funding, academic/practice partnerships were revisited in a pilot project with renewed energy, creativity, and resolve by three major universities in Pennsylvania and four affiliated nursing homes. Early on, the lack of curriculum models for faculty educating pre-licensure students in the delivery of quality care in nursing home settings was identified as a barrier to progress in the TNH project. The authors of this paper present the groundbreaking work that was done by an interdisciplinary panel of over 40 expert healthcare practitioners and academicians who came to consensus in the identification and qualitative development of a curriculum that prepares healthcare professionals and their faculty through academic/practice partnerships. Competencies include: creating a culture of care; improving diversity, equity and inclusion; person/family-centered care; models of care delivery; geriatric syndromes; interdisciplinary practice; regulation and finance; and information technology.
NURSE STAFFING AND PRN PSYCHOTROPIC DRUG USE IN VA HOSPITALS
Authors: Shorr Ronald , Lo-Ciganic Wei-Hsuan , Hahm Bridget , Gamble Julia , Powell-Cope Gail , Luther Stephen , Yang Seonkyeong
Published: January 2025

Reducing physical and chemical restraint use in hospitals is vital for patient safety. Studies have linked excessive physical restraint use to nurse shortages and increased risks (e.g., deaths). PRN (as needed) psychotropic drugs are used in hospitals for behavioral disturbances, yet their safety remains debatable. The impact of nurse staffing on PRN psychotropic use is unclear. Using data from 166 nursing units in Veterans Affairs (VA) hospitals from October 1, 2012, to September 30, 2017, we examined the relationship between PRN psychotropic use (i.e., antipsychotics or benzodiazepines) and two nursing staffing indicators: total nursing hours per patient day (TNHPPD) and the skill mix of registered nurses (RN), namely the proportion of nursing hours provided by RNs. Of 9,770 unit months (average 565.4 person-days of care), 25.8% involved veterans aged ≥75, 95.3% were male, and 31.6% had high Nosos risk scores. We categorized each unit into one of four quantiles based on their monthly TNHPPD, with mean and standard deviation ranging from 7.0 (1.5) in the lowest group to 15.2 (3.0) in the highest group. RN skill mix decreased as TNHPPD increased, from 71.5% to 63.1%. PRN psychotropic was 1.4%, consistent across TNHPPD levels. Multivariable mixed modeling showed PRN psychotropic use was not associated with TNHPPD levels (p=0.27) or RN skill mix (p=0.07). Our findings indicate that nurse staffing levels were not associated with PRN psychotropic use in VA hospitals.
SELF-NEGLECT CO-OCCURS WITH AND IS A RISK FACTOR FOR ELDER MISTREATMENT
Authors: Lewis Stuart , Connolly M T , Kimball Patricia , Rogers Geoff , Salvo Erin , Burnes David
Published: January 2025

Elder mistreatment is abuse, neglect, or exploitation occurring in a relationship involving an expectation of trust.1 Yearly, 10%–14% of community dwelling older adults experience mistreatment, with only 15% of cases being reported to Adult Protective Services (APS) for investigation.2 Self-neglect (not defined as elder mistreat- ment) comprises 50% of APS investigations and 65% of substantiated APS cases.3 How self-neglect relates to other forms of mistreatment is not well understood. Maine APS data was analyzed to delineate the relationship between self-neglect and elder mistreatment. Self-neglect as a risk factor for elder mistreatment has important implications for policy, practice, and the prevention of future harms. Our analysis demonstrates that Self-neglect frequently co-occurs with elder mistreatment. A first allegation of self-neglect, substantiated or not, is associated with a shorter time to elder mistreatment and an estimated 33% of all cases of elder mistreatment could be attributed to self-neglect. These findings have important implications for prevention, policy, and practice. While causality cannot be presumed—a limitation in all retrospective analyses—elder mistreatment and self-neglect share risk factors: cognitive impairment, physical disability, lack of social support, and social isolation. Our analysis suggests that early intervention, even in unsubstantiated allegations of self-neglect, may prevent subsequent mistreatment.
ADVANCING EQUITY AND COMMUNITY ENGAGEMENT IN AGING IN CENTERS ON AGING
Authors: Gaugler Joseph , Frazier Robbin , Mahoney Jane
Published: January 2025

The ultimate goal of much gerontological scholarship is to improve the lives of older people. To meet the needs and preferences of our rapidly diversifying communities of older persons, creating equitable partnerships with older adults, families, neighborhoods, and organizations is often necessary, if not essential. This symposium aims to highlight centers/institutes on aging across the U.S. that have adopted various strategies and approaches to build partnerships with aging communities, co-create innovative scholarship, culturally adapt evidence-based/evidence-informed programs, and effectively disseminate knowledge to achieve health equity in aging. Our symposium will feature equity and community engagement missions, activities, opportunities, and challenges for four centers on aging, representing different types of institutions and areas of the country. Featured centers/institutes include the University of Texas-Austin’s Texas Aging & Longevity Consortium, Wayne State University’s Institute of Gerontology, Johns Hopkins University’s Center for Equity and Aging, and the University of Minnesota’s Center for Healthy Aging and Innovation. Jane Mahoney, MD, Director of the Community-Academic Aging Resource Network (CAARN) of the University of Wisconsin-Madison, will synthesize equity and community engagement efforts in centers/institutes on aging and will provide a roadmap for future initiatives to sustain this critical work.
I NEED HELP: AN EXPERIMENT IN COMMUNITY OUTREACH
Authors: Angel Jacqueline
Published: January 2025

