bluuebunny/crossref_metadata_2025 huggingface dataset:
SOCIAL NETWORK SIZE AND THE TRANSITION TO NONDRIVING
Authors: Hansmann Kellia , Gangnon Ronald , McAndrews Carolyn , Robert Stephanie
Published: December 2023

Having family and friends available to provide rides is an important coping factor after people stop driving. Social networks may also be a means by which older adults can reduce or stop driving earlier while maintaining their mobility. We examined whether social network size was associated with 3-year changes in driving behavior among U.S. older adults. We analyzed data on community-dwelling drivers in the National Health and Aging Trends Study (n = 5,140; 2015 cohort). We categorized whether participants reported zero, one, or two or more people to talk to about important things (who lived in their county). We used weighted logistic regression models to estimate whether having more same-county people to talk to about important things was associated with incidence of any of four new driving avoidance behaviors (avoiding driving: at night, in bad weather, on highways, or alone) or driving cessation, at three-year follow up, adjusting for biopsychosocial variables. There was no significant association between having two or more same-county people to talk to about important things and the odds of driving cessation at follow up (adjusted Odds Ratio [aOR]: 1.00, 95% Confidence Interval [CI]: 0.58-1.71) compared to drivers who reported having no one to talk to about important things. Similarly, there was no significant association with the incidence of one or more new driving avoidance behaviors (aOR: 1.16 95% 95% CI: 0.91-1.47). Future research should examine whether other aspects of social networks (e.g., type, quality, closer proximity) might play important roles in supporting the transition to non-driving.
THE EYE OF THE STORM: END-OF-LIFE CARE IN NEW YORK CITY DURING THE COVID-19 PANDEMIC: LESSONS FOR THE FUTURE OF HOSPICE
Authors: David Daniel , Franzosa Emily , Brody Abraham
Published: December 2023

Public health containment and mitigation policies in response to the COVID-19 pandemic, including social distancing, infection control, and self-quarantine led to a substantial reduction in transmission of COVID-19. Yet they also brought about significant disruptions in healthcare, particularly care at the end of life. These challenges were amplified in older adults of color and those who contend with differing social determinants of health that impact care outcomes. Hospices played a key role in supporting patients at home throughout the pandemic and yet concomitant with the surge in demand for hospice, there was a gap in hospice delivery, exposing latent vulnerabilities in the capacity to respond to a crisis that demanded a coordinated, synchronized approach. We present the findings of an innovative, mixed methods study funded by the National Institute of Nursing Research that combines qualitative content analysis of linked electronic health records with qualitative stakeholder interviews to gain an in-depth understanding of the challenges of delivering hospice care in NYC during the pandemic. Interviews include the perspectives of nurses, managers, administrators, physicians, medical directors, social workers, and clergy from several healthcare practices. Our presenters address 4 key areas: a) Provider experiences and organizational challenges and successes, b) Challenges in transitioning from primary care to hospice, c) Efforts to provide equity-focused hospice care, and d) The central role of home health aides in end-of-life care. Together, these experiences provide insights into lessons learned and point to new opportunities to design and deliver high-quality hospice care in the future.
DIVERSIFYING THE PIPELINE OF GERONTOLOGISTS AT THE UNIVERSITY OF MASSACHUSETTS BOSTON
Authors: Miller Edward , Stokes Jeffrey E , Nadash Pamela , Boerner Kathrin , Birchander ellen
Published: December 2023

The University of Massachusetts (UMass) Boston is a public research university serving approximately 16,000 students. It is the most diverse university in New England and third most diverse university in the nation. UMass Boston prioritizes fostering an anti-racist and health-promoting institutional culture. Consistent with this priority, the Gerontology Department is committed to growing the size and diversity of the professional pipeline in aging services, policy, practice, and research. This presentation describes the multi-pronged approach taken to achieve this objective, while identifying associated facilitators and challenges. Department-wide initiatives include prioritizing work in disparities and a commitment to diversity, equity and inclusion in faculty hiring and implementing curriculum self-assessment and climate survey tools. Doctoral program initiatives include establishing a scholarship in Social Justice and Aging and submitting a training grant application in Health Equity Research. Undergraduate program initiatives include changing the name of the major to “Aging Studies” to make the content clearer and more accessible, proposing a minor in Aging Studies to make it possible for students from across the University to earn a valuable credential, having all courses meet Social and Behavioral requirements in general education (including, in select cases, the Diversity requirement as well), and expanding the number and attractiveness of course offerings (including “Diversity and Aging”). The Department is also implementing an initiative where undergraduates receive paid internships at local-area aging agencies with potential for continued employment post-graduation. Enhancing diversity goes hand-in-hand with growing program enrollment with positive benefits for older adults and their families, caregivers, and communities.
STUDY METHODOLOGY AND SAMPLE SELECTION TO DEVELOP AGE-INCLUSIVE STRATEGIES
Authors: Lin Yan , Xu Shu
Published: December 2023

