bluuebunny/crossref_metadata_2025 huggingface dataset:
END-OF-LIFE HOSPITALIZATION SPENDING IN THE LAST SIX MONTHS OF LIFE AMONG CANCER PATIENTS
Authors: Akksilp Katika , Tan Vanessa , Lim Julian , Lim Keith , Chen Cynthia
Published: December 2022

End-of-life care may constitute a vast proportion of health care expenditure globally. In the US, one-quarter of all medicare spending goes towards healthcare for people near the end of life. This is especially true for cancer patients. Our study aimed to estimate hospital spending in cancer patients in the last six months of life. Patients with cancer who died between June 2015 to December 2016 (n=653) were extracted from Singapore’s electronic medical records. A two-part model was used to estimate hospitalization spending. In the last month of life, we found that 85% of the patients did not have chemotherapy, 43% had good quality care, and 31% had palliative care. The average total hospitalization spending in the last six months of life was S$59,180. Further analysis by month from death revealed that spending increased sharply by 62%, from $7,591 in the sixth month of life to $12,315 in the last month of life. Decedents who received chemotherapy in the last month of life spent $6,925 more on hospitalization expenditure than those who did not ($17,915 vs $10,990). Among decedents seen by a palliative doctor, hospital expenditures in the last month were $8,745 higher compared to those who did not ($16,119 vs $7,374). The study depicted the huge hospitalization spending during the end-of-life for cancer patients in Singapore. Expenditure on end-of-life care can be further reduced with investment in community-based services and integrated care across the community and acute sectors, where hospital-to-home services and earlier palliative care can provide potential cost-effective solutions.
RELAXATION ELEMENTS WITHIN A HOME ENVIRONMENT AND OLDER ADULTS’ SOCIOEMOTIONAL EXPERIENCES OF CHALLENGING TASKS
Authors: Mejía Shannon , Chin Jessie , Washington Faith-Christina , Desai Smit , Ramesh Durga , Deshpande Falguni , Hong Sungjae
Published: December 2022

Older adults protect their well-being under stressful experiences by carefully selecting their environments, social interactions, and tasks. This bias toward positive over negative experiences may reduce engagement in novel, intellectually challenging, or social complex activities that promote healthy aging over the long term. Environments that foster socioemotional well-being could provide older adults with the psychological resources to engage in novel and challenging tasks that support healthy aging. This study examined how relaxation elements within the environment, such as a fireplace, can support socioemotional experiences while engaging in complex cognitive tasks. The study employed a 2x2 (relaxation vs. not X stress vs. not) within-subject design and took place within the home office of a home simulation environment. Under each condition, 61 participants (age 50–82, 57% female) played a cognitive game on a tablet, reflected for 30 seconds, and described feelings while playing the game by telling a story and rating positive and negative adjectives. Relaxation and stress were manipulated via an electric fireplace and a modified Trier paradigm where game performance was observed remotely by a neurologist. The relaxation condition significantly differentiated the coupling of positive and negative sentiment and positive and negative affect. The negative correlation between positive and negative affect increased, whereas stories became more emotionally complex, with both positive and negative sentiment, when the fireplace was on. Our findings suggest that simple modifications to the environment can differentiate the socioemotional experiences of engaging in novel and challenging experiences. The implications for enrichment seeking in older adulthood are discussed.
VALIDATION OF THE ENVIRONMENTAL AUDIT SCORING EVALUATION (EASE) TOOL FOR LTC HOUSEHOLDS
Authors: Kaup Migette , Calkins Margaret , Davey Adam , Wrublowsky Robert , Zachgo Ashlyn , Gibson Samantha , Parker Madison
Published: December 2022

This poster will share the results from a research initiative funded by the National Institutes of Health to assess the validity of the Environmental Audit Scoring Evaluation (EASE) tool in its ability to distinguish between different types of skilled care models based on the environmental and operational practices that can be observed and documented. The EASE tool was compared against three existing tools; PEAP, TESS-NH, and EAT-HC. Twenty-eight living areas in nursing homes across the state of Kansas identified as a traditional, household, or hybrid model were observed. The scores of the EASE were compared against the scores of three existing tools in order to evaluate its construct validity. The EAT-HC was most closely related to the EASE, with an R-value of 0.8817. The PEAP and the TESS-NH were less correlated to the EASE, with R-values of 0.8175 and 0.7097, respectively. Results found that the EASE was able to distinguish between traditional and homelike settings, though it could not identify hybrid models with a high degree of certainty. The analysis of variance between homelike and traditional homes was significant at 0.016, while the variance between homelike and hybrid and between hybrid and traditional were not significant. Inter-rater reliability of the EASE was consistently high (.96 and above). The outcomes demonstrated the EASE tool was able to assess the homelike characteristics of the environment of nursing homes better than or equally as well as previously validated tools.
GREENSPACE AND COGNITION: EXPLORING SPECIFIC GREENSPACE MEASURES
Authors: Ajith Aniruddh , Godina Sara , Zhu Xiaonan , Harding Alyson , Rosso Andrea
Published: December 2022

