bluuebunny/crossref_metadata_2025 huggingface dataset:
Corpse identification in mass disasters and other violence: the ethical challenges of a humanitarian approach
Authors: Vaswani Vina , Caenazzo Luciana , Congram Derek
Published: December 2023

In October 2022, the Centre for Ethics of Yenepoya University hosted a national workshop entitled: “Respect for human dignity of the unidentified dead from mass disasters and other violence: strategies for the ethical management of biological samples and personal data”. The aim was to explore and share experience and ethical considerations regarding the management and identification of human remains in the event of disasters, with the purpose to arrive at a general consensus about what constitutes the ethical foundation of the management of unidentified human remains in forensic practice and, in particular, contextualizing this in India. The main ethical consideration that emerged was tracing the missing and identifying the dead are crucial to maintaining or restoring basic human rights and responsible relief activities. Identification is not only an organizational and scientific achievement but, regardless of circumstances, also necessarily and always an activity with significant political, epistemic, and philosophical relevance and consequence. In India, it could be important to consider new legal provisions for the management of human samples so that this would provide a starting point for the treatment of human remains managed for forensic purposes with uniformity in the country. Another important step in which governments should take part regards the involvement and education of the general public to develop their interest in this important goal. In the field of forensic anthropology, artificial intelligence can support, through the use of algorithms, the decision-making process that leads to the identification of the victim or its remains. Furthermore, they can be used to extract new knowledge from huge databases and shorten identification through computer automation of data binding activities. Applying artificial intelligence tools in forensic sciences to collect new information from massive datasets to enhance knowledge, and reduce human subjectivity and errors, provides a greater scientific basis that could improve the strength of the evidence and support the admissibility of expert evidence. In light of the general lack of national/international guidance about ethical oversight for identification and care of human remains, the fact that regulations are frequently not adequate to govern ethical aspects, we hope that an internationally recognized body should develop such guidance in collaboration with relevant organizations.
EARLY LIFE COGNITION, EDUCATION, AND DEMENTIA RISK
Authors: Herd Pamela , Williams Victoria , Sicinski Kamil
Published: December 2023

Educational attainment is one of the strongest predictors of Alzheimer’s and Related Dementias (ADRD). Yet, much remains unknown as to how early life factors, particularly early life cognitive function, and early life environments, such as family environments, help explain why education so robustly protects against later life dementia. Is the influence of educational attainment not so much the additional schooling, but rather antecedent factors, like early life cognition and family environments that both build cognitive reserve and predict subsequent educational attainment? In short, is education merely a proxy for these antecedent influences? Consequently, we use the Wisconsin Longitudinal Study, which includes 80 years of prospectively collected data on a sample of 1 in every 3 high school graduates, and a selected sibling, from the class of 1957. Sibling models, and the inclusion of prospectively collected early life cognitive function and educational histories, allows us to explore the role of these early life conditions and the role they play in shaping the relationship between education and ADRD. We find a robust independent influence of education on ADRD risk, early life family environments had little impact on the relationship. Adolescent cognition, however, which we show is influenced by family environments, does partly explain why educational attainment influences later life ADRD risk, though both adolescent IQ and education independently influence the risk for and resilience against dementia.
BUILDING THE COLLABORATIVE COMMUNITY-ACADEMIC TEAM, DESIGNING OBJECTIVES, AND GETTING FUNDED
Authors: Baker Zachary , Fairbanks Sheryl , Wolfe Warren , Frazier Robbin , Millenbah Ashley
Published: December 2023

Having attended the Former Dementia Caregiver Re-Entry Initiative since 2019, its benefits were readily apparent but two limitations were identified: 1) two facilitators (i.e., Wolfe and Fairbanks) cannot serve the millions of Bereaved Dementia Caregivers in the US alone and 2) members have primarily been non-Hispanic White. These realizations inspired efforts to bring the group to more Bereaved Dementia Caregivers. The present community-created model of helping Bereaved Dementia Caregivers deserved community-integrated leadership if that model was to be effectively adapted and disseminated. Our team’s ambition is to bring the group to racially and ethnically minoritized Bereaved Dementia Caregivers, broadly. However, we felt that we could most effectively do this in stages. Rather than trying to figure out how to make the model fit for all people, we homed in on African Americans, with whom we had many local ties. We also took a step back (at the behest of Ms. Frazier) to not only ask about how to adapt the model for a need we assumed existed, but also to explore the strengths of African American communities and ask if unmet needs existed. This model had the benefits of intellectual humility, respect for the persons we were working with, and strengthened the value of our funded research (i.e., even if we found there weren’t unmet needs, we would be able to learn of strengths that we might be able to share with other communities who do have unmet needs).
REAL-TIME HEALTH OUTCOMES AMONG OLDER ADULTS INITIATING MEDICAL CANNABIS FOR CHRONIC PAIN
Authors: Wang Yan , Sibille Kimberly , Li Zhigang , Przkora Rene , Schmidt Seigfried , Lo Margaret , Abrantes Ana , Cook Robert
Published: December 2023

