bluuebunny/crossref_metadata_2025 huggingface dataset:
MISSISSIPPI’S BOLD PUBLIC HEALTH RESPONSE TO DEMENTIA IN RURAL AND TRIBAL AREAS
Authors: White Kina , Edwards-Childs Paulita
Published: January 2025

Individuals living in rural communities are at an increased risk for Alzheimer’s disease and related dementias (ADRD), which aligns with other complex place-based health disparities. ADRD represents a significant public health issue in Mississippi, with the state having the highest age-adjusted mortality rates due to ADRD in the nation. The burden of ADRD in Mississippi falls disproportionately on rural and minority populations, with the state having the highest percentage of Blacks/African Americans in the nation and all 82 counties being considered medically underserved due to a lack of physicians and healthcare facilities. Given that Alzheimer’s disease and related dementias are more common with advanced age, this may increasingly affect Indian Country with a higher health burden. Mississippi’s BOLD public health response to addressing ADRD includes a collective impact of key stakeholders and prevention strategies to emphasize a life course approach for improved health outcomes. The response encompasses strategies such as community education, caregiver support programs, early detection initiatives, and access to dementia-friendly services. Moreover, it emphasizes the importance of collaboration with tribal nations, leveraging local resources, and integrating traditional and healing practices into dementia care. Key examples of these strategies include establishing dementia-friendly congregations and communities, as well as training older adult volunteers as healthy aging champions to advocate for improved local policies that allow them to age in their places and communities.
“STANDING IN THE GAP”: EXPERIENCES OF MEDICAID HOME AND COMMUNITY-BASED SERVICE SUPPORTS PLANNERS IN MARYLAND
Authors: Fabius Chanee , Rathakrishnan Sharmini
Published: January 2025

Medicaid Home and Community-Based Service (HCBS) care managers (called “supports planners” in Maryland) are responsible for coordinating care delivery and play a crucial role in bridging the gap between older adults, families, and home care and state agencies. This assistance is particularly relevant for older adults living with dementia and their families, as they represent nearly one-third of Medicaid HCBS participants, nationally. Despite their pivotal role in home care delivery and care quality, there is a paucity of research describing the contributions and experiences of supports planners. This study aims to improve the understanding of the role of supports planners, with implications for enhancing care coordination for older adults with dementia within Maryland’s Medicaid HCBS. We conducted seven semi-structured interviews with supports planners in Maryland from December 2023 to February 2024. Interviews were recorded, transcribed, and coded by the research team. Supports planners ranged in age from 26 to 54, were mostly female (n=5). Four supports planners were white, and three were black. Thematic analysis revealed four key themes highlighted by supports planners: 1) collaborations with paid and unpaid caregivers; 2) dementia-related care coordination; 3) the electronic management system as an information hub; and 4) supports planners’ role as liaisons in HCBS. The present study further emphasizes that supports planners are involved in numerous aspects of home care delivery. Our findings illuminate the role of supports planners in Medicaid HCBS and have implications for improving care coordination for older adults living with disabilities, especially those living with dementia.
HOME HEALTH CLINICIAN PERSPECTIVES ON ASSESSING AND SUPPORTING DEMENTIA CAREGIVERS
Authors: Burgdorf Julia , McDonald Margaret , Bowles Kathryn
Published: January 2025

Home Health Care (HHC) delivers skilled services via visits to patients’ homes. One-third of HHC patients have dementia and caregivers play a critical role in their care. Yet, it is difficult to assess caregivers’ training/support needs during HHC. As part of ongoing formative research aimed at developing a dementia caregiver assessment intervention for HHC, we convened semi-structured group interviews with 16 frontline staff from a large, urban HHC agency—Registered Nurses (n=5), Physical Therapists (n=5), and Social Workers (n=6). Staff shared their perspectives on current communication with caregivers and reacted to a proposed health information technology (HIT) solution for assessing caregiver needs. Participants highlighted social work’s critical role in connecting caregivers with community resources to bridge the gap of “a short-term benefit trying to meet long-term needs”. Staff emphasized the importance of gathering information regarding dementia patients’ complex caregiving networks (encompassing family, paid attendants, and HHC aides with varying schedules and task loads) but noted there were few options for storing and sharing this information in the patient record. Respondents expressed enthusiasm for an HIT-driven assessment tool linked to the patient record and requested that such a tool (1) come with a repository of community resources, (2) support information sharing among the care team and between episodes, and (3) include education for caregivers on dementia symptoms and the scope of HHC. Findings shed light on current barriers and opportunities for supporting dementia caregivers in HHC and reveal practical considerations for designing an intervention that will integrate with existing HHC workflows.
UNMET CAREGIVING NEEDS AMONG HOME HEALTH PATIENTS WITH DEMENTIA: FRONTLINE CLINICIAN REPORTS
Authors: Burgdorf Julia
Published: January 2025

