bluuebunny/crossref_metadata_2025 huggingface dataset:
THE ESSENTIAL ROLE OF PAID CAREGIVERS IN HOME-BASED DEMENTIA CARE
Authors: Reckrey Jennifer , Spetz Joanne
Published: December 2023

Paid caregivers (e.g., home health aides, other home care workers) provide essential support to the rapidly growing number of people with dementia living in the community. This symposium presents innovative findings on the role of paid caregivers in home-based dementia care though exploration of the clinical, family, and care-delivery contexts in which paid caregivers work. First, Reckrey et al describe the scope of paid caregiving in dementia using nationally representative data examining factors associated with receipt of paid care among older adults with overlapping dementia and non-dementia serious illness. Next, we examine mechanisms of delivering paid care: Osakwe et al explore paid caregiver perceptions about the use of telehealth in home health and identify paid caregivers concerns about routine use of this technology in care of people with dementia, and Gordon-Wexler et al explore family caregiver perspectives on navigating Medicare and Medicaid insurance for people with advanced dementia and the challenges they experience coordinating paid care. Finally, we explore how paid caregivers work with other care team members. Quach et al discuss multidisciplinary perspectives about how paid caregivers support person-centered and relationship-centered care to family dementia caregivers, while Fabius et al examine information sharing practices within home care agencies and describe differences and similarities in information sharing needs for people with and without dementia. Taken together, these presentations highlight the important ways that paid caregivers work with providers and families within the care delivery system and identify ways to better support and integrate these essential workers into dementia care teams. This is a Paid Caregiving Interest Group Sponsored Symposium.
“CAREGIVING IS TEAMWORK...” INFORMATION SHARING IN HOME CARE FOR OLDER ADULTS WITH DISABILITIES IN THE COMMUNITY
Authors: Fabius Chanee , Wec Aleksandra , Saylor Martha Abshire , Smith Jamie , Gallo Joseph , Wolff Jennifer
Published: December 2023

Direct care workers provide assistance with daily activities to persons with disabilities. Direct care workers are well positioned to recognize and share information about care gaps and changes in function and behaviors but are often viewed as unskilled and excluded from interdisciplinary care team interactions. We conducted 11 semi-structured interviews with administrators (n=5), nurses (n=3), and direct care workers (n=3) from home care agencies (“residential service agencies” in Maryland) to understand information sharing between direct care workers, family caregivers, and clinicians in home care delivery for older adults with disabilities, including those living with dementia. Thematic analysis was completed by the research team. Leveraging Systems Engineering Initiative for Patient Safety (SEIPS) 2.0 model, a human factors framework, respondents highlighted aspects of information sharing across (1) work systems, (2) processes, and (3) dementia-related adaptations. Work system characteristics relevant to information sharing included the utilization of electronic management systems and patient portals to communicate within agencies and with clinicians and using multiple methods to gather information about client goals and preferences (e.g., assessments, client profiles). Process characteristics include collaborations between families and residential service agency staff to deliver optimal care. Direct care workers did not report differences in coordinating care for persons living with dementia, however they reported dementia-related adaptations like an increased need to establishing and sustaining strong relationships with family members and communicating with clinicians during medical visits. Findings highlight the care demands experienced by direct care workers and support calls to better coordinate information sharing between interdisciplinary care teams.
INFRASTRUCTURES OF CAREGIVING: RECONSTITUTING HOMELINESS AND FAMILY IN SINGAPORE
Authors: Chia Arthur , Malhotra Rahul
Published: December 2023

Caregiving comprises concrete everyday tasks that are built-on and revolve around the home, yet few studies have looked at caregiving as practice(s) that shape the home as a place of/for care. We examined the socio-material arrangements of people, activities, and things that enable caregiving at home, asking how caregiving is orchestrated, sustained, and delivered at home, and how the home is in turn re-constituted by caregiving. In-depth interviews were conducted with 40 family caregivers, aged 55-85 years, caring for their spouse and/or parent(s). Relations, activities, and things that enabled caregiving were analyzed through the theoretical lens of “care infrastructure”. Caregiving is enacted through a network of people and things – including family members, live-in hired helpers, medical and social workers; technologies like surveillance cameras and strategically placed mirrors at home to monitor care recipients; televisions turned-on 24/7; assistive devices such as wheelchairs and ramps, and placement of hospital beds at home, etc. – that change living arrangements and routines. Care tasks, responsibilities, and decisions are marked by negotiations, tensions, and compromises between people and with things. Caregivers appropriate, adapt, and improvise in situations of uncertainty, conflict, and impossible demand. We conclude that new socio-material arrangements of people, activities, and things that emerge because of caregiving change/disrupt the notion of home as a place of safety, familiarity, and comfort for caregivers. Understanding the emplacement/displacement and interconnection of things, activities, and people sheds light on how the home shapes the effects of caregiving and vice versa.
FIVE REALITIES: A TYPOLOGY OF CAREGIVERS OF PERSONS WITH DEMENTIA AND THEIR INTERVENTION OUTCOMES
Authors: Ashida Sato , Lynn Freda , Thompson Lena , Donohoe Maria , Schneider Haley , Williams Kristine
Published: December 2023