Practical, feasible, and impactful age-friendly campus strategies to advance age inclusivity were identified through focus group and Delphi panel methodologies. Sixteen virtual focus groups with 78 participants (41 faculty, 16 students, and 21 staff/administrators; 44% ages 45-64 and 12% 65 and older) were conducted to assess age inclusivity in three institutional functions defined as high impact: teaching and learning, personnel, and student affairs. Facilitators presented participants with questions based on strategies and challenges identified from open-ended survey responses to our previous study. Following similar scripts for each of the three groups, facilitators asked 5 to 6 questions regarding potential strategies to address challenges such as those related to teaching older, age-diverse students; intergenerational tensions and biases; student support services; and incentives for faculty to integrate aging content into their courses. Next, the strategies yielded from this analysis were presented in online surveys to the Delphi panelists to assess their feasibility and impact. These 18 panelists had been selected based on their broad experience in higher education and upper-level administrative knowledge, professional connections, and/or expertise in diversity/inclusion/equity initiatives. In the first round, they evaluated the relative importance of 21 challenges to age inclusivity and their appropriateness, feasibility, and likelihood of implementation. The second-round survey narrowed the list of strategies to those rated as most viable (feasible and appropriate) in the first round and identified priorities among the selected strategies.
PREDICTIONS FOR DEMENTIA BURDEN AND POLICY RESPONSES IN CHINA AND UK BY 2050
Authors: Liao Jing , Brunner Eric
Published: December 2023

The goal of this symposium is to provide a forum to interact with the principal communities, who are developing research on the projection of dementia burden to ageing society and policy responses. It is driven by the UK-China Health and Social Challenges Ageing Project (UKCHASCAP). China’s rapid ageing process is occurring at an earlier stage of economic development than many other countries including UK, posing great demands on families, communities and health and care services. Thoughtful comparison of health and social care policy across the contrasting countries will be scientifically illuminating and valuable to policy makers. Preliminary results from four studies will be presented. Two studies based on large ageing cohorts of China and the UK, using multi-state Markov modelling (IMPACT-CAM, IMPACT-BAM) to construct predictions of dementia and related health status (e.g. CVD and physical disability) to 2050. The British model will highlight calculation of dementia incidence trend over time. The following study further used IMPACT-CAM to predict socioeconomic cost of medical, informal and formal care, and quality adjusted life years associated with dementia in China in corresponding years. The fourth study systematically evaluates the effects of implementing long-term care insurance in pilot cities in China, and analyses the main challenges in establishing a nationwide equitable long-term care system for older people. Through this symposium, the panel will provide state-of-art modelling and latest data on the innovative, interdisciplinary and international collaboration for predicting dementia, and provide scientific advices for policy making on healthy ageing in China, the UK and globally.
MOBILIZING INTERDISCIPLINARY RESEARCH TO ILLUMINATE DIVERSITY ACROSS THE CANCER CARE CONTINUUM
Authors: Halpin Sean , Krok-Schoen Jessica
Published: December 2023

Cancer diagnoses increase precipitously with age, impacting diverse populations who have different experiences, needs, and resources. In our symposium, we bring together researchers from multiple disciplines to present on the diversity of older adults living with cancer and the ways that health care providers, systems, and researchers are innovating to support them. Carrion presents the knowledge of gender-specific types of cancer among older Latinos/as. Seaman presents research on the use of comprehensive geriatric assessments by oncology and primary care providers who work with older adults. Blackberry discusses the use of age-friendly models of care within cancer care. Halpin discusses the results from a scoping review of cancer therapy decision-making among patients with co-morbid dementia and cancer and their caregivers. Ultimately, we discuss the need for multiple methods to understand the experience of patients from diverse populations and with various cancer diagnoses and innovate in cancer care research.
THE ROLE OF AGE-FRIENDLY HEALTH CARE IN OLDER ADULTS WITH CANCER
Authors: Blackberry Irene Darmadi , Rich Stacey , Hodge Oliver , Rasekaba Tshepo , Webb Nicole , Steer Christopher
Published: December 2023

It is estimated that 51% of cancer incidence worldwide occurs among adults aged 65 years and older. The care of older adults diagnosed with cancer is complex due to an interplay of biopsychosocial factors, including comorbidities, geriatric syndromes, functional status, nutritional health and socioeconomic characteristics. Working within an age-friendly model of care is important in ensuring the complexity of ageing is taken into consideration, while understanding what matters most to the patient undergoing cancer treatment. Age-friendly models of care such as the 4Ms framework (Mentation, Mobility, Medications, and (what) Matters) are gaining support across the globe, but little is known of the use of age-friendly models of care in cancer care. This scoping review aimed to understand the current state of age-friendly care in cancer care and to highlight how age-friendly models can be implemented in cancer care to improve the experience of treatment for older adults.
SOMATIC COMORBIDITY PATTERNS IN PEOPLE WITH DEPRESSION: A POPULATION-BASED COHORT STUDY
Authors: Luo Hao , Vetrano Davide , Triolo Federico , Zucchelli Alberto , Zhang Yingyang , Wang Pengcheng , Man Kenneth , Lai Francisco
Published: December 2023