Background: Rigorous data are needed on the short- and long-term effects of medical cannabis (MC) on older adults with chronic pain. In response, this prospective study combines technology-based ecological momentary assessments (EMA) and in-person visits over 12 months to obtain subjective and objective data on MC’s effects on older adults. Method: The study recruits and follows older adults (50 years or older, 50% male) with chronic pain for one year. Some will have initiated MC (MC group) and others will not use MC (comparison group). Target enrollment will be 328 (1:1 ratio for MC and comparison group) participants. Collection of subjective and objective data occurs at in-person visits (baseline & 12 months) and via smartphone- and sensor-based measurement bursts at 1, 3, 6, and 9 months. The EMA data capture detailed MC use patterns and subjective short-term outcomes (e.g., pain intensity rating). These data will be integrated with objective data collected using a wearable sensor-based Fitbit (e.g., physical activity and sleep). Results: Multilevel modeling will examine changes in real-time symptoms measured by EMA and objective, sensor-based behavioral outcomes. Results will include changes in momentary pain intensity rated on 0-100 visual analog, real-time anxiety and depressive symptoms, daily sleep duration and quality, and level of physical activity. Conclusions: Our results will provide evidence on whether older adults who initiate MC will have greater reductions in real-time pain intensity and more improvements in physical and emotional functioning compared to those in the comparison group.
ADVANCE CARE PLANNING FIDELITY TOOL IN THE CONTEXT OF COGNITIVE IMPAIRMENT: THE SHARE TRIAL
Authors: Cagle John , Roth David , Boyd Cynthia , Hussain Naaz , Smith Ambrym , Reiff Jenni , Scerpella Daniel
Published: December 2023

2. Conducting high-quality advance care planning (ACP) conversations with persons living with ADRD and their family members is inherently challenging. Differing levels of cognitive function, judgment, ability to engage, and care partner involvement adds to the complexity of such ACP conversations, necessitating flexible fidelity monitoring to accommodate contextual factors. This presentation will focus on the process of measuring ACP fidelity. The SHARE ACP fidelity checklist was developed to measure the protocol adherence during ACP meetings, monitor for areas in which ACP facilitators may require re-training or additional support, and to inform analyses of the impact of the overall exposure to the study intervention. The fidelity checklist items are organized into three overarching domains: Meeting Set-Up, ACP Meeting Topics, and Facilitator Communication Skills. For the present study, a fidelity adjudication team from a pool of 7 raters, listened to and independently rated recorded conversations for protocol adherence. Each checklist item is scored ranging from 0 to 2 (0=not done; 1=needs improvement; or 2=effective) with higher scores indicating greater adherence. Fidelity ratings tended to improve over time, suggesting a facilitator experience effect. The goal to achieve an overall fidelity rating of ≥80% was met in 63% of dyad conversations. Based on subscale scores, project targets were most frequently met on the Communication Skills subscale and less frequently accomplished on the Meeting Set Up subscale. Despite some challenges, preliminary assessments of SHARE intervention fidelity appear promising, and evidence suggests the fidelity checklist is both valid and reliable.
ACCESS TO DENTAL CARE AND ORAL HEALTH INEQUITIES AMONG DIVERSE POPULATIONS IN THE UNITED STATES AND CHINA
Authors: Qi Xiang , Chen Xi , Ghezzi Elisa
Published: December 2023

Although the oral health status of the world population has improved over the years, structural and societal inequities in dental care and oral health are pervasive with older adults. This symposium discusses findings from three studies that examine structural and societal determinants of dental care and oral health inequities among diverse populations in the US and China. Mao’s study investigated correlates of dental care utilization among informal dementia caregivers in the US. Findings demonstrate that spousal caregivers and those who provide intensive care are less likely to visit a dentist. These findings suggest that dementia caregiver support intervention strategies should target these populations to improve dental care-seeking behaviors. Qi’s study examined the population attributable fraction of poor oral health on incident dementia in comparison with other modifiable risk factors. This study found that poor oral health, including edentulism and oral health problems, is a significant risk factor for incident dementia. The study highlights the need to integrate dental care as an integral component of a comprehensive approach to promoting cognitive health. Qu’s study explored social structural disparities in dental care utilization among adults in China’s megacities. This study revealed that social structural factors, such as hukou status, occupational status, and city of residence, are associated with disparities in dental care utilization. Overall, these studies shed light on important factors that impact dental care utilization and oral health. Addressing disparities in dental care utilization and oral health should be a priority in promoting overall health and well-being, particularly among vulnerable populations.
MATERNAL DIFFERENTIAL TREATMENT AND ADULT CHILDREN’S DEPRESSIVE SYMPTOMS IN THE FACE OF COGNITIVE IMPAIRMENT
Authors: Suitor J Jill , Gilligan Megan , Frase Robert , Ogle Destiny , He Ranran
Published: December 2023

