bluuebunny/crossref_metadata_2025 huggingface dataset:
DIGNITY THERAPY FOR OLDER ADULTS WITH CANCER: COMMUNION FACILITATES DIGNITY
Authors: Bluck Susan , Koch Mary Kate , Maggiore Sophia , Wilkie Diana , Chocninov Harvey , Bylund Carma
Published: December 2023

Nearly 600,000 older Americans die a cancer-related death annually. Maintaining dignity is central to their quality of life. Dignity Therapy (DT; Chochinov, 2005) was designed to preserve dignity despite health declines. Patients report benefits of DT but mechanisms have not been empirically investigated. Grounded in gerontological life review research, DT involves therapists guiding patients to tell their unique life story and leave a legacy. This study investigates level of communion in the life story told in DT as a mechanism for DT efficacy. Communion reflects personal strivings for warm and close relationships (McAdams, 1986). Participants were 204 older cancer patients receiving outpatient palliative care (Mage= 66 years, SD = 7.43, 65% female) who participated in DT. Session narratives were audio-recorded and reliably (κ=.71–1) content-analyzed for communion themes (McAdams, 2001). Participants completed pre-post measures, including the Dignity Impact Scale. Mediation analyses showed significance for the direct effect of Dignity Impact from pre- to post-test, B = .50(.06), p < .001 as well as for paths from pre-test Dignity to Communion, B = .20(.08), p <.01 and from Communion to post-test Dignity, B = .20(.06), p = .001. Sobel test for the mediation effect of Communion between pre- to post-test Dignity was z = 2.06(.02), p = .039; point effect = .04. Participating in DT is shown to increase older cancer patients’ feelings of dignity. That is partially explained by the extent to which these older adults tell a life story rich in communion, reflecting on loving, caring relationships, during DT.
ECONOMIC BOOM AND FINANCIAL RECESSION—WHAT ARE THE EFFECTS ON RELOCATION PATTERNS FOR OLDER ADULTS?
Authors: Dahlgren David , Hansson Asa , Iwarsson Susanne , Schmidt Steven , Kylén Maya
Published: December 2023

While previous research shows that older adults choose to relocate to a different home for numerous reasons (e.g., changes in the household composition, health decline), little is known about the influence of economic factors. The economic situation on aggregated level can influence the individual in more ways than by consumer demand and income, for example, financial crisis, fluctuating housing prices, and more general uncertainties about the future. Representing a novel approach, the aim of this study was to investigate the impact of macroeconomic events on relocation rates among older adults in Sweden. We used high quality panel data from Swedish registers, based on a random sample made 1994 with 300,000 individuals. Data was analyzed from 1970-2016 using a repeated cross-sectional design. Preliminary results show that the number of relocations was volatile the first year of a financial crisis. Depending on the characteristics of the crisis, the number of relocations decreased or increased; crises that are less connected to the property market had a reduction in number of relocations. This effect was observed for 1-2 years and stabilized to “normal levels” in the subsequent years. Especially high volatility was observed for the older age groups (75-84 and 85-90), which could be because they have a shorter time horizon for investment planning and great need to transfer housing wealth to liquidity. Knowledge in this field enables policymakers to plan housing investment, and negative shocks to the economy may lead to short term impacts on the housing market for older adults.
FORGING COMMUNITY–ACADEMIC PARTNERSHIPS FOR HEALTHY AGING: A COMMUNITY-LED TOOLKIT TO COMBAT AGEISM
Authors: Urbanski Dana , Johnson Elma , Almiron Maby , Chapman Steve , Keinan Amina , Thomas Phyllis , Yang Mayla , Frazier Robbin
Published: December 2023

There is growing recognition that community-engaged research approaches are essential for bridging the evidence-to-practice gap, especially for minoritized communities underrepresented among academic researchers. Such approaches often adopt a consultative model in which community members provide insights, perspectives, and feedback to support academic-driven projects. This strategy can be mutually beneficial when paired with cultural sensitivity and humility; however, there is a pressing need to form community-academic partnerships that flip this consultative relationship—placing university researchers as advisers on community-led projects that reflect local needs, priorities, and values. Here, we highlight the work of one such community-academic partnership led by the Center for Healthy Aging and Innovation’s (CHAI’s) Community Advisory Board with support from University of Minnesota faculty, staff, and graduate students. First, we describe the vision and formation of our Community Advisory Board (CAB), along with recruitment of its diverse membership representing eight cultural communities of the Twin Cities. We then outline the collaborative needs assessment process by which the CAB identified and prioritized action areas to advance healthy aging and health equity. Finally, we present preliminary results and early lessons learned from the CAB’s first project initiative—creation of a community-led, culturally responsive toolkit to address and reframe community-based sources of age-related stigma and discrimination. Findings from this project: 1) offer a plausible model and process for community-academic engagement which may be adapted and refined to fit local contexts; 2) underscore the value of community-led academic partnerships for addressing age-related stigma and other social factors associated with poor aging outcomes.
HOW NOT TO DATA ARCHIVE IN 10 WAYS
Authors: Millenbah Ashley , Albers Elizabeth , Louwagie Katie
Published: December 2023