People with depression often present with co-existing somatic conditions, which impact survival and steer patients’ clinical management. This study aimed to identify unique patterns of somatic comorbidity in people with depression and examine their associated mortality. We used population-based electronic health records from the Clinical Data Analysis and Reporting System in Hong Kong. People aged 40+ who had an incident depression diagnosis between 2001 and 2015 were included and followed up until 31 December 2018. Latent class analysis was applied, separately by decades, to individuals with depression and at least one comorbid somatic condition. Cox proportional hazard models were used to examine the risk of mortality associated with specific comorbidity patterns, adjusting for sociodemographic and clinical characteristics. We identified 38,889 eligible individuals (mean age: 62.8; 68.7% women). Latent class analysis identified an increasing number of patterns with age (two to seven). Compared with the unspecific pattern, the following patterns were associated with the highest mortality risk in different age groups: cardiometabolic and cerebrovascular diseases in individuals aged 40-49 (hazard ratio [HR] 2.5 [95% CI 1.7-3.7]), cardiometabolic diseases and anemia in those aged 50-59 (HR 3.4 [2.6-4.5]) and 70-79 (2.7 [2.3-3.3]), cardiometabolic, cerebrovascular diseases, and anemia in those aged 60-69 (HR 2.5 [2.0-3.2]), and cardiorespiratory disease in those aged 80+ (HR 2.0 [1.8-2.3]). Specific somatic comorbidity patterns were independently and substantially associated with the risk of mortality. This highlights the importance of taking combinations of somatic conditions into account when tailoring the clinical and care approach to people with depression.
PHYSICAL ACTIVITY AND IMPACT ON PSYCHOLOGICAL AND BEHAVIOR SYMPTOMS ASSOCIATED WITH DEMENTIA
Authors: Drazich Brittany
Published: December 2023

The aim of this study was to examine the impact of physical activity during hospitalization on behavioral and psychological symptoms of dementia among older adults, after controlling for covariates (age, gender, race, comorbidities, care interactions, and treatment group) and examine the association of physical and behavioral and psychological symptoms of dementia among hospitalized older adults living with dementia. Data from the first 365 participants in the FFC-AC-EIT study was used. Physical activity was measured over 24 hours and was based on the Physical Activity Survey which included the following activities: walking, wheeling, bathing, dressing, feeding, grooming, and toileting. Behavioral and psychological symptoms associated with dementia were based on the Neuropsychiatric Inventory (NPI). The mean age of participants was 83.18 years, the majority was female (63.6%) and White (69.4%), the mean NPI was 1.28(SD=1.85) and mean activities was 8(SD=5). A total of 16% of individuals performed no activity. The most common activity was eating and the least commonly performed was self-propelling in a wheelchair. A total of 40% engaged in walking and 60% performed some bathing and dressing while hospitalized. After controlling for covariates, physical activity explained an additional 2% of the variance in NPI scores (beta=-.13., p=.05). There was no evidence that engaging patients in physical activity resulted in behavioral symptoms and activity may help to decrease these symptoms. Continued focus is needed to engage older adults living with dementia when hospitalized to engage in routine physical activity by performing activities of daily living.
ADVANCING HEALTH EQUITY AMONG OLDER ADULTS THROUGH COMMUNITY ENGAGED RESEARCH
Authors: O’Conor Rachel , Lewis-Thames Marquita
Published: December 2023

Health equity, the absence of unfair and avoidable differences in health among social groups, has garnered mainstream attention due to recent civil unrest in communities, yet remains an elusive goal for aging health researchers. Community-engaged research is one approach to improve older adult health equity. Community-engaged research involves partnerships between researchers and community organizations, community health centers, and community members to pursue a common goal. To shift the traditional paradigm of investigator-led and -implemented research, community-engaged principles emphasize the co-production and ownership of knowledge. While community-engaged research has a successful track record in facilitating health disparities research, far fewer partnerships have been formed to 1) elevate the voices of older adults and 2) investigate and act on root causes of health disparities in older adults. To advance the practice of community-engaged research focused on older adult health, this symposium presents five community-academic partnerships elevating older adult voices from diverse groups and health conditions while simultaneously describing engagement strategies across the research process. First, Grant outlines processes for leveraging community representatives as partners in developing multilevel interventions for older cancer survivors. Second, Filec describes a multi-year community-engaged research journey that culminated with a study investigating the health impacts of a home repair program. Third, Singh details a user-centered design approach through a community advisory board to develop a telehealth navigation tool. Fourth, Lewis-Thames describes a community-based qualitative assessment capturing telehealth utilization among rural older cancer survivors. Lastly, Oladejo presents the community-driven development of a culturally-tailored dementia caregiving program for Black caregivers. This is a Community-Engaged Research Interest Group Sponsored Symposium.
TELEHEALTH UTILIZATION BY RURAL OLDER CANCER SURVIVORS: A COMMUNITY-BASED QUALITATIVE ASSESSMENT
Authors: Lewis-Thames Marquita , Trimble Shawn , Rosen Francesca
Published: December 2023