Parental differential treatment has been shown to have a negative impact on adult children’s psychological well-being, particularly among daughters. In this paper, we explore whether mothers’ cognitive impairment (CI) moderates the impact of maternal favoritism/disfavoritism on psychological well-being when children are entering their later years (M=60), and their mothers are in their 80s-90s. We address these questions using mixed-methods data from 297 adult children who participated in wave 3 of the Within-Family Differences Study. Quantitative and qualitative analyses revealed that the effects of perceived favoritism/ disfavoritism were shaped by the combination of child’s gender and mothers’ CI status. Perceptions of disfavoritism, particularly regarding mothers’ disappointment, affected daughters’ depressive symptoms; however, the effect was decidedly muted by mothers’ CI. In the case of mothers’ preferences regarding their future caregivers, the differences by cognitive status were particularly striking. Contrary to expectations, daughters’ perceptions that they were their mothers’ preferred caregivers predicted depressive symptoms when mothers showed no signs of CI, but had no impact when mothers were cognitively impaired. Among sons, depressive symptoms were not affected by mothers’ favoritism or disfavoritism, regardless of mothers’ CI status; a gender difference in the impact of mothers’ appraisals on well-being that we have seen emerge across the 20 years we have followed these families. Qualitative analyses suggest that mothers’ CI reduced daughters’ emotional reactions to their mothers’ differential treatment because they believed that their mothers had less control of their behaviors and less awareness of the negative impact of their appraisals and expectations.
CHANGES IN ADULT SIBLING CONFLICT AND OLDER PARENTS’ COGNITIVE IMPAIRMENT: THE MODERATING ROLE OF CARE PROVISION
Authors: Gilligan Megan , Suitor J Jill , Ogle Destiny
Published: December 2023

The life course concept of “linked lives” emphasizes that the life events of one family member have implications for other family members. Health events have been shown to be particularly salient in later-life families. We considered the consequences of older parents’ cognitive impairment on adult sibling relationship quality. Using mixed methods data from 327 adult children (nested within 96 families) collected as part of the Within-Family Differences Study (WFDS) T3, we examined the role of adult children’s care provision in the association between parents’ cognitive impairment and adult sibling tension. At T3 of the WFDS, the adult children were on average 60 years old and their parents were on average 90 years old. We conducted lagged multilevel linear regression modeling to account for nonindependence and to control for sibling tension seven years earlier before parents were experiencing cognitive impairment. The results of the quantitative analyses revealed that reports of sibling tension were higher in families in which parents experienced cognitive impairment. Moderation analyses indicated that the association between parents’ cognitive impairment and sibling tension was stronger for caregivers than noncaregivers. Qualitative analyses revealed that discrepancies in perceptions of the caregiving situation between caregivers and noncaregivers fueled sibling tension. Noncaregivers often seemed unaware of the caregiving situation or actively disengaged to avoid conflict. Taken together, these findings indicate that sibling tension is particularly high in the context of caring for older parents with cognitive impairment. In particular, adult children who are providing care are at increased risk of sibling tension.
SUPPORT EXCHANGES IN COUPLES COPING WITH EARLY-STAGE ALZHEIMER’S DISEASE
Authors: Huo Meng , Kim Kyungmin
Published: December 2023

People living with Alzheimer’s disease (AD) typically receive considerable support from their spousal caregivers. Yet, we know little about whether people with early-stage AD may still be able to help their caregivers and how potential support exchanges in these couples may vary depending on the quality of their relationships. We drew on dyadic data from 37 older couples in which one partner lives with mild-to-moderate AD (Mage = 77yrs, 48% male) and the other serves as a spousal caregiver (Mage = 76yrs, 53% female). Couples participated in concurrent interviews during which they each reported on a variety of demographic and relationship characteristics, such as relationship quality, and couple support exchanges. People with early-stage AD perceived their relationships with spousal caregivers as more positive and less negative than did these caregivers. Support did not flow unidirectionally in these caregiving couples, especially not among those in better-quality relationships. Specifically, caregivers who viewed their relationships as more positive/less negative considered it less stressful to provide emotional and practical support to their partners with AD. Patients who viewed their relationships as more positive/less negative provide more frequent emotional and practical support to their caregivers and also found such support provision more pleasant and less stressful. Findings reveal positive contribution that older adults with dementia, who have been solely treated as recipients of care, can make and shed light on the development of dyadic interventions by highlighting the importance of mutually beneficial relationships in early stages of AD.
AEROBIC EXERCISE ATTENUATES FRAILTY IN AGING MALE AND FEMALE C57BL/6 MICE AND EFFECTS SYSTEMIC CYTOKINES DIFFERENTIALLY BY SEX
Authors: Howlett Susan
Published: December 2023

