bluuebunny/crossref_metadata_2025 huggingface dataset:
ENGAGING PEOPLE LIVING WITH DEMENTIA, CARE PARTNERS, AND STAFF TO INFORM REMOTE ME AND MY WISHES
Authors: Towsley Gail
Published: January 2025

Me & My Wishes, is a video recording approach for documenting, viewing, listening, and discussing nursing home (NH) residents’ preferences for daily and end-of-life care. This project addressed the alignment and measurement domains of the Readiness Assessment Pragmatic Trial Model. Using a qualitative descriptive design, we conducted focus groups with experts representing persons living with dementia (PLWD) (n=6), care partners (n=8), and NH staff (n=9) to inform us of what mattered to them when implementing and evaluating a remote format of Me & My Wishes. We coded and analyzed audio-recorded transcripts, resolved coding discrepancies in team meetings, and derived domains from finalized codes. Three domains for implementing Me & My Wishes remotely was shared across groups. Prioritizing Care Conferences included leadership providing staff resources and support to prioritize care conferences utilizing Me & My Wishes. Addressing Competing Demands that Prevent Key People Attending involved identifying times for care conferences that allow residents, care partners, and staff to participate. Utilizing Technology and Learning to Communicate in a Virtual Environment encompassed recommendations to have a trained facilitator whom engages attendees and additional support (e.g. technical, emotional) for the PLWD. Experts provided input on content, structure, and design of a template for capturing video highlights, changes in preferences, and results of conversations that could be included in the medical record. Outcomes most important to them included person-centered care, dignity, feeling heard and understood, and improved knowledge. Experts identified key alignment and measurement aspects that informed modifications for delivering Me & My Wishes remotely.
“DIAGNOSE AND ADIOS”: MULTIPERSPECTIVE INSIGHTS ON FORMAL SERVICE USE IN DEMENTIA FAMILY CAREGIVERS
Authors: Greenfield Annabelle , Mason Hannah , Osso Francesco , Bumbalova Katerina , Bloom Rachel , Falzarano Francesca
Published: January 2025

Over 11 million unpaid family caregivers currently provide care to 6.7 million individuals with Alzheimer’s disease and related dementias (ADRD). The diverse roles associated with ADRD caregiving range from physical care responsibilities, providing emotional support, in addition to more complex roles such as medical/legal/financial decision-making. Formal and informal supports (e.g., respite, training/education, social support) may be protective against adverse stress-related outcomes such as depression, anxiety, and burden. Despite the existence of such supports, caregivers’ utilization rates remain remarkably low. Using focus group methodology, the current study explored ADRD caregivers’ experiences with the formal services system and identified barriers that hinder service access and utilization. Five semi-structured focus groups were conducted with ADRD family caregivers (n=13) and Dementia Care Community Partners (n=17). Qualitative findings identified three overarching concepts: 1) “Pathways to Preparedness,” categorized primary domains of unmet needs of support, specifically regarding education, emergency preparedness, financial/legal guidance, and mental health. 2) “Multi-Level Barriers” examines obstacles identified across the individual, provider, and systemic levels that hinder service identification and access. 3) “Bridging the Gap” illustrates technology’s potential in mending the broken needs-to-services continuum by providing tailored and personalized support to caregivers. Findings underscore the complex disconnect between caregivers’ needs and existing services, leading to a lack of preparedness for caregiving roles and stress-related adverse outcomes. Yet, a viable solution lies in web-based behavioral interventions, creating a clear pathway for caregivers to identify, access, and utilize formal services, thus improving their overall experiences and outcomes.
THE TIMING OF SUPPORT UTILIZATION AND ITS IMPLICATIONS FOR THE EFFECTIVENESS OF FORMAL CAREGIVING SUPPORT
Authors: Svec Joseph , Meinertz Naomi , Lee JeongEun
Published: January 2025

Current literature on caregiving support indicates a mixed association between formal support (e.g., paid help, respite, training) and caregiver well-being. Compared to informal support from family and friends, formal support often comes with additional costs to caregivers in the form of financial, knowledge, and time barriers to access. This study seeks to examine those barriers, particularly the issue of when caregivers seek and utilize formal support as a predictor of its effectiveness. We utilize four waves of data from the National Study of Caregivers (NSOC) toward a series of fixed-effect linear regression models for caregiver emotional distress and physical health on formal support usage (N = 2,083). The dependent variable, experiencing any financial, emotional, or physical difficulties (M = 0.83, SD = 0.87), is regressed on whether the caregiver received support from paid help, financial help, or respite (M = 0.51, SD = 0.77). The findings show that formal support is positively associated with higher levels of caregiving difficulty (coeff = 0.22, p < 0.05); however, when controlling for past levels of difficulty (previous wave difficulty) and past usage of formal support (previous wave formal support), the positive association of formal support is mitigated. This suggests that the timing of adopting formal support can play a role in the challenges faced by caregivers, with earlier adoption potentially leading to reduced burdens of informal caregivers. While formal support remains positively associated with perceived difficulty, the mitigated coefficient when including lagged variables suggests that formal support effectiveness is also time sensitive.
EXPLORING SECONDARY STRESSORS ON ADRD CAREGIVERS’ EXPERIENCES WITH HOME AND COMMUNITY-BASED SERVICES (HCBS)
Authors: Falzarano Francesca , McCarthy Megan , Mason Hannah , Greenfield Annabelle , Osso Francesco
Published: January 2025