Caregivers of persons living with dementia report wide-ranging lived experiences, including feelings of burden and frustration but also positive outcomes. This study uses novel survey data to describe distinct types of caregiving experiences from a holistic perspective. We then explore the extent to which responses to a caregiver intervention are contingent on experience type. Using baseline data from a randomized trial, we use the k-means clustering algorithm on eight caregiver perceptions (adversity: burden, anxiety, network unmet-expectations, and network stress; positivity: positive aspects of caregiving, self-efficacy accessing services, caregiving preparedness, and network support) to identify experience types. Differential responses to intervention at 3-months by typology were assessed using OLS regression methods. Eighty-one caregivers were partitioned into five latent classes: Thriving (low adversity, high positivity); Deeply Struggling (high adversity, low positivity); Struggling but feeling prepared; Struggling and unprepared; No Plans (unprepared but not anxious). Attrition was highest among struggling groups and lowest among thrivers. Caregivers who are “Struggling but feeling prepared” (p=0.01) or “Struggling and unprepared” (p=0.03) showed significant increase in self-efficacy to use community services at 3-months. The latter group also showed a significant increase in knowledge about community services (p=0.03). Network stress at 3-months increased significantly more for the control than intervention group (p=0.03); by cluster, group differences were most pronounced among “Deeply struggling” (p=0.04) and “No Plans” (p=0.05). Types of caregiving experiences may determine caregiver participation in programs and their response to programs intended to support caregivers. Research and practice should focus on identifying strategies that fit caregiver experiences.
ADRD CAREGIVERS’ ROLE PERCEPTION AND MENTAL HEALTH AFTER LTC-PLACEMENT OF FAMILY MEMBERS
Authors: Kim Hyejin , Paun Olimpia , Bishop-Royse Jessica , Inventor Ben , Mayahara Masako , Ailey Sarah , Fogg Louis
Published: December 2023

The Chronic Grief Management Intervention-Video (CGMI-V) clinical trial tested the effects of an 8-week live online intervention for caregivers who placed their family members with ADRD in LTC on caregivers’ mental health outcomes (grief, depression and anxiety symptoms, positive states of mind). This cross-sectional study used baseline data (n=95) from the CGMI-V. We performed hierarchical linear regression to examine the main effects of caregiving role perceptions on caregivers’ levels of grief, depression, anxiety symptoms, and positive states of mind, controlling for potential covariates. At baseline, perceived caregiver role captivity was the most significant factor of outcome variables, followed by feelings of guilt and loss. Increased feelings of role captivity were linked to sum scores of grief as measured with the Marwit-Meuser Caregiver Grief Inventory. These findings indicate that increased feelings of role captivity were associated with increased feelings of loss and loss of interpersonal connections. Higher levels of perceived role captivity were associated with more depressive and anxiety symptoms. Caregivers with lower levels of perceived role captivity had higher levels of positive states of mind. The findings confirmed the need for interventions targeting caregivers’ feelings of role captivity, loss, and guilt related to caregiving obligations post-LTC placement of family members with ADRD to reduce caregivers’ grief, depression, and anxiety and to increase their positive states of mind. These baseline findings are preliminary. Future presentations will report the effects of the CGMI-V intervention on caregivers’ grief and mental health, including weeks 8 and 24 follow-up data.
BUILDING SCIENTIFIC COLLABORATIONS IN ALZHEIMER’S DISEASE RESEARCH: THE ADRD SPECIAL INTEREST GROUP
Authors: Gaugler Joseph , Urbanski Dana , Yam Hawking , Baker Zachary , Merkel Emily , Waring Stephen , Sheets Kerry
Published: December 2023

Since the advent of the National Alzheimer’s Project Act, an unprecedented increase in federal funding to advance the science of dementia and dementia care has occurred. The Alzheimer’s Disease and Related Dementia (ADRD) Special Interest Group (SIG) of the University of Minnesota’s Center for Healthy Aging and Innovation aims to build and enhance scholarly collaborations in ADRD research between faculty, post-doctoral fellows, and graduate students across the University of Minnesota and beyond. Given the challenges of identifying mutual areas of scientific interest across disciplines, the ADRD has utilized several strategies to identify potential points of engagement, including a crosswalk procedure to create a matrix of members’ interests, methodological expertise, and available data resources; a member-led journal club; and a dashboard to track collaborative process. Although early in its development, the ADRD SIG aims to facilitate these initial partnerships to result in peer-reviewed publications and, eventually, team science-based project in ADRD.
GENDER DIFFERENCES IN INFORMANT REPORTS OF COGNITIVE FUNCTIONING IN MEXICO AND THE US
Authors: Cantu Phillip
Published: December 2023

Background

Increasingly, researchers are attempting to measure cognitive functioning in large population-based surveys using both direct measurement and informant reports, but little work examines how gender affects measurements. For example, the role of gender in the division of labor is different in the U.S. and Mexico so questions relating to household chores will overestimate functional impairment in Mexico relative to the U.S. Method: Data from the U.S. Health and Retirement Study (HRS) and the Mexican Health and Aging Study (MHAS) will be used to examine disparities in how informants report cognitive change, measured by the total Community Screening Instrument for Dementia (CSI′D’) score, are related to gender of participants and informants. Result: Female participants in Mexico have higher CSID scores than men but not in the U.S. Conversely, female informants report higher CSID scores than male informants in the U.S. but not in Mexico.