This paper describes community outreach activities by faculty affiliated with The UT Austin Texas Aging & Longevity Consortium. Communities across the country like Austin are aging rapidly, while they are becoming more racially diverse and facing an ever-growing need for assistance to older citizens. The City of Austin is a vibrant and cosmopolitan metropolis comprising multiple communities of color—African American, Latino, and Asian which require affordable and culturally-appropriate services and supports. Often these are difficult to find or are simply not available. Many older adults suffer from multiple chronic conditions which increases their need for assistance. As a consequence, community outreach is desperately needed, and investigations in to the most cost-effective and efficient ways of informing clients about available services from which they might benefit is vital. This presentation lays out proposed solutions to confronting these challenges. Specifically, the presentation highlights one award-winning community-based policy research initiative that investigates important possibilities for building an age-friendly Austin that might be applied elsewhere. The public-private initiative uses a multimethod approach to establish an intergenerational community-based resource and activity center (IDC) to optimize space in public places. The IDC model would expand current public health services, including child and adult day care aging, service coordination, and tele-behavioral health in one location. We end with a discussion of lessons learned regarding research-based strategies that encompass three domains: community outreach, co-production, and building partnerships inside and outside the UT campus.
THE CENTER FOR EQUITY IN AGING AT JOHNS HOPKINS UNIVERSITY
Authors: Ornstein Katherine , Allgood Sarah , Thomas Kali , Samus Quincy
Published: January 2025

The Center for Equity in Aging was launched in 2022 Johns Hopkins University to advance scholarship, research and advocacy focused on aging and serious illness care. The Center seeks to transform the diverse experiences of aging and serious illness to enhance equity and well-being across the life course. Hosted by the School of Nursing, the Center includes 2 dozen principal faculty and draws upon a variety of disciplines including nursing, epidemiology, gerontology, health services, and health policy. In this presentation we will discuss how the Center advances equity in aging by engaging in research, training and scholarship that supports diverse individuals and populations, identifies health disparities in aging throughout the life course, and develops interventions, policies, and models of care to reduce inequities in the opportunities and resources needed to grow and age as healthily as possible. We will discuss the Center’s collaborations and partnerships with a diverse set of stakeholder groups to promote community-engaged research practices that inform research across all stages and describe new initiatives focused on advancing equity within the Center and how the Center collaborates with other centers/institutes both within and outside of the Johns Hopkins community. Center leadership will discuss their visions for promoting equity in aging research and reflect on key challenges in the field.
THE ASSOCIATIONS OF LATE-LIFE BLOOD PRESSURE WITH CERAD AND BRAAK STAGES: FINDINGS FROM THE NACC DATASET
Authors: Sin Mo-kyung , Dowling N Maritza , Roseman Jeffrey , Ahmed Ali , Zamrini Edward
Published: January 2025

CERAD and Braak staging are two major scoring systems for quantifying neuropathological features of Alzheimer’s disease (AD). Midlife hypertension is a risk factor for AD, but less is known about the relationships between late-life systolic blood pressure (SBP) with CERAD and Braak staging, the examination of which was the objective of the current study. This study analyzed data from 5,160 participants in the National Alzheimer’s Coordinating Center dataset which had data on 4 longitudinal SBP measurements before death and on CERAD (n=2,600) and Braak (n=2,560) autopsy data. CERAD score was dichotomized into moderate/severe versus none/sparse; Braak stage was dichotomized into groups: III-VI vs 0-II. Logistic regression models were used to examine odds of higher CERAD or Braak staging associated with SBP ≥130mmHg (mean of 4 late-life measures). In a model that controlled for age at death, last BP to death (in years), and sex, a late-life mean SBP ≥130mmHg compared to SBP < 130mmHg was associated with an estimated odds ratio for a more severe CERAD score of 1.13 (95% CI: 1.00, 1.26). In a model that also controlled for antihypertensive medications and APOE ε4 status, SBP ≥130mmHg was associated with a slightly increased estimated odd for a more severe CERAD score of 1.15 (95% CI: 1.02, 1.30). We found a direct association between late-life mean SBP with CERAD score, but not with Braak stage. This analysis supports the importance of maintaining control of BP into late life as a strategy to slow the rate of progression of AD pathology.
THE INTERPLAY AMONG IMMUNITY, INFLAMMATION, AND FRIED FRAILTY ON ALZHEIMER’S DISEASE
Authors: Chen Jiachen , Doyle Margaret , Cao Yumeng , Ragab Ahmed , Murabito Joanne , Lunetta Kathryn
Published: January 2025