DOI: 10.1093/gerona/glab297
DISSECTING RACIAL DIFFERENCES IN THE PERCEPTION OF DOMAIN-SPECIFIC LIFE SATISFACTION
Authors: Goler Timothy , Bhatta Tirth
Published: December 2023

This study examines factors contributing to racial differences in domain-specific life satisfaction. Our study offers a major contribution to prior research that has tended to pay greater attention to psychological well-being outcomes such as life satisfaction which do not directly pertain to material circumstances of older adults. Those studies generally report better life satisfaction and fewer depressive symptoms among Black older adults than their White counterparts. Our study is based on 409 randomly selected older adults from Cleveland (mean age 79 and 25% African American). We considered socioeconomic status, stressors such as recent negative life events and coping resources such as religiosity to understand their impact on domain specific life- satisfaction (e.g., satisfaction with neighborhood, housing, and standard of living). Our ordinary least squares regression estimates suggest that, on average, Black older adults reported lower levels of domain-specific life satisfaction (b=-0.81, p< 0.01) compared to their White counterparts, despite having stronger social support and being more religious. Even though social support and religiosity did not contribute to racial differences in domain specific life satisfaction, the inclusion of education, income, and recent negative life events fully explain such differences. Findings indicate that interrelated factors such as socioeconomic disadvantage and greater life adversities such as negative life events contribute to lower domain life satisfaction among Black older adults. This finding highlights the need for further exploration of factors shaping material-related well-being outcomes for Black older adults. Our study informs future policies addressing racial well-being inequities.
RELIGIOSITY AND SPIRITUALITY DEVELOPMENT ACROSS MID- TO LATER LIFE: AN ACCELERATED LONGITUDINAL DESIGN
Authors: Nelson Niccole , Joiner Raquael , Martinez Brandy , Bergeman Cindy
Published: December 2023

It is widely accepted that religiosity and spirituality (R/S) increase with age, although the multidimensional nature of R/S complicates this conclusion. Specifically, religiosity entails engagement in communal and independent religious practices, whereas spirituality refers to a sense of communion with divine being(s). Furthermore, religious and/or spiritual individuals may use their faith to carry them through hard times, and thus engage in positive and/or negative religious/spiritual coping. Critically, these R/S facets may follow distinct developmental trajectories across adulthood, and the nature of these trajectories remain unclear. Therefore, in the present study, we followed an accelerated longitudinal design, modeling developmental trends in six R/S facets across ages 45-80. Participants included 768 subjects from the Notre Dame Study of Health & Well-being (NDHWB), a 10-year, multi-cohort, longitudinal study of adult development and aging (Wave 1 Age: Mean= 59.24, SD= 8.65). Using two-level, hierarchical linear modeling, we estimated no change, linear change, quadratic change, and cubic change trajectories across ages 45-80 in communal and independent religious practices, spirituality, positive and negative religious/spiritual coping, as well as composite R/S; cohort effects in these change trajectories were also tested. Communal and independent religious practices, spirituality, negative religious/spiritual coping, as well as composite R/S, followed unique, cubic trajectories across mid- to later life. Positive religious/spiritual coping followed a linear trajectory, although cohort effects precluded the interpretation of developmental change in this R/S facet. Individuals appear to engage with their faith in different ways as they age, meaning extant conclusions about age-graded increases in R/S may be oversimplified.
INTERGENERATIONAL COURSE ABROAD EXPLORES AGE INCLUSIVITY IN SCOTLAND
Authors: June Andrea , Andreoletti Carrie
Published: December 2023

In 2017, Central Connecticut State University (CCSU) joined the Age-Friendly University (AFU) global network. Guided by the AFU framework to promote age inclusivity in higher education, many programs and services at CCSU have been expanded to encourage the participation of older adults in all core activities of the university. The authors have a particular interest in fostering intergenerational learning opportunities, for which there are reciprocal benefits (e.g., Andreoletti & Howard, 2016). With the goals of promoting intergenerational connection and global age-inclusivity, we developed a course abroad to Scotland called Global Aging & Age-Friendly Initiatives. Prior to traveling, students are introduced to theory and research in lifespan development and to the World Health Organization’s (WHO) definition of healthy aging and domains of livability aimed at enhancing well-being and longevity. Livability community efforts in the USA are explored so that similarities and differences can be examined while in Scotland. During 9 days of travel, students are exposed to urban and rural areas of Scotland, noting the accessibility of public transportation, the availability of green spaces, the cultural attitude toward older adults, and other domains of livability. They will also hear from local academics and community organizers invested in promoting engagement across the lifespan. In June 2023, eight age-diverse learners will travel with the authors. In addition to providing more detail on the development and implementation of the course abroad, this presentation will share feedback from students and international collaborators with the goal of encouraging other AFUs to develop similar opportunities.
MEDICAL VERSUS FINANCIAL RISKY DECISION MAKING IN OLDER AND YOUNGER ADULTS
Authors: Frank Colleen , Pachur Thorsten
Published: December 2023