Conclusion

Further analysis is needed to determine if national differences in the association of gender and reports of cognitive impairment are due to differences in how informants report impairment.
ASSOCIATIONS BETWEEN ENVIRONMENT AND COGNITIVE FUNCTIONING FOR OLDER ADULTS: A CASE STUDY OF SINGAPORE
Authors: Liu Yuezhong , Wong Chek Hooi , Ho Ringo , Theng Yin-Leng
Published: December 2023

This study aims to examine the interplay between the intrinsic capacity of older adults and built environmental characteristics, and how these factors influence their outside daily life gait speed (DGS) in neighbourhoods. We collected and analyzed 33 participants who travelled a total of 2,428 kilometres and took a combined 1,428,793 steps outside of their homes over a period of 220 days in Singapore. Mini-Mental State Examination (MMSE) cut-offs (accounting for education attainment) were used to distinguish between those with cognitive impairment (CI) and those without cognitive impairment (Non-CI). The mean (SD) age of the participants was 69.2 (7.14), and 21 (64%) of them were female. 14 (42%) participants were identified as having cognitive impairment. A high Gross Plot Ratio was found to be associated with a lower DGS for both CI (b=-0.03, t = 0.19, p < .01) and Non-CI (b=-0.03, t = 0.16, p < .01). The DGS of individuals with CI was generally slower compared to Non-CI, with the greatest difference observed in business areas where the Non-CI group walked at a speed twice as fast. Individuals with CI had a slower DGS and required more adaptation to the environment. They also experienced lower quality of life-space interaction and relied more on vehicular travel from the density and frequency of activity points. Creating an environment that requires less attention and reduces cognitive load may help promote safe walking among individuals with CI and compensate for their reduced ability to perceive environmental risk.
COGNITIVE IMPAIRMENT, FALLS, AND DEMENTIA: NOVEL APPROACHES FOR EARLIER DETECTION AND MORE EFFECTIVE INTERVENTION
Authors: Reid Kieran , Blumen Helena , Verghese Joe
Published: December 2023

This symposium will discuss novel digital approaches for the remote assessment of cognitive status and detection of fall risk in older adults. We will then describe several emerging digital exercise, ballroom dancing, and other non-invasive intervention strategies targeted for vulnerable older populations at increased risk for falling, or developing cognitive impairment and dementia. Collectively, we posit that these innovative detection and intervention strategies hold significant potential as more effective and scalable approaches for identifying cognitive impairment, preventing falls, and mitigating cognitive decline in high-risk older adults. In presentation 1, Roque et al. examines the utility of ecological momentary cognitive assessment and its potential as a digital biomarker of cognitive impairment in community-dwelling older adults. In presentation 2, Mahoney et al. discusses the development and clinical potential of a novel digital health app, CatchU®, that remotely captures visual-somatosensory integration performance to detect fall propensity in older adults. In presentation 3, Bajdek et al. describes the feasibility of a 12-week digitally delivered home-based fall prevention exercise program for older adults with elevated fall risk. In presentation 4, Blumen et al. report preliminary efficacy and mechanistic findings from a randomized trial of social ballroom dancing in older adults at increased risk for dementia. In presentation 5, Reid et al. describes the feasibility of a real-world community-level physical activity intervention for older adults with motoric cognitive risk syndrome. The discussant, Dr. Verghese, will integrate the key findings from these studies, discuss their theoretical and methodological contributions, and consider future research directions.
RELIGIOUS ATTENDANCE AND SLEEP QUALITY IN US OLDER ADULTS
Authors: Britt Katherine , Dong Fanghong , Hodgson Nancy
Published: December 2023

Sleep is an important proponent of memory, learning, and cognitive processing with changing patterns throughout the life course; poor sleep contributes to cognitive decline and dementia risk. Spiritual and religious activities are associated with better cognitive health, yet the biological mechanism is not well understood. This study aims to investigate whether religious and spiritual activity is associated with sleep quality in U.S. adults. Data were drawn from a U.S. longitudinal survey of a national probability sample, Midlife in the United States (MIDUS), from MIDUS Wave 2 (2004-2006), and MIDUS refresher (2011-2014). We examined cross-sectional associations between self-reported religious service attendance measured with 1 item (high, low religious attendance) and sleep quality measured with the Pittsburgh Sleep Quality Index (PSQI) (n=1,168) across three adult age groups (early, middle, late). We adjusted for sex, education, marital status, BMI, and smoking. Higher religious service attendance was significantly associated with better sleep quality among older adults (aged 60 – 80 years) (B=-1.02, p=0.011), while associations in young (aged 20-40 years) (B=-0.76, p=0.087) and middle-aged adults (aged 40-60 years) (B=-0.54, p=0.061) were marginal. Religious service attendance may contribute to better sleep quality amongst older adults by providing a sense of purpose and reducing feelings of helplessness and a sense of loss of control associated with aging. In addition, religious attendance is associated with decreased depressive symptoms and anxiety, possibly contributing to greater spiritual well-being and promoting better sleep. Longitudinal studies are needed to examine these associations over time.
THE MINI-MENTAL STATE EXAMINATION IN A CHINESE POPULATION: RELIABILITY, VALIDITY, AND MEASUREMENT INVARIANCE
Authors: Andersson Bjoern , Luo Hao
Published: December 2023