Unraveling shared mechanisms for both frailty and Alzheimer’s Disease (AD) including immunity and inflammation is crucial for understanding the link between these two complex multifactorial conditions. This study aimed to characterize the interplay among circulating immune cells, inflammatory biomarkers, and frailty phenotypes on AD onset in the Framingham Heart Study Offspring cohort. A sample of 519 participants (52% female, mean age 66 years), had extensive profiling of immune cells from peripheral blood mononuclear cells and inflammatory protein biomarkers (OLINK Proteomics) at Exam 7 and were dementia-free at the time of Fried frailty measurement (Exam 8). Data from 146 immune cells, 68 proteins, and 5 frailty phenotype components were integrated using sparse multiple Canonical Correlation Analysis (SmCCA) adjusted for relevant covariates. SmCCA seeks linear combinations of variables maximizing inter-correlated canonical scores for all three datasets, yielding signatures of immunity, inflammation, and frailty for each participant that screened variables contributing to the establishment of signatures and inter-datasets pathways. Full follow-up for up to 13.8 years (median 12.1 years) identified 24 incident AD cases. Cox proportional hazard models, accounting for covariates including age, sex, education, and APOE genotype, were employed to assess signatures as risk factors for AD incidence. The inflammation and immunity signatures were correlated (r2=0.32, p-value< 0.001). Both immunity and frailty signatures were significantly associated with AD incidence (immunity: HR=1.1, p-value=0.03; frailty: HR=3.14, p-value=0.02). This study disentangles potential pathways among immune cells and inflammatory biomarkers that contributed to associations with frailty and AD. We will extend to larger studies for replication.
EFFECTIVENESS OF A DEMENTIA CARE INTELLIGENT RECOMMENDER SYSTEM ON CARE PROBLEMS: A RANDOMIZED CONTROLLED TRIAL
Authors: Sun Yue , Wang Zhi-wen
Published: January 2025

Background

The complexity and diversity of problems encountered in dementia care varies from the individual, and the health recommender system provides a pathway for realizing solutions for universal access to professional guidance.

Objectives

To examine the effectiveness of dementia care intelligent recommender system (DCIRS) for dementia care on improving the number of care problems and their level of distress.

Methods

250 caregivers of dementia patients were included and randomly assigned them to either the intervention group receiving the intervention of DCIRS or a waiting-list control group with 12 weeks of intervention length. The number of care problems and their level of distress was measured using the care problems evaluation sheet for people with dementia. The outcomes were compared between groups by using generalized estimating equations (GEE) based on intention-to-treat principle.

Results

A total of 250 participants were included in the analysis. The dietary, dressing, and excretory care problems of the patients with dementia in the control group significantly increased at T2, while there was no significant change in the number of care problems in the intervention group. GEE results showed that participants in the intervention group revealed significantly greater reductions on the level of distress related to care problems than the control group at T1 (β = −3.01, p = 0.026) and T2 (β = −5.80, p = 0.006). Conclusions: The DCIRS was effective in improving the number of care problems and their level of distress. Longer follow-up study is needed to uncover its long-term benefits on clinical outcomes.
EMERGING STRATEGIES FOR AGING
Authors: Ambrosio Fabrisia
Published: January 2025

This session on Emerging Strategies for Aging focuses on the potential of therapeutically targeting specific pathways/hallmarks of aging for extending healthspan. These targets include increasing mitophagy as a way to improve mitochondrial function, the use of extracellular vesicles from young serum to improve tissue homeostasis, modulating lipid metabolism to reduce the number of senescent cells through induction of ferroptosis and targeting the N6-methyldeoxyadenosine epigenetic mark regulated by DNA damage and stress. The session also will include discussion of approaches to target these different pathways in mice, C. elegans and human cell types derived from iPSCs as well as human brain tissue and provide evidence that genetic variants in lipid metabolism indeed affects the level of senescence in humans. Overall, the goal of the session is to provide examples of the types of novel approaches that could be used to target different pathways important for aging and disease.
SHIELDS OF CHIFFON: THE FORTITUDE/RESILIENCE OF AGING DRAG ARTISTS
Authors: Chapman Brian , Brenick Alaina , Donorfio Laura
Published: January 2025