Data sharing offers opportunities to replicate published findings, improves transparency in science, and increases the impact of the research by allowing other researchers to conduct new analyses. Effective January 25, 2023, the National Institute on Aging has new mandates for data sharing. However, many researchers are not experienced in data sharing and curation. Researchers will need to become more familiar with data sharing, specifically archiving data in data repositories. With these new requirements, many teams are attempting data sharing or archiving for the first time. We present 10 lessons learned the hard way, from real experience, prohibiting successful data archiving. Many of the challenges encountered could be avoided by effective planning, such as securing funding for curation and/or de-identification, adding data archiving details into the grant, and finding multiple repositories to potentially use. Other problems can be avoided by writing a consent form that allows for data archiving, such as by not limiting access to data, or limiting the type or format of data to be shared. Consulting with a legal team with experience in data archiving, such as at a data repository, is also recommended. By avoiding these pitfalls, researchers can successfully archive their data, ensuring their data are maintained and usable for other researchers in the future.
UTILIZING CARE PREFERENCE ASSESSMENT TO UNDERSTAND THE NEEDS OF OLDER ADULTS AT ADULT DAY SERVICES (ADS) IN TAIWAN
Authors: Liou Chih-ling
Published: December 2023

Understanding individuals’ preferences and honoring them throughout the care delivery process is essential for care services. When preferences are understood and honored, care recipients perceive a greater sense of autonomy, which improves their quality of life and emotional well-being. Adult Day Services (ADS), a fast-growing community service offers daytime programs for those with physical and/or cognitive impairments. In order to better understand ADS attendees’ care preferences and to help ADS staff to deliver person-centered care in Taiwan, this study adapted the Preferences for Everyday Living Inventory for ADS in Chinese (PELI-ADS-C) to assess preferences for activities and lifestyle experiences. Forty-three interviews were conducted with older adults recruited from three different ADS centers in Taiwan. The majority of participants were females (85%) with ages ranging from 67 to 93 years old. Among the 43 preference items, “do things with groups of people” and “participate in religious services or practices” were rated as most important followed by “reminisce about the past” and “exercise.” “Volunteer your time” and “gender of the staff taking care of you” were rated as least important. Participants shared that “It is not good for us to be alone.” “It is more fun for me to be with a group of people.” “I had no time to be a volunteer when I was younger. Now, I have to attend the center every day with no time to be a volunteer.” Results can be shared with ADS staff to develop care and activities that corresponded with attendees’ preferences.
ALCOHOL CONSUMPTION AMONG ADULTS IN WISCONSIN
Authors: Carney Amy Knepple , Manders Imagine , Hammond Allison , Wessel Leslie
Published: December 2023

Alcohol usage as we age can lead to worsening health conditions and higher rates of accidents. There have been mixed results on alcohol use in adulthood, and many of these studies use only one metric of alcohol consumption. With higher-than-average (55.1%) drinking rates in the United States, Wisconsin currently ranks third highest for adult alcohol consumption (64.4%), it is essential to understand age trends for nondrinking, binge drinking, and heavy drinking. Using 2021 data from the CDC, we examined a series of logistic regressions to determine age differences in alcohol consumption. First, whether a person had at least one drink in the past 30 days, odds ratios show that relative to older adults (65+), 45-to-64-year-olds are 1.35 times more likely, 25-to-44-year-olds are 1.72 times more likely, and 18–to-24-year-olds are 1.09 times more likely to have reported having at least one drink in the last 30 days. Second, binge drinking, odds ratios show that relative to older adults (65+), 45-to-64-year-olds are 2.95 more likely, 25-to-44-year-olds are 5.41 times more likely, and 18-to-24-year-olds are 3.86 times more likely to binge drink. Last, heavy drinking, odds ratios show that relative to older adults (65+), 45-to-64-year-olds are 1.84 more likely, 25-to-44-year-olds are 1.94 times more likely, and 18-to-24-year-olds are 1.71 times more likely to drink heavily. Implications of these results are examined more fully but include the adverse effects on health for young-to-middle-aged adults, the potential to die younger for heavy drinkers, and the positive effects of lower drinking rates in later adulthood.
ASSOCIATIONS BETWEEN DAILY STRESSORS AND ALCOHOL USE IN THE MIDUS STUDY
Authors: Miller Sara , Almeida David
Published: December 2023

Daily stressors are minor but frequent challenges of everyday life (e.g., arguments). Although daily stressors are typically less severe than stressful life events, daily stressors can have more immediate effects on wellbeing. Despite this relevance, there is limited research evaluating the influence of daily stressors on alcohol use in older populations. This study examined daily associations between stressor characteristics (exposure, type, and severity) and alcohol use and evaluated differences in associations for younger/middle-aged (< 65 years) vs older adults (65+ years). Participants (n=1,603; Mage=52.82) were non-abstaining adults from the Midlife in the United States (MIDUS) study and the MIDUS Refresher who participated in 8-day diary projects. Survey items included stressor exposure (1=yes), stressor types (interpersonal, work, home, network), stressor severity (0=not at all; 1=not very; 2=somewhat; 3=very), and number of drinks. Covariates included the day of the week, sociodemographic characteristics, personality traits, psychological factors, and health behaviors. Multilevel linear regression analysis revealed that neither daily stressor exposure nor stressor severity was associated with reported alcohol use (p>0.05), but there were differences in alcohol use by stressor type. Specifically, days with interpersonal stressors were associated with reporting more drinks (p=.049), while days with work stressors were associated with reporting fewer drinks (p=.001). Further, age significantly moderated the relationship between any stressor exposure and reported alcohol use (p=.035), such that stronger relationships were observed for older adults than younger/middle-aged adults. Study findings highlight the importance of considering stressor characteristics when evaluating the covariation of daily stressors and alcohol use.
RISKY BEHAVIORS WITH NONALCOHOLIC FATTY LIVER (NAFLD) AND NONALCOHOLIC STEATOHEPATITIS (NASH) AMONG OLDER ADULTS
Authors: Tseng Tung-Sung , Lin Wei-Ting , Ting Peng-sheng , Huang Chiung-Kuei , Chen Po-Hung , Lin Hui-Yi
Published: December 2023