Family caregivers are the primary care providers for the growing population with Alzheimer’s Disease and Related Dementias (ADRD), yet they often feel unprepared and ill-equipped to carry out their role. While caregivers report high unmet needs, the low uptake of home- and community-based services (HCBS) underscores major gaps between the family care unit and the formal healthcare system. Further, little research has examined how stressors outside of direct care provision influence how caregivers perceive HCBS. Thus, using the stress process model as a theoretical framework, the current study examines the differential influences of secondary stressors on caregivers’ experiences with and attitudes toward HCBS, and its subsequent impact on psychosocial outcomes. ADRD caregivers (n=63) completed an online survey of measures assessing multiple dimensions of care-related stress. Path analyses were used to test caregivers’ perceived experiences with HCBS as mediators influencing the relationship between care-related stress and psychosocial outcomes. Results showed that those with greater family conflict reported more negative experiences with HCBS, which subsequently predicted greater levels of burden. The magnitude of the direct effect was significantly reduced and became non-significant (from β=.26, p<.05 to β=.16, p=.24), providing evidence of full mediation. Additionally, difficulty finding services partially mediated the relationship between cost-of-care and role captivity on burden, self-efficacy, and depression. Findings underscore the need for additional research focused on gaining a more holistic understanding of factors that influence how caregivers interface with the HCBS to promote advancement and continuity across the needs-to-service-use continuum.
DIGITAL HEALTH LITERACY AND SELF-EFFICACY IN USING E-HEALTH RESOURCES AMONG CAREGIVERS OF INDIVIDUALS WITH ADRD
Authors: Oh Kyeung Mi , Lee Jung-Ah
Published: January 2025

This study explored digital health literacy skills, self-efficacy in utilizing e-health resources, and self-efficacy in managing personal health, with a focus on caregivers of individuals with Alzheimer’s disease and related dementias (ADRD). Data from the Health Information National Trends Survey 2022 were analyzed, involving a sample of 96 family and unpaid caregivers of individuals with ADRD. Among these caregivers, 49.9% lacked confidence in utilizing e-health resources. While over 70% utilized certain digital health tools, such as accessing medical information and viewing medical test results, usage of health or wellness apps (57%) and wearable devices (48%) was relatively lower. Engagement in sharing health information (21%) or interacting with individuals with similar health problems (33%) on social media was low, while watching health-related videos on social media (72%) was relatively high. Telehealth (59%) and patient portal usage (87% for own health and 34% for care recipient) were moderate. Controlling for demographic characteristics, each digital health literacy skill was assessed in relation to self-efficacy in utilizing e-health resources. The skill for using health or wellness apps (AOR=111.13, 95%CI: 109.45-112.83) showed the strongest association with self-efficacy, followed by the use of patient portals (AOR=15.77, 95% CI:15.58-15.97) and accessing test results online (AOR=5.64, 95% CI: 5.59-5.69). Significant correlations were found between self-efficacy in using e-health resources and managing personal health among ADRD caregivers (r=.166, P< 0.001). The insights from this study can guide the development of tailored e-health interventions to provide enhanced support for caregivers in their crucial role.
AACN COMPETENCY-BASED ESSENTIAL REVISIT: EVIDENCE-BASED VALIDATION VIA RANDOMIZED CONTROL TRIAL
Authors: Kao Hsueh-Fen , Kiani Shirin
Published: January 2025

In April 2021, American Association of Colleges of Nursing (AACN) approved The Essential for Professional Nursing Education, which calls for preparing future nurses using a competency-based approach in designing curricula for schools of nursing. Taiwan’s nursing education system follows the American Model. This study, conducted in fall 2022 to spring 2023, intended to validate the competency-based approach through entrustable professional activities (EPAs) in the yet widely used nursing education arena. EPAs are practical approaches in assessing competence in real-world settings. A randomized control trial was used in Registered Nurse to Bachelor of Science in Nursing (RN-BSN) students at a college in southern Taiwan. ‘Wound care for older adults with diabetes’ was chosen to be the EPA intervention. After random assignment, students in the experimental group (n=31) received extra EPA simulation laboratory practice with feedback, and those in the control group (n=34) received usual practice and evaluation without simulation laboratory practice and feedback. In the end of semester, data in Competency Inventory of Nursing Students, Learning Satisfaction, Objective Structured Clinical Examinations were collected using analysis of variance (ANOVA) and Student’s t test for analysis. The experimental group demonstrated significantly higher scores in competency and clinical examinations than the control group. However, both groups experienced an increase in learning satisfaction without reaching a significant difference, probably due to receiving more attention. Results of the study indicate that evidence-based pedagogy, e.g., EPAs, can serve as effective strategies in designing competency-based curricula in nursing education to meet the new AACN standards with compelling evidence.
LANGE/PAROLE, STRUCTURE/ACTION: TOWARD A REFRAMING OF AGENCY IN GERONTOLOGY AND LIFE COURSE STUDIES
Authors: Dannefer Dale , Zhou Nan
Published: January 2025