Increased exposure to greenspace is potentially associated with lower risk of Alzheimer’s disease and related disorders (ADRD) through increased physical activity, decreased stress, cleaner air, and social cohesion. Previous studies have primarily used global measures of greenspace, thus specific aspects of different types of greenspaces are overlooked. We assess how different measures of greenspaces associate with global cognitive functioning. We examined data from year 10 of the Pittsburgh site of Health, Aging, and Body Composition Study, a longitudinal cohort study of community-dwelling, Black and White adults aged 70–79 years at baseline. Measures derived from the National Land Cover Database (NLCD) use satellite imaging and include total greenspace, forests, and an index of greenspace diversity. Measures from Google Street View virtual neighborhood audits include dedicated greenspace that promotes physical activity, abandoned buildings, and undeveloped land. We measured global cognitive functioning using the Modified Mini-Mental State Examination (3MS). We conducted cross-sectional linear regression models. Covariates included race, education, and neighborhood socioeconomic status. Age was not included as a covariate because the range was narrow, and results did not vary by age. The sample (n=584) was 82.2 years old on average, 57% female, and 35% Black. Total greenspace (F=0.46, p=0.49), forests, and greenspace diversity, dedicated greenspace for physical activity (F=0.87, p=0.35), undeveloped land (F=1.49, p=0.22), and abandoned buildings (F=3.6, p=0.058) were not associated with 3MS, although the relation with abandoned buildings approached significance. We found no association between greenspaces and ADRD, although specific measures, such as abandoned buildings, may need further investigation.
THE POTENTIAL CLINICAL AND ECONOMIC IMPACTS OF OVER-THE-COUNTER HEARING AIDS IN THE UNITED STATES
Authors: Borre Ethan , Johri Mohini , Dubno Judy , Pavon Juliessa , Myers Evan , Francis Howard , Ogbuoji Osondu , Schmidler Gillian Sanders
Published: December 2022

Food and Drug Administration regulations (released 8/16/22) for over-the-counter (OTC) hearing aids (HAs) allow the purchase of OTC HAs for adults with perceived mild-to-moderate hearing loss. Given this new development, the quality-of-life benefits and costs of OTC devices are now relevant but also unknown. We sought to project the population-level costs and effectiveness of US OTC HA provision. We used a microsimulation of hearing loss (DeciBHAL-US) to simulate: 1) traditional HA provision validated to published estimates of HA uptake (10-year delay), and 2) OTC HA provision for persons with perceived mild-to-moderate hearing loss at increased uptake rates (5-year delay) across quality-of-life and cost combinations. Simulated adults experienced probabilities of hearing loss (0.1–10%/year), subsequent age- and severity-dependent HA uptake (traditional HAs: 0.5–8%/year; OTC HAs: 1–16%/year) and discontinuation (4–13%/year). Utility benefit for traditional HAs was +0.11, and was +0.05–0.11 for OTC HAs. Costs included traditional HA uptake ($3,690; maintenance=$1,000/year) and OTC HA uptake ($600-$2,000; maintenance=$220–500/year). Our model projected lifetime discounted quality-adjusted-life-years (QALYs) for traditional HAs of 18.140/person, and 18.139–18.174/person for OTC HAs varying with utility benefit (+0.05–0.11). As long as OTC HA utility benefit was >+0.05, increased access resulted in higher QALYs and was cost-effective ($4,000/QALY-$92,500/QALY, varying with HA cost and utility benefit). Our results were sensitive to variations in OTC HA uptake rates. In conclusion, OTC HAs may increase population health and access to hearing healthcare in a cost-effective manner, and our model may continue to explore the costs and benefits of OTC HAs as pricing and evidence evolves.
JOB CHARACTERISTICS ASSOCIATED WITH INTENT TO QUIT AMONG NURSING HOME EMPLOYEES AND MANAGERS
Authors: Kennedy Katherine , Mohr David
Published: December 2022

High turnover and recruitment challenges of nursing home employees and managers is an ongoing concern. This study’s objective was to examine intent to quit among all staff and assess the roles of job characteristics and job satisfaction. Employees and managers within one nursing home chain working in direct patient care or nursing were compared. Data came from the Work, Family, Health Network 18-month follow-up survey in 2012 (Total = 1,000, Managers = 101, Employees = 899). A cumulative logit model controlling for demographics was estimated for lower intent to quit. Herzberg’s Two-Factor Theory of Work Motivation guided the study. Employees scored significantly lower on family-supportive supervisor behaviors (FSSBs), schedule control (SC), and decision authority (DA) than managers. Employees and managers did not differ on job satisfaction, intent to quit, or job demands. Satisfied workers had 5.88 times greater odds of lower intent to quit compared to workers who were neutral or disagreed (p < .0001). DA (OR=0.29) and SC (OR=0.19) were related to higher intent to quit. In contrast, FSSBs (OR = 1.45), safety compliance (OR=1.41), and the combination of high DA with high SC (OR = 1.4) were related to lower intent to quit. Among nursing home staff, lower intent to quit may be achieved through improving job satisfaction, safety culture, the quality of supervision, and job enrichment through more schedule control and decision-making power. It is also imperative to develop strategies to retain those with more education through further research.
ROLE OVERLOAD AND SLEEP DISTURBANCE AMONG CAREGIVERS OF PERSONS WITH DEMENTIA: THE MODERATING EFFECT OF RESILIENCE
Authors: Irani Elliane , Wang Fei , Griggs Stephanie , Hickman Ronald
Published: December 2022