In a nationwide survey, rural clinic uptake of telehealth utilization increased by 70% compared to pre-pandemic utilization. Despite advancements in tele-delivered cancer care for rural residents, older adults are slower to engage the technology; yet examinations of the challenges rural older cancer survivors face when incorporating telehealth into complex cancer care are limited. Guided by the Andersen Healthcare Utilization Model, we qualitatively examined barriers and facilitators of telehealth utilization for rural older cancer survivors. Ongoing interviews began in March 2022. We purposively sampled telehealth-using rural older cancer survivors, caregivers of rural older cancer survivors, and healthcare professionals that served this population. The interview guide probed participants regarding telehealth utilization for cancer and survivorship care. We used thematic analysis and deductively coded to the Andersen Model constructs. Preliminary findings are based on six rural older cancer survivors, caregivers, and healthcare professionals. Most participants were Non-Hispanic White, had at least some college, traveled greater than 31 minutes to an oncologist, and used their cell phone or computer to access telehealth. We coded similar perceptions between survivors, caregivers, and healthcare providers. Emergent themes included (1) Telehealth provided critical and necessary services, (2) Existing technological literacy and infrastructure enabled telehealth uptake, (3) Geographic isolation related to the rural environment impaired participant’s ability to access telehealth-delivered care, and (4) Real-time provider-patient communication at critical points in participants’ care facilitated telehealth utilization. Overall, participants reported that telehealth was useful for overcoming barriers common to rurality and often a suitable strategy to deliver cancer care.
IT’S A FAMILY AFFAIR: ADDRESSING THE NEEDS OF BLACK DEMENTIA CAREGIVERS THROUGH COMMUNITY-BASED RESEARCH
Authors: Oladejo Dianne , Chapman Joyce , Roberson Tonya , O’Conor Rachel
Published: December 2023

Racial disparities exist in dementia diagnosis, co-morbid health conditions, and socioeconomic characteristics between older Black and White adults, compounding caregiving responsibilities for Black families; yet few dementia caregiving programs offer culturally competent, family-centered dementia caregiving programs for Black individuals. In a collaboration between two community-based organizations (CBO) and an academic medical center, a culturally tailored, family-centered, dementia caregiving program for Black individuals on Chicago’s Far South Side was proposed. Local CBOs convened community members to co-design a key informant interview guide and conducted 30 interviews among Black dementia caregivers. The caregivers interviewed were primarily caring for parents or grandparents and shared caregiving responsibilities with other family members. Caregivers recommended the program focus on five top concerns related to their caregiving experience: 1) feelings of stress and burden while being committed to their family member with dementia, 2) education on the progression of dementia and discussion of cultural beliefs, 3) personal experiences with racism and intersectional identities, 4) kinship responsibilities and managing dementia-specific changes that occur with loved ones, and 5) a need for respite and local medical and community-based resources. Anticipated barriers to participation in this program included time, an accessible location to members of the far south, and care for family members during participation. Though a community-directed approach, we elevated Black dementia caregiver experiences to better understand the influence that race and culture has on Black caregivers, which will provide the foundation for a Black family-centered dementia caregiving program to build capacity in routine caregiving and reduce caregiver stress.
PERSONALIZED AND TYPICAL CONCURRENT RISK: JOINT MODELS OF RECURRENT OUTCOMES AND MORTALITY BY RACE/ETHNICITY
Authors: Allore Heather , McAvay Gail , Wyk Brent Vander , Han Ling , Quiñones Ana
Published: December 2023

The growing burden of multiple chronic conditions documented by a U.S. Department of Health and Human Services initiative noted the importance of studies that 1) “Develop tools to identify and target population subgroups of individuals with multiple chronic conditions who are at high risk for poor health outcomes”, and 2) “Improve knowledge about patient trajectories temporally in relation to changes in health status, functional status, and health services use”. Expanding upon our methods for jointly modeling multiple outcomes, where each person’s shared influence on concurrent outcomes can be captured by using a random intercept term, we demonstrate how to model additional heterogeneity. Based on the estimates from the joint model, the typical concurrent risk (TCR) of each outcome (i.e., probability) can be estimated at the cohort level, providing a method for identifying average longitudinal effects of risk factors useful for healthcare system policies. In contrast, a person-specific effect reflects the probability of each outcome within a defined interval of time, while currently at risk for another non-mutually exclusive outcome (i.e., personalized concurrent risk [PCR]). Chronic conditions and sociodemographic risk factors may partially account for the heterogeneity of a cohort. However, differences in the occurrences and associations among these may differ for minoritized groups. These methods identify persons above (or below) average risk. We expanded these joint models to address truncation of measurement due to death and the interdependence of outcomes at the person-level, while maintaining the Type I error rate. We have made the code publicly available.
EMERGING COHORT DISPARITIES IN MULTIMORBIDITY IN US ADULTS ENTERING EARLY OLDER ADULTHOOD
Authors: Bishop Nicholas , Haas Steven , Quiñones Ana
Published: December 2023