Almost by definition, “Emancipatory Gerontology” carries implications like “choice” and “freedom” which in gerontology have often presupposed what is often termed “agency”. Agency remains a popular concept in gerontology and related fields such as life-course studies when, e.g., exploring such matters as life transitions and decision-making in areas like family formation or retirement. Yet its often-glib and superficial invocation reflects daunting problems identified in recent scholarship, concerning agency’s conceptualization and measurement. For any construct, adequate measurement presupposes a sound conceptual definition. The very definition of agency remains unresolved and problematic, despite numerous recent efforts at theoretical reformulation and refinement. Some issues revolve around nuances in the history of the term and its dimensions, others around issues of measurement. We contend that an even more fundamental set of problems arise because of a continued lack of recognition of the force of culture-specific symbol systems and social structure to frame the categories and nuances of thought within which agentic intentions are externalized in action. For example, no one chooses their native language, yet even freely chosen and passionately pursued “agentic” acts represent an expression of conscious intent formulated within perceptions, aesthetics, etc., structured by that language and its accompanying culture. We suggest that the structure-agency tension corresponds closely to the distinction between language and speech (langue/parole) articulated by de Saussure, and to related insights offered by Bourdieu. We contend that emancipation ultimately requires rigorous attention to constraint, and hence recognition of the structuring of agency by unrecognized and naturalized features of context.
UNDERGRADUATE STUDENTS CONDUCTING GERONTOLOGY RESEARCH: AN AVENUE FOR INTERGENERATIONAL CONNECTION
Authors: Stephan Abigail , Martinez Vanessa , Moss Daniel , Walton Mary , McVey Ava , Cooper Kalvry , Phillips Christine , Ross Lesley
Published: January 2025

With the proportion of older adults and subsequent rates of age-related assets (e.g., wisdom) and challenges (e.g., Alzheimer’s disease/related dementias), projected to rise over the coming decades, it is imperative that professionals across disciplines understand how physical, cognitive, and everyday function in older adulthood impact individuals, families, and communities. As educators, we have a responsibility to train professionals to be competent and aware of older adults’ needs, whether or not students plan to pursue careers directly related to gerontology or geriatrics. Many forms of experiential learning have been employed to accomplish this goal, though students’ direct involvement in gerontology research has not been examined in detail. Our investigation debriefs the experiences of students and faculty involved in a pilot gerontology study where undergraduate students conducted in-person visits with older adult participants. Feedback was collected through anonymous online surveys, guided focus groups, and unstructured team conversations. A salient theme, and the focus of this presentation, was meaningful engagement between students and study participants. Students described gaining personal insights and professional skills from working with participants. Notably, we found that several structures supported positive connections (e.g., in-person interactions, pairing two student testers with a participant, shared goals, balance of structured activities and wait time for conversation). Areas for improvement included additional training for managing participants’ study task pacing. Although these findings reflect lessons learned from one case, they can guide future endeavors of faculty who want to include undergraduate students in their research while promoting intergenerational learning.
DESIGNING INTERGENERATIONAL LEARNING PLACES: STRATEGIES AND OUTCOMES AT AN AGE-FRIENDLY UNIVERSITY
Authors: Shovali Tamar
Published: January 2025

The idea that universities play a vital role in promoting intergenerational learning and reciprocal sharing of knowledge among learners of all ages is a key principle of the Age Friendly University model. Although there is abundant research on the benefits of intergenerational relationships and learning in the classroom there is less information about details of how to transform a classroom space into a place where these relationships can occur. This suggests a need for reports of practical approaches in this area. I will describe an intergenerational team-based strategy employed with first year undergraduates in an intensive 3-week course. Students collaborated in teams across the semester to design an intergenerational activity tied to Age Friendly University principles to execute at the end of the semester. To assess the quality of intergenerational learning I surveyed students and older participants about the impact of the project on themselves, the College, and the local community. Prior to engaging in the projects the majority of students (66.7%) and older adults (66.7%) reported occasionally interacting with the other. Both reported an increase in the quality of their intergenerational interactions, students by 50% and older adults by 22.3%. Older and younger learners agreed that intergenerational projects benefit the College and the wider community beyond the College. Qualitative results about outcomes of this programming highlighted friendships and intergenerational communication and learning from younger learners and enjoyment and hope from older learners. Necessary to success in developing effective course-based programming are intentional design and ongoing evaluation.
EFFECTIVENESS OF FRIENDLY CALLING TO IMPROVE SOCIAL ENGAGEMENT AMONG MEALS ON WHEELS CLIENTS
Authors: Smith Matthew , Belazis Laura , Florence L Carter
Published: January 2025