Sleep disturbance is a significant sleep health problem among caregivers of persons with dementia and could exacerbate numerous adverse health outcomes. Resilience is one’s ability to recover from challenges and is a protective factor that is posited to blunt the effect of caregiving stress on sleep disturbance. Therefore, the purpose of this study was to examine if resilience moderates the association between perceived role overload and sleep disturbance using data from the 2017 wave of the National Study of Caregiving. The sample consisted of 480 informal caregivers (mean age = 61.77 years, SD = 13.69 years) of persons with dementia in the U.S. Participants completed self-report questionnaires about their sociodemographic and health characteristics, perceived role overload, resilience (i.e., adjusting to change and recovering from hardship), and sleep disturbance (i.e., frequency of trouble maintaining sleep). Data were analyzed using multiple regression with interaction terms to evaluate the moderation effect of resilience. Higher perceived role overload was associated with higher sleep disturbance, while controlling for caregivers’ age, race, gender, education, and self-rated health. The association of perceived role overload with sleep disturbance was attenuated among caregivers with higher levels of resilience (b = -.029, 95% CI: -.058, -.001). This study highlights the stress-buffering and sleep health benefits of resilience in the context of dementia caregiving. Among caregivers of persons with dementia, approaches to improve their ability to recover, resist, and rebound during caregiving challenges may mitigate stress and optimize their sleep health.
RURAL SYSTEM-BASED COPING STRATEGIES FOR ADVANCING RESEARCH AND HEALTHCARE WHILE TRANSITIONING TO THE NEW NORMAL
Authors: Ilardo Joan , Zell Angela
Published: December 2022

The pandemic brought about many changes at a system level that were necessary to facilitate continuity of research and the practice of healthcare. Rural and underserved populations were and continue to be the hardest to reach both before and during the COVID-19 pandemic. Therefore, the innovative coping strategies that were implemented during the pandemic are essential to continue as we transition into the endemic stage and realize our new normal as researchers and practitioners. This symposium will highlight adaptations made to research and practice during the COVID-19 pandemic that will apply to future system-level strategies. Drs. Wiese and Park will present results from an online exercise intervention for rural older adults that are at risk of cognitive decline. Drs. Ilardo and Zell will present a roadmap inspired by the pandemic to promote food equity. Drs. Zell and Haque will address rural solutions to polypharmacy issues using an interdisciplinary team approach. Dr. Monaghan-Geernaert will discuss important implications that international caregivers have in fulfilling caregiving gaps in the US, followed by Dr. Freeman et al.’s discussion of rural, long-term care facilities (LTCF) experiences during the pandemic. These system-based coping strategies have policy implications for rural healthcare as we transition to the new normal.
MAXWELL A. POLLACK AWARD FOR CONTRIBUTIONS TO HEALTH AGING PRESENTATION AND LECTURE
Authors: Rozario Philip
Published: December 2022

The Maxwell A. Pollack Award for Contributions to Health Aging Lecture will feature an address by the 2021 Pollack Award recipient Namkee G. Choi, PhD, FGSA, of the University of Texas at Austin. This session will also include the presentation of the 2022 Maxwell A. Pollack Award to recipient Nancy Morrow-Howell, MSW, PhD, FGSA, of Washington University in St. Louis. The Maxwell A. Pollack Award for Contributions to Healthy Aging Award recognizes instances of practice informed by research and analysis, research that has directly improved policy or practice, and distinction in bridging the worlds of research and practice.
COVID CHALLENGES TO FULFILLING GENERATIVITY: PITFALLS AND BRIDGES FOR OLDER VOLUNTEERS TO RE-ENGAGE COMMUNITY
Authors: Shay Kimberly
Published: December 2022

The ongoing COVID pandemic undermines the social resources known to preserve health and well-being among older adults. This deeply affects developmental tasks, as traditional paths to fulfilling generativity are impaired. Generativity, a later life stage of seeking to nurture and contribute to the next generation, is accessible through volunteering. This pandemic has revealed gaps in our knowledge of the challenges and adaptations to generativity and meaningful social engagements for older adults. To address this, the author conducted an ethnographic study at four key sites of volunteer engagement by older adults from 2021 to 2022, utilizing a community-based study of older volunteers. Methods included participant-observation at public events and in-depth interviews with 14 key informants. This was a novel study period, post-vaccine, when hopes were raised, but not always achieved for return to generative activities. Analyses revealed three key themes: threats to the foci and spheres of generative expression (Rubinstein, et al, 2015) enacted through volunteering; difficulties and successes creatively crafting new modes to reestablish prior social ties; and threats to full-adult personhood. These themes were linked to altered capacities, experienced during quarantine, to participate with and contribute to the community. Fulfilling later life generativity is intrinsically linked to the ability to participate in community social life, but the pandemic limited opportunities and prompted new challenges and solutions. This paper highlights the need for research to prepare for threats from future disasters and pandemics that challenge meaningful participation and generativity for older adults.
TRANSPARENCY, DOCUMENTATION, AND OPEN SCIENCE
Authors: Isaacowitz Derek
Published: December 2022