The Mini-Mental State Examination (MMSE) is a widely used screening tool for cognitive impairment and dementia in many cultures and regions. However, the properties of the MMSE in the Chinese context have not been evaluated with large population-representative samples. It is also unclear whether item properties of the MMSE differ across age and education subgroups. We study the psychometric properties of the MMSE using data from 8974 respondents aged 60 years or older in the 2018 Chinese Health and Retirement Longitudinal Study (CHARLS). Using item response theory (IRT) for the ordinal data, we confirm a three-dimensional factor structure for the MMSE in CHARLS in accordance with the underlying theoretical framework and establish acceptable model-data fit (SRMSR = 0.036). Total scores and subscale scores of the MMSE correlated positively with each other and correlated negatively with ADL (r = -0.19), IADL (-0.30), and CESD scores (-0.25). The reliability of the total MMSE scores was estimated at 0.78, indicating moderate measurement precision in the study population. Multiple group IRT analysis found that item characteristics and item functioning of 5 items differed by age group and 14 items differed by educational level. This analysis provided evidence on violations to measurement invariance of MMSE items, pointing to a need to account for item-level differences in measurement properties primarily with respect to education level when using the MMSE in CHARLS and, more generally, in Chinese populations. In addition, revised cognitive measures are advised to be used in CHARLS to improve the precision of measurement.
EMERGING MR IMAGING AND SPECTROSCOPY APPLICATIONS FOR AGING RESEARCH IN MODEL ORGANISMS
Authors: de Cabo Rafael , Bouhrara Mustapha
Published: December 2023

Advances in quantitative magnetic resonance imaging and spectroscopy (MRI/MRS) methodology have enabled probing tissue microstructure and function with exquisite specificity and sensitivity in human and model systems. Using this technology to examine changes in tissue microstructure and function in aging or pathology has the potential to provide a window into the underlying age-related diseases’ mechanisms, and to nominate MR biomarkers for longitudinal assessment and intervention. Water molecules within biological tissues undergo interactions with their environment through nuclear relaxation, magnetization transfer, chemical exchange, and diffusion. These processes are sensitive to underlying local tissue properties such as density, microstructure, temperature, acidity, composition, and geometry. Through use of combinations of magnetic fields and radiofrequency pulse formalisms, MRI/MRS provides unique sensitivity and specificity to probe these mechanisms in all biological tissues. Advances in acquisition strategies, hardware designs, computational analyses, and signal modeling have positioned MRI/MRS as powerful emerging noninvasive modalities to studying biological tissue to differentiate normal from abnormal cell-level processes. These techniques are based on multicomponent relaxometry or diffusion, magnetization transfer, high-dimensional imaging or spectroscopy, susceptibility imaging, cerebral functioning, etc. However, their integration in clinical trials and investigations is still limited. This session will provide an overview about these emerging MRI/MRS techniques, their value and application in studying aging. The overarching goal is to generate further interest within the scientific community, disseminate and integrate these mature and unique noninvasive approaches in research settings and routine clinical protocols to advance our understanding of aging processes.
IMAGING MICROSCOPIC NEUROPATHOLOGY OF ALZHEIMER’S DISEASE USING MRI: FROM MODEL SYSTEMS TO HUMAN IN VIVO
Authors: Benjamini Dan
Published: December 2023

Microstructural magnetic resonance imaging (MRI) techniques are unique among neuroimaging modalities because they probe tissue features at the micron scale that are invisible using other methods. This class of MRI methods promises to address the unmet needs for neuroimaging in Alzheimer’s disease (AD) and related dementias: (1) early detection of subtle cellular and protein alterations and (2) delineation of comorbid pathologies. In particular, diffusion MRI is sensitive to alterations in cellularity and other microstructural changes, and relaxometery MRI is sensitive to chemical composition and macromolecular content. Benefiting from both modalities, multidimensional MRI is a new and emerging modality that maximizes chemical and microstructural information by probing relaxation and diffusion mechanisms simultaneously. This approach is ideal for detecting AD pathology, namely beta-amyloid plaques and Tau tangles, as well as comorbid pathologies, because of the microstructural and compositional alterations they induce in the affected regions. In order to actualize the promise of this method, a bridge must be built between the pathologic changes that define AD and detectable multidimensional MRI signatures. Our strategy starts with a ``bottom-up’’ approach that first uses radiologic-pathologic correlation in postmortem human tissue to elucidate the associations between specific cellular and macromolecular alterations in AD and their unique multidimensional MRI signatures. Building on that knowledge, we can then adapt this technology towards clinical in vivo application and complete the journey from bench-to-bedside.
THE IMPORTANCE OF PERSONALITY TRAITS FOR COGNITIVE HEALTHSPAN
Authors: Yoneda Tomiko , Lozinski Tristen , Graham Eileen , Piccinin Andrea , Muniz-Terrera Graciela
Published: December 2023