Background

Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) are emerging public health concerns among older adults, particularly those with risk behaviors.

Objectives

We evaluate the association between risk behavior and the prevalence of NAFLD and NASH in older adults.

Methods

A total of 1444 US individuals aged 60 years and older were included from the 2017- 2020 NHANES survey. Dietary, Sugar-sweetened beverages, smoking, physical activities, stiffness, controlled attenuation parameters, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) were measured. We performed multivariable logistic regression models with interaction terms and stratified analysis to assess the interplay effect between soda intake and body mass index (BMI) on liver stiffness measurements. All statistical analyses were under survey modules with an appropriate sampling weight.

Results

The prevalence of NAFLD/NASH varied significantly by age, gender, race, alcohol use, BMI, total energy consumption, ALT, and (all p≤0.001). The results showed that several risk behaviors, including smoking, physical inactivity, and sweetened beverage consumption, were not significantly associated with developing and worsening NAFLD and NASH among elderly individuals. However, higher total energy consumption, obesity, and alcohol use were risk factors for NAFLD/NASH.

Conclusion

Our study findings highlight the importance of promoting some healthy lifestyle behaviors among elderly individuals to prevent the development and progression of NAFLD and NASH. Further research is needed to investigate optimal strategies for promoting healthy beh
EFFECTS OF ACTIVITIES ON THE PSYCHOLOGICAL WELL-BEING OF CAREGIVERS OF OLDER ADULTS
Authors: Won Sarah , Regier Natalie
Published: December 2023

It is well-known that the caregiving role is perceived as stressful and is often associated in the literature with decreased well-being. Given that approximately 41.8 million Americans provide unpaid care to an older adult, it is critical to identify strategies or interventions to maximize their well-being. Activity engagement is one such promising intervention. Consequently, the goal of this study was to investigate which activities of caregivers of older adults significantly improve their well-being. To that end, a three-stage literature review (title/abstract review, full-text review, reference list review) was conducted, resulting in a total of 2,959 articles identified in PsycINFO. Inclusion/exclusion criteria narrowed this down to 24 relevant full-text research articles. Results showed a total of eight cohesive categories of activities for caregivers: Physical (n=5), Social (n=5), Arts/entertainment in the home (n=2), Arts/entertainment outside of the home (n=2), Religious/Spiritual (n=4), Psychotherapy (n=5), Psychoeducation (n=3), and Multimodal (n=4). Indicators of caregiver well-being in the outcome variables of studies included depressive symptoms, overall mental health, stress-induced cellular aging, life satisfaction, distress, quality of life, caregiver burden, satisfaction with the caregiving role, salivary cortisol, caregiver mastery, and stress. Activity categories that had the greatest frequency of positively impacting caregiver well-being were physical activities, social activities, religious/spiritual activities, and psychoeducational activities. All other activity categories except for arts/entertainment activities outside of the home were effective in some studies in improving caregiver well-being. Findings suggest that caregivers of older adults should seek opportunities for engagement in meaningful activity, particularly physical, social, religious/spiritual, and psychoeducational activities.
PERCEPTIONS ON A DIGITAL HEALTH PHYSICAL ACTIVITY PROGRAM IN OLDER FAMILY CARE PARTNERS OF PERSONS WITH HEART FAILURE
Authors: Baik Dawon
Published: December 2023

Many family care partners (FCPs) neglect managing their own health and wellness when providing care to others. Older FCPs are more vulnerable in managing their health because of physical and psychological distress, age-related health needs, and less social support. We developed a digital health physical activity (PA) program, TPA4You, to begin to address these issues. We elicited perceptions of the integrated components of TPA4You (i.e., Zoom PA with a health coach, Fitbit, motivational text messaging) among older FCPs of persons with heart failure (HF-FCPs) using scenario-based design methods. Participants were recruited at the University of Colorado Hospital between September and December 2022. Fifteen qualitative interviews were conducted. Mean age was 65.9±4.4 years, 73% female, 93% White, and 13/15 were spouses. The perceived value of TPA4You was reported as (1) convenience because travel not required, (2) increased motivation from being held accountable by the separate technology components, and (3) consideration of improving FCPs’ health and wellness. Challenges described were (1) scheduling, finding time dedicated to exercising with the health coach by Zoom and (2) feeling overwhelmed, integrating the technology components in the FCP’s life. The keys to motivating PA and exercise through TPA4You were (1) usefulness of content in text messages and a good relationship with the health coach, (2) encouragement provided by TPA4You engagement, and (3) desire to improve their health and quality of life. Future studies should conduct field-testing of TPA4You in older HF-FCPs by providing one-on-one, hands-on sessions using the integrated technology components to optimize usability and acceptability.
BARRIERS TO DISEASE SELF-CARE AMONG OLDER NON-HISPANIC BLACK AND HISPANIC MEN WITH CHRONIC CONDITIONS
Authors: Smith Matthew , Bergeron Caroline , Sherman Ledric , Oloruntoba Oluyomi , Merianos Ashley
Published: December 2023