Some GSA journals are especially interested in promoting transparency and open science practices, reflecting how some subdisciplines in aging are moving toward open science practices faster than others. In this talk, I will consider the transparency and open science practices that seem most relevant to aging researchers, such as preregistration, open data, open materials and code, sample size justification and analytic tools for considering null effects. I will also discuss potential challenges to implementing these practices as well as reasons why it is important to do so despite these challenges. The focus will be on pragmatic suggestions for researchers planning and conducting studies now that they hope to publish later.
RECRUITING AND ENGAGING TRANSGENDER, NON-BINARY, AND INTERSEX OLDER ADULTS IN AGING RESEARCH
Authors: Lampe Nik
Published: December 2022

Aging research often erases sex and gender variation, thus ignoring the experiences of older transgender, non-binary, and intersex (TNBI) populations. At the same time, researchers have faced unique methodological challenges with recruiting and engaging with TNBI older patient populations in sexual and gender minority (SGM) aging research. Using data from 51 semi-structured individual interviews with TNBI older Americans, I explore methodological approaches for effectively recruiting and engaging TNBI older respondents. I describe the importance of disclosing researcher positionality and understanding community discourse (e.g., intersex status as a sex identity vs. a medical condition) when recruiting and engaging with TNBI older adults. Finally, I share why some traditional recruitment approaches in SGM aging research (e.g., purposive/snowball sampling techniques) may not be as effective towards TNBI older adults while offering some alternative techniques for meaningful recruitment and engagement opportunities.
ASSESSING NONSAMPLING BIAS ERROR AMONG SEXUAL MINORITY OLDER ADULTS IN THE CENSUS' HOUSEHOLD PULSE SURVEY
Authors: Ortiz Kasim
Published: December 2022

Previous research shows data quality and nonsampling bias error reduce accuracy of COVID-19 vaccination coverage in the Census' Household Pulse Survey. However, it is unclear how these issues relate to older sexual minority populations. Moreover, previous research has shown that sexual minority older adults survey nonparticipation rates are similar to their heterosexual older adult peers. Yet, it is less clear whether racial/ethnic variability in nonparticipation rates and patterns of missingness among sexual minority older adults exist. The current investigation utilizes repeated pooled data from the Census' Household Pulse Survey (N=329,078) to fill these gaps. Findings reveal nonsampling bias error contributing to inflated racial/ethnic inequities in vaccination coverage among older sexual minorities, with distinct racial/ethnic variability in missingness patterns among sexual minority older adults. The paper concludes with recommendations for improving survey-based research and details suggestions to improve recruitment strategies that minimize nonsampling bias.
DE-RISKING THE EMPLOYER-EMPLOYEE RELATIONSHIP WHEN WORKERS HAVE MILD COGNITIVE IMPAIRMENT OR YOUNG ONSET DEMENTIA
Authors: McMurray Josephine , Astell Arlene , Levy AnneMarie , Boger Jennifer , Burns Catherine
Published: December 2022

The employee-employer relationship is one that is well established in law and involves a contract between a worker who performs the work, and an employer who determines when, how and where the work is done. Many countries have introduced legislation that helps guide employee-employer behavior when workers’ performance of their duties is disrupted by illness or disability, such as mild cognitive impairment or young onset dementia (MCI|YOD). At any one time, about 8-12% of the workforce is off due to occupational or non-occupational work injury or illness with direct disability and absence costs projected about 7% of payroll in 2000. Drawing from data gathered in a systematic literature review and case study, this paper determined that uncertainty and risk influence employer-employee relationships when workers are identified with MCI|YOD. Employers’ industry context, size and corporate values influence their “integrated risk management” approach to workers with MCI|YOD, and early intervention is considered key to managing financial and liability risk. In contrast, progressive onset, delayed diagnosis, stigma, privacy concerns, workplace uncertainty, and lack of information may delay employee disclosure, a common employee risk mitigation strategy. We conclude by considering strategies to de-risk relationships between workers with MCI|YOD and employers using dual process theory to understand intuitive and rational decisions in the context of the disability management process.
SELECTIVE ENGAGEMENT IN PREPARATIONS FOR OLD AGE: DETERMINANTS OF MOTIVATION
Authors: Park Jeongsoo
Published: December 2022

Preparations for old age in general are beneficial for one’s adjustment in later life. Using Selective Engagement Theory (SET) as a conceptual framework, we examined how the importance attached to functioning, as well as perceived control over functioning in different domains (e.g., family, social relations, finances, health, etc.) predicted engagement in preparing for old age five years later. Two-wave data was obtained from Ageing as Future Study. The sample consisted of N = 1,255 aged from 30-85 in the US (n=315), Hong Kong (n=317), and Germany (n=623). Consistent with SET, ratings of importance were strongly predictive of subsequent preparations and more predictive than perceived control, with evidence in several domains of functioning that this was particularly true for older adults. These findings highlight the interaction between personal goals and resources in determining older adults' willingness to prepare for old age.
PREPARING FOR A GOLDEN AGE? APPROACH AND AVOIDANCE MOTIVATION IN THE CONTEXT OF OLD-AGE PREPARATION
Authors: Rupprecht Fiona , Nikitin Jana
Published: December 2022