The existing literature consistently finds that personality traits are associated with dementia and with risk of mortality. However, few studies have simultaneously examined the impact of traits on dementia while accounting for death as a competing risk, which is critical as dementia and mortality are dependent outcomes and the likelihood of each increases alongside older age. In response, data were drawn from the Rush Memory and Aging Project (N=1954; baseline mean age=80 years; 74% female; up to 23 annual assessments). We used multi-state survival models to investigate whether traits (conscientiousness, extraversion, and neuroticism) were associated with transitions between cognitive status categories (No Cognitive Impairment, NCI; Mild Cognitive Impairment, MCI; dementia) and death. Further, multinomial regression models estimated cognitive healthspan (i.e., years without cognitive impairment) and total longevity. Adjusting for demographics, depressive symptoms, and APOEε4, personality traits were most important in the transition from NCI to MCI; higher conscientiousness was associated with a ~22% decreased risk of transitioning from NCI to MCI (HR=0.78, 95%CI=0.72, 0.85), whereas higher neuroticism was associated with a ~12% increased risk of transitioning from NCI to MCI (HR=1.12, 95%CI=1.04, 1.21). Life expectancy analyses suggested that participants who were higher in conscientiousness were estimated to live longer without cognitive impairment compared to individuals lower in conscientiousness. Findings were similar, though less pronounced, for individuals higher in extraversion or lower in neuroticism. Importantly, none of the traits appeared to be important for total longevity. Together, these results highlight the importance of personality traits, particularly conscientiousness, for maximizing cognitive healthspan.
CHALLENGES AND OPPORTUNITIES FOR RECRUITMENT AND RETENTION OF OLDER HISPANICS FOR CLINICAL RESEARCH
Authors: Samper-Ternent Rafael
Published: December 2023

Older Hispanics represented 9% of the population over 65 years of age in the USA in 2019. That number is expected to increase to 21% by 2060. Representation of older Hispanics in clinical research is not proportional to the projected increase of older Hispanics. I will discuss the lessons learned on recruitment and retention of older Hispanics and their family caregivers from a large multi-site pragmatic clinical trial I am a part of and a small pilot project I am co-leading. The pragmatic trial compares a health-system-based approach and a community-based approach to dementia care. For this pragmatic trial, 2,176 dyads of persons living with dementia and their family caregivers were recruited. More than 20% of participating dyads belong to underrepresented racial and ethnic groups and 8.8% identified as Hispanic. The pilot project tests the cultural adaptation of the Patient Priorities Care (PPC) approach for older Hispanics. For the pilot project, we recruited 5 older Hispanics with multiple chronic conditions (MCC) and 20 Hispanics with MCC and dementia. I will describe the recruitment strategies used in each study, the barriers we faced, and the approaches we think worked best for the recruitment of Hispanics. I will also reflect on the challenges we currently face to conduct pragmatic trials that include older Hispanics and the opportunities for improvement.
ADAPTING A PHYSICAL ACTIVITY INTERVENTION FOR RURAL AREAS: PEOPLE WITH MCI AND CARE PARTNER DYADS
Authors: Hoffman Rashelle , Watanabe-Galloway Shinobu , Riffin Catherine , Monin Joan
Published: December 2023

Rural populations face an increased risk of Alzheimer’s Disease (AD) compared to urban populations. Physical inactivity is a modifiable risk factor of AD and a prevalent issue for people with mild cognitive impairment (MCI) that can be addressed remotely with telerehabilitation. However, rural older adults differ from urban-dwelling as they often view physical activity as physical labor and have unique barriers (e.g., low social support). Involving a care partner for social support and improving physical activity is essential for people with MCI. The telerehabilitation physical activity behavioral (TPAB) intervention involves weekly discussions about self-monitoring physical activity with a FitBit, setting goals, and discussing personal barriers/facilitators and has been shown to be feasible and efficacious to increase daily step count in other older adult populations. Evidence is lacking for the TPAB’s use in people with MCI living in rural settings and their care partners (patient + care partner dyads). Results from the first phase of our study include three focus groups (four people per group) from a Nebraska rural community including medical providers, care partners, and older community-dwelling adults to identify ways to adapt the study design and TPAB intervention for rural patient + care partner dyad implementation. Discussion will focus on feasibility (Person-Based Approach) and adaptation (FRAME framework) of the TPAB intervention for implementation in rural communities. The results of this project will lead towards using telehealth technology to overcome detrimental geographical impacts on health (i.e., living in rural communities) to advance the care for patient + care partner dyads.
THE READYR PROGRAM FOR WELL-BEING IN DEMENTIA: PILOT STUDY AND SIX-MONTH FOLLOW-UP RESULTS AMONG SPOUSE–PARTNER DYADS
Authors: Miller Lyndsey , Steele Joel , Hiatt Shirin , Kaye Jeffrey , Whitlatch Carol
Published: December 2023