Socially vulnerable older adults are at increased risk for social disconnectedness. Friendly calling, defined as regularly scheduled check-in calls by a trained staff member or volunteer, is believed to provide companionship to older adult clients and ensure they are safe. However, less is known about the elements of success for coordinated friendly calling initiatives across multiple sites. The purpose of this pilot was to assess the effectiveness of friendly calling among Meals on Wheels (MOW) clients at seven sites across the country. To collect and manage data, a technology platform designed to coordinate meal delivery to MOW clients was integrated with a friendly calling scheduling solution and a risk assessment for social disconnectedness. All friendly callers underwent extensive training about meaningful engagement and the data platform before contacting clients. The 13-item Upstream Social Interaction Risk Scale (U-SIRS-13) was used to assess the effectiveness of the 7-site pilot between January to November 2023. A total of 10,400 calls were placed to MOW clients, totaling over 114,300 minutes of talk time. Of the 316 clients receiving friendly calls, 80.4% were at risk for social disconnectedness at baseline. On average, from baseline to 3-month follow-up, MOW clients significantly reduced their social disconnectedness risk (t=-3.15, P=0.002), with 52% of participants reporting reduced social disconnectedness risk (z=-2.92, P=0.003). Findings suggest that coordinated friendly calling initiatives can reduce social disconnectedness risk among MOW clients within short durations (i.e., 3 months), which highlights the feasibility of telephone-based intervention strategies for socially vulnerable older adults.
DEVELOPING COMMUNITY-BASED AGING SERVICES IN NORWAY: LESSONS FROM THE US
Authors: Scharlach Andrew , Tingvold Laila
Published: January 2025

Ongoing transformations in the Norwegian welfare state reflect decreasing reliance on government and an increasing role for civil society. Norway’s current “Live Safely at Home” policy, for example, aims to expand community-based supports to enable older adults to live at home for as long as possible, while simultaneously promoting community engagement and social participation. In an effort to learn from the US’ well-established mix of governmental and non-governmental aging support services, we began a study of the experiences of community-based aging service providers in the US. In the first phase, we conducted six weeks of ethnographic fieldwork and 31 in-depth interviews with staff and participants at aging service provider organizations in Northern California. Data were analyzed following thematic analysis procedures proposed by Braun and Clarke (2006, 2019). An overarching theme emerging from the data was tension between the goals of personal support and social inclusion. Organizations focused primarily on community engagement (e.g., senior centers, Villages) appeared to have limited ability to serve individuals as their physical or cognitive functioning declined, while organizations focused primarily on personal care typically provided little attention to fostering community engagement or social participation. These findings reflect a tension between the goals of “aging-in-place” and “aging-in-community.” As Norway develops a more comprehensive community-based aging services system, it will be important to ground services in existing social institutions and informal social networks, enabling older Norwegians with functional disabilities to live safely at home while maintaining meaningful social and community engagement.
LEARNING ABOUT THE PROCESS OF REVISION OF POLICIES AROUND INNOVATIVE CARE MODELS AT THE VHA
Authors: Syed Quratulain
Published: January 2025

Having practiced as a geriatrician in underserved neighborhoods and post-acute care in the United States, I have witnessed older adults and individuals with multimorbidity facing the brunt of health policies that favor the healthy and the well-resourced. These observations have formulated my vision for age friendly health policies, and the need for front line clinicians to get a seat at the health policy table and influence the policies. The VA track of the Health and Aging Policy Fellows’ Program is an opportunity for professionals involved in healthcare and research focused on older Veterans to nurture skill necessary for development and implementation of health policies that impact older Veterans. During the session, I will discuss my placement at the Veterans Health Administration Central Office with the Home & Community Based Programs. This opportunity has allowed me to learn about the process of updating and revision of policies and directives around innovative care models with demonstrated clinical outcomes.
DANCE AND EMOTION: THE IMPACT OF OLDER PERFORMERS ON AUDIENCE ENGAGEMENT
Authors: Miyazaki Atsuko
Published: January 2025

This study explores the emotional connections between dancers of advanced age and their audience, investigating the role of dance in promoting happiness and social engagement among older adults. The Federation International of Dancers Association Japan (FIDA JAPAN), a general incorporated association supporting dance activities for those aged 65 and above, has been actively launching hip-hop dance teams for older adults across Japan since 2021. In September 2023, the FIDA GOLD CUP 2023 dance competition was held, featuring 13 teams from various regions in Japan. Among the dancers who participated in the competition and responded to the post-performance survey (n=148, mean age=70.99 years, SD=5.46), 62.8% started dancing at the age of 65 or older. Audience members (n=81, mean age=51.69 years, SD=15.85) were also surveyed. Both surveys assessed various aspects of emotional experiences using a 5-point scale. Analysis revealed that dancers reported significantly higher levels of emotional resonance (M=5.24, SD=0.82) compared to the audience (M=4.68, SD=0.62), t(227)=5.58, p< 0.001, Cohen’s d=0.77, indicating a large effect size. Additionally, a statistically significant positive correlation was found between dancers’ feelings of exhilaration on stage and the audience’s applause (ρ=0.31, p< 0.01), suggesting that the emotional experiences of dancers and their audience are interconnected. The results highlight the emotional interplay between dancers of advanced age and their audience, emphasizing the potential for dance to foster a shared emotional experience. The findings contribute to understanding how dance can enhance emotional well-being and social engagement, particularly for those who take up dancing in later life.
CHARACTERIZATION OF DYNAMIC ADAPTATION TO STRESSORS USING MULTISYSTEM STIMULUS–RESPONSE DATA
Authors: Bandeen-Roche Karen , Zhu Jiafeng , Xue Qian-Li , Buta Brian , Laskow Thomas , Walston Jeremy , Varadhan Ravi
Published: January 2025