This presentation discusses findings from a mixed methods study examining the intersection of aging, drag artistry, and individual wellbeing. Drag artists remain an understudied and underrepresented population in scholarship (Knutson et al., 2020; O’Brien, 2018). More specifically, older drag artists have yet to be studied in social science literature (Henneberry et al., 2022). Participants completed a semi-structured interview and a self-administered survey to understand the perspectives of drag artists over the age of 50 (n=22; ages 50-94). Qualitative analysis of the interviews revealed themes related to personhood, family impact, coping, resilience, generativity, community advocacy, activism, and performance. Participant interviews were augmented through an electronic survey that validated themes and provided a greater understanding of personality characteristics illuminated in the interviews. The survey assessed resilience (CD-RISC; Connor & Davidson, 2003), depression (CES-D; Radloff, 1977), personality (TIPI; Gosling et al, 2003), and coping (Brief COPE, Carter, 1997) of 20 drag artists (51-94 years). Descriptive analyses reveal high levels of resiliency (M =80.32/100) and low levels of depression (80% of participants reported below threshold rates/symptomatology). The sample is significantly more extraverted, conscientious, and open than population comparison means (51+ years) (t-tests; p’s=0.01-0.001). Repeated measures ANOVA Additionally, results showed that participants used healthier coping methods (i.e., problem-focused>emotion-focused>avoidant (Repeated Measures ANOVA, p’s<0.001). The lived experiences revealed in this study also provides data about the unifying impact of shared episodic events. The session will close with a discussion of potential future research including intergenerational approaches.
THE POWER OF EPHEMERAL GESTURES: THEORIES OF GENDER AND PERFORMANCE
Authors: Highberg Nels , Chamberlin Emma
Published: January 2025

Questions of what defines gender have long been central to theorists, activists, and artists who place gender and sexuality at the center of their work. This presentation provides an overview of feminist and queer theories that can deepen the thinking of those who engage with drag performers. We begin by providing a definition of cultural hegemony informed by the work of Antonio Gramsci and James Lull. Theorizing of power and ideology – including ageism, sexism, and homophobia – Gramsci and Lull argue that dominant ideologies result from intergroup interactions like those exemplified in the anti-drag legislation that dominates the United States. From there, we shift to feminist and queer theories of performativity and identity formation. We start with the foundational work of Judith Butler, whose “Gender Trouble: Feminism and the Subversion of Identity” in 1990 and “Who’s Afraid of Gender?” in 2024 ask how much of “gender” comes not from an essential, internal core but from repeated, unconscious actions enforced by external socio-political forces. That leads to the value of performance and gesture in the creation of a lasting queer legacy. José Esteban Muñoz theorized a queer ephemera that includes drag in his 2009 publication of Cruising Utopia: The Then and There of Queer Futurity, highlighting how gestures in drag aid in the creation of a culturally forbidden queer history, a history that becomes richer and more complex as these drag artists – along with theories about gender and sexual minorities in general – age.
IMPLEMENTATION OF COMMUNITY-BASED PALLIATIVE CARE: A SYSTEMATIC SCOPING REVIEW
Authors: Ho Dorian , Dissault Nicole , Vick Judith , Skalla Lesley , Dukkipati Haripriya , Ma Jessica , Kaufman Brystana
Published: January 2025

Community-based palliative care (CBPC) models, which include palliative care (PC) delivered in outpatient clinics and homes, improve quality of life for people living with serious illness and their care partners. CBPC access has been expanding across the United States, with the goal of delivering PC earlier in the trajectory of serious illness care. This systematic scoping review aimed to summarize provider perspectives regarding barriers and facilitators to CBPC program implementation. MEDLINE and CINAHL were searched for peer-reviewed qualitative research published between 1/1/2010 and 1/9/2024 that included provider perspectives on CBPC, excluding hospice or end-of-life care. Two reviewers screened articles and extracted themes. Framework synthesis was used to categorize themes into provider, organization, and environmental levels according to the PRISM (Practical, Robust Implementation and Sustainability Model) framework. Thirty-five articles were included, varying by providers (PC providers, referring providers, administrators) and practice settings (PC clinic, specialty-embedded PC clinic, home). At the provider level, misperceptions of PC by referring providers, poor inter-provider communication, and unclear roles were perceived barriers to CBPC. Conversely, multidisciplinary PC teams, referring provider PC education, and collaboration were perceived facilitators. At the organizational level, time constraints were perceived barriers while leadership buy-in, shared medical records, and colocation of PC into specialty clinics were perceived facilitators. At the environment level, limited PC workforce and PC reimbursement were perceived barriers. Few articles addressed cultural sensitivity; standardized performance data; and social needs resources. Successful CBPC implementation requires addressing factors at the provider, organizational, and environmental levels.
CHARACTERIZING CARE PARTNER INVOLVEMENT IN THE COMMUNITY AGING IN PLACE, ADVANCING BETTER LIVING FOR ELDERS PROGRAM
Authors: Perepezko Kate , Toto Pam , Fields Beth
Published: January 2025