The READyR Program assesses and targets everyday routines of care dyads (older adults with cognitive impairment and their co-habiting partners) using in-home sensors and video-conference sessions in order to understand future care needs, and promote greater well-being. This study aimed to evaluate the feasibility, acceptability, and pilot test of efficacy for READyR. Fifteen dyads (96% married) were enrolled in the 6-month study, and randomized to immediately join READyR (n=8 dyads) or to complete READyR after an educational control condition (n=7 dyads). Feasibility was high: 100% of enrolled dyads completed ≥1 session; 80% completed all sessions. Acceptability was also high: responding participants (n=26) reported that READyR helped them express their care values and understand their care needs (92%), that they were comfortable sharing their views (92%) and doing so with their partner present (96%). Hearing and visual impairments were reported to interfere with online sessions for 4 and 6 participants, respectively, but 93% of participants reported that the digital components were easy to use and understand. After receiving the READyR sessions, awareness of future care needs among care partners increased (d = 0.85) and relationship strain for both dyad members decreased (d = 0.58–0.82), when compared to changes among participants in the active control group. No effect was observed on participants’ quality of life, mood, or care-related strain at post-test or at 6 month follow-up. As a remote dyadic intervention, READyR is feasible, acceptable, and may help dyads decrease strain in the care relationship and prepare for future care needs.
USING INTENSIVE REPEATED MEASUREMENT TO EXAMINE THE AFFECTIVE CONSEQUENCES OF NEGATIVE RELATIONSHIP EXPERIENCES
Authors: Witzel Dakota , Cichy Kelly
Published: December 2023

Across midlife and older adulthood, daily relational contexts provide a lens through which daily experiences shape health and well-being. How daily relational contexts inform health and well-being is complex, with buffering and exacerbating effects of the relationship context on well-being reported in past work. One mechanism through which daily relational experiences influence health and well-being is through changes in emotions. The current series of talks examine how daily relational experiences (interpersonal stress, marriage and loneliness, perceived social isolation, caregiving stress) influence emotional well-being using innovative intensive repeated measurement designs. First, using eight days of daily diary data from the National Study of Daily Experiences, Dakota Witzel will consider the protective effects of perceived control on affective reactions to interpersonal daily stressors on the same day and the following day. Second, using a pre-registered, 14-day ecological momentary assessment design, Jin Wen will discuss the potential implications of affective reactions to interpersonal daily stressors on subsequent sleep quality. Third, using 14 days of ecological momentary assessments from the Einstein Aging Study, Karina Van Bogart will explore the moderative influences of marriage and cognitive impairment on the effects of daily emotional loneliness on intrusive thoughts. Finally, using a 14-day daily diary design, Frank Puga will present on the implications of daily caregiver stress and perceived social isolation on perceived emotional control. Kelly Cichy will serve as discussant and summarize the theoretical and methodological contributions of these studies for enhanced understanding of the dynamic interplay between relational experiences and emotional well-being in daily life.
COMPARING EARLIER- VERSUS LATER-BORN CENTENARIAN COHORTS FROM THE HEALTH AND RETIREMENT STUDY
Authors: Lee Gina , Martin Peter
Published: December 2023

The current study aimed to compare the health status of earlier and later born centenarian cohorts. Using the data from the Health and Retirement Study, we selected those who survived to at least 98 years and divided them into earlier (n=189) and later (n=304) cohorts. The birth year of the earlier cohort ranged from 1890 to 1906, and the birth year of the later cohort ranged from 1907 to 1920. We first recoded variables to examine health status when all participants were at least 98 years old. To explore differences in health status between earlier vs. later cohorts, we computed t-tests/χ2 difference tests with activities of daily living, depressive symptoms, self-report of health and health change (SRHC), BMI, current smoking, drinking, cognition, and a number of diseases. There were significant differences in depressive symptoms, SRHC, high blood pressure, and current drinking between the earlier and later centenarian cohorts. The later cohort had significantly higher blood pressure, more depressive symptoms, worse SRHC, and later cohorts had a higher proportion of participants who currently consumed alcohol. Finally, the results of two separate regression analyses predicting depressive symptoms indicated that no demographic or health variables of the earlier cohort significantly predicted depressive symptoms, but years of education and current diagnosis of cancer significantly predicted depressive symptoms for the later cohort. Overall, the later born cohort had a worse health status compared to the earlier born cohort. This findings highlights the need for healthcare providers to pay attention to psychological health among cancer-diagnosed centenarians.
AGE-VARYING COGNITIVE IMPAIRMENT AND SOCIAL SUPPORT AMONG PEOPLE AGING WITH AND WITHOUT HIV
Authors: Bender Alexis , Haardörfer Regine , Perkins Molly , Moore David , Cooper Hannah
Published: December 2023