When it comes to old-age preparation, individuals may be motivated by positive outcomes they wish to approach (e.g., social connectedness) or by negative outcomes they wish to avoid (e.g., loneliness). We expected approach motivation to be adaptive in younger ages, when resources and possibilities for old-age preparation should be plentiful. For older adults, whose resources and time for (continued) old-age preparation are limited, the maintenance- and loss-oriented perspective of avoidance motivation may however be the more adaptive one. Using data from 2054 individuals aged 18 to 96 years and representing five cultures, we adopted a domain-specific, cross-cultural, and age-differential perspective on our research question. Results indicate that individuals tend to be both approach- and avoidance-motivated when it comes to old-age preparation and confirm the age-differential adaptivity of approach and avoidance motivation in terms of both, actual preparatory behavior and psychological well-being.
A FAT-PROMOTING BOTANICAL EXTRACT ARTEMISIA SCOPARIA EXERTS GEROPROTECTION IN C. ELEGANS
Authors: Ghosh Bhaswati , Guidry Hayden , Johnston Maxwell , Bohnert Adam
Published: December 2022

Like other biological processes, aging is not random but subject to molecular control. Natural products that modify core metabolic parameters, including fat content, may provide entry points to extend animal lifespan and promote healthy aging. Here, we show that a botanical extract from Artemisia scoparia (SCO), which promotes fat storage and metabolic resiliency in mice, extends the lifespan of the nematode Caenorhabditis elegans by up to 40%. Notably, this lifespan extension depends significantly on SCO’s effects on fat; SCO-treated worms exhibit heightened levels of unsaturated fat, and inhibiting Δ9 desaturases, which oversee biosynthesis of monounsaturated fatty acids, prevents SCO-dependent fat accumulation and lifespan extension. At an upstream signaling level, SCO prompts changes to C. elegans fat regulation by stimulating nuclear translocation of transcription factor DAF-16/FOXO, an event that requires AMP-activated protein kinase under this condition. Importantly, animals treated with SCO are not only long lived but also show improved stress resistance in late adulthood, suggesting that this fat-promoting intervention may enhance some aspects of physiological health in older age. These findings identify SCO as a natural product that can modify fat regulation for longevity benefit and add to growing evidence indicating that elevated fat can be pro-longevity in some circumstances.
DIVERSITY OF EXPERIENCES OF AGING AMONG BIRTH COHORTS AND RACIAL/ETHNIC GROUPS IN NSHAP
Authors: Waite Linda , Karraker Amelia
Published: December 2022

Aging, the process of getting older, takes many forms. This symposium uses data from the National Social Life, Health, and Aging Project to study changes and differences between groups in the experience of older adults. Dale and coauthors look at the implications for future mortality of failing to respond to a follow-up interview in an ongoing survey. Those who drop out of NSHAP are more similar to those who died than to those who are reinterviewed, suggesting that survey dropout carries important information about health that has been ignored to this point. Choi and Waite compare social networks and social support for the Silent Generation cohort, born 1920-1947, to the Baby Boom cohort, born 1947-1965, and finds that the BB cohort has fewer kin in their networks and receive less support from family and friends than the older cohort, suggesting that they are more disconnected. Piedra and Iveniuk compare social networks of White, Black and Hispanic older adults. They find that Hispanics are initially more likely to have restricted networks, showing low social connectivity but increase in network diversity over time, suggesting resilience, whereas White and Black move toward lower connectivity as they get old. Iveniuk and Gupta compare marital histories of older adults in different racial and ethnic subgroups, with Blacks least and Whites most likely to be married at older ages, and Hispanics more likely to be recently widowed. These presentations point to the diversity of pathways through aging, and their consequences.
A JOURNEY INTO HOW PLACE MATTERS
Authors: Lewinson Terri
Published: December 2022

It is now well known that housing is a significant determinant of health and that systematic inequities shape the influence of home for many people. In this paper, I will present my research program designed to incrementally understand housing-health experiences of low-income residents in hotels, assisted living facilities, and senior housing apartments using qualitative, community-based, and biomedical approaches in Metropolitan Atlanta. Focused through an ecological lens, I will share insights from pedagogical and policy experiences that contributed to (and detracted from) the promotion of environmental justice for marginalized communities using inclusive strategies that were respectful of population identity. In this talk, I will discuss how institutional influences shaped opportunities for me to advance work on healthy housing as a social justice issue and detail my current project exploring air quality in a nontraditional home setting.
SENSORY LOSS AND BRAIN HEALTH: SPOTLIGHTING JUNIOR INVESTIGATORS IN THE SENSORY HEALTH INTEREST GROUP
Authors: Deal Jennifer , Whitson Heather
Published: December 2022

Sensory loss (hearing, vision, touch, smell, taste) is common in older adults, with over 2/3 of adults over age 55 experiencing loss in multiple senses. Sensory loss has been consistently linked to dementia and cognitive decline in epidemiologic studies. However, research gaps exist, with some senses having been studied more widely than others. Given differing underlying anatomy and physiology of the senses, the nature of the pathways linking sensory loss to dementia may vary and some have yet to be elucidated. For some, it may be that they are both caused by a common underlying biology (e.g., neurodegeneration). Alternatively, potential causal mechanisms include increased cognitive load, changes brain structure/function, social isolation and/or reduced activity. Additionally, gaps exist in how sensory loss may impact the lived experience of people with dementia. This session will address these research gaps by highlighting the work of outstanding junior investigators in the GSA Sensory Health Interest Group. The association between touch and dementia will be reported, a relationship which hitherto has not been well described. We will present on the relationship between olfaction and white matter integrity in the brain and describe how sensory function predicts levels of Alzheimer’s disease biomarkers over 10 years. We will present evidence for associations between audiometric hearing, structural brain volumes, white matter integrity, and cognitive test performance on speech-in-noise processing and will conclude by describing how hearing loss may impact patient-provider communication among older adults with dementia.
DEMENTIA AND HEARING LOSS: A DOUBLE HIT ON PATIENT-PROVIDER COMMUNICATION?
Authors: Powell Danielle , Reed Nicholas
Published: December 2022