Disease self-care is multi-faceted and influenced by physical, mental, social, and environmental factors. Because males traditionally underutilize preventive healthcare services, self-care is increasingly important to manage disease symptomatology and slow disease progression. This study examines factors associated with barriers to disease self-care among Hispanic and non-Hispanic Black men ages ≥65 years with ≥1 chronic condition. Data were analyzed from a national sample of 470 Hispanic (43.2%) and non-Hispanic Black (56.8%) men and collected with an internet-delivered questionnaire. The 5-item Barriers to Self-Care Scale served as the dependent variable (range=5-20). A least squares regression model was fitted to identify factors associated with barriers to disease self-care. The model adjusted for sociodemographics, disease characteristics, health status, and social engagement and support. On average, participants were age 70.1 (±4.5) years and reported 3.9 (±2.6) chronic conditions. Men with higher body mass index (β=0.13, P=0.001), more depressive symptomatology (β=0.09, P=0.046), and lower self-rated quality of life (β=-0.23, P< 0.001) reported higher barriers to disease self-care. Further, men with poorer access to healthcare (β=-0.17, P< 0.001) and higher healthcare frustrations (β=0.17, P< 0.001) reported higher barriers to disease self-care. Barriers to self-care were positively associated with being more socially disconnected (β=0.09, P=0.049) and higher reliance on others to manage health problems (β=0.14, P< 0.001). Findings reinforce the importance of mental health, healthcare access, and social support for disease self-management among Hispanic and non-Hispanic Black men. Efforts are needed in clinical and community-based settings to reduce self-care barriers through culturally appropriate self-management education, interventions, and services.
PHYSICAL SYMPTOMS REACTIVITY TO DAILY STRESSORS AND CARDIOVASCULAR DISEASE: A COMPARISON OF BLACK AND WHITE ADULTS
Authors: Moore Sebastiana , Smith Claire , Mu Christina , Lee Soomi
Published: December 2023

Black adults have higher risk for cardiovascular disease (CVD) compared to their White counterparts. Biopsychosocial frameworks suggest that this racial difference may not only be due to higher stressor exposure (e.g., discrimination) but also to stressor reactivity (i.e., heightened automatic reactions to stressors). This study examined if racial disparities in CVD is explained by elevated physical symptoms in response to daily stressors (“physical symptom reactivity to stressors”). Data came from 1,727 adults (non-Hispanic Black=38%, non-Hispanic White=62%) who participated in the Midlife in the United States Study at Time-1 (T1: 2004-2009). A subset (n=1,482) was reassessed at Time-2 (T2: 2013-2019). Race, daily physical symptoms, and daily stressors were measured at T1. Physical symptom reactivity to stressors (i.e., individual slope of physical symptoms as a function of daily stressor severity) was calculated using 8-day diary data. Physician-diagnosed CVD was captured at T1 and T2. Indirect pathways (A path: race->stressor physical reactivity, B path: race->CVD) were tested, adjusting for health and sociodemographic covariates. At T1, Black adults exhibited a higher risk of CVD compared to White individuals through higher physical symptom reactivity to stressors (A path: B=0.004, SE=0.0006, p<.001; B path: B=-3.56, SE=1.32, p=.007; indirect effect=0.12, SE=0.03, 95% CI=[0.06, 0.18]). These indirect pathways were also supported when predicting the risk of CVD at T2 after controlling for T1 CVD (B path: B=-3.23, SE=1.56, p=.038; indirect effect=0.07, SE=0.04, 95% CI=[0.02, 0.16]). Findings newly suggest that racial differences in physical manifestations of stress may contribute to disproportionate development of CVD, the deadliest disease in America.
PSYCHOSOCIAL RISK, SUBCLINICAL CVD, AND BRAIN VOLUMES: EXAMINING SEX DISPARITIES IN DEMENTIA RISK
Authors: Wright Regina , Bygrave Desiree
Published: December 2023