There is compelling but limited evidence that the combination of HIV, methamphetamine (meth) use, and aging form a deleterious trio that undermines cognitive functioning. Currently, a gap exists in our understanding of the intertwining relationships among drug use, HIV, and cognitive function across biological ages and over time. Interventions to reduce meth use and support brain health among aging PWH are vital and improving social relationships is a promising area of intervention. Cross-sectional and limited longitudinal studies indicate that positive social relationships and social support are associated with better cognitive function among healthy older populations. This association has received limited attention among PWH who use drugs beyond adolescence and young adulthood. This study leverages NIH’s prior and ongoing investments in research to develop a new analytic cohort by combining participants from 23 studies at the HIV Neurobehavioral Research program. Enrollment in this cohort spans from 2009-2021. At baseline, our sample consists of 862 people with a mean age of 52 (range 18-81). Most participants are male (73%), White (74%), and over half (61%) are living with HIV. Using a life course perspective and time-varying estimation modeling, we examine age-varying cognitive impairment and variation in cognitive function across age by HIV status, meth use, and social relationships. First, we examine how cognitive impairment changes over time for the full sample then examine the differing transitions/turning points among those aging with and without HIV and meth use. Lastly, we show how positive and negative social relationships alter these trajectories among each group.
PRESIDENTIAL SYMPOSIUM: IMPACT OF DISCRIMINATORY POLICIES ON LGBTQ+ OLDER ADULTS’ HEALTH AND WELL-BEING AND HOW TO COMBAT THEM
Authors: Kwak Jung , Fredriksen-Goldsen Karen
Published: December 2023

Despite some advances in LGBTQ+ rights over the past few decades, many states lack legal protections against discrimination based on sexual orientation or gender identity, and the current political climate raises concerns about future challenges to LGBTQ+ rights. This symposium explores the implications of discriminatory policies on the health, housing, and economic well-being of LGBTQ+ older adults, and solutions for promoting empowerment, equity, and inclusion throughout the care continuum, from long-term services and supports to end-of-life care. The first presentation describes a complex paradox in which sexual and gender minority (SGM) older adults avoid formal services due to fear of discrimination and poor treatment despite significant health disparities and a lack of informal support, discusses opportunities to improve access and health through education and awareness, and elucidates implications for policy and research. The second presentation describes geographic variations in access to, and receipt of gender-affirming surgery among transgender and gender-diverse Medicare beneficiaries using national Medicare data and discusses policy implications. The third paper focuses the role of spirituality and faith in the lives of LGBTQ+ older adults and reports findings from a mixed-methods study on how involvement in faith communities shape their end-of-life care perceptions and preparation. The fourth presentation describes barriers and facilitators to communicating with SGM hospice patients and caregivers about their sexual orientation and gender identity and recommendations for developing communication training to promote authentic end-of-life care for this population. Karen Frederickson-Goldsen as discussant will provide policy and practice implications of these important works.
FAITH, SOCIAL SUPPORT, AND END-OF-LIFE CARE PREPARATION AMONG LGBTQ+ OLDER ADULTS
Authors: Lampe Nik , Barbee Harry , Tran Nathaniel , McKay Tara
Published: December 2023

Faith communities can provide older adults support as they plan for end-of-life care, but how this support unfolds for lesbian, gay, bisexual, transgender, and queer (LGBTQ+) people is uncertain. Although many LGBTQ+ people experience marginalization within faith communities, they also report experiences of acceptance and affirmation. This mixed-methods study investigates how LGBTQ+ older adults’ involvement in faith communities shape their end-of-life care perceptions and preparation. First, we analyze panel data from the Vanderbilt University Social Networks, Aging, and Policy Study (N=1,256) to assess the relationship between faith community involvement and levels of social support. We find that 63% of older LGBTQ+ respondents identify with a religious affiliation, and 31% attend religious services several times a year or more. Attending religious services several times a year are more is associated with having a spouse in the household (11.4 vs 7.1%, p<.05) and reporting larger personal networks (11.7 vs 9.9 individuals; p<.001). Service attendance is also associated with having support when seeking advice about important decisions and having social support from friends. In the second portion of our study, we analyze data from in-depth interviews with 47 LGBTQ+ older adults to understand how faith communities influence preparation for end-of-life care. Many interviewees described their faith communities as guides that help them select reliable healthcare providers and formulate their end-of-life care plans. Overall, these findings reveal important ways that faith communities can foster social support and promote optimal end-of-life care among older LGBTQ+ adults.
BUILDING BRIDGES ACROSS AGE-FRIENDLY ELEMENTS GUIDED BY THE 4MS FRAMEWORK
Authors: Petrovsky Darina , Mitchell Anne
Published: December 2023

The 4 Ms framework is a set of evidence-based elements of high-quality care delivered to older adults. These include What Matters, Mobility, Medication, and Mentation. By following these principles and practicing age-friendly older adults are more likely to experience good quality care that addresses their needs. This symposium aims to build bridges across age-friendly elements that focus on the 4 Ms framework by highlighting the research of four nurse scientists. Representing the “What Matters” element, advance care planning and palliative care interventions aim at understanding and aligning care with older adults’ care preferences. In the first presentation, Dr. Rahemi will present findings of health disparities across sociodemographic groups in advance care planning using data from the Health and Retirement Study. In the second presentation, Dr. Carpenter will report on findings from a pilot pragmatic clinical trial that examined the feasibility, acceptability, and preliminary effectiveness of a primary palliative care intervention among nursing home residents with serious illness. Under the element of “Mobility”, Dr. Sefcik will present findings from a qualitative descriptive study aimed at discovering how the COVID-19 pandemic affected the outdoor activities of senior living community-residing older adults. In the fourth presentation, Ms. Coates presentation examines the last two elements of the framework - Medication and Mentation. She will report on findings from a longitudinal case-control observational study using data from the National Health and Aging Trends Study examining differences in the frequency of unpleasant symptoms experienced by older adults with polypharmacy and/or dementia.
OUTDOOR ACTIVITY ENGAGEMENT PRIOR TO AND DURING THE COVID-19 PANDEMIC IN SENIOR LIVING COMMUNITIES
Authors: Sefcik Justine , Euiler Elizabeth , Na Annalisa , Greenberg Sherry , Katsev Danielle , DiMaria-Ghalili Rose Ann
Published: December 2023