One-third of Medicare home health care (HHC) patients have diagnosed dementia and rely heavily on support from family caregivers to implement the plan of care, but no prior work has examined unmet caregiving needs among these patients. Drawing on clinician reports in 2018 Medicare HHC assessment data for a national sample of 426,606 HHC patients with diagnosed dementia, we define unmet caregiving needs stemming from lack of availability (i.e., no caregiver is present) or lack of capacity (i.e., caregiver requires clinician supervision and training). Given the progressive nature of the disease, we compare across 3 levels of dementia symptom severity, determined by clinician-reported cognitive and behavioral symptoms. Comparing those with mild, moderate, and severe dementia symptoms, unmet needs due to lack of caregiver availability were present for 9.1%, 6.9%, and 5.3% of patients, respectively; unmet needs due to lack of caregiver capacity were present for 70.6%, 71.1%, and 74.9% of patients, respectively. In adjusted multilevel models controlling for patient and HHC agency characteristics and clustering at the agency level, individuals with more severe dementia symptoms were less likely to have an unmet need for caregiver assistance due to a lack of caregiver availability (aOR: 0.63; 95% CI: 0.60-0.66), but more likely to have an unmet need due to a lack of caregiver capacity (aOR: 1.15; 95% CI: 1.12-1.17). Findings suggest the need for varied approaches to caregiving-related support based on dementia disease stage and highlight widespread needs for clinicians to provide caregiver training during HHC episodes for those with dementia.
EXPLORING THE IMPACT OF TELE-GERIATRIC MENTAL HEALTH SERVICES ON RURAL CAREGIVERS’ WELL-BEING
Authors: Humber Marika , Carlson Chalise , Brodrick Marisa-Francesca , VanPutten Rachel , Peeples Amanda , Trivedi Ranak , Lloyd Althea , Gould Christine
Published: January 2025

Rural caregivers may experience unique barriers to support including lack of services, transportation, and internet access. Within the Veterans Health Administration (VHA), a virtual geriatric psychiatry consultation service evolved to increase specialty mental health care access for rural older Veterans. Although the Veteran and their neurocognitive disorder (e.g., Alzheimer’s disease) and/or mental health condition (e.g., depression, PTSD) were the focus of the service, caregivers were also present at appointments. This study explored the impact of the service on rural caregivers in two VHA regions. The median age of patients was 77; caregivers were a spouse or adult child. Semi-structured interviews with caregivers (n=13) inquiring about overall experience and satisfaction with the service, changes to patient care and symptoms resulting from visits, and the service’s impact on the caregiver were conducted from September 2022-November 2023. Using rapid qualitative analysis, interview transcripts were summarized and compared to identify themes. Caregivers reported working with the geriatrics providers normalized the caregiving experience and provided helpful techniques and resources for managing challenging patient behaviors. Rural caregivers appreciated that visits were done at home alleviating the time and effort required to travel to distant VHA facilities and that providers could spend more time focusing on patient and caregiver needs. The direct access to specialty providers via follow-up appointments or by telephone to ask questions and address emergent problems was particularly valuable. These findings indicate that integrating caregivers into specialty tele-geriatric mental health services may decrease burden and improve well-being for caregivers of rural older Veterans.
ADAPTING DIALECTICAL BEHAVIOR THERAPY TO ADDRESS CAREGIVER HEALTH IN HIGH-CONFLICT CAREGIVING SITUATIONS
Authors: VanPutten Rachel , Drossel Claudia , Waltz Thomas
Published: January 2025