Recent evidence of generational disparities in multimorbidity risk among older adults indicates earlier transitions into multimorbidity and greater disease burden for those born to later cohorts. As costs of managing chronic disease will rise with population aging, it is imperative to identify whether cohort effects in multimorbidity extend to cohorts just entering early older adulthood. We use representative data from the Panel Study of Income Dynamics to model cohort trends in multimorbidity from 1999–2019 in adults who were 50 years of age or older at any observational period (n = 4,975; 40,822 person-observations). Multimorbidity was assessed as a count of nine chronic conditions (stroke, hypertension, diabetes, cancer, lung disease, heart problems, emotional problems, arthritis, mental loss). Weighted Poisson mixed models were used to estimate multimorbidity trajectories adjusted for fixed effects of cohort, linear and quadratic age, and sociodemographic covariates. The model accounted for repeated measures though inclusion of a random effect for within-person error covariance across wave. After adjustment, those born to the Early and Late Baby Boom cohorts (b. 1946–1955 and b. 1956–1964, respectively), as well as those born to the early Gen X cohort (b. 1965–1972), reported significantly greater multimorbidity burden than those born to the late depression-era (b. 1931–1942). These findings extend evidence of cohort effects in multimorbidity in U.S. older adults, indicate these problematic trends apply to U.S. adults entering early older adulthood, and suggest practitioners and policymakers should prepare for an aging population with expanding disease burden.
MEASURING COGNITIVE FUNCTION IN OLDER ADULTS WITH SENSORY LOSS
Authors: Deal Jennifer , Nichols Emma , Gross Alden , Swenor Bonnielin
Published: December 2023

Neurocognitive batteries are administered orally or on paper, requiring participants to hear and see to participate; yet 55% of Americans aged 60+ years have hearing or vision loss. We will review 3 studies investigating whether sensory loss could bias cognitive testing. First, we used item response theory to test whether cognitive testing is more difficult (biased) for individuals with vs. without sensory loss, controlling for underlying cognitive function using Atherosclerosis Risk in Communities (ARIC) Study and Baltimore Longitudinal Study on Aging data. Although differential item functioning exists for some tests, it is not salient (>1 standard error difference), suggesting that sensory loss may not have a strong impact on measuring cognitive function in well-designed and conducted research studies. Second, we described how audiometric hearing loss impacts completion of neurocognitive testing, and how missing test scores affect estimates of the hearing loss-cognitive test performance association in a cross-sectional analysis of 3,678 adults (72-94 years) in ARIC. Hearing loss was associated with greater missingness on two auditory-only tests (Logical Memory, Digits Backwards) and two written tests (Boston Naming, Trail Making B). Ignoring this missing data underestimated the hearing-cognition association. Finally, we identified cohort studies measuring cognition in older adults through systematic review, and surveyed investigators for how sensory health was addressed in their studies. We found variation in methods used to assess sensory loss, with implications for resource allocation. Using these studies, we will discuss how to best measure cognition in adults with sensory loss, with a focus on inclusion and equity.
HEARING LOSS AMONG OLDER ADULTS IN THE NATIONAL HEALTH AGING TRENDS STUDY
Authors: Reed Nicholas
Published: December 2023

Hearing loss is an important condition that affects healthy aging. However, nationally representative estimates of hearing loss among older adults are limited due to differences in measures and categorization of hearing as well as limited sampling of older adults. The aims of this presentation are to review the meaning of different hearing measures and categorization and to estimate the prevalence of hearing loss by age and demographic covariates of adults over 70 years. The National Health and Aging Trends Study (NHATS) is a large nationally representative panel study of Medicare beneficiaries aged 65 and older with robust oversampling of the oldest old adults that added pure-tone audiometry, the current gold standard for quantifying hearing loss to the 2021 NHATS round 11 protocol. Cross-sectional (n=2620) weighted prevalence estimates by age, sex, race/ethnicity, education, and income were applied to corresponding United States Census Bureau estimates. Using traditional definitions of hearing loss, an estimated 67.9% (22.4 million) of adults over 70 years have at least some degree of hearing loss (37.4% mild, 25.8% moderate, and 4.6% severe). Prevalence is higher among White, male, lower-income, and lower education attainment subpopulations and increases with age such that 97.6% of adults 90 years and older have hearing loss. Application of new World Health Organization categories of hearing loss resulted in an increase in prevalence from 67.9% to 82.7% of adults over 70 years. The near ubiquitous nature of hearing loss in this population raises questions about identifying actionable cut points in future research.
NEW MEASURES AND POPULATION PREVALENCE OF VISION IMPAIRMENT IN NHATS
Authors: Nagarajan Niranjani , Ehrlich Joshua
Published: December 2023