Resilience has emerged as a major gerontological concept aiming to promote more consistently positive outcomes following stressors. Achieving this aim relies on determining mechanisms underlying capacity to respond resiliently. This paper addresses the hypothesis that physical aspects of said capacity arise considerably from the fitness of one’s physiology governing stress response, conceptualized as a dynamical system. We leverage the Study of Physical Resilience and Aging (“SPRING”) pilot and Phase II studies, which implemented stimulus-response experiments to characterize physiological fitness in older adults scheduled for major stressors of either total knee replacement, incident hemodialysis, or bone marrow transplant for hematological cancers. We develop physiologic resilience capacity measures using time series from Holter monitor assessment, cortisol response to adrenocorticotropic hormone stimulation, and repeated diurnal salivary cortisol assessment. Principal components (PCs) of the multivariable summaries from these tests were derived using SPRING pilot data. The first two components represented “steady state” and “adaptation” mechanisms. Steady state and adaptation PC scores were separately regressed on major stressor type, hypothesized static physiologic indicators (physical frailty phenotype, self-report of health), and personal characteristics. Substantial association was manifest by stressor type and the static physiologic indicators: for both PCs, average scores were 0.6 SD higher for persons deemed robust versus prefrail/frail after stressor type adjustment (p< 0.05). Cross-validation analyses using Phase II data, as well as analyses to discriminate resilience phenotypes and outcomes post-stressor with these data, will be reported. Our study lays groundwork to better forecast and foster resilience of older adults to clinical stressors.
THE OPIOID USE IN OLDER ADULTS COMPENDIUM OF RESOURCES: A USER-FRIENDLY TOOL FOR PRIMARY CARE
Authors: Vinson Latrice , Dotson Vonetta , Bierman Arlene
Published: January 2025

Older adults are at greater risk of harm from opioid use, yet there is limited understanding of how to manage opioid use, misuse, and opioid use disorder among older adults, particularly in primary care practices (PCPs). AHRQ launched an initiative to synthesize the literature and create resources and tools to support PCPs in improving opioid management for older adults. This presentation describes the development of the initiative’s final product, the “2024 Opioid Use in Older Adults Compendium of Resources” and recommendations for using the tool in practice and future research. The Compendium was created though an iterative, three-stage process: environmental scan; technical expert panel feedback; and testing and refining the tool by two learning collaboratives (LCs) across 14 PCPs implementing quality improvement (QI) projects. Resources from the scan and data derived from the LCs were packaged into a driver diagram, which was iteratively revised by the panel and LCs. The resulting Compendium identified seven high-leverage changes (e.g., risk assessment, patient engagement), each associated with a change strategy, key activities, and existing and newly developed tools/resources to bring about the desired change practices can use to improve opioid management and prevent misuse in older adults. PCPs can access the user-friendly Compendium on AHRQ’s website to plan and implement QI activities related to opioid management. The Compendium identifies innovative screening measures, interventions, and patient-facing tools that present promising targets for future research.
DETERMINANTS OF SETTLEMENT INTENTIONS AMONG OLDER CHINESE INTERNAL MIGRANTS: AN INTEGRATED PERSPECTIVE
Authors: Kang Rui , Zhou Jia-jia
Published: January 2025

Understanding factors driving settlement intention of older migrants is important for policies to promote successful integration. This research examined to what extent the adaption, attachment to hometown, and environmental factors affect the settlement intentions among older internal migrants in China. A cross-sectional survey was conducted among 598 older migrants aged 50 and above in Shenzhen and Guangzhou, two large cities in China. Data on settlement intention, Hukou transfer intention, multidimensional adaption, environmental factors and attachment to hometown were collected using questionnaire survey. Multinomial logistic regression modelling was employed to identify the determinants of settlement intention. The findings revealed that better psychological adaptation and frequent participation in community activities increased the likelihood of settling in the host city and transferring Hukou registration. Regular involvement in voluntary activities and increased access to welfare services decreased the probability of expressing reluctance to settle and transfer their Hukou status. Conversely, maintaining connections with friends from their hometown reduced the likelihood of settlement in host city. Older migrants with living parents in their hometown are more likely to resist settle in the host city. However, a higher perceived quality of physical environments in the neighborhood elevated their likelihood of not deciding to settle and transfer their Hukou status. It is crucial for policy and service interventions to focus on enhancing the welfare and service environments in neighborhoods. Such improvements can facilitate the successful integration of older migrants into their new communities, thereby promoting their well-being and contributing to the overall social cohesion.
IT’S BEYOND PERSONAL: MULTILEVEL FACTORS AFFECTING THE WILLINGNESS FOR PALLIATIVE CARE UTILIZATION
Authors: Tong Juncheng , Cao Jiawei
Published: January 2025

