bluuebunny/crossref_metadata_2025 huggingface dataset:
IMPROVING DEMENTIA DETECTION IN PRIMARY CARE: PROCESS EVALUATION FOR THE ERADAR BRAIN HEALTH TRIAL
Authors: Barnes Deborah , Greenwood-Hickman Mikael Anne , Hsu Clarissa , Karliner Leah , King Deborah , Lee Sei , Coley Rebecca , Dublin Sascha
Published: December 2023

The eRADAR Brain Health Study is an ongoing embedded, pragmatic trial testing whether targeted screening improves detection and diagnosis of dementia in primary care clinics at Kaiser Permanente Washington and the University of California, San Francisco. The validated eRADAR algorithm, which uses electronic health record data to calculate a risk score for undiagnosed dementia, identifies high-risk patients age ≥65. Participants are randomized at the primary care physician (PCP) level to receive usual care or an invitation to a brain health visit for functional and cognitive assessment. We assessed patient acceptance (% completed brain health visit) and satisfaction (responses to post-visit survey) in patients enrolled to date. Of 575 high-risk patients invited, 157 (27%) agreed and 116 (20%) completed a brain health visit. The primary reason for declining the visit was lack of interest. Those who completed the visit had a mean (SD) age of 83.4 (5.1) years; 70 (60.34%) were women; 82 (70.7%) attended with a care partner. Seventeen (15%) had results consistent with dementia and were referred to their PCP for further evaluation. Fifty-five (47%) had results consistent with mild cognitive impairment (MCI) and were counseled to follow up with their PCP in 1 year. Analysis of the first 40 survey responses indicated high satisfaction: 33 (83%) agreed the visit was helpful and 36 (90%) did not feel upset/concerned by the visit. This suggests that, although acceptance was low, those who participated had high rates of possible dementia or MCI and reported high satisfaction with the targeted screening process.
RELATIONSHIPS BETWEEN CEREBRAL VASCULOPATHIES AND MICROINFARCTS IN COMMUNITY-BASED OLDER ADULTS
Authors: Sin Mo-kyung , Cheng Yan , Roseman Jeffrey , Zamrini Edward , Ahmed Ali
Published: December 2023

Cerebral microinfarcts are associated with cognitive impairment and dementia. Less is known about the relationships of various vasculopathies (arteriolosclerosis and cerebral amyloid angiopathy (CAA) with microinfarcts. This case-control study examined the associations of the vasculopathies with microinfarcts in 842 older adults in the Adult Changes in Thought (ACT) autopsy data. Arteriolosclerosis was assessed by histological examination using the H&E stain; CAA was assessed using the Congo red histochemical stains; and microinfarcts was ascertained by blinded board-certified neuropathologists. Multivariable-adjusted logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CI) for the presence of cerebral microinfarcts associated with the two cerebral vasculopathies. Cerebral microinfarcts were present in 417 (49.5%) participants. Mild, moderate, and severe arteriolosclerosis was present in 13.2%, 43.9%, 29.7% of participants with microinfarcts, and 28.9%, 40.0%, and 12.5% of participants without microinfarcts, respectively. ORs (95% CIs) for microinfarcts associated with moderate and severe arteriolosclerosis were 2.15 (1.45-3.17) and 4.59 (2.88-7.33), respectively. Mild, moderate, and severe CAA was present in 18.0%, 17.5%, and 3.6% of participants with microinfarcts, and 18.1%, 16.5%, and 2.4% of participants without microinfarcts, respectively. ORs (95% CIs) for microinfarcts associated with moderate and severe CAA were 0.97 (0.65-1.44) and 1.37 (0.59-3.21), respectively. Cerebral microinfarcts were common in older adults and were associated with a higher prevalence of arteriolosclerosis, but not with CAA. Our study underscores the need for additional studies to better understand this complex relationship to develop interventions for primary prevention of cognitive impairment.
MULTI-COMPONENT RELAXOMETRY FOR STUDY OF AGING
Authors: Kolind Shannon
Published: December 2023

While relaxation characteristics of MRI are used regularly for conventional, qualitative imaging, more information can be extracted by fitting multiple water components to the measured signal. Parameters including the myelin water fraction or T2 of intra/extracellular water can provide information about myelin development and degeneration, or inflammation and edema. Multiple approaches to both acquisition and analysis have emerged. This talk will provide an overview of some recent advancements and uses in aging.
COMBINED USE OF NOVEL MR IMAGING AND FLUID BIOMARKERS REVEAL DETERMINANTS OF MYELIN AND AXONAL LOSS WITH AGING
Authors: Walker Keenan
Published: December 2023