While risky decision making is often tested using monetary outcomes in the laboratory, many decisions in the real-world elicit considerable levels of affect––for example, when deciding about a medical treatment that has bodily consequences, such as side effects to a medication. Previous research suggests that choices systematically diverge between these more “affect-rich” medical decision problems and economically equivalent “affect-poor” monetary problems, leading to what is called an ‘affect gap’ in risky choice. However, it is unknown to what extent this pattern holds in older adults, who make some of the most consequential medical and financial decisions among the population, and for whom it has been hypothesized that affect may be a more important guide. Thus, in the present, preregistered study, we examined age-related differences in the affect gap of risky decision making. We compared decision quality and risk attitude between affect-rich (medical side effects) and structurally identical affect-poor (monetary losses) decisions in 100 older (aged 65-80, M=69.7) and 100 younger (aged 18-29, M=23.5) adults. In line with previous findings, we found that individuals were more risk-averse (Odds Ratio (OR) = 1.52) and made worse quality decisions (OR = 2.13) for affect-rich, compared to affect-poor, problems and this did not differ between younger and older adults. Follow-up work using computational modeling will reveal if decision strategy differed between age groups. These findings indicate that the affect gap is also present in older adults, which has serious implications for risk communication in medical decision making
WE CAN WORK IT OUT: NURSING HOME SOCIAL WORK AND CONFLICT MEDIATION
Authors: Roberts Amy , Kusmaul Nancy , Bern-Klug Mercedes
Published: December 2023

Drawing from a nationally representative survey of social service directors (N=922), this presentation will provide an overview of nursing home staffing trends and describe the ways in which social service staff routinely interact with residents, families, and staff. Social workers are involved in many aspects of care, including the admissions process, planning and providing care, care transitions, and general supportive services. As members of the interdisciplinary team, social workers advocate for resident rights, and support decision-making and care planning in times of family crisis and high conflict situations. Summary statistics will be presented to identify the directors’ frustrations with the role – including their perceptions of major barriers to care, and draw attention to the changes that would improve job satisfaction (e.g., higher salary/wage, 51%; lower staff turnover among direct care staff, 47%; and more time to focus on the social and emotional concerns of residents, 45%). The presentation will conclude with an overview of directors’ interest in training topics that may help to mediate conflicts among residents, families, and staff. Specifically, we will share how prepared directors feel to train other staff in conflict-resolution skills (e.g., working with the resident/family and team to balance resident self-determination with the nursing home’s responsibility to minimize risk), and the use of an ethical framework to guide action.
SOCIAL WORKERS AS INFORMAL LEGAL INTERMEDIARIES: RESOLVING CONFLICTING RIGHTS IN NURSING HOMES
Authors: Perone Angela
Published: December 2023

Conflicting rights arise often in nursing homes among residents, staff, and family. Nursing home social workers sit at a unique nexus of these rights, given their macro, mezzo, and micro-level training. This study employs a multi-method qualitative design with semi-structured staff interviews (n=90) (direct care, mid-level professional, top management), content analysis of long-term care facility policies (n=376), and ethnographic observation of two facilities (n=8 months) for a multi-layered cross-comparative in-depth case study. While social workers represented only a very small number of the overall nursing home workforce, data revealed the overwhelming reliance on social workers to resolve conflicting rights that arose among residents, staff, and family. Certified nursing assistants, nurses, directors, and administrators regularly deferred to social workers via written policies and unwritten practices to resolve a variety of issues, including discrimination concerns by staff, residents, or family, concerns about quality of care and workforce shortage, and concerns about conflicting rights to resident autonomy, dignity, medical decision-making, and safety (e.g., bed rails). Staff at all levels and professions described the emotional labor and unique professional experience that these conflicts required and felt ill-equipped to resolve these issues. While social workers resolved most of these conflicts, they, too, reported feeling ill-prepared for this role and worried about out-of-scope practice. Ultimately, they relied on their social work training in systems-level change, case management, and interpersonal communication to resolve conflicting rights. This presentation will discuss social worker challenges as informal legal intermediaries and opportunities for better support and training.
COGNITIVE ASPECTS OF MANAGING STRESS AND UNWANTED EMOTION SUCCESSFULLY IN OLD AGE
Authors: English Tammy
Published: December 2023