The majority of the sex disparity in dementia remains unexplained. One potential risk factor for women’s higher incidence of dementia is subclinical cardiovascular disease (SCVD), including carotid atherosclerosis and arterial stiffness. To date, there is a significant gap in what is known about sex differences in the impact of psychosocial risk on pre-dementia risk factors both directly and via SCVD. Therefore, this study aimed to examine the mediating influence of SCVD on the relationship between psychosocial risk and brain volumes, as a proxy for pre-dementia risk, and whether the relationship is moderated by sex. The analysis included 136 older adults with a mean age of 68.04y who underwent neuropsychological, psychosocial, and vascular assessment (pulse wave velocity [PWV], carotid intima media thickness [IMT]), and 3T cranial magnetic resonance imaging. Moderated mediation analyses, adjusted for age and education, showed a mediating role of PWV in the relation of loneliness to total brain volumes (global measure of atrophy) was more pronounced among women (average causal mediation effect [ACME]=.44; p=.11). Unadjusted analyses trended toward moderated mediation, such that the mediating role of carotid IMT in the relation of anxiety to total WMLV (ACME=.001; p=.06) and total frontal WML volumes (ACME=.001; p=.05) was more pronounced among women than men. Findings suggest that in women, but not men, psychosocial risk factors may influence brain volumes via subclinical CVD. Additional research is needed to determine if these interrelations help to explain some of the sex disparity in dementia risk.
URBAN–RURAL DISPARITIES IN CHRONIC DISEASE PROGRESSION AMONG CHINESE OLDER ADULTS
Authors: Zhao Yuanchang , Kelley Jessica
Published: December 2023

Over the last thirty years, China has experienced rapid increases in the prevalence of hypertension and diabetes, across urban and rural areas. Studies do indicate that the prevalence rates both hypertension and diabetes are higher in urban areas than in rural areas, seeming to indicate higher chronic disease burden among urban older adults. Few studies, however, focus on the progression of hypertension and diabetes once diagnosed. Given the likelihood of under-diagnosis in rural areas, the aim of our study is to examine urban-rural disparities in the progression of hypertension and diabetes among older Chinese who have been diagnosed with either or both conditions. We utilize two waves of the CHARLS, examining adults over age 50 (n=5,067). Our findings confirm that rural older adults are less likely to be diagnosed with diabetes or hypertension than urban older adults, net of other risk factors. Among those with a diagnosis, and controlling for whether they received treatment, the nested logistic regression models indicate that rural older adults report 32% higher odds of worsening hypertension compared to their urban counterparts. Likewise, the odds of worsening diabetes are 52% higher in rural older adults than in urban older adults. Our findings indicate that although rural older adults are less likely to have a diagnosis of diabetes or hypertension, among those with a diagnosis, rural older adults tend to be sicker and worsen more quickly. We discuss the implications of rural-urban disparities in access to health care and treatment.
CHINESE AMERICAN FAMILY CAREGIVERS’ PERCEPTIONS OF HOME CARE AND FACILITY CARE FOR LOVED ONES WITH ADRD
Authors: Li Chien-Ching , Paun Olimpia , Gao Xiaojun , Lei Xiao Ying
Published: December 2023

Cognitive decline and impairment among older adults are significant public health concerns because they lead to increased disability, caregiver burden, and healthcare costs associated with the treatment of declining cognitive function. The Chinese American population, the largest Asian group in the US, is aging rapidly, and it is expected that older Chinese Americans and their caregivers will increasingly need ADRD care planning for home care and facility care. Therefore, the goal of this study is to examine the beliefs and attitudes of Chinese American family caregivers regarding home care and facility care for their loved ones with ADRD. In our study, N=17 Chinese American caregivers were recruited to participate in the study interview through a partnership with the Alzheimer’s Program at the Chinese American Service League. The mean age of the caregivers was 49.6 years, and the majority were female, married, had college degrees or higher, and reported being in good health. Results indicated that most ADRD patients needed medium or high levels of care and were cared for at home. Chinese American caregivers were reluctant to place their loved ones in facilities, such as nursing homes or memory care centers, due to high costs, poor quality of care, language barriers, and Chinese filial piety. Additionally, most Chinese caregivers lacked knowledge regarding the types of home care and facility care and the services provided. Therefore, future development of culturally and linguistically targeted interventions for ADRD care planning is necessary for Chinese American patients with ADRD and family caregivers.
DIFFERENTIAL MRI ATROPHY PROFILES IN OLDER ADULTS WITHOUT DEMENTIA FROM AGING STUDIES IN THE US AND CZECH REPUBLIC
Authors: Nelson Monica , Small Brent , Nedelska Zuzana , Lerch Ondrej , Vyhnalek Martin , Andel Ross , Hort Jakub
Published: December 2023

Alzheimer’s disease is a progressive neurodegenerative disorder with extensive neuropathological heterogeneity. We aimed to identify distinct latent subgroups of neuropathology and differentiate them using sociodemographic, contextual, and cognitive factors. Participants without dementia from the Alzheimer’s Disease Neuroimaging Initiative (ADNI; n=1703) and the Czech Brain Aging Study (CBAS; n=385) were included. Latent profile analysis was used to detect profiles using 10 volumetric structural magnetic resonance imaging regions of interest derived using Freesurfer algorithm (hippocampus, middle temporal, superior temporal, precuneus, anterior cingulate, medial orbitofrontal, pericalcarine, precentral, lingual, and caudate regions). Four profiles emerged in ADNI: Minimal Atrophy (n=192), Mild Atrophy (n=691), Moderate Atrophy (n=567), Severe Atrophy (n=253). Two profiles emerged in CBAS: Mild Atrophy (n=208) and Severe Atrophy (n=177). For all but the caudate region, there were significant pairwise differences in volumetry between each profile. Further, Minimal Atrophy was the youngest, had the highest proportion of participants with normal cognition, had the lowest progression to dementia, and the best cognition compared to all other groups – the remaining pairwise comparisons suggested that participants were older, more likely to have mild cognitive impairment, progress to dementia, and have poorer cognition, transitioning from Mild to Moderate to Severe Atrophy. Findings were consistent in CBAS. In ADNI, Minimal and Mild Atrophy had higher education and premorbid abilities compared to Moderate and Severe Atrophy. In CBAS, Mild Atrophy had better premorbid abilities compared to Severe Atrophy. Biological heterogeneity among older adults without dementia should be considered to understand who may be at risk of cognitive decline.
RELATIONSHIP-TYPE DIFFERENCES IN SUPPORT SEEKING AND MENTAL HEALTH FOR ADULT CHILDREN OF PARENTS WITH MEMORY LOSS
Authors: Gad Dustin , Monin Joan
Published: December 2023