Cerebral white matter damage is a feature of Alzheimer’s disease, vascular dementia, and other neurodegenerative conditions, yet little is known about the molecular underpinnings of key features of white matter pathology. In a series of studies we have used targeted assays and large-scale proteomics platforms to determine how biomarkers of Alzheimer’s disease pathology (Aß42/40 ratio; pTau181), neuronal injury (NfL), reactive astrogliosis (GFAP), and other disease processes relate to state-of-the-art diffusion-based MRI measures of brain myelin content and axonal density in cognitively unimpaired older adults. Using data from the Baltimore Longitudinal Study of Aging (BLSA) and the GESTALT study, we measured plasma biomarkers using the Quanterix Simoa assay (targeted measurement of 4 proteins) and the SomaScan proteomic platform (untargeted measurement of 7000 proteins). Additionally, participants underwent 3T MRI, from which measure of myelin content (defined by myelin water fraction [MWF]) and axonal density (defined by neurite density index [NDI]) were derived. We found an association between higher plasma GFAP and lower myelin content in temporal brain regions. Additionally, higher levels of NfL and GFAP were associated with lower total brain axonal density. Using untargeted proteomics, we identified a set of 155 plasma proteins that were associations with myelin content (P <0.05). Using these findings, we applied machine learning to construct a plasma protein-based predictor of brain myelin content, which we plan to validate in a cohort of individuals with multiple sclerosis: a condition characterized by demyelination.
ASSESSING AGE-RELATED CHANGES IN SKELETAL MUSCLE PERFUSION AND MICROVASCULAR FUNCTION WITH MRI
Authors: Reiter David
Published: December 2023

MRI affords a wide variety of non-invasive and quantitative approaches for characterizing tissue perfusion, each providing distinct strengths and weaknesses. Skeletal muscle exhibits a tremendous range of metabolic activity with up to a 50-fold increase in oxygen consumption between resting state and heavy exercise. Even at rest, perfusion of skeletal muscle is a dynamic process where blood flow delivery to capillary beds fluctuates and is regulated by a host of cellular, metabolic, and neurovascular inputs. This talk will present an overview of current and emerging MRI methodologies used for characterizing skeletal muscle perfusion and microvascular function. Strengths and weaknesses of each methodology will be presented with emphasis on studies in aging and age-related disease.
Sleep, Mental Health, and Cognition Across Diverse Adult Populations
Authors: Lee Soomi , Kaufmann Christopher , Spira Adam
Published: December 2023

Sleep is often impaired in late life, raising concerns about the effect of poor sleep on mental and cognitive health in aging individuals. This symposium brings together five rigorous studies that show how poor sleep may be an under-recognized risk factor for mental health and cognitive outcomes in the second half of life. Specifically, this symposium showcases data from a variety of study cohorts (including Midlife in the United Study, Einstein Aging Study, and Study of Muscle, Mobility, and Aging), using diverse indicators of subjective and objective sleep. Paper 1 focuses on healthcare workers (HCWs), a group critical for the delivery of quality patient care, and examines both individual and joint associations of poor sleep and pain with mental health in HCWs vs. non-HCWs. Paper 2 investigates the association between EEG-measured sleep and depressive symptoms in older adults. Paper 3 explores the relationship between intra-individual variability of sleep and mild cognitive impairment (MCI) and identifies gender differences in these associations. Paper 4 establishes the associations of actigraphy-measured sleep and circadian rest-activity rhythms with multiple domains of cognition in older adults. Paper 5 examines the effect of latent dose/duration patterns of common sleep medications on development of Alzheimer’s disease and related dementias. The discussant, Dr. Adam Spira, will integrate key findings from these studies, discuss their contributions to the literature, and consider opportunities for future research. This is a Sleep, Circadian Rhythms and Aging Interest Group Sponsored Symposium. This is a collaborative symposium between the Alzheimer’s Disease and Related Dementias, Geroscience, and Health Behavior Change Interest Groups.
MAINTENANCE OF HEALTH BEHAVIOR CHANGE: CHALLENGES, IMPLICATIONS, AND FUTURE DIRECTIONS
Authors: Hughes Jaime
Published: December 2023

Health behavior change is critical for healthy aging. Evidence-based programs are available to support a variety of health behavior changes in older adults, including programs for activity, diet, sleep, and medication adherence. Health behavior change programs are typically guided by one or more theoretical models or frameworks describing common constructs related to behavior change. Examples of such constructs include intention, motivation, self-efficacy, and self-regulation. To date, much focus has been on how such constructs relate to initiating and/or achieving behavior change. Although some models specify anticipated outcomes of behavior change over time, maintenance remains largely overlooked. This symposium presents a series of presentations exploring concepts and challenges related to maintenance of health behaviors in older adults. Together, these presentations will explore the definitions and characteristics of maintenance as described in the scientific literature, review maintenance-related trends within physical activity interventions, and discuss findings from stakeholder-engaged sessions designed to identify gaps within the theoretical and scientific literature describing maintenance. The session will conclude with recommendations for future research. This is a Health Behavior Change Interest Group Sponsored Symposium.
PHYSICAL ACTIVITY AND WEIGHT LOSS MAINTENANCE IN OLDER ADULTS: LONG-TERM FOLLOW-UP DATA FROM FIVE RANDOMIZED TRIALS
Authors: Houston Denise , Neiberg Rebecca , Chen Shyh-Huei , Miller Michael , Kitzman Dalane , Rejeski W , Messier Steve , Nicklas Barb
Published: December 2023