With so much effort devoted to the development of palliative care, significant progress has been achieved in the past few years in China. One of the foci is the patient education and public advocacy. However, evaluation research on this aspect is scarce, and little is known regarding people’s willingness to engage in conversations about palliative care and potentially use such services if needed. Thus, this survey study aims to examine the public’s willingness of palliative care utilization and associated factors from micro, meso, and macro levels. Ordinal regression analyses were performed to achieve this goal. Among 2,645 adult participants (aged 18-95), approximately 78% either ‘agree’ or ‘strongly agree’ with the statement that they are willing to use palliative care services if they are terminally ill. Regression results showed that at the micro-level (individual), willing to pay out-of-pocket and believing palliative care can improve end-of-life quality were associated with higher odds of willing to use palliative care. Meso-level measurement of family support and macro-level measurement of filial piety were also significant factors. Specifically, more family support was associated with an increase in the odds of willing to use palliative care (OR = 1.040, p = 0.034); and the odds of willing to use palliative care for people who considered palliative care not to be in line with filial piety was 0.014 (p < 0.001) times that of those who did. Married people were also more likely to be willing to use palliative care. Implications for research, policy, and practice are discussed.
NO ONE REMEMBERS MY NAME: (RE)NEGOTIATING IDENTITY, AGENCY, AND RESILIENCE IN LATE-LIFE IMMIGRANT SOUTH ASIAN WOMEN
Authors: Khan Mushira
Published: January 2025

Despite a growing South Asian (SA) population in the US, little is known about the lived experiences of late-life SA immigrant women who may face unique challenges as they navigate their later years in a new cultural and social space. This qualitative study explored how late-life SA immigrant women negotiate issues around identity, faith, and the continuity/rupture of norms and familial bonds in the context of migration and multigenerational living. Using an intersectional lifecourse perspective, in-depth interviews were conducted with twelve SA women who immigrated to the US at age 65 or older and co-resided with their adult children and/or grandchildren in a large cosmopolitan US city. Thematic analysis of the interview data uncovered the resilience and strength of the study participants as they navigated settlement challenges, including culture shock, language barriers, health and social care access issues, and the intricate dynamics of multigenerational living. Drawing from their cultural heritage, they navigated these transitions while also (re)interpreting cultural traditions to find meaning and cope with a perceived loss of status in the family. Furthermore, despite migration challenges, study participants found solace in embracing their grandmother role and through support from their religious and cultural enclaves. These findings highlight the salience of faith, family, and community in the lives of late-life immigrant SA women–a group that often remains invisible in policy and practice–and can help policymakers and stakeholders, including community service providers, faith leaders, researchers, and family members, to provide culturally appropriate support and promote their health and well-being.
LIFE SATISFACTION IN CENTENARIANS: FINDINGS FROM THE SWISS100 MAIN STUDY
Authors: Jopp Daniela , Hoffman Adar , von Gunten Armin , Herrmann Francois , Roecke Christina , Martin Mike , Cavalli Stefano
Published: January 2025

With increasing numbers of centenarians world-wide, quality of life in these very old individuals has become a topic of high interest, expanding prior biomedical research. Switzerland is not only among the countries with very high life expectancy but is also among the leading countries in terms life satisfaction. In the present study, we investigated the levels and predictors of life satisfaction in Swiss centenarians. The present analysis included a total of 148 centenarians of the SWISS100 Main Study (Mage = 101.8; range: 100-106; 74.3% female). After identification through the national address registry, centenarians were visited for in-person interviews. Centenarians’ health was quite limited: they had an average of six health issues and over half of them lived in care facilities (57.4%). Their cognitive level was moderate to high. Most were widowed, 84% had children, and they reported a substantial number of social contacts. The majority of centenarians (82.4 %) were satisfied with their lives. Correlations indicated that sociodemographic and health variables had only few associations with life satisfaction, but that psychological aspects including optimistic outlook and meaning in life showed notable links. A regression analysis combining significant variables from domain-specific regressions revealed that optimistic outlook was the strongest predictor of interindividual differences in life satisfaction, followed by meaning in life. In sum, findings highlight that Swiss centenarians present poor levels of health yet manage to maintain high life satisfaction through psychological mechanisms, suggesting high resilience in these very old individuals, which replicates and extends results from prior centenarian studies.
DECODING CENTENARIAN DAILY ACTIVITIES: A REAL-LIFE SENSOR APPROACH
Authors: Stahlmann Melanie , Buehrer Tabea , Roecke Christina , Jopp Daniela , Cavalli Stefano , von Gunten Armin , Herrmann Francois , Martin Mike
Published: January 2025