The ability to cope with stressors and manage unwanted emotion is central to health-related outcomes across adulthood. Prominent models of adult development suggest there may be age-related shifts in motivational strivings and accumulated knowledge that help support emotional well-being in old age. At the same time, older adults have cognitive and physical vulnerabilities that may offset some of these strengths. This session will showcase new work leveraging experimental and experiencing sampling methods to examine how people of varying ages and resource levels manage their emotions. These studies provide new insights into how older adults respond to stressors and adverse stimuli in controlled settings and daily life contexts. The first talk centers on how individuals are negatively impacted by cognitive stressors regardless of age, but older adults show more resilience than younger adults after stressor exposure. The second talk focuses on how a cognitive process known as affective labeling (or naming one’s emotions) can create emotion regulation difficulties, especially in old age. The third talk examines emotion regulation success and the benefits of instructional support for cognitively normal older adults compared to those with mild cognitive impairment (MCI). The fourth talk extends this work by tracking emotion regulation motives in daily life, showing that cognitively diverse older adults report fewer attempts to manage their emotions, but similar reasons for doing so, compared to relatively younger adults. Together these presentations delineate age-related similarity and differences in emotion regulation, highlighting avenues through which coping capacity may be maintained and improve in late life.
A THEORETICAL FRAMEWORK TO UNDERSTAND INTRINSIC HEALTH
Authors: Cohen Alan , Picard Martin , Beard John , Belsky Daniel , Fried Linda , Hall Kelli , Herbstman Julie , Makarem Nour
Published: December 2023

Traditional approaches to measuring health have relied largely on measures of function and capacity, or on subjective assessments. These approaches are important, but they result in a large gap between the biology underlying health and our ability to measure it. Here, we propose a novel concept – intrinsic health – defined as a field-like state emerging from the dynamic interplay of energy, communication, and structure within the organism, which enables robustness, resilience, adaptability, and performance. It reflects the capacity of an organism to maintain its internal dynamic equilibrium. These three pillars – energy, communication, and structure – are derived from first principles, and are the basic ingredients of life. Disruption or optimization in the organized flow of energy and information through biological structures provide a foundation to understand the causes of disease, and the foundation for health, respectively. For each pillar, we discuss available measurements that cover multiple levels of biological organization, empirical evidence linking them to traditional health outcomes, and also the limitations of isolated measurements. This motivates the use of more integrative, time-series data reflecting the dynamic psychobiological interplay among organ systems. We then situate intrinsic health in the context of environmental, behavioral, and cultural factors that affect how it is transformed into “realized health,” the health we experience as individuals and populations. The intrinsic health framework can be extended to understand how intrinsic health intersects with aging, disease, and wounds. Finally, we propose a measurement framework to quantify intrinsic health at the individual level.
THE EFFECT OF GERMANY’S LONG-TERM CARE STRENGTHENING ACT II ON NURSING HOME USE
Authors: Diederich Freya
Published: December 2023

In Germany, out-of-pocket costs for nursing home care have substantially increased during the last years. There is an ongoing discussion whether these out-of-pocket costs should be capped. However, a decrease in costs may increase nursing home use and the social costs of nursing home care. This study analyzes how a change in out-of-pocket costs for nursing home care affects nursing home use. We use discontinuities in out-of-pocket costs that arose from Germany’s Long-Term Care Strengthening Act II in 2017. The Long-Term Care Strengthening Act II decreased average nursing home care costs for people with higher care needs and increased average costs for people with lower care needs. Long-term care insurance data are analyzed using a regression discontinuity design. There is no significant change in nursing home use among people who enter long-term care with relatively high care needs. However, there is a significant decrease in nursing home use among those who enter long-term care with relatively low care needs. The results are robust regarding different specifications of the model. We conclude that the elasticity of nursing home use depends on the level of care needs. For people with high care needs, nursing home care is often without alternatives, whereas people with lower care needs may substitute nursing home care with informal care. A generous public policy does not necessarily increase demand for nursing home care.
IMPROVING REHABILITATION OUTCOMES FOR PEOPLE AGING WITH LONG-TERM HAND IMPAIRMENTS
Authors: Sanford Jon , Lee Susan , Chen Yi-An , Bhattacharjya Sutanuka , Buchman Emily , Norgaard Martin , Weinberg Gil
Published: December 2023

Despite the importance of hand and upper extremity function in ADL performance and successful aging-in-place, contextual and engaging in-home rehabilitation interventions that promote use, feedback of progress, and long-term monitoring of changes in functional ability among individuals with chronic upper limb deficits are lacking. This presentation will present the findings from three TechSAge pilot projects focused on the use of technology to support in-home rehabilitation for individuals aging with long-term upper extremity disabilities. DigiHand, is a smartphone-based application combined with sensor-embedded objects used in daily activities (e.g., coffee cup) that enables users to self-manage their own rehabilitation, obtain feedback on progress to refine movements, and allow remote monitoring by therapists. Similarly, KeyStroke is an in-home piano training mobile app that provides engaging music exercises to promote long-term rehabilitation and therapists’ monitoring of progress of stroke survivors. Finally, 3DP for AT is generating design requirements to support the development of an open-source software tool that would allow assistive technology service providers, who are novice users of 3D printers, to create and fabricate highly customized 3D-printed assistive devices that are more durable, aesthetic, and will better meet the unique needs of people aging with long-term hand impairments.
“CAREGIVING MADE ME GRATEFUL”: THE UNEXPECTED BLESSINGS OF DEMENTIA CAREGIVING
Authors: Lewis Jordan
Published: December 2023