A growing number of interventions exist to help older adults age safely and independently in their homes, however, many of these programs overlook care partners (i.e., family or friends who provide support). The purpose of the current study was to report on the types of care partner involvement in the Community Aging in Place-Advancing Better Living for Elders (CAPABLE) program. We characterize care partner involvement using multiple data sources: (1) Number of interventionist contacts, (2) Number of goals set, and (3) Quality of care partner interactions with the older adult. We used personas to represent the major types of care partner involvement observed (Miaskiewicz & Kozar, 2011). Preliminary analysis revealed three types of care partners, “Passive Peter,” “Collaborative Candice” and “Safety-Conscious Savannah.” Passive Peter had minimal communication throughout the program (n=1) and did not identify any goals. Collaborative Candice had some contact with interventionists (n=3) but couldn’t attend all visits because she worked full time. Interventionists described her as “working well” with the older adult. She identified two goals for herself. Finally, Safety-Conscious Savannah was involved in one intervention visit and spoke with interventionists on the phone (n=2). She provided support for the older adult’s goals and identified her own goal that was focused on the older adult’s safety. Interventionists described her as doing a lot of work for the older adult. These findings reveal different ways that care partners are involved in an aging in place intervention and can inform future interventions aiming to include care partners.
DO FAMILY CAREGIVERS MATTER FOR HEALTH CARE UTILIZATION? A STUDY OF MENTAL HEALTH SERVICES USE BY OLDER VETERANS
Authors: Wyman Mary , Jacobs Josephine , Stalter Lily , Ventakesh Manasa , Voils Corrine , Trivedi Ranak , Gleason Carey , Amy Byers
Published: January 2025

Mental health (MH) concerns are common in late life. Compared to younger adults, however, older adults are much less likely to use MH services. To guide efforts to increase appropriate utilization, it is important to understand factors impacting MH use. Family caregivers represent a novel, yet understudied, pathway. Using a unique data resource combining 2000-2012 U.S. Health and Retirement Study with Veterans Affairs administrative records, we used mixed effects logistic regression to examine the association between receiving assistance from a caregiver and the likelihood of MH utilization in a sample of community-dwelling, primarily male (96.5%) and non-Hispanic white (77.0%) older veterans. After accounting for demographics, caregiver availability, health factors, and socioeconomic status, caregiving receipt was associated with two-fold odds of MH utilization, compared to receiving no assistance (N=8839 person-observations; OR=2.02; 95% CI 1.54-2.65). The relationship between caregiving receipt and MH use was potentiated by the care recipient both being classified as having dementia and as having less severe MH symptoms. Subsequent logistic regression models examined the impact of multiple caregiver characteristics on utilization among veterans receiving assistance. Primary caregiver female gender was the only predictor which retained an independent, positive association with the outcome (N=764; OR=2.95, CI 1.45-6.00). Findings suggest that caregivers represent an underutilized resource to reduce age-related mental health access disparities, but that certain caregiver subgroups (e.g., male caregivers) may benefit from targeted education or support to help facilitate appropriate MH service use by older adults.
SUPPORTING FORTITUDE AMONG FAMILY CAREGIVERS: THE ROLE OF ADULT DAY SERVICES FOR PERSONS WITH DEMENTIA
Authors: Young Heather , Tonkikh Orly , Ogugu Everlyne , Famula Jessica , Bell Janice
Published: January 2025

Caring for a person with dementia requires family fortitude in terms of commitment, time, energy and ability to manage a trajectory of several years. Family caregivers provide the vast majority of care for over 7 million individuals living with dementia. Many are adult children who deal with competing demands of other family members and employment. Adult Day Services (ADS) offer respite for family caregivers and meaningful support for persons with dementia. This study presents caregiver perspectives from the California Community Program for Alzheimer’s Supports and Services Pilot Program that engaged seven sites in a learning community to develop care standards and advance equity. We conducted semi-structured interviews and thematic analysis of recorded transcripts. The sample included 24 caregivers aged 25 to over 85 (12 spouses, 10 adult children and 2 other relatives). Caregivers described ADS services as life sustaining, being a vital resource that enabled them to continue in their role, balancing other demands. ADS improved mental health and physical health, reduced strain, and fostered self-care and engagement in the broader social network. The services also provided education and enhanced their skills in caring, prolonging their ability to continue. ADS services benefit both persons with dementia and caregivers. Future research could illuminate the long-range health care and societal costs and benefits of ADS for both persons with dementia and caregivers. Sustainable solutions bolster fortitude and optimize person and family-centered care.
FAMILY CAREGIVING FOR INDIVIDUALS WITH PARKINSON’S DISEASE AND LEWY BODY DEMENTIA IN CALIFORNIA
Authors: Whitney Robin , Bell Janice , Link Benjamin , Bhurtel Shikha , Ogugu Everlyne , Tonkikh Orly , Kelly Kathleen , Young Heather
Published: January 2025