The National Health and Aging Trends Study (NHATS) is a nationally representative panel study of older U.S. adults that in 2021 (Round 11) added to its annual protocol a suite of objective visual function measures consisting of distance visual acuity, near visual acuity, and contrast sensitivity tests. These measures were developed to approximate clinical gold-standard tests, while allowing for administration on a tablet in participants’ homes. The tests were found to have good agreement with clinical gold-standards based on their limits of agreement, correlations, and lack of systematic bias between tests. In the initial 2021 fielding of the NHATS visual function measures, 27.8% (25.5%-30.1%) of U.S. adults over age 70 had one or more visual impairment (VI) (distance VI: 10.3% [8.9%-11.7%]; near VI: 22.3% [20.3%-24.3%]; contrast sensitivity impairment: 10.0% [8.5%-11.4%]), and the prevalence was highest among those who were older, had less education, lower income, and were of Hispanic ethnicity and non-White race. Additionally, the adjusted prevalence ratio for dementia was significantly higher among those with each type of VI compared to those with normal vision (moderate/severe distance VI=1.72 [1.26-2.35]; any near VI=1.40 [1.16-1.69]-; contrast sensitivity impairment =1.31 [1.04-1.66]). Since few other national studies of older adults include objective visual function measures, NHATS now serves as a vital resource for the study of vision epidemiology and the impact of VI and blindness on later-life health outcomes and trajectories.
EXPERIENCES OF STAFF MEMBERS RELOCATING FROM A NURSING HOME TO AN INNOVATIVE LIVING ARRANGEMENT FOR OLDER ADULTS
Authors: Brouwers Mara , Boer Bram , Groen Wim , Verbeek Hilde
Published: December 2023

More innovative living arrangements are developed within long-term care, leading to an increase in relocations. Relocating within long-term care is a long pending and intensive undertaking, especially for staff members. The combination of relocating and achieving a successful culture change might be a daunting task for staff members. Given the increase in the number of relocations and the fast development of innovative living arrangements, it is key to expand our knowledge concerning the impact such an undertaking has. The research question is therefore: ‘How is the relocation from a regular to an innovative living arrangement experienced by staff members?’ To answer this research question, 41 semi-structured interviews with staff members of several nursing homes undergoing a relocation were conducted. These nursing homes had to undergo a relocation to an innovative living arrangement. Findings indicate that a relocation process within long-term care is an intensive and stressful undertaking. Staff members often describe the relocation process as ‘stressful’, ‘chaotic’, and ‘intense’. Furthermore, although staff members are mostly positive about the new physical environment, they experience an array of barriers when trying to implement a new way of working. They define two key elements for successfully relocating and implementing a new way of working. First, clear communication and receiving sufficient information throughout the relocation process. Second, proper preparation for implementing a new way of working and coaching on the job. It is evident that relocating to an innovative living arrangement is a large undertaking that requires careful planning.
EVALUATING WAYFINDING INFRASTRUCTURES FOR PEOPLE LIVING WITH DEMENTIA—THE 360 DEGREE MAPS STUDY DENHB
Authors: Altona Janissa , Wiegelmann Henrik , Mena Emily , Misonow Julia , Schuez Benjamin , Wolf-Ostermann Karin
Published: December 2023

Recent studies point to the importance of the built environment for the cognitive and social health of community-dwelling people living with dementia. One key aspect is wayfinding infrastructure, especially in urban areas. However, currently there are no clear indicators of wayfaring infrastructure and no standardized assessment instruments. Here, we provide such an instrument with the potential for online digital assessment as the result of the German DenHB-study. Based on an umbrella review and further research, we first developed a questionnaire to evaluate local wayfinding structures which are sectioned in different thematic blocks like general streetscape, signage, public transportation, buildings etc. Second, we conducted a cross-sectional validation study in the urban area of Bremen, Germany using Apple Maps Street View (2022) with a 360-degree viewing angle at more than 3,000 randomly selected geo coordinates within urban districts with a high proportion of older residents (>65 years). The results document supportive as well as inhibiting wayfinding structures from the perspective of people living with dementia and can also form a basis for a later automated digital evaluation of wayfinding structures. Hence, providing easy to obtain new insights helps to support the development of actions to promote the dementia-friendliness of urban living structures.
CULTURAL INFLUENCES ON AMERICAN INDIAN AND ALASKA NATIVE DEMENTIA CAREGIVERS
Authors: Kim Steffi , Jackson Lexie
Published: December 2023

Associated with aging, Alzheimer’s disease and related dementias (ADRD) are likely having a disproportionate effect on North American Indigenous communities due to longer life expectancies and high rates of chronic diseases. Despite missing prevalence data on ADRD in for Native Elders, it is known that one in five American Indians and Alaska Natives experience subjective cognitive decline and one in four adults are currently caregivers. Similarly, Native Hawaiians and Pacific Islanders (NHPI) are twice as likely to have dementia compared to non-Hispanic Whites. Yet, little is known about the journey of dementia caregivers within American and Alaska Native, Native Hawaiians and Pacific Islanders (NHPI) and how their unique cultural influences shape their caregiving experiences within their communities. We will present the voices from the transcripts of three 3 different qualitative data sets that include 93 American Indians and Alaska Natives, and six Native Hawaiian/Pacific Islander caregivers and elders about their personal experiences with taking care of family or community members with dementia and approaches to care. in their communities. The presentation focuses on the influences on cultural values on the caregiving experience, caregiver access to resources, and generative moments throughout caregiving. Results identify similarities among these groups but also distinct variations, which emphasize the importance of linguistic and culturally tailored research, interventions, and policies. Based on our findings, we outline culturally specific recommendations to improve the caregiving experience for each of these Indigenous groups.
NIA DIVISION OF GERIATRICS AND CLINICAL GERONTOLOGY
Authors: Eldadah Basil
Published: December 2023