In response to the decade of healthy aging, understanding daily activities in older adults has become increasingly important in aging research. While ambulatory assessment is now quite common, it often misses the oldest age groups. The SWISS100 study is the first to fill this gap by employing real-life sensors to explore Swiss centenarians’ lives, blending questionnaire data with actigraphs for physical activity assessment, and smartphones equipped with the Electronically Activated Recorder (EAR) to capture everyday sounds and conversations. Out of N = 44 German-speaking centenarians who consented to the EAR study, technical issues and other challenges led to a final dataset from 35 participants. Over a time period of four days, more than 10,000 audio clips were collected, equating to roughly 2.7 hours of recordings per participant, which is about 4% of their waking hours. These recordings were then transcribed and analyzed to identify activities and social interactions. The analyses revealed that centenarians primarily spend their time alone (85%), with TV watching and resting as their main activities. When interacting, centenarians mostly engage with one familiar person, with a significant portion of conversations being “substantive talk” (44%), followed by “practical talk” (34%), though notable variations exist among individuals. These findings offer a deeper understanding of Centenarians’ social and leisure patterns, enriching our knowledge of their daily lives. This study also demonstrates the feasibility and value of mobile sensing in researching very advanced ages, encouraging future studies to integrate such innovative methods for a more comprehensive view of participants’ real-life experiences.
PROVIDERS, FUNCTIONS, AND ADEQUACY OF CARE AMONG CENTENARIANS: INSIGHTS FROM SWISS100
Authors: Masotti Barbara , Zaccaria Daniele , Herrmann Francois , Jopp Daniela , von Gunten Armin , Cavalli Stefano
Published: January 2025

At age 100 and beyond, individuals deal with increasing support needs, especially when their social network is at risk due to the death of spouses, siblings, and friends, while children may face own age-related health issues. However, little is known about the specific aids received by centenarians. Drawing from the care convoy framework, this study explored the diversity of care among Swiss centenarians. We investigated the composition and the functions of their care convoys and analysed the impact of individual and contextual characteristics. Additionally, we examined participants’ perception of the adequacy of the aids received. The analyses are based on centenarian and/or proxy reports from the study SWISS100 (N = 275; Mage = 101.789) using descriptive statistics and logistic regression models. Subjective adequacy is examined through qualitative content analysis. Findings indicate that centenarians are part of intricate convoys of care. The diversity of types of care and providers was high among community-dwelling, where informal and formal caregivers both provide help with a wide range of tasks (e.g., personal care, monitoring). In institutional settings there was a more defined division of roles, with family and friends providing administrative and socioemotional support. The impact of individual and contextual factors varied depending on the type of care and/or the care provider. Participant satisfaction did not always align with the quantity of care received. Considering, in conclusion, the diversity of care observed, understanding centenarians’ needs and resources is essential for developing tailored policies and services for them and their families.
TRENDS AND VARIATION OF MEDICARE ADVANTAGE AMONG LONG-STAY NURSING HOME RESIDENTS
Authors: Yun Hyunkyung , Kosar Cyrus
Published: January 2025

Despite the large growth of the Medicare Advantage (MA) to now comprise over 50% of all Medicare beneficiaries, the role of MA in long-term care has been understudied. We examined trends in MA enrollment among long-stay nursing home (NH) residents and geographic variation in these trends (2010 to 2021). We compared the individual and NH characteristics between beneficiaries of traditional Medicare (TM), general MA, and MA plans specialized for long-term care, Institutional Special Needs Plans (I-SNPs). Among long-stay residents, MA enrollment grew from 13.0% in 2010 to 31.6% in 2021, while MA enrollment increased from 23.6% to 40.8% for all other Medicare beneficiaries. I-SNP enrollment grew substantially; in 2010, 34 I-SNPs enrolled 15.7% of MA long-stay residents. By 2021, 126 I-SNPs enrolled 30.8% of them. The individual- and facility- characteristics for TM and non-I-SNP MA enrollees were broadly comparable. I-SNP enrollees, however, were more likely to be Black (20.4% of residents vs 14.5% for TM, 13.5% for other MA) and dually enrolled in Medicaid (I-SNP 97.7%, TM 83.6%, other MA 83.1%). I-SNP enrollees were more likely to be in NH with 1-2 (low) star-ratings (I-SNP 38.7%, TM 38.4%, other MA 38.2%) and less likely to reside in facilities with 4-5 (high) star-ratings (I-SNP 38.7%, TM 42.1%, other MA 42.4%). MA enrollment has grown substantially among long-stay residents. As new models such as I-SNPs become more prevalent, future research and monitoring are needed to ensure that the care needs of this high-need population are being adequately met.
PERCEIVED AND PERFORMANCE FATIGABILITY IN UNDERSTANDING HEALTHY AGING: STUDY OF MUSCLE, MOBILITY AND AGING (SOMMA)
Authors: Glynn Nancy , Cawthon Peggy , Schrack Jennifer
Published: January 2025