Parkinson’s Disease (PD) and Lewy Body Dementia (LBD) are related progressive neurodegenerative disorders that primarily affect older adults. Many individuals with PD/LBD require support from a family caregiver. However, caregivers of individuals with PD/LBD are infrequently studied. We extracted data from 2019-2022 in CareNavTM, a statewide electronic platform with data from caregivers served by the eleven California Caregiver Resource Centers, to compare caregiver sociodemographic characteristics, caregiving activities, and outcomes among caregivers of individuals with PD/LBD to those of individuals with Alzheimer’s Disease and related dementia (ADRD) and other chronic conditions (OCC). Care recipient condition was examined as a predictor of caregiving outcomes (e.g., loneliness, depressive symptoms, strain, and worsening health) using multivariable logistic regression models. There were a total of n=13,649 caregivers, with a majority caring for someone with ADRD (66%), followed by OCC (23%), and PD/LBD (10%). PD/LBD caregivers were more likely to be older, female, white, college-educated, and retired. PD/LBD caregivers were more likely to care for a spouse, spend >40hrs/wk on caregiving, assist with more personal care, and experience problems with the care recipient waking others up at night. In multivariable models, PD/LBD caregiving was independently associated with caregiving strain (OR 1.2; 95% CI [1.0-1.4], p= 0.01) and worsening health (OR 1.2; 95% I [1.1-1.4], p< 0.01), but not with depressive symptoms or loneliness. PD/LBD caregivers are a unique subset of family caregivers engaged in intense and complex care. Services and supports tailored to this condition and related needs may be warranted to optimize caregiver wellbeing.
INTERSECTION OF RACE/ETHNICITY, NATIVITY, AND EMPLOYMENT IN SLEEP QUALITY: A MULTILEVEL MODELING STUDY
Authors: Karakida Maki , Stokes Jeffrey
Published: January 2025

Sleep disorder is a common problem seen in middle-aged and older adults. Work-related stress can also impact people’s sleep quality, yet differences between working and retired older adults’ sleep is unclear. This study examines the relationships between work, retirement, and sleep health, including their intersection with race/ethnicity and nativity, among 31,868 Americans aged 50+. Using the Health and Retirement Study samples (2014 – 2020), we analyzed how diverse older workers and retirees experienced their sleep health differently. We used multilevel linear regression to examine the associations between working/retirement status, race/ethnicity, birthplace, and sleeplessness, controlling for age, gender, birthplace, assets, education, marital status, smoking, exercise, and self-reported health. The regression model without interaction terms demonstrated that compared to retirees, older workers have a significantly higher likelihood of sleep disorder. Black race, assets, education, and age had positive and significant relationships with sleep deprivation, whereas martial loss (divorced, widowed, and never-married) and female gender had significantly lower onsets of sleep disturbances. In the model examining the intersection of race/ethnicity and nativity - interacted with work status - revealed that, compared with US-born non-Hispanic White adults, US-born and foreign-born non-Hispanic Black adults had a significantly higher risk of insomnia. In contrast, non-native Hispanic workers and foreign-born non-Hispanic Other workers had a significantly higher prevalence of sleep difficulties than US-born non-Hispanic White workers. Multilevel findings suggest that the intersectionality of race/ethnicity and nativity plays a decisive role in the association of work status and sleep quality among midlife and older adults in the US.
HOW TO GET AN NIA GRANT
Authors: Santora Kenneth
Published: January 2025

Dr. Santora will provide an overview of the NIA application process, funding opportunities, and relevant policy changes for early-career researchers.
EXAMINING THE IMPACT OF ADVERSE CHILDHOOD EXPERIENCES AND ACTIVE COPING ON COGNITION IN OLDER AFRICAN AMERICANS
Authors: Graham Karen , Steinman Audrey , Paun Olimpia , Barnes Lisa
Published: January 2025

Objective

To examine the association between Adverse Childhood Experiences (ACEs) and cognition in older African Americans and to determine whether active coping moderates the effects of ACEs on cognition later in life. Design: Secondary analysis of data from the Minority Aging Research Study (MARS), a longitudinal community-based study that examines cognitive health and aging in older African Americans.

Methods

Data from 756 MARS participants were analysed. Participants completed cognitive global functioning tests as well as questionnaires to evaluate exposure to ACEs (The First 18 Years Survey) and active coping (John Henryism Active Coping Scale). We used a correlational analysis (t-tests, ANOVA, linear regression) to examine the associations between ACEs and cognition. Additionally, active coping (an inner ability to address difficult experiences) was examined to determine if it moderated the impact of ACEs on cognition.

Results

ACES were not associated with global cognitive functioning. However, a negative relationship was found between active coping and global cognitive functioning, such that more active coping was associated with lower cognition. We did not find active coping to be a significant moderator of ACEs. Conclusions: High active coping scores were found to be correlated to impaired cognitive functioning. More research is needed to address this phenomenon as well as the impact of ACEs on older Black people.
CHILDHOOD PARENTAL RELATIONSHIP AND COGNITIVE HEALTH IN LATER LIFE: ASSOCIATIONS MEDIATED BY SELF-ESTEEM AND SENSE OF CONTROL
Authors: Zhu Xi
Published: January 2025