Intentional weight loss (WL) in older adults is controversial as it may accelerate age-related muscle and bone loss, even if weight is regained. Current WL guidelines recommend physical activity (PA) for the maintenance of WL. However, whether participants who maintain WL have higher PA following randomized controlled trials (RCTs) of WL and PA is unknown. We examined PA among older adults from five WL and PA RCTs. Participants were invited to return for a follow-up visit 5-15 yrs after RCT completion (mean, 9.1 yrs). Among the 632 participants alive at long-term follow-up, 326 completed a follow-up visit (mean±SD age and BMI at randomization, 67.5±4.2 yrs and 33.8±4.9 kg/m2; 70% women). Weight change from baseline to long-term follow-up was assessed and participants categorized as weight gainers (>3%, 16%), weight maintainers (±3%, 32%), small weight losers (3-<10%, 28%), and large weight losers (>10%, 25%). Self-reported (CHAMPS) and objective (ActivPAL worn for 7 days) PA were assessed at long-term follow-up. Differences in PA by weight change groups were examined using mixed effects models adjusted for age, sex, race, WL assignment, time and study (as a random effect). There were no differences in self-reported PA by weight change group (all p’s>0.0.08). Objectively-measured steps per day (p=0.06) and stepping time (p=0.04) were marginally significant between groups, with large weight losers having greater values compared to weight gainers (mean: 4915 vs. 3790 steps/day and 70.8 vs. 55.1 minutes/day, respectively; p<0.05). Among those who returned at long-term follow-up, objectively measured PA was greater among large weight losers.
AGE-SPECIFIC POPULATION ATTRIBUTABLE FRACTIONS FOR THE IMPACT OF HYPERTENSION ON INCIDENT DEMENTIA
Authors: Smith Jason , Sharrett A Richey , Pike James , Gottesman Rebecca , Lutsey Pamela , Windham B Gwen , Coresh Josef , Deal Jennifer
Published: December 2023

The population attributable fraction (PAF) of dementia in United States attributable to hypertension is estimated at 7-9%. However, prior studies of the PAF might underestimate hypertension’s impact on dementia risk, given specific design limitations. Additionally, prior work neither accounted for changing prevalence/effects of hypertension with age nor considered early vs. later occurring dementia. Here, we quantified PAFs of dementia by age 80 from hypertension measured at midlife and late-life using individual-level data from the Atherosclerosis Risk in Communities Study. Incident dementia was determined by adjudicated review, telephone interviews, informant interviews, hospitalization records, and death certificates. We used measures of systolic and diastolic blood pressure (SBP, DBP) to define BP categories: normal BP (SBP < 120 and DBP < 80), elevated BP (SBP 120-129 and DBP < 80), stage 1 hypertension (SBP 130-139 or DBP 80-89), and stage 2 hypertension (SBP ≥140 or DBP ≥90); we also defined an overall non-normal BP value (SBP ≥120 or DBP ≥80). We generated hazard ratios (HRs) of 32-year incident dementia from Cox regression models that adjusted for demographic and clinical characteristics, and stratified by age at BP ascertainment (45-54, 55-64, 65-74). We then used the HRs to quantify PAFs of dementia from hypertension. We estimated that 15-20% of dementia cases by age 80 were attributable to non-normal BP. The strongest PAFs (12-21%) were from stage 2 hypertension. Current estimates of the dementia risk attributable to hypertension may be low. Targeting hypertension from midlife through early late-life could sizably reduce dementia risk.
AGE AND COHORT TRENDS OF RACIAL/ETHNIC DIFFERENCE IN RELIGIOUS PARTICIPATION AMONG MIDDLE-AGED AND OLDER AMERICANS
Authors: Liu Jingwen
Published: December 2023

Religious involvement is an important way of maintaining social connectedness for older Americans. While large quantities of studies have explored age and cohort effects of religious participation separately, less is known about racial/ethnic disparities. Applying growth curve modeling to the 2004-2020 waves of the Health and Retirement Study (N=134,734 person-years), the current study examines how religious attendance changes across the life course and among recent birth cohorts, as well as how exposure to immigration policy regimes (IPR) shapes Hispanic immigrants’ religious participation behaviors. Results suggest an overall reversed U-shape age trajectory with lower average levels and faster declines among more recent cohorts. Compared to White older adults, Black and Hispanic populations attend religious activities more frequently, but their attendance declines at faster rates in later life, leading to minimal White-Nonwhite differences in the oldest ages. However, Hispanic immigrants display significantly less decline in religious participation among more recent cohorts relative to Whites, although no similar trend is found between White and Black/native Hispanic older adults. Further analyses of Mexican Hispanic immigrants suggest that longer exposure to restricted IPR (since the Immigration Reform and Control Act of 1986, IRCA) is associated with increased religious attendance, but less restricted IPR (between 1964 and 1985) is associated with decreased religious participation net of age and cohort effects. These findings emphasize the importance of understanding the civic engagement experiences of Hispanic immigrants against the context of immigration policy regimes.
FUNSAT: A FUNCTIONAL SKILLS TRAINING PROGRAM
Authors: Czaja Sara , Harvey Philip , Kallestrup Peter
Published: December 2023