Characterizing fatigability, the quantification of an individual’s susceptibility to fatigue in the context of standardized physical task(s), is a more sensitive approach to assess the presence and severity of fatigue, a critical prodromal trait of chronic and acute health conditions. We have validated measures of perceived physical fatigability (Pittsburgh Fatigability Scale, PFS) and performance fatigability (Performance Deterioration [PD, measured during a fast-paced 400m walk by calculating gait speed of lap2-lap9/lap2*100] and the Pittsburgh Performance Fatigability Index [PPFI, measured during a usual-paced 400m by using wrist-worn raw accelerometry data to quantify percent cadence decline). Our symposium will capitalize on the extensive phenotype data collected at baseline in SOMMA (N=879, mean age 76.3±5.0 years; walking speed 1.04±0.20 m/s; 59.2% women; 85% white), to further elucidate the correlates and consequences associated with greater perceived and/or performance fatigability in order to inform potential interventions to promote healthy aging. First, Ms. Reagan Garcia will examine whether time spent in activPAL measured sedentary behaviors are related to higher perceived physical fatigability (PFS). Next, Dr. Kyle Moored will share findings on the role of maximal treadmill cardiorespiratory fitness (VO2peak) and PFS on life-space mobility and whether these associations are moderated by perceived neighborhood factors. Dr. Caterina Rosano will explore the association between nigrostriatal dopaminergic integrity and performance fatigability (PD). Lastly, Ms. Emma Gay will be comparing skeletal muscle energetics and walking energetics profiles of those with lower PFS/lower PPFI vs. higher PFS/higher PPFI. Discussant, Dr. Jennifer Schrack will offer insights for new directions for fatigability research.
PHYSICAL FITNESS, FATIGABILITY, AND LIFE-SPACE MOBILITY: DIFFERENCES BY NEIGHBORHOOD CONTEXT
Authors: Moored Kyle , Duchowny Kate , Rosso Andrea , Cawthon Peggy , Carlson Michelle , Glynn Nancy
Published: January 2025

Physical capacity (e.g., objective fitness, perceived fatigability) contributes independently to life-space mobility, the extent and independence of travel within the community. This relationship may differ by neighborhood context, where higher physical capacity may be especially necessary to overcome environmental barriers to mobility. We examined baseline associations between physical capacity and life-space mobility in community-dwelling older adults, and whether these associations were moderated by perceived neighborhood factors. Participants were from the Study of Muscle, Mobility and Aging (SOMMA; N=775, Mean±Standard Deviation age=76.1±4.9). Life-space mobility was self-reported using the Life-Space Assessment (higher=greater life-space, 83.6±19.3). Physical capacity measures included maximal treadmill cardiorespiratory fitness (VO2peak, 20.3±4.8 mL/min/kg) and perceived physical fatigability (Pittsburgh Fatigability Scale (PFS) Physical score, higher=more fatigability, 15.4±8.5). Self-reported neighborhood physical disorder (e.g., trash/vandalism) and social cohesion (e.g., neighborhood trust) scores were stratified into tertiles. Linear regressions estimated associations adjusted for demographic, health, and socioeconomic confounders. Each 1-SD higher VO2peak was associated with 2.5-point higher (95% CI: 0.84,4.2) life-space score, with associations significantly greater for the highest physical disorder tertile (b=3.8, 95% CI: 1.5,6.2, p-interaction=.018) and lowest social cohesion tertile (b=5.7, 95% CI: 2.9,8.6, p-interaction=.046). Each 1-SD higher PFS Physical score was associated with 3.2-point lower (95% CI: -4.6,-1.7) life-space score, with no differences by neighborhood measures (p-interactions>.15). Unlike perceived physical fatigability, the impact of objective fitness on life-space mobility may be greatest for those living in more disordered and less socially integrated neighborhoods. Findings reinforce the importance of considering individual-level contributors to life-space mobility within the environmental context (i.e., person-environment fit).
CAN DETERIORATION IN BALANCE BE EASILY DETECTED IN MIDDLE AGE?
Authors: springer Shmuel , Hayek Roee , Toledo Silvi Frenkel , Baranes Guy
Published: January 2025

Balance and physical performance tend to start declining in middle-age. However, most existing tests are generally not sensitive enough to detect subtle balance disorders in this population. We aimed to evaluate the utility of the Brief Balance Evaluation Systems Test (Brief-BESTest) and accelerometry data to identify middle-aged individuals with excessive balance deterioration. Young adults (YA, 25.3±2.3 years), early middle-aged (EMA, 47.7±2.6 years), and late middle-aged (LMA, 60.6±3.6 years) individuals, 25 subjects in each group, were tested using the Brief-BESTest with accelerometer (Delsys, USA) placed over their lower-back to measure the trajectory of the center-of-mass during standing tasks (95% confidence ellipse of trajectory, 95%CE). Significant differences in Brief-BESTest scores were found between the young and the two middle-aged cohorts (P < 0.05) and between EMA and LMA (p < 0.05). The 95%CE showed significant differences between YA and LMA in all standing conditions (P < 0.05) and between EMA and LMA (p < 0.05) when standing on a foam with eyes closed. Both, the Brief-BESTest scores and the 95%CE values demonstrated increased variation with age, allowing to identify subjects in the lower interquartile range (LIQR) defined as having accelerated balance deterioration. Significant moderate correlation (R2=0.44, P=0.001) was found between Brief-BESTest and 95%CE of single-leg-stance, and 46% of individuals in the LIQR were identified by both tests. These results enhance the utility of balance testing in midlife with the long-term goal of minimizing age-related functional decline. In addition, the results suggest that balance assessment using accelerometry motion data, available on any smartphone, can further facilitate early detection of balance decline.