There is a cultural value among Alaska Natives to care for their Elders and this commitment applies to all Elders, regardless of health status or cognitive health. Caregiver duties can lead to stress, isolation, and depression that negatively impact their overall health and wellbeing. Interviews were conducted with 22 Alaska Native caregivers for Alaska Natives with Alzheimer’s Disease and Related Disorders in rural and urban communities across Alaska. Interviews lasted approximately 60 min and were transcribed verbatim. We examined the caregivers’ experiences of ADRD and the unexpected blessings associated with being a caregiver. Alaska Native caregivers shared the challenges associated with caregiving duties, and the lack of education, awareness, and available resources exacerbated their stress and challenges. As their family member experienced changes related to the ADRD, the blessings took different forms and served different purposes. Spending more time with their family member, remembering family history, engaging in generative behaviors, and strengthening intergenerational relationships were the most frequently discussed blessings. Focusing on these blessings enabled caregivers to continue to find meaning in this role and carry on their cultural values and traditions. This study shifts the focus of caregiving research to highlight the unexpected blessings. The focus on strengths of caregiving and sharing these stories has the potential to provide current and future caregivers to step into this role with a different perspective, or at least not just hear of the challenges and barriers associated with ADRD caregiving.
NAVIGATING AGING WHILE CAREGIVING: LONGEVITY PLANNING CONSIDERATIONS FOR CAREGIVERS OF ADULT CHILDREN
Authors: Cerino Lauren , Felts Adam , Balmuth Alexa , Miller Julie , Coughlin Joseph
Published: December 2023

Caregiving is a demanding, complex, and costly role. According to AARP (2020), an increasing population of older adults in the U.S. are providing unpaid care to younger adult family members, with over two million adults in the U.S. providing care for an adult child. Caregivers of adult children experience unique challenges that can affect how they plan for their own longevity, as well as their adult child’s longevity. To further explore the experiences of aging caregivers of adult children, the MIT AgeLab conducted an exploratory, qualitative study based on interviews with participants drawn from the MIT AgeLab’s CareHive panel. Through a series of interviews conducted in June 2022, three key transition points in the lives of caregivers of adult children were identified. These transitions included the discovery that the child has special needs, the child’s transition into legal adulthood, and the aging of the caregiver. The last transition point, focused on the aging of the caregiver, often presents complex implications including balancing one’s own care needs with those of their child; navigating difficult family conversations; and preparing for continuation of care after one’s own eventual death. Leveraging insights from these interviews, this session will explore complexities within each of the three key transition points, using Schlossberg’s Transition Theory as a lens for analysis. The session will also identify resources and support desired by caregivers for support in this transition point, shedding a particular light on important considerations for professionals across multiple sectors and industries.
EVIDENCE-BASED STRATEGIES TO DELIVER AND PROMOTE AGE-FRIENDLY CARE IN HOSPITAL SETTINGS
Authors: King Barbara , Hook Mary , Golden Blair
Published: December 2023

The number of adults aged 65 and older will double by 2050. Older adults have more chronic conditions and complex care needs compared to younger adults. To support the health of older adults the Age Friendly Health Systems model was initiated in the US. Age Friendly Care is comprised of 4 core elements (called the 4 M’s framework), What Matters, Medication, Mentation and Mobility, aimed to ensure that older adults receive the best care possible and are not harmed by health care systems. This symposium will present several papers describing how components of age friendly care were implemented in hospital settings. Paper 1 will describe strategies used by acute care nursing staff to overcome challenges imposed by COVID to implement a mobility intervention to improve ambulation of older adult patients; Paper 2 will present psychometric findings on an instrument to measure a patient’s level of ambulation to promote mobility during a hospital stay; Paper 3 will describe a quality improvement initiative to implement the 4 M’s framework on in-patient medical units; and Paper 4 will provide insights on implementing the What Matters component of 4 M care and strategies for promoting patient goals and preferences for care delivery. Age-Friendly Health Systems have the potential to improve care delivery for older adults. The papers presented demonstrate it is feasible to implement 4 M’s framework in hospitals, but innovative strategies and reliable tools are needed.
A COLLABORATIVE PILOT FOR AGE-FRIENDLY HOSPITAL CARE
Authors: Hirvela Kari
Published: December 2023