Life course researchers have found that early-life experiences are linked to later-life cognitive health. However, very few studies have paid specific attention to the parent-child relationship in childhood. This study extends the current literature by considering the relationship between childhood parental relationship and cognitive health in later life. Using data from the National Longitudinal Study of Youth (1979-2020), I looked at both positive and negative/dysfunctional parental relationships in childhood and examined whether they predicted older adults’ self-rated memory and objective cognitive function. To further understand the mechanisms behind the relationship, I also examined the mediation role of self-esteem and sense of control. Findings show that childhood parental love and affection are related to better self-rated memory in later life. Dysfunctional parental relationship is associated with worse self-rated memory. Childhood parental relationships show null association with objective cognitive function among older adults. In addition, KHB mediation tests suggest that self-esteem and sense of control significantly mediated the relationship between childhood parental relationships and later-life subjective cognition. This study contributes to a deeper understanding of the complex factors that influence cognitive health and self-perception of memory in older adults. It suggests that parent-child relationship from early life has a long-term impact on how individuals perceive their cognitive abilities. It also indicates that enhancing psychological resources might have a positive effect on self-perceived cognitive health in older adults. Furthermore, this study highlights the need for clinicians and researchers to distinguish between subjective self-assessments and objective cognitive tests in evaluating older adults’ cognitive health.
ABDOMINAL MYOSTEATOSIS IS ASSOCIATED WITH LOWER PROCESSING SPEED IN A MULTIETHNIC COHORT OF OLDER ADULTS
Authors: McNeish Brendan , Mijkovic Iva , Allison Matthew , Hughes Timothy , Nasrallah Ilya , Terkpertey Eric , Rosano Caterina
Published: January 2025

Prior research linking myosteatosis to cognition in older adults has been conducted in relatively homogenous populations with narrow age ranges. We evaluated if abdominal myosteatosis was associated with processing speed and general cognition in a multiethnic cohort of middle aged and older adults. The sample included 1,268 adults (45-84 years old, mean 63±9 years, 52% female of 41% White, 19% Black, 14% Chinese, and 26% Hispanic) a subset from the Multi-Ethnic Study of Atherosclerosis (MESA). Bivariate analyses were performed between abdominal computed tomography derived muscle densities (a myosteatosis measure) at year 3 with Digit Symbol Coding (DSC) and Cognitive Abilities Screening Instrument (CASI) at year 10. Multivariable models were first adjusted for demographics and education, and further adjusted for other known predictors of cognition: dementia risk factors (APOE-4, physical activity, diabetes, cholesterol, smoking, and hypertension), central adiposity, and cytokines. We tested two-way interactions by 1) race and 2) sex. Myosteatosis was significantly associated with worse DCS (B=0.333, 95% CI: 0.031,0.835) but not CASI (0.106, 95% CI: -0.089,0.300), independent of demographics or education. Results were similar after adjustment for dementia risk factors, central adiposity, and cytokines. Tests for interactions by sex and race were not statistically significant. Abdominal myosteatosis is associated with worse processing speed but not general cognition in this middle-aged and older multiethnic population of men and women, independent of other known predictors of cognition. Longitudinal studies should assess myosteatosis’ impact on cognition and its underlying mechanisms.
ABDOMINAL MYOSTEATOSIS AND COGNITIVE FUNCTION: INSIGHTS FROM CARDIA STUDY
Authors: Acevedo-Fontanez Adrianna , Rosano Caterina , Yaffe Kristine , Carr J Jeffrey , Terry James Greg , Nair Sangeeta , Cvejkus Ryan , Miljkovic Iva
Published: January 2025

The role of myosteatosis in cognitive decline is largely from cross-sectional studies in White populations. Longitudinal studies including Black populations, who have a higher risk of both myosteatosis and dementia than Whites, are warranted. We tested the association between abdominal myosteatosis with 5-year change in cognition in 2,501 White and Black American men (n=1,078; 42% Black) and women (n=1,423; 49% Black) from the Coronary Artery Risk Development in Young Adults (CARDIA), and whether associations vary after adjustment for demographics, center, education, muscle area, follow-up-time, baseline DSST score, smoking, physical activity, diabetes, hypertension, lipid-lowering medication, and BMI. IMAT was log-transformed, and results were standardized with effects shown per standard deviation (SD). Higher IMAT predicted a significant DSST decline in Whites (5-year decrease in DSST: b=-0.77 points for 1 SD of log IMAT, p-value=<0.01) but not in Blacks (b=-0.03, p-value=0.910). By race, higher IMAT was associated with a significant decline in DSST score. We did not see a significant difference in a 5-year decrease in DSST by sex. Abdominal myosteatosis may be a novel risk factor for cognitive decline, especially in Whites. Future studies using an expanded battery of cognitive tests, longer follow-ups, and in other populations, as well as mechanistic studies, are warranted to further confirm and advance our understanding of the novel role of myosteatosis in dementia risk.
PROJECT RESPECT: EXPERIENCES OF SERIOUSLY ILL LGBTQ+ PATIENTS AND PARTNERS WITH THEIR HEALTH CARE PROVIDERS
Authors: Stein Gary , Berkman Cathy
Published: January 2025