Dr. Eldadah will discuss research priorities for the NIA Division of Geriatrics and Clinical Gerontology. Dr. Eldadah will also be available for small group discussion.
THE HEALTHY BRAIN INITIATIVE ROAD MAP CATALYZES ACTION AMONG STATE, LOCAL, AND NATIONAL PARTNERS
Authors: Fadel Meghan , Holtgrave Peter , Beaty Carissa , Roberts Shelby
Published: December 2023

The Healthy Brain Initiative Road Map Series (Road Map) has achieved measurable success in spurring action in health departments across the country. Evaluation data from the Alzheimer’s Association shows all 50 states have implemented actions from the 2018-2023 Road Map and the majority of states completed at least one action in each of the four domains of the Road Map. The Healthy Brain initiative has also sponsored initiatives to accelerate the implementation of Road Map actions. The projects described are separate from the CDC’s BOLD Program Awards for state and local health departments. The Road Map Strategist Initiative supports local health departments and tribal organizations. It has funded 16 agencies over the past two years to implement Road Map actions in their communities. A coordinated campaign to increase implementation and utilization of the BRFSS caregiving and subjective cognitive decline modules has near nationwide uptake, and, in 2023, a new project, Data for Action, launched in four states to support the use and dissemination of BRFSS and other data. Together, these projects improve assessment, planning and measurement of community health outcomes related to brain health. The 4th edition of the HBI Road Map has an accompanying evaluation tool offering common measures for state and local health departments to track their success as they implement the new actions. This session will explore the past impact of Road Map actions and opportunities for future measurement.
MULTISECTOR COLLABORATION DRIVES THE DEVELOPMENT OF THE FOURTH HEALTHY BRAIN INITIATIVE ROAD MAP
Authors: Clifford Kristen , Appleby James , Sands Talyah , Rodriguez Juan , Shean John
Published: December 2023

Partnerships and collaboration across sectors played a critical role in the development of the fourth edition of the Healthy Brain Initiative Road Map (Road Map). The public health community, leaders in related fields, and people living with dementia contributed to the development and review. The Alzheimer’s Association and CDC invited 20 national leaders from public health, aging, academia, health care and health systems to guide the development of the fourth HBI Road Map as a part of the Leadership Committee. Their contributions included reviewing data, setting the overall direction of the review and leading five workgroups, composed of 68 subject-matter experts, who recommended actions on Risk Reduction of Cognitive Decline; Timely Detection, Diagnosis and Management of Cognitive Impairment; Dementia Caregiving; Health Equity; and Community Linkages. Health departments offered input through facilitated listening sessions and an open input period. Their feedback emphasized the importance increased information on health equity and partnerships in the Road Map. The Leadership Committee also advised continued partner engagement through the review process. This translated to review by the Alzheimer’s Association, CDC subject matter experts, external health equity experts, the Leadership Committee, workgroup members, the Healthy Brain Initiative Collaborative, the Alzheimer’s Association Early Stage Advisory Group and ultimately CDC leadership. This presentation will explore important themes that emerged throughout this process that shaped the design and evolution of the HBI Road Map series to its most recent iteration, as a guiding document with health equity and multi-sector collaboration action at its core.
RACIAL/ETHNIC COGNITIVE HEALTH DISPARITIES: THE ROLE OF OCCUPATIONAL COMPLEXITY AND OCCUPATIONAL STATUS
Authors: Sheftel Mara , Goldman Noreen , Pebley Anne , Pratt Borianna , Park Sung
Published: December 2023

High levels of labor market segregation mean that Black and Latino workers may not have the same exposure to jobs involving complex work as their White counterparts, an aspect of work that appears to be protective of older adult cognition. The association between cognitive disparities and variation in exposure to occupational complexity by race/ethnicity remains understudied. Using work histories constructed from the Health and Retirement Study (HRS) life history data we analyze the role of occupational complexity in the development of dementia at older ages and address a conjecture that complexity reflects occupational status. Findings highlight that: (1) occupations involving complex work with data during working ages may be protective against dementia at older ages, potentially contributing to the differentials in dementia prevalence by race/ethnicity, and (2) occupational complexity reflects occupational status. This research increases understanding of the implications of labor market segregation for cognitive health disparities by race/ethnicity.
LOW-INCOME, MARGINALIZED OLDER WORKERS: FINANCIAL STRAIN, HEALTH, AND MENTAL HEALTH
Authors: Matz Christina , Coley Rebekah Levine , Teixeira Samantha , Lai Patrick
Published: December 2023