Family caregivers of older adults with neurocognitive disorders (NCDs) are invisible patients in the U.S. healthcare system. This is especially concerning because poor caregiver mental or physical health predicts coercive care practices (e.g., yelling or threatening the older adult). When older adults with NCD come to providers’ attention for emotional and behavioral changes, systematic strategies for assessing and intervening on caregiver health and potential coercive caregiving patterns are lacking. The present study consisted of a retrospective chart review of clinical records from family caregivers who participated in dialectical behavior therapy (DBT) skills training groups adapted for high-conflict situations involving older adults with NCDs (Drossel, Fisher, & Mercer, 2011) in a doctoral-level psychology training clinic in the Midwest. Data from 32 family caregivers enrolled across eight 8-week DBT groups showed that caregivers whose medical records indicated significant health problems tended to describe themselves as healthy when completing the RAND 36-Item Health Survey (SF-36; Hayes et al., 1993). Attrition from the groups was mainly due to acute medical crises, and caregivers required significant individual support to address their medical concerns, prompting modifications to the DBT mindfulness and interpersonal effectiveness modules (e.g., developing DEAR MAN scripts to delegate care tasks to third-party providers). These findings suggest the need for routine, systematic, and direct assessments of caregiver health and skills-based approaches targeting health promotion and disease prevention to address coercive caregiving practices.
LIFETIME AND CURRENT CANNABIS USE BY OLDER WOMEN WITH HIV PARTICIPATING IN THE MACS/WIHS COMBINED COHORT STUDY
Authors: Bobitt Julie
Published: January 2025

The proportion of persons living with HIV who use cannabis is 2-3 times higher than the general population with past-year use rates ranging from 23%-56% in persons with HIV compared to 13% in persons without. A Women’s Interagency HIV Study (WIHS) found cannabis use by women to be 27%. We will present findings from interviews with 30 women aged 60+ enrolled in the MWCCS Cook County site. Guided by the socioecological framework, the interviews explore the multi-level influences on cannabis use decision-making and health outcomes. Our thematic analysis focuses on the following influences: 1) individual (attitudes, knowledge, health conditions); 2) Relationship (social connections/responsibilities); 3) Community (medical), and 4) Societal (legalization). We also explore cannabis use drivers on HIV-related pain relief, anxiety, and stress. As cannabis use among chronically ill persons continues to rise, it is important to understand the factors that influence use and health outcomes.
THE CLARK TIBBITTS AWARD AND HIRAM J. FRIEDSAM AWARD LECTURES AND PRESENTATIONS
Authors: Montepare Joann
Published: January 2025

The Clark Tibbitts Award Lecture will feature an address by the 2024 award recipient Joann M. Motepare, PhD, FGSA, FAGHE, of Lasell University. The Hiram J. Friedsam Award Lecture will feature an address by the 2024 award recipient Dana Burr Bradley, PhD, FGSA, FAGHE, of the University of Maryland Baltimore County. AGHE’s Clark Tibbitts Award was established in 1980 and named for an architect of the field of gerontological education. The award is given each year to an individual or organization that has made an outstanding contribution to the advancement of gerontology and geriatrics education. Hiram J. Friedsam was the professor, co-founder, and director of the Center for Studies in Aging and dean of the School of Community Service at the University of Northern Texas. Dr. Friedsam was an outstanding teacher, researcher, colleague, and mentor to students, faculty, and administrators, as well as a past president of AGHE. The purpose of this award is to recognize those who emulate Dr. Friedsam’s excellence in mentorship.
LONG-TERM OUTDOOR AIR POLLUTION CONCENTRATIONS AND COGNITION: FINDINGS FROM THE HCAP SUBSTUDY OF ELSA
Authors: Gessa Giorgio Di
Published: January 2025

Background

Although air pollution has been associated with cognitive impairment, several key details of these relationships remain unknown. This includes understanding how different pollutants and their emission sources impact the brain as well as the particular aspects of cognition that are susceptible to pollution. In this study, we consider the associations between 8 years of exposure to different air pollutants (including total PM2.5 and PM2.5 from different emission sources, and NO2) with different domains of cognitive performance among older people.

Methods

We used data from the Harmonized Cognitive Assessment Protocol (HCAP) sub-study of the English Longitudinal Study of Ageing (2018, N~1,200). This study measured a range of key cognitive domains affected by cognitive ageing, including attention, memory, executive function, language, and visuospatial function. Outdoor concentrations of each pollutant for all HCAP respondents’ residences were assessed since 2010. Averages and group-based trajectory modelling were then used to summarise long-term air pollution exposures and their relationships with cognition After adjustment for key personal and neighbourhood confounders.

Results

Preliminary results suggest that respondents with higher residential levels of air pollution reported poorer cognitive function, especially for verbal fluency and executive function. Particularly, we found sustained high levels of NO2 to be associated with poorer cognition, even when baseline levels of cognition were accounted for (B=-1.75, 95%CI=-3.43;-0.06). Regarding PM2.5, our results suggest that emissions from industry are particularly detrimental to cognition.