Discrimination against LGBTQ+ persons in healthcare creates barriers to serious illness care, including patients avoiding or delaying necessary care, providers disrespecting wishes of surrogates, and adverse outcomes for patients and families. A cross-sectional mixed methods study using an online survey was used to determine the extent to which LGBTQ+ patients and spouses, partners, and widows experienced disrespectful or inadequate care due to sexual orientation or gender identity. A total of 290 LGBTQ+ patients and partners reported high levels of disrespectful and inadequate care. Patients reported these discriminatory actions from healthcare providers: insensitive to me as an LGBTQ+ person (35.2%); not aware of LGBTQ+ health needs (30%); made me feel judged for being LGBTQ+ (23.1%); were rude to me (20.7%); didn’t use my correct pronouns (20.3%); and disregarded my treatment decisions (19.7%). Partners reported they were denied access to their loved one in intensive care or emergency room (12.4%); were treated badly (12.1%); and that their decisions were not followed (10%). Black and Hispanic patients were two to four times more likely than non-Hispanic white patients to report discrimination. This study demonstrated high levels of disrespectful and inadequate care towards patients and partners due to being LGBTQ+, especially problematic for Black and Hispanic patients and those living in politically conservative regions. Recommendations include federal and state civil rights laws to prohibit LGBTQ+ discrimination, and institutional practices to address discrimination, including cultural sensitivity training for staff.
EXPLORING THE NEEDS OF LGBTQIA+ CAREGIVERS OF PEOPLE LIVING WITH NEURODEGENERATIVE DISEASES
Authors: Flatt Jason , Yamada Cody , Klenczar Brittany , Kittle Krystal , Wharton Whitney , Anderson Joel
Published: January 2025

The Administration on Aging estimates 4 million adults aged 60+ in the U.S. identify as lesbian, gay, bisexual, transgender, queer, intersex and/or another identity (LGBTQIA+). Experiences and health-related concerns of LGBTQIA+ caregivers of people living with a neurodegenerative disease, such as Alzheimer’s disease and/or Parkinson’s disease (AD/PD), have been understudied. We synthesize data from two qualitative studies with LGBTQIA+ AD/PD caregivers, including Parkinson’s Research with Inclusion, Diversity, and Equity (PRIDE) and the Research Inclusion Supports Equity (RISE) Registry. Interviews were conducted with LGBTQIA+ caregivers of people living with AD (n=25) and PD (n=8) to explore their needs, experiences, and concerns with using aging and long-term care services and personal health and social needs. Thematic analysis was used to identify key themes. The first theme involved LGBTQIA+ AD/PD caregivers experiencing several financial, legal, and social challenges (e.g., reluctance to access long-term care services) when caring for someone living with AD/PD. Another theme involved LGBTQIA+ caregivers describing that they often supported their care recipients with medical-/nursing-related tasks, stress from caregiving demands, and experiencing financial and/or eligibility challenges when accessing respite care. The final theme focused on caregivers’ health and access of services, with LGBTQIA+ AD/PD caregivers describing difficulties managing their own health, feelings of depression and loneliness, and perceived discrimination when accessing long-term care and aging-related services. We highlight the need for additional research and creation of innovative long-term care services and caregiver support programs to better meet the needs of LGBTQIA+ caregivers of people living with AD/PD.
ISOLATED VERSUS SUPPORTED: THE PERSONAL HEALTH CARE NETWORKS OF OLDER ADULTS LIVING WITH TYPE 2 DIABETES
Authors: Clair Catherine , Bandeen-Roche Karen , Wolff Jennifer , Taylor Janiece , Ornstein Katherine , Tobin Karin
Published: January 2025

Older adults with Type 2 diabetes may or may not have family and friends involved in their care; using social network methods, we can investigate the personal healthcare networks of this population. Objectives included 1) Describe care networks of older adults with Type 2 diabetes; and 2) Characterize the family and friends who provide support for various activities of daily living (ADL), instrumental activities of daily living (IADL), and medically-oriented tasks. We administered a quantitative ego-centric social network inventory to community-dwelling older adults (65+) living with Type 2 diabetes (n=58). The sample was on average, 73.1 years old (SD: 5.9, Range: [65, 86]). and majority female (n=44, 75.9%) and non-White (n=37, 63.8%). Descriptive statistics were conducted overall and by Black (n=32) and White (n=21) race. Ten (17.5%) participants reported no family or friends involved in their care; six were Black and four were White. Those experiencing care isolation were more likely to have never been married compared to those with care networks (p=0.002). Of those with a network, there was an average of 2.9 (SD: 2.0, Range: [1, 11]) individuals in the network; there were no statistically significant differences in network size by race. Of the 140 family and friends across the entire sample, 23 (16.4%) assisted with ADLs, 126 (90.0%) with IADLs, and 48 (34.3%) with medically-oriented tasks. Fourteen (10.0%) individuals assisted with at least 1 activity in all three categories. These findings demonstrate a spectrum of family and friend involvement in the care of this population.