Performance of everyday activities is often challenging for older adults, especially for aging adults with a cognitive impairment (CI), which threatens independence and quality of life. We developed a novel computer-based functional skills assessment and training (FUNSAT) program, which includes simulations of everyday technology-based tasks (e.g., online banking, prescription refill, online shopping) important to everyday living. This presentation will present preliminary findings from our study that is evaluating the FUNSAT program with aging adults with and without a cognitive impairment. The sample includes 153 adults (83 with a CI, 130 females and 23 males) ranging in age from 60-92 yrs. Initially, participants completed the FUNSAT assessment and then engaged in the FUNSAT training program for up to 24 hours over 12 weeks at home after an initial in-person training. The non-cognitively impaired participants completed the FUNSAT training alone. The participants with a cognitive impairment were randomized into one of two conditions; FUNSAT training alone, or Cognitive Training (3 weeks) followed by FUNSAT training. We also evaluated transfer of training using ecological momentary assessment (EMA). Our preliminary findings indicate that participants irrespective of cognitive status are demonstrating significant gains in performance following training on the training tasks. Further, they are reporting an increase in confidence with respect to performing the tasks in daily living and the EMA data suggest transfer of training to other technology-based tasks. We will also discuss adherence to the home training protocol, which has important implications for implementation of the program beyond the research setting.
IMMIGRANT EXPERIENCES AND CARE ARRANGEMENTS LATER IN LIFE: EVIDENCE FROM THE MARIEL BOATLIFT
Authors: Diederich Freya
Published: December 2023

The role of public policy in older immigrants’ use of and access to services has mainly been regarded with respect to its legal framework. However, the way public policies are framed and societies’ perceptions of immigrant groups can additionally influence immigrants’ experiences, with long-lasting effects on needs and services use later in life. Still, the importance of these mechanisms has rarely been analyzed. This study uses the Mariel boatlift in 1980 as a case study to assess the relationship between circumstances that surround an immigrants’ cohort and their care arrangement later in life. Cuban immigrants from the Mariel boatlift were perceived in a different way by the federal government and the general population than Cuban immigrants who arrived previously. Based on data from the American Community Survey (2008-2021), care arrangements of older Cubans who arrived in 1980, who are limited in daily activities, and who reside in the Miami area are compared to care arrangements of Cubans that immigrated before. Regression models are estimated and individual characteristics are accounted for. Compared to Cubans who arrived before 1980, Cubans of the Mariel boatlift are more likely to live in the community than in an institutional setting. However, among those living in the community, Cubans of the Mariel boatlift reveal a higher risk of living alone. The results suggest that Cubans of the Mariel boatlift are at higher risk for unmet needs. It is discussed how circumstances that surround immigrants’ cohort of arrival shape immigrants’ services needs and use.
THE USE OF AMBULATORY VERSUS EMERGENCY SERVICES AMONG SENIOR ADULTS WITH LIMITED ENGLISH PROFICIENCY
Authors: Glicksman Allen , Davey Adam , Albert Steven , Friedman Ari , Lai Philip , Ring Lauren , Rodriguez Misha , Liebman Michael
Published: December 2023

Senior adults who are immigrants with limited English proficiency may have difficulty accessing health and social services. However, identifying patients with LEP in large databases such as insurance claims has historically been challenging. We overcome this with two strategies. First, we conducted focus groups among older Spanish and Chinese speakers. Based on the findings we hypothesize that 1) we can expect distinct patterns of service use associated with a common language and 2) Chinese speakers are more likely than Spanish speakers to use ambulatory services and less likely to use emergency services because Chinese speakers feel more confident in their ability to navigate formal systems. Next, we obtained data on Spanish and Chinese speakers aged 60 and older and living in Philadelphia from a regional health information exchange, including routinely collected data on patients’ primary language and English proficiency. We are using the data to test our hypotheses regarding these specific LEP populations. The data will be used as pilot for a study to further investigate attitudes and perceptions of formal care providers in these two LEP communities.
DELIVERING AND EVALUATING A VIRTUAL DYADIC BEHAVIORAL SLEEP INTERVENTION
Authors: Brewster Glenna , Pelkmans Jordan , Hepburn Kenneth
Published: December 2023

Disturbed sleep is prevalent among persons living with cognitive impairment and dementia and their care partners. While there are few interventions for care partners to manage their sleep problems there is a paucity of interventions where both the person living with cognitive impairment and their care partner work together to improve their sleep outcomes. The aim of this presentation is to discuss how we recruited participants and delivered and evaluated caregiver and person living with cognitive impairment outcomes of a 4-week videoconferencing delivered cognitive behavioral therapy for insomnia intervention. Recruitment is time intensive but feasible. In general, both members of the dyad reported a reduction in their insomnia scores. Care partners supported the person living with cognitive impairment with completing the diaries. Qualitatively, care partners didn’t report much difficulty with completing the diaries. Dyads reported enjoying the relaxation and the pleasant activities. Among those who had pets, it was difficult to follow the instructions regarding not having them in bed. They also had difficulty with the cognitive therapy logs. Most persons living with cognitive impairment did not use the cognitive therapy logs. This pilot study of a 4-session videoconferencing-delivered cognitive behavioral therapy for insomnia intervention resulted in positive outcomes for persons living with cognitive impairment and/or dementia and their care partners and qualitative feedback provided ways to tailor the intervention for a larger study.
ACCEPTABILITY AND PRELIMINARY EFFICACY OF THE TAKING CARE OF US INTERVENTION FOR COUPLES LIVING WITH HEART FAILURE
Authors: Lyons Karen , Whitlatch Carol , Vest Amanda , Upshaw Jenica , Johnson Stacy Hutton , Walters Anna , Lee Christopher
Published: December 2023