Research shows that midlife children still rely on their parents for emotional and tangible support, which has implications for their mental health. Little is known about how these dynamics change when a parent enters the early stage of dementia or memory loss. One characteristic that may be important for these dynamics is the relationship-type (daughter-mother (n= 82), daughter-father (n= 29), son-mother (n=17), son-father (n= 14)). As part of a larger study, adult children 18 years of age and older (n= 142) completed self-report surveys including measures of emotional and tangible support seeking from their parent (Feeney, 2004), the 10-item CESD (Orme et al., 1986), the 12-item Zarit Burden Inventory (Bédard et al., 2001), and the PANAS (Watson et al., 1988). Results showed that tangible and emotional support seeking levels were low across all dyad-types, with no differences between groups. There was a trend for depressive symptoms (F= 2.559, p= .058) showing more in daughter-father than in son-mother dyads. Daughter-father dyads were the only group meeting the depression cut-off score. There were significant differences for burden (F= 3.377, *p= .020) with more burden in daughter-mother compared to son-father dyads. For the PANAS (F= 2.926, *p= .036), there was more negative affect in daughter-father compared to daughter-mother dyads. Results suggest that the relationship-type of the adult child and parent matters for mental health in the early stages of memory loss. This has implications for dyadic interventions helping adult children and their parents cope in the early stages of the dementia caregiving journey.
PAIN MEDICATION AND FALL RISKS AMONG COMMUNITY-DWELLING OLDER ADULTS WITH ARTHRITIS
Authors: Yoshikawa Aya , Fortinsky Richard
Published: December 2023

Pain medication is commonly used among older adults with arthritis. Research indicates an elevated fall risk among older adults with arthritis, yet this association among those who take medication for pain is not fully studied. This population-based study investigated the association of falls with pain medication use by arthritis status. A sample of community-dwelling Medicare beneficiaries in the 2015 National Health and Aging Trends Study, representing older adults who reported arthritis (n = 4,229) and no arthritis (n = 3,258), were analyzed using survey-weighted logistic regression analysis. Sensitivity analysis was performed to investigate differences in associations by the frequency of taking pain medication. All analyses were controlled for sociodemographic characteristics, living arrangements, balance problems, and chronic conditions. The majority of participants was 70 years or older (70.7%), female (55.3%), White (80.1%), had a high school or higher education (58.4%) and had two or more chronic conditions (53.6%). Significantly higher proportions of those with arthritis reported pain (67.9% vs. 32.1%) and pain medication use (63.1% vs. 36.9%) than those with no arthritis. Pain medication use (OR = 1.11, 95% CI: 1.03, 1.20) and balance problems (OR = 4.39, 95% CI 3.45, 5.59) were associated with falls among those with arthritis. Taking medication for pain every day a week (OR = 1.48, 95% CI: 1.05, 2.09) was associated with falls among those with arthritis. Findings suggest that the heavy use of pain medication may increase fall risk. Nonpharmacological pain management education is encouraged for supporting active living among older adults with arthritis.
CREATION OF A FAMILY CAREGIVER NEGOTIATION TRAINING PROGRAM USING ARTIFICIAL INTELLIGENCE
Authors: Murawski Alaine , Ramirez-Zohfeld Vanessa , Schierer Allie , Ramirez Ana , Mell Johnathan , Brett Jeanne , Lindquist Lee A
Published: December 2023

Family caregivers of people with dementia (PWD) experience conflicts as they navigate the healthcare system but do not have adequate training to resolve these disputes. We sought to develop and pilot test an artificial-intelligence negotiation training program, NegotiAge, for family caregivers. With NIH funding [R01AG068421], we convened a team of negotiation experts, geriatrician, social worker, and community-based family caregivers (Illinois/Florida/New York/California). Content matter experts created informational videos to teach negotiation skills. Family caregivers generated dialogue surrounding caregiver conflicts. Computer science experts input generated dialogue into the Interactive Arbitration Guide Online (IAGO) platform to develop avatar-based agents (e.g. sibling, older adult, physician) for caregivers to practice negotiating. Family caregivers review didactic material then access scenarios to negotiate (e.g. physician recommendations, sibling disagrees with care, PWD refusing support). Caregivers negotiate in real-time with avatars designed to act like humans, including emotional and irrational behaviors. Caregivers can use negotiation tactics until either mutual agreement occurs or time expires. Immediate feedback is generated from the responses chosen and tactics to assist with the negotiation skills training. Pilot testing was conducted with family caregivers of PWD (n=12) and showed that the negotiation and conflict resolution training program was feasible and usable for family caregivers. Subjects found the program to present real-world applicability. NegotiAge is an Artificial Intelligence-based Caregiver Negotiation Program, that is usable and feasible for family caregivers to become familiar with navigating conflicts seen in caring for PWD.
DEVELOPMENT OF AN ONLINE DISASTER PREPAREDNESS PROGRAM FOR CAREGIVERS OF PERSONS WITH DEMENTIA
Authors: Donohoe Maria , Ostrem Nicholas , Rudzianski Nicholas , Gay Jane , Smith Brigid , Wunderlich Tiffany , Ashida Sato
Published: December 2023