Hearing difficulty may adversely impact patient-provider communication and be exacerbated by the presence of other conditions like dementia. We examined the association between reported Alzheimer’s disease/dementia and reported difficulty communicating with providers. Using the 2019 Medicare Current Beneficiary Survey, we included participants were aged ≥65 years who reported functional difficulty hearing. Exposure was the presence of reported Alzheimer’s disease/dementia. Our outcome is reported difficulty communicating with medical providers. Multivariate logistic regression was used for association between the added presence of dementia and reported difficulty communicating with healthcare providers. Among 5,535 beneficiaries reporting hearing difficulty, diagnosis of Alzheimer’s disease or another dementia showed 2.76(95%CI:1.97-3.87) times greater odds of reporting difficulty communicating with providers compared to not reporting dementia. In summary, older adults with reported hearing difficulty and dementia may have increased difficulty communicating with medical providers. Findings suggest hearing management may aid in improving health outcomes for adults with dementia.
THE EXPERIENCE OF THE COVID-19 PANDEMIC AMONG OLDER ADULTS IN PUERTO RICO
Authors: Burnette Denise , Haidar Yamile Martí
Published: December 2022

Older age groups and racial and ethnic populations are more likely to have medical conditions that increase their risks for illness, hospitalization and death from COVID-19. Puerto Rico has a high prevalence of acute and chronic health conditions and the lowest percent of people reporting good / excellent health of all U.S. states and territories. The effects of poor health on the island have been compounded in recent years by economic and political instability and by major natural disasters; yet, as of February 2022, 95% of persons aged 65 and older had received at least one vaccination and 88% were fully vaccinated. This symposium comprises five papers based on a study of personal, social, physical health, and mental health factors associated with COVID-19 in a community sample of 213 adults aged 60 and over in Puerto Rico. The first paper will introduce the study, including its purpose, theoretical framework, and methodology. Next, we will address methodological and ethical challenges of conducting research with older adults during the pandemic and strategies we used to overcome these. The third paper will report on the core focus of the project: to assess the knowledge, attitudes, and practices of older Puerto Ricans toward COVID-19. The fourth paper will focus on mental health effects of loneliness and loss, two of the most challenging exigencies of the pandemic for older adults. Finally, we will consider participants’ responses to open-ended questions about how they have coped with the pandemic and made meaning of their experiences.
FACTORS ASSOCIATED WITH HOME CARE AIDES' JOB SATISFACTION DURING COVID-19
Authors: Chunga Richard , Cimarolli Verena , Bryant Natasha , Boerner Kathrin , Stone Robyn
Published: December 2022

The COVID-19 pandemic has pronounced already high turnover rates among home care aides (HCAs). High turnover negatively affects home care quality. Job satisfaction among HCAs is a major driver of turnover, but little is known about factors associated with HCAs’ job satisfaction during COVID-19. Using survey data, the purpose of this study was to identify variables associated with job satisfaction among HCAs during the pandemic (N=114). Correlational analyses show that lower job satisfaction is associated with experiencing financial hardship, lack of PPE and employer protocols/guidance, understaffing, lower quality of employer communication related to COVID-19, and HCAs’ lower perceived preparedness to care for clients with COVID-19. In a regression analysis, experiencing financial hardship and lower quality of employer communication remained significant predictors. Findings underscore the importance of employer supports in HCAs’ job satisfaction and provide important lessons for how employers can support HCAs during the pandemic and beyond.
WORKING WITH COMMUNITIES TO INCREASE DIVERSITY, EQUITY, AND INCLUSION IN GERONTOLOGICAL RESEARCH
Authors: Chow Stephanie , Rooks Ronica
Published: December 2022

Gerontological researchers are encouraged to include older adults from underrepresented populations in their research and to think broadly about how they conceptualize diversity, equity, and inclusion (DEI) efforts in their work. This includes not only research on older adults from minority racial and ethnic communities, but also lesbian/gay/bisexual/trans*/queer+ (LGBTQ+) communities, as well as other cultural, religious, and socioeconomic groups. One of the most successful ways for reaching older adults in these populations is through community-based participatory research (CBPR). CBPR is a partnership approach to research that equitably involves community members, organizational representatives, researchers, and others in all aspects of the research process, with all partners in the process contributing expertise and sharing in the decision-making and ownership. Two papers in this symposium use CBPR to identify and include older adults from minority populations in their studies. A third paper reports on working with a Community Advisory Board to recruit bereaved dementia caregivers for research. The final paper walks us through steps to increase DEI efforts by meticulous research question development and thoughtful determinations regarding literature review terminology, recruitment efforts, data collection, and reporting and dissemination techniques.
SEX-DIMORPHIC REGULATION OF INNATE IMMUNITY DURING AGING
Authors: Benayoun Bérénice
Published: December 2022