There are over 1 million hospital admissions and 3 million emergency room visits for heart failure (HF) annually in the USA. Despite significant impact of HF on both members of the care dyad, there are few interventions focused on optimizing the mental and relational health of the dyad. The Taking Care of Us© (TCU) intervention is a communication-based program for the couple living with HF. Sessions focus on facilitating greater shared appraisal, communication, collaborative illness management, confidence, and support between partners. Thirty seven couples were randomized to TCU (18 couples) or an educational control (19 couples). Both programs were delivered virtually over two months. Adults with HF (AwHF) were, on average, 69.9 (SD=9.6) years old and predominantly male (70%). Eighty one percent of couples participated in at least one session (attrition was relatively even across conditions and primarily due to poor health and partner drop-out). Twenty-four couples (65%) completed follow-up surveys. The majority of TCU participants were satisfied with the program (AwHF 82%; care partners 100%) and felt they understood their partner’s needs better (AwHF 91%; care partners 91%). TCU care partners felt the relationship had improved (91%) and felt more confident managing HF (91%). Depressive symptoms decreased in TCU AwHF (ES=.60) compared to the active control group. TCU couples also reported increases in collaboration (ES=.50-.70) and communication (ES=.35-.50). Discussion will focus on the individual versus dyadic benefits of the TCU program, recruitment and retention challenges, and qualitative feedback from participants regarding strengths of the program and areas for improvement.
DAILY STRESSOR CONTROL AND AFFECTIVE REACTIONS: THE UNIQUE ROLE OF INTERPERSONAL STRESS
Authors: Witzel Dakota , Cerino Eric , Taylor Zachary , Almeida David
Published: December 2023

Perceived control over daily stressors varies across life and stressor domains, but little is known about the function of perceived control as a protective resource for the impact of daily stressors on affective well-being. Using the third wave of the National Study of Daily Experiences (NSDEIII; N=1,263, Mage=62.62, 57.20% women), we examined how stressor control across domains (interpersonal stress, work and home overloads, network stressors) was associated with both negative and positive emotions on the same-day (i.e., reactivity) and next-day (i.e., residue). Over eight consecutive days, participants reported their daily negative and positive emotions, as well as exposure to and control over stressful experiences. After adjusting for age and gender, two-level multilevel models revealed a protective patterning of stressor control for dampened affective reactions to daily stressors driven by stressor control domains specific to interpersonal interactions (ps<.05). Days when people perceived more control over their arguments or avoided arguments were related to less negative and positive affective reactivity (smaller increases/decreases in negative/positive affect, respectively) compared to days with less perceived control. Perceived control over daily work stressors and home stressors were associated with dampened negative and positive affective reactivity, respectively. No associations between perceived stressor control and affective residue were significant. Results underscore the import of perceived stressor control for interpersonal stressors and the utility of perceived control as a protective factor for the effects of arguments and avoided arguments. Individuals may aim to leverage additional resources to feel more in control of their own daily arguments and avoided arguments.
TIFFS, TOSSES, AND TURNS: EFFECTS OF AFFECTIVE REACTIVITY TO INTERPERSONAL STRESSORS DURING THE DAY ON NIGHTLY SLEEP
Authors: Wen Jin , Klaiber Patrick , Sin Nancy
Published: December 2023

Background

Sleep has been recognized as an antecedent as well as a consequence of daytime stress. However, less research has compared the role of different stressor types on same-night sleep in the context of daily life. Interpersonal stressors may be particularly important, given that social stressors to elicit greater stress responses than other forms of stressors. This study tested the hypothesis that following days when a person exhibits greater negative affect (NA) reactivity to stressors (versus on days with less NA reactivity), sleep quality will be lower. This link between affective reactivity to stressors and subsequent sleep was expected to be more pronounced for interpersonal stressors versus non-interpersonal stressors.

Methods

In this pre-registered study, 252 adults in British Columbia, Canada (ages 25 to 87y; 68% women; 64% White) completed mobile surveys 5x/day for 14 days to assess daily stressors and NA. Self-reported sleep quality was assessed in morning surveys. Multilevel-models tested daily stressors (interpersonal, non-interpersonal, or no stressors), daily NA (averaged across the day), and their interaction as predictors of subsequent sleep quality, controlling for prior-night sleep quality and sociodemographics.

Results

Daily NA and stressor occurrence independently predicted poorer subsequent sleep quality. Stressor type moderated the relationship between NA and sleep quality, such that this association was stronger for interpersonal compared to non-interpersonal stressors.