To ensure older adults receive the best care possible, Age Friendly Health Systems has become a national effort in the US. This initiative is based on 4 core components (called 4 M’s framework), What Matters, Medication, Mentation, and Mobility. We piloted a multi-disciplinary care model based on the 4 M’s framework to improve healthcare delivery for older adults at a large academic hospital. Using the Plan-Do-Check-Act, a care model was developed. Plan: A multi-disciplinary stakeholder group identified best practices for each of the 4Ms, including: 1) asking and documenting “what Matters most” and mobility; 2) pharmacy review of high-risk medications; 3) creation of 4M provider patient list in electronic health record (EHR); 4) implementation of delirium rounds. Education was provided to hospital champions. An interactive dashboard was created to demonstrate impact. Do: The 4M’s were implemented for patients ≥ 65 years old on 2 inpatient units. Check: 4M’s interventions was monitored via dashboard. Findings revealed low provider utilization of the patient list template and provider-initiated adaptations to the care plan. Feedback hospital providers was largely positive. Act: Based on feedback, revisions were made within the EHR, and a 4M’s patient flyer was created. 73% of older adults received 4M’s care on the 2 pilot units, meeting the criteria demonstrating “Committed to Care Excellence” by the Institute of Healthcare Improvement. We were able to effective implement 4 M’s care. Age friendly care is an evidence-based model that may improve outcomes for older adults.
BIODEMOGRAPHY OF AGING, CELEBRATING JAMES W. VAUPEL, PHD
Authors: Christensen Kaare
Published: December 2023

James W. Vaupel, PhD (1945 – 2022), was an international leader in demography and aging research and a pioneer in the field of biodemography. He was a highly creative researcher and very entrepreneurial in the development of new interdisciplinary research environments. This symposium highlights a few of the biodemographic research areas that Dr. Vaupel has been a catalyst for. Denmark was Dr. Vaupel’s home country during the last third of his life, and Dr. Christensen reports on findings from Danish nationwide genetic-epidemiological studies on twins and the oldest old: familial influence on aging phenotypes, cohort differences in health among the oldest old, associations of early life events with late life health, as well as tongue-in-cheek research on perceived age and teeth. Dr. Alberts discusses the ‘invariant rate of aging’ hypothesis that was developed by Vaupel and others. She presents comparative analyses from multiple nonhuman primate populations showing that, while life expectancy can continue to improve, we probably can’t slow the demographic rate of aging. Dr. Campos presents evidence from a wild baboon population in Kenya that glucocorticoid levels—biological markers of stress responses—are strong prognostic indicators of survival and may be key explanations of life span disparities. Dr. Carey presents key discoveries from large-scale studies involving the Mediterranean fruit fly. These include the slowing of mortality at older ages, context-specific sex mortality differentials, a behavioral biomarker for morbidity, dietary conditions for maximizing lifespan versus reproduction and a stationary population identity whereby life lived equals life left.
FIVE BIODEMOGRAPHIC PRINCIPLES OF AGING THAT EMERGED FROM RESEARCH ON THE MEDITERRANEAN FRUIT FLY
Authors: Carey James
Published: December 2023

Because of its large size, visually-distinct sex differences, abundance in the wild and ease of rearing at both industrial and individual levels, the Mediterranean fruit fly (medfly) is an ideal model organism for conducting research on the demography of aging. I will present details on and implications for what I consider to be the five most interesting and important aging-related discoveries from the NIA-funded research my colleagues and I conducted over the past three decades using the medfly model. These discoveries include (1)Deceleration of mortality at advanced ages; (2)Equivocality of the gender gap due to context-specific sex mortality relationships; (3)Supine behavior as a biomarker of both morbidity onset and time-to-death; (4)A dietary disconnect between maximizing longevity vs maximizing lifetime reproduction; and (5)the life table population identity in which the fraction age x in a stationary population equals the fraction with x years to live. I will end with brief comments about the use of non-conventional model organisms for research on aging in both the laboratory and the field.
AGING IN THE RIGHT PLACE: TEMPORARY SUPPORTIVE HOUSING FOR OLDER MALE VETERANS IN CALGARY, CANADA
Authors: Hoselton Jill , Grittner Alison , Walsh Christine
Published: December 2023

In 2019 an estimated 1.6% of emergency shelter users in Canada were veterans (1,905 individuals), which is consistent with the proportion of veterans in the general population (1.7%). However, veterans tend to be older, male, and cite an illness or medical condition as a contributing factor to their homelessness, than their non-veteran counterparts. As part of the Aging in the Right Place (AIRP) study, we sought to understand the housing and support needs of older male military veterans (age 50+) living in a congregate temporary supportive housing in Calgary, Alberta. This exploratory, multi-methods study used: (1) de-identified document review, (2) environmental audit, (3) in-depth qualitative key informant interviews with service providers and (4) in-depth qualitative and Photovoice interviews with older shelter residents to understand the shelter needs of older homeless veterans. The data was collected between February and June 2023. Interviews were transcribed, managed with NVivo 1.6.1, and team-based flexible coding was employed on the key informant (n=5) and shelter resident (n=5) interviews to determine older male veterans’ shelter needs. In this presentation we share the findings of the study and offer recommendations for shelter and services designed to assist older housing insecure veterans to age in the right place.