Conclusions

Efforts to reduce levels of exposure to air pollution should continue as this is a risk factor for poorer cognitive performance.
LONG-TERM EXPOSURE TO AIR POLLUTION AND RISK OF DEMENTIA AMONG OLDER INDIVIDUALS OF A DANISH NATIONWIDE ANALYSES
Authors: So Rina , Andersen Zorana , Lim Youn-Hee , Zhang Jiawei , Tuffier Stéphane , Cole-Hunter Thomas
Published: January 2025

The evidence linking air pollution with dementia has been fast growing over the last decade, but who is most susceptible remains rarely explored. Therefore, we aimed to examine the association between long-term exposure air pollution and incidence of dementia and identify the most susceptible groups by age, sex, socioeconomic status (SES), and comorbidities with major chronic diseases. We followed all Danish residents aged 60 years or older on January 1st, 2000 until December 31st, 2018. Annual mean concentrations of fine particulate matter (PM2.5), nitrogen dioxide (NO2), and black carbon (BC) in 2010 (100x100m) were estimated using European-wide hybrid land-use regression models and assigned to the baseline residential address. We used Cox proportional hazard models to evaluate the association between air pollution and dementia incidence, accounting for individual and area-level SES, and introduced an interaction term to test for effect modification by age, sex, income, education, employment, and co-morbidity with cardio-metabolic, respiratory diseases and depression. Of 934,792 subjects, 81,731 developed dementia. We detected statistically significant associations of all three pollutants with incidence of dementia, with hazard ratios (HRs) and 95% confidence intervals (CIs) of 1.14 (1.12-1.16) per 1.9 μg/m3 increase in PM2.5, 1.25 (122-1.28) per 10.2 μg/m3 increase in NO2, and 1.23 (1.20-1.26) per 0.5×10-5/m increase in BC. Associations were stronger in the elderly (≥75 years), stroke patients, unemployed, and those with the lower income or education. In this nationwide analysis in a low-exposure setting in Demark, long-term exposure to air pollution contributes to the development of dementia.
EXTREME HEAT EXPOSURE AND EPIGENETIC AGING ACCELERATION AMONG OLDER ADULTS IN THE US
Authors: Choi Eunyoung , Ailshire Jennifer
Published: January 2025

Extreme heat exposure is a major risk factor for cardiovascular diseases and mortality. However, knowledge about the biological ramifications of extreme heat exposure is limited, particularly among older adults who face elevated vulnerability. This study examines the association between heat exposure and epigenetic aging, a key molecular marker of biological aging based on DNA methylation (DNAm) levels throughout the genome. We used data on 3,414 US adults aged 50 or above from the 2016 Health and Retirement Study Venous Blood Study with measured DNAm. To assess heat exposure, we calculated daily heat index values at the census tract level using high-resolution meteorological data from gridMet and linked them to each respondent’s geocoded residential location. We considered both acute (on the day of blood collection) and chronic (1-year moving average) exposure windows. Multilevel regression models with natural cubic splines were used to assess the effects of heat exposure on epigenetic aging acceleration (i.e., Horvath, Hannum, PhenoAge, GrimAge, and DunedinPACE). Acute exposure to high heat index values (90th percentile compared to room temperature of 68F) was significantly associated with increased Horvath (0.77, p<.05), Hannum (0.73, p<.05), and PhenoAge (1.09, p<.001) acceleration. For long-term exposure, high heat index values were associated with increased PhenoAge (0.78, p<.05), GrimAge (0.52, p<.01), and DunedinPACE (0.02, p<.01). These findings provide insights into the biological underpinnings linking heat exposure to a broader spectrum of morbidity and mortality risks. Our study adds to the evidence highlighting the strong need to mitigate the adverse biological modifications induced by extreme heat.
THE RESIDENTIAL CARE TRANSITION MODULE: SUPPORTING DEMENTIA CAREGIVERS FOLLOWING INSTITUTIONALIZATION
Authors: Gaugler Joseph , Boltz Marie
Published: January 2025