Aging is accompanied by striking changes in chromatin and gene expression across cell types and species. Yet, how chromatin landscapes change with age and regulate transcription, and how epigenomic changes in turn influence aging in response to external or internal cues, is largely unknown. In addition, accumulating evidence indicates that sex hormones play a key role in driving aspects of cellular and molecular sex-dimorphism. In parallel to sex hormones, karyotypic sex (i.e. XX vs. XY) is also likely to have important impact outside of gonadal sex determination. A key compartment whose activity can be actively modulated by sex-dimorphic mechanisms throughout life is the immune system, whose function declines sharply with aging and may be actively modulated by sex. Indeed, aspects of the immune responses differ between sexes, with a more robust immune response in females and an increased susceptibility to infection in males. Thus, our main cell models of study are key components of the innate immune system and the inflammatory response: macrophages, which accomplish key tasks such as phagocytosis, antigen presentation and cytokine production, and neutrophils, the most abundant leukocyte type serving as a “first line of defense” against infection. Excitingly, we and others have observed strong sex-related differences in the transcriptional and functional phenotypes of these cells and have observed sex-dimorphic “omic” trajectories for these cells with aging. Based on our data and published literature, it is likely that mechanisms involving both gonadal hormones and sex chromosomes may fine-tune different aspects of immunity and, thus, overall health and lifespan.
MEXICAN AMERICAN CAREGIVER HEALTH AND TURNOVER: THE ROLE OF STRESSORS, RESOURCES, AND BACKGROUND FACTORS
Authors: Rote Sunshine , Angel Jacqueline , Markids Kyriakos
Published: December 2022

The purpose of this study is to explore the role of caregiver background, stressors, and resources for Mexican American caregiver turnover and depressive symptoms. Using two waves of the Hispanic Established Epidemiologic Study of the Elderly Caregiver Supplement (H-EPESE CG, 2010/2011-2016 N=333) and informed by the sociocultural caregiver stress process model, we estimate logistic and OLS regressions of caregiver turnover and caregiver depressive symptoms over five years. Neuropsychiatric expressions of dementia were significantly associated with caregiver turnover and relative to caregivers who were adult children of the care recipient, grandchildren caregivers and other kin and non-kin caregivers were more likely to experience caregiver turnover. While depressive symptoms were relatively low at both waves, there was a greater increase in depressive symptoms for caregivers who completed the interview in Spanish, which was partially explained by lower caregiver resources (e.g., support from others). The findings demonstrate the need for dementia care supports for Mexican American caregivers, improving support systems for Spanish-speaking caregivers, and supporting Mexican American caregivers who may be entering the role unexpectedly (e.g., grandchildren or non-kin).
DEPRESSIVE SYMPTOMS AND MULTIMORBIDITY IN CONTEXT: INTERPERSONAL, SOCIOCULTURAL, AND TEMPORAL EFFECTS
Authors: Mindlis Irina , Revenson Tracey
Published: December 2022

Among older adults with multimorbidity (MM), disease-related stressors (e.g., pain) are associated with greater depressive symptoms. However, the contextual factors influencing this relationship remain understudied. We explored the moderating effects of interpersonal, sociocultural, and temporal factors as buffers of this relationship. Adults ≥ 62 years with MM (n=366) recruited through a national health volunteer registry and an online panel platform completed validated scales assessing diagnoses, disease-related stressors (pain intensity, subjective cognitive function, physical function, somatic symptoms), depressive symptoms. Potential moderators: age, expectations regarding aging, perceived social support, and difficulty affording medications (proxy for SES). Data were analyzed with structural equation modeling. Participants were 62-88 years old and living with many illnesses (M = 3.5; range: 2-9); 15% reported moderate-to-severe depressive symptoms. Among those with low social support, the effect of disease-related factors on depressive symptoms was greater (B = .70, SE = .06, p <.001) than for those with high social support (B = .46, SE = .06, p < .001)]. The negative effect of disease-related factors on depressive symptoms was stronger for those with worse expectations of aging (B = .68, SE = .07, p <.001), compared to those with more positive expectations (B = .47, SE = .06, p < .001). Age and difficulties affording medications were not significant moderators. Among older adults with MM, garnering social support and addressing low expectations for old age may be key to preventing the detrimental effect of MM on mental health.
MEALS ON WHEELS UTILIZATION AND THE RISK OF HOSPITALIZATION AMONG MEDICARE ENROLLEES OVER TIME
Authors: Weaver France , Walsh Sarah , Chubinski Jennifer
Published: December 2022