Social inequalities over the life course shape later life opportunities and outcomes in important ways. Research on paid work in later life has not always captured (and has sometimes mischaracterized) the variety and complexity of lived experiences in later life—in particular for low-income workers, workers of color, women, and others marginalized due to their social position. Marginalized older workers often face greater financial instability, limited interpersonal power, and reduced access to benefits like health insurance and paid leave, all of which can lead to increased risk of early retirement, poor health/well-being, and early mortality. Trend statistics and other aggregated data often obscure how the most marginalized older adults are faring in the aging and work literature and there is a need for more research that centers these voices to inform social change, particularly in the wake of the COVID-19 pandemic. The current study aims to fill this gap by drawing on data collected in 2022/2023 among residents of a large public housing development in New England who are age 40 and older (current N=166; expected N=250). Analyses explore relationships between social resources, financial strain, health, and well-being by work status and age. Preliminary analyses suggest that certain forms of social support can buffer the negative effect of financial strain on mental health (but not physical health) among older adults living in poverty and in poor housing conditions. Implications for interventions aimed toward older marginalized adults who are working or looking for work will be discussed.
PHYSICAL CAPACITY AS MARKER FOR RATE OF AGING IN MID LIFE
Authors: Tzemah-Shahar Roy , Agmon Maayan
Published: December 2023

Biological age captures the heterogeneity of aging by providing an estimation for rate of aging. As an alternative to the widely investigated laboratory biomarkers of aging, behavioral functional markers of physical capacity may offer a feasible alternative for identifying individuals at risk for negative aging trajectory. We aimed to examine the associations of different functional tests both together and as a composite score of physical capacity with rate of aging. We conducted a cross-sectional study, with midlife adults (age ~45) reporting being able to perform leisure physical exercise. Biological age was estimated using the Klemera-Doubal method and a set of physiological biomarkers; rate of aging, ∆Age, was defined as the difference between age and estimated biological age. Physical capacity was measured using a testing battery of 15 functional tests linked with six physical capacity domains. 116 participants completed the testing battery. For women, better results in terms of strength, flexibility, cardiorespiratory fitness, and balance tests were negatively correlated with ∆Age (r=0.38-0.29, p<0.05); for men, beyond these tests, agility was also negatively correlated with ∆Age (r=0.27-0.59, p<0.05). A sex-standardized composite score of physical capacity was negatively associated with ∆Age after controlling for chronological age, smoking, and education (r=-0.437, p=0.007; r=-0.491, p<0.001 for women and men respectively). The suggested physical capacity battery offers a functional assessment for ∆Age. Higher physical capacity metrics correlate with smaller ∆Age, corresponding with younger biological age. Measuring physical capacity may help to assess aging trajectory and offer a suitable behavioral intervention goal.
PARTICIPATION IN DIVERSE SOCIAL ACTIVITIES IS ASSOCIATED WITH LOW MORTALITY RISK
Authors: Jeon Sangha , Turiano Nicholas , Charles Susan
Published: December 2023

Social activity is often associated with better physical health outcomes. Yet, less is known about specific qualities of social activity beyond its frequency, such as whether engagement in diverse social activities (social activity variety) is important for health. The current study assessed whether social activity variety, which was calculated as the number of different types of social activity, relates to mortality risk beyond non-social activity variety and how its relationship varies depending on age groups. Using data from the Health and Retirement Study (HRS), we included 5,559 adults who completed a questionnaire on social activity participation in 2008 and whose mortality status was recorded in 2019. We also examined whether age was related to the relationship between social activity variety and mortality risk. Cox proportional hazard model analyses revealed that those with higher social activity variety were more likely to survive over the following 11 year than those with low social activity variety. This result remains robust when adjusting for health status and non-social activity variety. The association of social activity variety with mortality risk is significant across all age, but it is stronger in older adults compared to young adults. Findings suggest that social activity variety is beneficial for longevity beyond non-social activities and health status across adulthood.
WORKING LIFE EXPECTANCY AND UNPAID CAREGIVING: HOW WORKING LIVES DIFFER ACROSS CAREGIVER GROUPS
Authors: Sacco Lawrence , Beach Brian
Published: December 2023

Informal or unpaid caregiving (i.e. unpaid and untrained help and support to an ill relative or acquaintance) is becoming more prevalent as a result of population ageing and policies promoting ageing in place. Informal or unpaid caregiving is most common in mid-to-later life and can generate conflict with individuals’ participation in paid work at a time when working lives are being extended in several countries. Few studies have examined the impact of unpaid caregiving on working life as a whole. The current study examines how unpaid caregiving affects working life expectancy (WLE) among people aged 50 or older. Measuring paid work through WLE allows engagement in paid work in later life to be examined accounting for the fact that retirement transitions have become more complex due to the diversity of retirement pathways (e.g. un-retirement, phased retirement). Furthermore, using longitudinal data to measure WLE in the context of unpaid caregiving over several years enables us to differentiate among frequent caregivers and sporadic spells of caregiving. Data from the English Longitudinal Study of Ageing (ELSA) and the Swedish Longitudinal Occupation Survey of Health (SLOSH) were used to evaluate how WLEs are affected among individuals who provided unpaid care. We highlight the impact of different trajectories in unpaid caregiving on WLE, distinguishing caregivers according to intensity (hours and frequency per week) as well as provision of care over time.