Families often continue to engage in various care activities following relatives’ entry to residential long-term (RLTC) care settings such as nursing homes. Dementia caregivers’ emotional and psychological adaptation to this transition is variable. We conducted rigorous, mixed methods randomized controlled evaluation to ascertain the efficacy of a remotely delivered, psychosocial/psychoeducational intervention when helping caregivers navigate the placement transition of relatives living with Alzheimer’s disease and Alzheimer’s disease-related dementias. The Residential Care Transition Module (RCTM) provided six formal sessions of consultation (one-to-one and family sessions) over a 4-month period to family caregivers who have admitted a relative living with dementia to an RLTC setting as well as ongoing, “ad hoc” consultation over an additional eight months. This symposium presents the quantitative, qualitative, and mixed methods findings of this dementia care intervention.
A QUALITATIVE ANALYSIS OF MECHANISMS OF BENEFIT IN THE RESIDENTIAL CARE TRANSITION MODULE
Authors: Albers Elizabeth , Birkeland Robyn , Louwagie Katie , Yam Hawking , Baker Zachary , Mittelman Mary , Gaugler Joseph
Published: January 2025

This study aimed to determine the perceived benefits of the Residential Care Transition Module (RCTM), a multi-component, psychoeducational/psychosocial, telehealth intervention for caregivers of cognitively impaired relatives living in residential long-term care (RLTC). We conducted semi-structured exit interviews with 30 purposively selected participants who had been randomly assigned to receive the RCTM. An open-ended survey question solicited feedback from all RCTM participants at four (n=90), eight (n=79) and 12 months (n=77). Available qualitative data were analyzed for thematic content. Participants mentioned nine mechanisms of benefit: six strategies or educational content for caregiving and three aspects of counselor support. Common benefits attributed to RCTM included improved mood, caregiving confidence and communication. Through this analysis we achieved a more comprehensive understanding of the RCTM’s mechanisms of benefit which we will explore more in the presentation.
CLAIMS-BASED FRAILTY INDEX FOR IDENTIFYING MODERATE-TO-SEVERE DEMENTIA IN MEDICARE BENEFICIARIES
Authors: Park Chan Mi , Sison Stephanie Denise , McCarthy Ellen , Shi Sandra , Kim Dae Hyun
Published: January 2025

Identifying dementia severity from administrative claims poses challenges. This abstract discusses developing and validating a claims-based frailty index (CFI) cut-point for identifying moderate-to-severe dementia among Medicare beneficiaries, using data from the National Health and Aging Trends Study (NHATS) and Medicare Current Beneficiary Survey (MCBS). We used 2015 data from NHATS linked to Medicare claims to calculate CFI and determine the optimal cut-point that maximizes sensitivity and specificity in identifying moderate-to-severe dementia based on the Functional Assessment Staging. We validated this measure on an independent sample of community-dwelling Medicare beneficiaries with dementia from MCBS. Performance metrics included sensitivity, specificity, and positive and negative predictive values. From the NHATS development cohort (n=814), the CFI cut-point of 0.280 demonstrated strong performance (C-statistic of 0.78) in differentiating moderate-to-severe dementia cases, achieving the maximum sensitivity of 76.9% and specificity of 62.8%. This cut-point correlated significantly with dementia indicators, including higher rates of functional disability, dementia medication use, mortality, and nursing home admissions. Subsequent validation using the MCBS cohort (n=658) supported the cut-point’s utility in identifying moderate-to-severe dementia, with modest sensitivity of 0.49 and high specificity of 0.80. These two pivotal studies suggest that the CFI, with a cut-point of 0.28, is a robust tool for identifying moderate-to-severe dementia in Medicare claims data. By offering an evidence-based metric, this research facilitates a more targeted approach to allocating healthcare resources and planning care interventions for dementia patients, bridging a critical gap in the absence of direct clinical measures of dementia severity.
HONORING OUR HEALTH AND HISTORY: OPERATIONALIZING CONCEPTS AND RESULTS FROM THE SHARP STUDY
Authors: Gordon Taryn , Newby Launa , Fuller Patrice , Fennell Charles , Croff Raina
Published: January 2025