There is growing evidence regarding the benefits of spending time outdoors. However, it is less understood if the COVID-19 pandemic has deterred or increased older adults’ outdoor leisure activities when they reside in senior living communities. This study aimed to discover how the pandemic affects senior living community-residing older adults’ outdoor activities. Older adults 65 and older were recruited through ResearchMatch and university partnerships. A qualitative descriptive approach was taken with semi-structured individual interviews conducted over Microsoft Teams, telephone, or in-person. A conventional content analysis was employed. Interviews were conducted in 2021-2022 with 4 females and 3 males from suburban Pennsylvania. While there were indoor restrictions and regulations (e.g., mask wearing when around others), the outdoor environments were less regulated and routine outdoor activities continued during the pandemic. Facilitators to outdoor activities were: 1) senior living campus features (e.g., paved walking paths, outdoor recreational sport areas), 2) structured outdoor activities (e.g., bocce ball and golfing tournaments facilitated by staff), and 3) access to transportation (e.g., to drive or visit other locations). A barrier to outdoor activities was: needing assistance from staff to exit buildings due to decreased mobility. This study illuminates that amenities and structured activities at senior living facilities promoted mobility in outdoor activities for those who preferred going outside. Findings inform design features that encourage mobility and outdoor activities among older adults. Policy implications include supporting senior living communities with less resources for maintaining campuses and neighborhoods, which could contribute to promoting outdoor activities and health equity.
WHO, HOW, AND WHEN TO PREPARE FOR CARE? PREPAREDNESS AMONG CAREGIVERS OF PERSONS LIVING WITH DEMENTIA
Authors: Mroz Emily , Crawford Nicole , Monin Joan
Published: December 2023

Our health systems rely on family caregivers to provide critical support for over six million persons living with dementia (PLWD) in the US. Caregivers, however, often report low preparedness for care roles, promoting negative outcomes for themselves and their care recipients. As the number of PLWD grows, preparing close others to perform and thrive in caregiving roles is a public health priority. This symposium provides insights on who, how, and when to prepare for the care of a PLWD. First, Falzarano et al. will discuss the individual, psychosocial, and contextual factors influencing caregivers’ use of supportive services, and implications for self-efficacy and preparedness. Mroz et. al. will introduce the concept of ‘experienced’ caregivers of PLWD, those who have been caregivers previously, and describe ways to address persisting psychological tolls and low confidence from prior care roles to prepare these caregivers for current care roles. Fox et al. will describe interaction between preparedness and family dynamics, showcasing differences in these relations across dementia- and non-dementia care roles. Vu et al. will describe how caregiver engagement in a health priorities identification process can better prepare caregivers to make values-based medical decisions on behalf of the PLWD. Crawford et al. will describe the influence of burden on caregivers’ emergency preparedness. Takeaways from these papers and Joan Monin’s discussion collectively respond to priorities outlined by the NIA IMPACT Collaboratory’s Lived Experience Panel, offering direction on best practices and needed initiatives to bolster preparedness in this caregiver population.
EMPLOYMENT AND FINANCIAL STATUS BEFORE AND AFTER THE COVID-19 PANDEMIC AMONG OLDER PEOPLE IN ENGLAND
Authors: Zhu Jingmin
Published: December 2023

The COVID-19 pandemic has negatively affected society and the economy worldwide. By the end of 2021, most legal COVID-19 restrictions were lifted in England, pushing society into a post-pandemic phase. However, it remains unclear whether the post-pandemic world has convalesced, particularly with regard to socioeconomic circumstances among older people. According to the English Longitudinal Study of Ageing (ELSA), the percentage of employment among older people aged 50 years and above living in England decreased dramatically from 24.9% in 2018/9 to 17.6% in June/July 2020 and 19.8% in November/December 2020. Preliminary results from data collected between October 2021 and November 2022 suggest that post-pandemic the percentage of older people in paid work bounced back to pre-pandemic levels. Nevertheless, the post-pandemic financial status was worse than that before the pandemic. Whereas approximately 22% of respondents were worried about the future financial situation during the pandemic, this prevalence increased to nearly 30% in 2021/2. Moreover, there is an indication that some groups (including those with low education; those in routine and manual occupations; and those living alone) fared worse in the post-pandemic times. Overall, despite some evidence suggesting that the employment of English older people has bounced back to pre-COVID-19 pandemic levels, their financial situation seems to have deteriorated, most likely reflecting also the current rising cost of living and financial crisis in the UK.