Meals on Wheels (MOW) services provide nutritional and social support for clients and may influence acute care use as a result. This study estimates the associations between MOW utilization and the risk of hospitalization for Medicare enrollees aged 65 and over, according to the degree of home-boundness (an eligibility criterion for MOW access). Attention is paid to the heterogenous role of MOW according to gender, race, and ethnicity. The analysis uses the 2014-2020 National Health and Aging Trends Study (NHATS) and includes 17,345 person-year observations. The study uses longitudinal complex survey Probit models of the likelihood of hospitalization, including interaction terms between lagged MOW usage and the extent of home-boundness. Control variables include sociodemographic indicators, living arrangements, health status, region and time fixed effects. Over the study period, the mean probability of hospitalization for Medicare enrollees aged 65+ is 20.5 percent, and the proportion of MOW users is 5.2 percent. Some 11.4 percent report being partially homebound and 5.6 percent mostly/fully homebound. Results reveal that MOW utilization is associated with a lower risk of hospitalization for those who are partly homebound (p= 0.058). This negative association is the largest and statistically significant for males (p=0.034) and whites (p=0.035) only. Further investigations will assess whether these associations are explained by differences between MOW and non-MOW users. The findings suggest that MOW services may delay or limit, to some extent, hospitalizations among partly homebound Medicare enrollees.
IMPACT OF COVID ON PERSON AND FAMILY ENGAGEMENT IN ASSISTED LIVING
Authors: Beeber Anna
Published: December 2022

Advancing person-centered care in assisted living (AL), while minimizing safety risks (e.g., injury, elopement, or medication errors), requires effective partnerships among residents, family members, and staff. The COVID-19 pandemic adversely affected capacity across and within AL settings to establish and nurture these relationships, ultimately affecting and changing person and family engagement in care. Using data from qualitative interviews, we will report findings about person and family engagement in the safety of AL from the perspectives of 104 residents, families, and staff. Particular attention will be given to examining the effect of COVID-19 on person and family engagement for residents at increased risk for disparities in assisted living, including residents who are living with mild cognitive impairment or dementia. The presentation highlights both challenges and promising practices that emerged from the COVID-19 pandemic. Implications for AL are presented to support the transition from pandemic to endemic.
BEFORE A NEUROCOGNITIVE EVALUATION: ROLES AND COMPETENCIES OF BEHAVIORAL HEALTH PROVIDERS
Authors: Steffen Ann , Allen Rebecca
Published: December 2022

Neurocognitive disorders are among the most stigmatized medical conditions in the USA and across the globe. Cultural beliefs about cognitive aging also impact how individuals, families and healthcare teams respond to concerns about cognitive impairment. GSA’s revised KAER Toolkit for Primary Care Teams (Fall, 2020) provides useful information for the early stages of this process, including kickstarting the conversation about brain health concerns and conducting screenings. This presentation outlines additional competencies for behavioral health clinicians involved in patient, family, and health care team discussions regarding cognitive health concerns. Culturally responsive strategies and resources are suggested to help clinicians explore the decision for a formal evaluation and shape the nature of the referral question(s).
OVERVIEW OF NIA MISSION AND RESEARCH
Authors: Hodes Richard
Published: December 2022

Dr. Hodes will provide an overview of NIA's structure and mission, in addition to discussing research foci from across the Institute's scientific divisions.
GSA’S CONGRESSIONAL UPDATE
Authors: Lindberg Brian
Published: December 2022

This popular annual session will provide cutting-edge information on what the 117th Congress has and has not accomplished to date, and what may be left for the lame duck session to address. Speakers will discuss key issues such as Social Security, Medicare, Medicaid, Older Americans Act, Build Back Better Act, social isolation, serious illness care, and funding. Predictions for the 118th Congress may be provided.
HOUSING AND COMMUNITY PARTNER VIEWS ON THE BENEFITS OF THE R3 PROGRAM
Authors: Miller Edward , Simpson Elizabeth , Nadash Pamela , Shellito Natalie , Lin Yan , Jansen Taylor , Cohen Marc
Published: December 2022

Housing with services programs have potential to benefit residents and operators of affordable senior housing communities. This study aimed to understand housing and community partner views on the benefits of the R3 program. Data derived from 31 interviews with R3 program managers and wellness team members, executives and direct service staff at the intervention sites, and community partners. Overwhelmingly positive overall assessments of the R3 program were reported. Concrete benefits to residents included receiving additional attention and support; connecting with family and health care resources; enhancing group programming; preventing ambulance transports; helping with transitions; and improving health and quality of life. Psychosocial benefits to residents included: empowering program participants; providing socio-emotional support; and alleviating psychosocial distress. Benefits to housing sites included augmenting staffing levels, skills, and capabilities; proactively tracking and responding to resident needs; lowering resident turnover; and learning from and adopting procedures and processes underlying the R3 philosophy.
TARGETING PARTICIPANTS AT HIGH RISK FOR ADVERSE HEALTH OUTCOMES IN THE R3 PROGRAM
Authors: Cohen Marc , Miller Edward , Nadash Pamela
Published: December 2022

The R32 program seeks to ensure that individuals at high risk for adverse health outcomes are identified, engaged, and linked to needed services. The program pays particular attention to identifying individuals with risks related to mental health, memory, nutrition, food insecurity, and emergency department or inpatient hospitalizations. Key performance indicators were tracked, including the number and proportion of participants whose needs were addressed by R32. Results indicate that the program has succeeded in engaging the vast majority (>90%) of individuals with specific risk factors and connecting them with needed services. Viewed in the context of managed care plans, this level of performance is noteworthy and would earn the program a 5 Star rating – the highest rating available. Findings underscore the strong advantage offered by having a wellness nurse and wellness coordinator embedded on site in senior housing and using this platform to manage prevention and care services to residents.