Discussion

The findings suggest that encountering interpersonal stressors may be particularly impactful to one’s subsequent sleep. Future studies should consider investigating potential mechanisms that may underlie this association, such as pre-sleep cognitive, emotional, and physiological arousal.
DAYS SPENT AT HOME BEFORE AND AFTER HIP FRACTURE AMONG MEDICARE BENEFICIARIES LIVING WITH DEMENTIA: A COHORT STUDY
Authors: Falvey Jason , Chen Chixiang , Johnson Abree , Ryan Kathleen , Shardell Michelle , Ren Haoyu , Reider Lisa , Magaziner Jay
Published: December 2023

Hip fracture is a disabling event experienced disproportionately by older adults with Alzheimer’s disease or related dementias (ADRD). Understanding how to better prognosticate outcomes for this population could drive more tailored clinical decision making. Our objective was to identify distinct trajectories of health before a hip fracture and determine their influences on post-fracture recovery trajectories and 1-year mortality rates among older adults with Alzheimer’s disease or related dementias (ADRD). We conducted a cohort study of 16,576 community-dwelling Medicare beneficiaries living with ADRD who experienced hip fracture between 2010 and 2017. We used latent mixture modeling to evaluate trajectories of days at home assessed monthly up to 180 days prior to hospitalization, and their associations with post-fracture days at home and 1-year mortality. Before a hip fracture, 3 distinct trajectories were identified: Robust (n=14,980, 90.3%), Impaired but Improving (n=809, 5.3%), and Impaired and Declining (n=787, 4.7%). Membership in the Impaired and Declining pre-fracture trajectory was strongly associated with membership in less favorable post-fracture recovery trajectories and 65% higher 1-year mortality rate (hazard ratio 1.65, 95% confidence interval 1.45-1.87) as compared to those in the Robust trajectory group. Similar albeit weaker associations were observed between membership in the Impaired but Improving pre-fracture trajectory and post-fracture outcomes. Overall, our results indicate that pre-fracture days at home trajectories are highly associated with post-hospitalization outcomes among older adults with ADRD and could be used to guide care management decisions.
BEYOND STEP COUNTING: SENSOR-BASED EVALUATION OF HIP FRACTURE PATIENTS’ MOBILITY IN THE REAL WORLD
Authors: Jansen Carl-Philipp , Klenk Jochen , Blain Hubert , Vereijken Beatrix , Helbostad Jorunn , Becker Clemens
Published: December 2023

After a hip fracture, rehabilitation starts with the primary aim to get older persons back on their feet and mobile again. Multidisciplinary hospital treatment is suggested as the first essential step for optimization of care immediately after the fracture, followed by subacute exercise interventions to further improve mobility. However, reported outcomes of rehabilitation vary widely geographically and within regions and most often consist of repeated physical capacity measures without knowledge of the actual mobility behaviour of patients after hospital care. Evidence emerges that small changes in physical capacity (e.g., gait speed) coincide with larger changes in physical activity (e.g., number of steps) during the first six months post-fracture. In a pooled longitudinal analysis of n=785 hip fracture patients (mean age: 83.4 years, SD=6.1) from Germany and Norway, we found daily walking duration trajectories to increase until week 28 post surgery, and that 50% of the peak mobility was achieved within the first four weeks. Still, in order to better understand the underlying mechanisms of mobility performance and to improve rehabilitation measures, in-depth data on patients’ real-world mobility beyond walking volume is needed. Therefore, in the Mobilise-D project, a novel sensor algorithm is used to quantify patients’ real-world mobility with higher granularity and more extensive information. Baseline data on physical capacity measures, sensor-based mobility outcomes, and patient-reported outcomes of mobility and function of n= 454 (mean age: 78.1 years, SD=9.2) hip fracture patients is presented.
GETTING BETTER OR GETTING WORSE: MARKERS OF LONGEVITY ACROSS COHORTS AND COUNTRIES
Authors: Martin Peter , Gondo Yasuyuki , Ribeiro Oscar
Published: December 2023

The expansion of life expectancy and the lengthening of the human life span are extraordinary achievements observed over the last century. Among those accomplishments is the increasing number of centenarians in many countries. However, it is not clear whether new cohorts of centenarians are in better health when compared to earlier born cohorts of centenarians. The purpose of this symposium is to compare centenarian cohorts across different countries. Two centenarian cohorts each from Hong Kong, Japan, and the United States are included in the analyses. Results provide different perspectives across countries. The Hong Kong Centenarian Studies compared current centenarians to those who participated at an earlier time and noted that proxies in the second study rated centenarians in worse health when compared to centenarian self-ratings. The Kyotango study assessed living conditions, care need level, ADL, IADL, and cognitive function by gender and noted cognitive improvement for men. Finally, later cohorts of the U.S. Health and Retirement Study were in worse health when compared to the earlier born cohort. The results provide an indication for policy makers and practitioners who will prepare for a larger number of centenarians in need of additional support. Although some improvement for later born cohorts is noticeable, it is obvious that more care provision will also be needed as centenarians around the world will survive with more health conditions. Additional research should evaluate centenarians in other parts of the world.
INTRODUCING CENTENARIAN STUDIES IN AN AGING WORLD
Authors: Martin Peter
Published: December 2023