Individuals with medical conditions, including persons with dementia (PWD), are vulnerable in disaster situations. Disasters limit caregivers’ ability to continue with care due to stress, reduced resources and limited social support. We previously developed and tested a disaster preparedness program for older adults, Disaster PrepWise, and showed its impact on improving preparedness and personal emergency support networks. Through community engaged approaches, we adopted this program to specifically support family caregivers of PWD. Contents were revised based on the emergency management and dementia caregiving literature, and input from the stakeholder advisory board (SAB) consisting of caregivers, aging service providers, public health, and emergency management agencies. The SAB also provided guidance on implementation strategies from the lens of over-burdened caregivers. The new program includes a five-step process with an emphasis on the needs of caregivers and caregiving tasks, for example, developing emergency caregiving network to be activated during and after a disaster. The program also informs caregivers of tasks involved in the event of an emergency and provides various information such as how to navigate staying at public shelters with PWD, identify services during and after an emergency, and manage stress. Preliminary data shows high levels of acceptance and perceived usefulness of this caregiver-specific program. The program is perceived to fill a gap in current disaster management approaches that have limited ability to support vulnerable populations. Caregivers and service providers also praised this program’s ability to connect caregivers to community programs and resources. Additional pilot data will be presented.
IMPROVING REPLICABILITY THROUGH DATA STANDARDIZATION: REFINING TELE-STELLA FIDELITY PROCEDURES
Authors: Mooney Aimee , Lindauer Allison , Gothard Sarah , McKenzie Glenise , Tadesse Ruth , Bernard Hannah , Boardman Charles , Danschin Arlene
Published: December 2023

Tele-STELLA (Support via TEchnology: Living and Learning with Advancing Alzheimer’s disease and related dementias) is a prospective, non-randomized, mixed methods clinical trial of a multicomponent videoconference-based psychoeducational intervention for family care partners to facilitate effective management of behavioral symptoms of dementia. The intervention is delivered by nurse “Guides” over two 8-week sessions with the goal of reducing care partner burden, assessed before, during and after intervention. To ensure treatment adherence to this complex intervention protocol, Guides complete intervention checklists after each session. Fidelity monitoring early in study implementation revealed inconsistency in Guide adherence to the intervention protocol as evidenced by gaps and barriers with data collection platforms. To optimize fidelity of the protocol, an iterative process of refinement was applied to procedural operations and data capture practices. These refinements included standardization of protocol tasks (procedural fidelity), explicit definition of guide behaviors (theoretical fidelity) for the continuity of fidelity assessments, and implementation of a unified data capture platform, REDCap®, providing immediate visibility and reference for all team members. We found lower, non-significant Zarit Burden Scores after process revisions (pre=9.14, post=8.43, p=0.29). We also found improvement in data capture with a significantly reduced proportion of missingness for required fields (p=2.2e-16). These findings provide meaningful signaling of improved treatment fidelity, which is associated with those mechanisms of action hypothesized to impact study outcomes. These findings further indicate that a more formal architecture was needed to implement this curriculum and standardization of these processes are vital for long-term replicability and downstream adoption.
AGING AND THE LIVED EXPERIENCES OF TRANSGENDER AND GENDER NONCONFORMING OLDER ADULTS
Authors: Koller Jeanne , Urbanski Paul
Published: December 2023

Adults identifying as transgender and gender non-conforming (T/GNC) in the United States may experience adversity, victimization, and discrimination across the life span (McDowell, et al., 2019). T/GNC older adults have higher rates of poverty, homelessness, social isolation, depression, and violence compared to older adults in the general population and compared with lesbian, gay, and bisexual (LGB) older adults (Sloan & Benson, 2022). This descriptive phenomenological study utilized a purposive and snowball sampling strategy and sought to increase understanding of this diverse group. Twenty participants aged 50 and older were interviewed. Themes included fear and/or actual loss of relationships after “coming out” as transgender; concerns and complexity of healthcare and anticipated changes in healthcare if faced with needing long-term care; navigating gendered space; living as their authentic self; “passing” as cisgender; finding acceptance within the LGB community; desire but struggles to have intimate relationships; conflict between internal and external sense of self; and histories of depression, and suicidality. Protective factors included having an internal source of strength; support within the T/GNC community; being in committed relationships; and receiving support from others. Age at time of transitioning, sex assigned at birth, and identifying as GNB but not transgender influenced lived experiences. McDowell, M.J., Hughto, J.M.W., & Resiner, S.L. (2019). Risk and protective factors for mental health morbidity in a community sample of female-to- male trans-masculine adults. BMC Psychiatry, 19(16), 1-12. https://doi.org/10.1186/s12888-018-2008-0 Sloan, S., & Benson, J. J. (2022). Toward a conceptual model for successful transgender aging. Qualitative Social Work, 21(2), 455-471. https://doi.org/10.1177/1473325021994666
SOCIAL SUPPORT, MENTAL HEALTH, AND SEXUAL ORIENTATION: A STUDY OF THREE TIME POINTS IN THE CLSA
Authors: Grady Alexandra , Stinchcombe Arne
Published: December 2023