Centenarian studies have come of age. With the first comprehensive centenarian studies conducted more than 35 years ago, there are now centenarian databases in the United States, in Europe, and in Asian countries. The major focus of these studies has been on genetic and family longevity factors, on support systems, personality, and on health behaviors. Another emphasis has been on various health components, such as physical health, mental health, frailty, and psychological well-being. In recent years, a second generation of centenarian studies has been initiated, comparing earlier born cohorts with later born cohorts. Among the first studies conducting a cohort comparison, the Danish centenarian studies, the Georgia centenarian studies, and the Tokyo centenarian studies showed inconsistent results. Whereas some studies indicated that later born cohorts enjoyed higher levels of functioning (e.g., Denmark, U.S. Georgia), other studies showed poorer performance (e.g., Japan). The current symposium sheds additional light on cohort comparisons with recently collected data from the second Hong Kong Centenarian Study, the Kyotango centenarian cohort, and the Health and Retirement Study. This presentation summarizes major findings from centenarian studies conducted around the world and highlights activities of the International Consortium of Centenarian Studies (ICC).
RANDOMIZED CONTROLLED TRIAL OF LAY-DELIVERED INTERVENTION FOR DEPRESSED OLDER ADULTS
Authors: Gum Amber , Conner Kyaien , Crawford Nicole , Raue Patrick , Sirey Jo Anne
Published: December 2023

The first speaker will describe the background, aims, methods, and progress of an ongoing NIMH collaborative R01, three-site RCT. Across three sites (University of Washington, Cornell Weill Medicine, and University of South Florida), 288 depressed older adults will be enrolled, randomized to receive 9 sessions of BA from clinicians (e.g., social worker or mental health counselor) or 9 sessions of DMFB from a trained older adult volunteer coach, and assessed on primary outcomes (Behavioral Activation for Depression Scale [BADS], Hamilton Rating Scale for Depression [Ham-D]) and other outcomes at baseline, 3-, 6-, 9-, 24-, and 36-weeks. Clinician BA training and certification involves two 2-hour training workshops including didactics, demonstration, and role play; followed by delivering the intervention with one “certification” client reviewed and approved by external raters. Coach DMFB training and certification follow a similar process, except that training is longer (4 2-hour workshops) with more didactics, demonstrations, and role plays. After training, clinicians and coaches participate in regular weekly supervision, and all client sessions are audio-recorded, with at least one session per client randomly selected for independent review. This trial involves close collaboration with representative of a county lead aging service agency, numerous senior centers and organizations, and an Area Agency on Aging (AAA) for recruitment, outreach events, engagement of clinicians and volunteer coaches, and study dissemination. Across sites, 24 clinicians and 23 volunteers have been trained and certified, and 124 participants have been enrolled (as of February 15, 2023).
RANDOMIZED CONTROLLED TRIAL OF LAY-DELIVERED INTERVENTION FOR OLDER ADULTS DISCHARGED FROM THE HOSPITAL
Authors: Conner Kyaien , Kip Stephanie , Gum Amber
Published: December 2023

The second speaker will describe the background, aims, methods, and progress of a PCORI-funded RCT to reduce rehospitalization for Black/African American and Hispanic/Latino older adults after medical hospitalization. Across three regional hospitals, 402 older adults living with chronic illness (e.g., cardiovascular disease, diabetes, hypertension etc.,) will be enrolled while inpatient at one of our three partnering hospitals and randomized to receive one of three interventions in this comparative effectiveness trial: (1) the evidence-based Care Transitions Intervention (CTI), (2) CTI plus a peer educator intervention (CTI+Peer), or (3) usual care. Participants are assessed at 4 timepoints (baseline, 30 days, 90 days and 6 months) to examine differences in the primary outcomes of 30-day all cause hospital readmissions and emergency department visits. Secondary outcomes including quality of life, self-efficacy managing chronic disease, functioning, perceived social support and mortality. CTI Coaches and Peer educators participate in rigorous trainings which includes both didactic and interactive components to ensure interventionists are able to deliver the intervention with fidelity to the models. After training, CTI Coaches and Peer Educators participate in regular supervision meetings. They receive weekly virtual supervision check-ins from USF study staff and participate in a monthly group-based supervision in person. This trial involves close collaboration with leaders and coordinators at each hospital and an Area Agency on Aging (AAA) for recruitment, engagement of study interventionists and study dissemination. Across sites, 18 CTI Coaches and 11 Peer Educators have been trained and certified, and 145 participants have been enrolled (as of 3/8/2023).
OLDER ADULT VOLUNTEER AND PEER EDUCATOR EXPERIENCES COLLABORATING ON INTERVENTION RESEARCH
Authors: Rubio Enid , Allen Odell
Published: December 2023

The final two speakers will present on their experiences, benefits, and challenges of collaborating on both trials described previously as an older adult volunteer coach or peer educator. One speaker is a DMFB Coach trained and certified in the DMFB intervention for depressed older adults, who delivered the intervention to five English-speaking older adults and is in the process of delivering the intervention to five Spanish-speaking older adults. One speaker is a Peer Educator for the hospital trial, trained and certified in a peer educator intervention for older adults after hospitalization, to support their transition and self-management at home. Each speaker will discuss their experiences delivering their respective interventions, including an overview of the training, certification, and supervision processes, as well as benefits and challenges. Benefits include the satisfaction of helping others, connecting with other coaches and peer educators, and learning technical skills and the intervention. Challenges have included technical issues related to virtual delivery, which are being overcome through technical assistance from the study teams; balancing the expectations of the program with other personal responsibilities, which are managed through discussion with supervisors and the study team being as flexible as possible, such as with scheduling; and occasional challenges with clients, which are addressed through regular and ad hoc supervision. The speakers will end with recommendations for other study teams that plan to work with older adults delivering behavioral interventions.
AGING-IN-PLACE TECHNOLOGY: PROGRAMMING TO ADDRESS SOCIAL CONNECTEDNESS AND MENTAL HEALTH
Authors: Morgen Keith , Jacob Peter
Published: December 2023

According to the National Academies of Sciences, Engineering, and Medicine, the drastic increase of older adult social isolation from the pandemic has contributed to premature death, dementia, anxiety, and suicide. Jewish Family Service of Central New Jersey (JFSCNJ) clients corroborated this phenomenon with 65% meeting the diagnostic criteria for moderate to severe older adult depression or anxiety in 2020. In 2022, JFSCNJ established the Fig Tree Virtual Senior Center, a dynamic program that focused on older adults as they readjust to a post-pandemic world. By addressing social isolation through a Person-Centered Trauma Informed and biopsychosocial approaches, various wellness programs were provided in-home via the use of virtual video programming. Sixteen older adults (age range 68-95 years-old) were assessed on anxiety and depressive symptoms and social connectedness both prior to and six months following the start of the video programming intervention. Paired samples t-testing found a significant reduction in self-reported anxiety (p=.01) and depressive (p=.05) symptoms after video programming engagement at six-months follow-up. Path analysis using bootstrapping with bias corrected confidence intervals found amount of video programming with a positive and significant indirect effect on both increased social connectedness and improved well-being. Implications for homebound older adult social engagement and well-being programming will be discussed.
IRVING S. WRIGHT AWARD, VINCENT CRISTOFALO AWARD, AND TERRIE FOX WETLE AWARD PRESENTATIONS AND LECTURES
Authors: Austad Steven
Published: December 2023

The Irving S. Wright Award of Distinction Lecture will feature an address by the 2023 recipient Rafael De Cabo, BS, FGSA of National Institute on Aging, National Institutes of Health. The Vincent Cristofalo Rising Star Award in Aging Research lecture will feature an address by the 2023 recipient Ming Xu, PhD of UConn Health. The Terrie Fox Wetle Award lecture will feature an address by the 2023 recipient Claire Ankunda, MD, MPH. MSc of Icahn School of Medicine at Mount Sinai. These awards are given by the American Federation for Aging Research, Inc.
HOW MEDICARE ADVANTAGE IS SHAPING THE CARE OF OLDER ADULTS WITH SERIOUS ILLNESS
Authors: Ankuda Claire
Published: December 2023

The Medicare Advantage (MA) program currently insures half of Medicare beneficiaries, and yet there are major gaps in our understanding of how it is impacting older adults, particularly those with serious illness and at the end of life. This population is particularly vulnerable to lapses in care quality in MA given their complex health care needs and challenges navigating MA cost-control mechanisms such as prior authorizations and narrow networks. I will present a framework to consider how MA is influencing care delivery and outcomes for older adults, a review of what we know about the impact of the dramatic growth of MA plans, and emerging data on the experience of older adults with serious illness in MA. This session will highlight best-practices regarding use of claims and population data to evaluate the MA program.
ADVANCE CARE PLANNING ACROSS SOCIODEMOGRAPHIC CHARACTERISTICS AND COGNITION LEVELS
Authors: Rahemi Zahra , Adams Swann
Published: December 2023

Older adults from underrepresented and minority groups have higher rates of chronic disease and cognitive impairment and lower rates of advance care planning and comfort care at the end of life. This study examined advance care planning in U.S. older adults across different sociodemographic characteristics and cognition levels. Secondary data analyses were conducted using the 2014 Health and Retirement Study. Logistic regression models were run with each outcome variable (having living will, durable power of attorney for healthcare [DPOAH], and both the living will and DPOAH) stratified by cognition (dementia/impaired cognition versus normal cognition). Prediction variables included race, ethnicity, rurality, marital status, gender, education, age, everyday discrimination, social support, and loneliness. Of the 17,698 respondents, 77.8% had normal cognition and 22.2% had a diagnosis of dementia or impaired cognition. Black and Hispanic participants and younger individuals with lower levels of education were less likely to have a living will or both DPOAH and living will in place. Race and ethnicity were significant predictors of DPOAH among the normal cognition group but not in the dementia group. Rurality significantly predicted having a living will and both DPOAH/living will for the normal cognition group but not the dementia/impaired cognition group. This study provides evidence of the need to understand advance care planning disparities among older adults with multiple marginalized identities and different cognition levels. The findings are important for examining advance care planning regarding what matters to diverse older adults as they age and confront health and cognition decline.