Lesbian, gay, and bisexual (LGB) older adults exhibit mental health disparities stemming from a lifetime accumulation of minority stress experiences. Psychological resources like social support may buffer against these poor mental health outcomes. The purpose of this study was to examine indicators of depression and social support by sexual orientation over time in a sample of Canadian adults ages 45-85. We used data collected at three time points in the Canadian Longitudinal Study on Aging (CLSA; baseline, 2011-2015; follow-up 1, 2015-2018; and follow-up 2, 2018-2021). Depression was measured using the Center for Epidemiologic Studies Depression scale (CESD-10) and social support was measured using the Medical Outcomes Study Social Support Survey (MOS-SSS). For depression symptoms (n=38,244; 830 LGB), results indicated a significant effect of sexual orientation (F(2, 38242)=35.93, p<.001) such that LGB participants had more depression symptoms than heterosexual participants. There was also a significant effect of time on depression symptoms (F(2, 38242)=26.07, p<.001); mean depression scores decreased over time. For social support (n=35,795; 770 LGB), results indicated a significant effect of sexual orientation (F(2, 35794)=45.31, p<.001) such that LGB participants reported lower levels of social support than heterosexual participants. There was also a significant effect of time (F(2, 35794)=5.98, p=.003); the mean scores for social support increased over time. The potential role of social support in moderating depression symptoms will be discussed. This study adds to our understanding of potential protective factors influencing the mental health of older LGB people.
WIDENING SEXUAL ORIENTATION INEQUITIES IN SMOKING AMONG OLDER ADULTS IN THE UNITED STATES, 2015–2019
Authors: Yang Jie
Published: December 2023

A recent editorial in Tobacco Control noted the neglect of older adults in the field of tobacco control, arguing that we must do better. This study seeks to answer that call and amplify its message by assessing what is missed in health equity research when older adults are ignored in another area of inequity: differences in smoking by sexual orientation. We used pooled data from the 2015-2019 National Survey on Drug Use and Health. We estimated smoking prevalence for older adults aged ≥50 (N=43,956) by gender and sexual identity. Following the National Center for Health Statistics guidelines for analysis of trends, we used logistic regression to examine the association between continuous year (time) and smoking controlling for sexual identity. We also tested inequities in change using an interaction between year and sexual identities. In Model 1, there was a significant decreasing trend of smoking among all older adults: With each passing year, the odds of smoking went down (aOR 0.98, 95%CI 0.95-1.00). Heterosexual men, gay men, bisexual women), and lesbian women had a higher likelihood of smoking than heterosexual women. In Model 2, there was a significant interaction between year and sexual identity (aOR 1.34, 95%CI 1.02-1.75). That is, the change in likelihood of smoking from 2015 to 2019 for bisexual women was significantly different than the change for heterosexual women. Widening inequities in current smoking across some sexual identities among older adults indicate the importance of ensuring cessation campaigns for LGB adults are not just reaching younger adults.
BARRIERS TO HEPATITIS C TREATMENT AMONG US BABY BOOMERS: PROVIDER PERSPECTIVES
Authors: Wethington Elaine
Published: December 2023

Chronic Hepatitis C (HCV) is a major health problem in the US for the baby boomer cohort (born 1945-65), affecting 1.8 million persons; 75% acquired it through injection drug use in earlier life. About 20% develop cirrhosis, often leading to end stage liver disease. HCV is curable and treatment has become more affordable and available. However, uptake of treatment has lagged. This paper reports on a semi-structured interview study of 36 health providers from 2 states (NY, AL) with experience treating/referring HCV+ patients, part of a mixed-methods study of providers and patients. Interviews were coded using thematic analysis. Providers reported that baby boomers, especially racial/ethnic minority and low income, experience barriers to HCV care, because of the complexity of the treatment cascade (testing, linkage to qualified providers, prescribing treatment, insurance delays, and successful completion of therapy). Low provider awareness of need to test for and treat HCV, limited access to specialists (the primary prescribers of HCV medications until recently), variable effectiveness of health systems in assuring successful treatment, and insurer initial reluctance to support treating all infected persons, have also contributed to disparities in care. Perceived stigma and discrimination are barriers to treatment even among the majority of newly diagnosed HCV+ baby boomers who no longer use injection drugs. Providers report that patients fear that families and workplaces will avoid or isolate them if their past drug use becomes known. Moreover, patients who have yet to experience serious health impact may delay treatment, given fears about discrimination against drug users.