Accessibility of mental and brain health education remains a challenge for older Black adults, hindered by cultural insensitivities within the field and discriminatory historical context. Operationalizing Black-centered theoretical concepts and narratives from the Sharing History through Active Reminiscence and Photo-imagery (SHARP) study on our website aims to leave older Black adults not only educated but empowered to address cognitive decline and engage in behaviors to mitigate it. Since 2016, 82 SHARP walkers in gentrifying areas of Portland and Seattle have generated over 400 narratives by walking 3x/week for 1, 4, or 6 months and reminiscing together, aided by image prompts about local Black history and culture. Reminiscence is audio recorded for an oral history archive. Transcribed narratives are vetted for content that may compromise participant integrity, then participant-checked. Next, narratives are coded to create a topical index for public users of the archive. SHARP researchers are now operationalizing SHARP theoretical concepts on our website and applying narratives to reach the wider Black public about brain health. The website integrates oral history from walks with tangible, culturally engaging educational content about aging, cognitive decline, and mental health. Asset-based and culturally celebratory messaging, tone, and Black history images counter the often fear- and deficit-based messaging around these topics. Framing Black health within the richness and vitality of Black history, culture, and community resilience, and through memories from other older Black adults taking agency over their health, can inspire learning and action to give readers agency in their mental and brain health.
CHANGES IN MARITAL AND HEALTH STATUS AS RISK FACTORS FOR A SUBSEQUENT NEGATIVE WEALTH SHOCK IN THE US, 1996–2020
Authors: Cho Tsai-Chin , Adar Sara , Choi HwaJung , Langa Kenneth , Kobayashi Lindsay
Published: January 2025

Negative wealth shocks, defined as a loss of ≥75% of one’s wealth over a short time-period, may decrease material living standards in later-life. However, the risk factors for negative wealth shocks are unclear. We aimed to examine the association of four risk factors, 1) separation from or loss of a spouse/partner; 2) diagnosis of a new chronic condition; 3) transition from low to high depressive symptoms; and 4) transition from normal cognition to cognitive impairment or dementia, with the subsequent experience of a negative wealth shock in mid-to-later life. We included respondents aged ≥55 in the US Health and Retirement Study between 1996-2020 (N=128,213 observations from 25,265 persons). Study participants were classified at each time-point as either having experienced a negative wealth shock between each biennial survey interview, or not. The risk factors were assessed over two years preceding negative wealth shocks. We performed multivariable logistic mixed effects models accounting for complex survey design to examine how each risk factor may trigger negative wealth shocks and evaluate effect modification by retirement status at the baseline of study intervals. Separation from or loss of a spouse/partner increased the odds of a negative wealth shock (AOR= 1.44; 95% CI: 1.24, 1.67). Compared to those not retired, retirees who became depressed had higher odds of a negative wealth shock (AOR= 1.23; 95% CI: 1.04, 1.47). This population-based prospective study suggests that changes in marital status and in mental health, for retired adults, may signal future negative wealth shocks, although further investigation is required.
PD1 BLOCKADE IMPROVES SURVIVAL AND CD8+ CYTOTOXIC CAPACITY, WITHOUT INCREASING INFLAMMATION, DURING NORMAL MICROBIAL EXPERIENCE IN OLD MICE
Authors: Camell Christina
Published: January 2025

The elderly and those with chronic diseases have a 2 to 10-fold increased risk of hospitalization and mortality following infection as compared with healthy adults. A significant contributor to disease severity is the aging of the immune system, including an expansion of exhausted T cells. These cells simultaneously promote excessive levels of inflammation and display impaired T cell activation and function. How exhausted T cells from aged individuals respond to infection and whether acute restoration of T cell activation further exacerbates the inflammatory environment or generates functional T cells is unclear. Previously, we used a mouse model of normal microbial experience (NME), where old specific pathogen-free (SPF) mice show 100% mortality following exposure to multiple microbes ordinarily found in pet store mice. In the present study, we show that when exposed to NME, old SPF mice have increased expression of multiple inflammatory pathways and exhibit elevated frequencies of a heterogenous exhausted CD8+ T cell pool that expresses differing combinations of the inhibitory receptor programmed cell death protein 1 (PD1), TOX, and CXCR5. Pre-treatment or intervention with an anti-PD1 monoclonal blocking antibody during the exposure of old SPF mice to NME significantly improves both antibody production and survival, without altering the acute inflammatory response. Anti-PD1 checkpoint blockade-mediated survival is dependent on CD8+, but not CD4+ T cells. Correspondingly, CD8+ PD1+ T cells from old mice given anti-PD1 monoclonal antibody have increased granzyme B production. These data reveal a new approach for reducing vulnerability to infections in the elderly by targeting CD8+ T cell exhaustion through PD1 checkpoint blockade immunotherapy.
WHEN YOUR CAREGIVER IS ALSO YOUR CONFIDANT: CAREGIVER FUNCTIONS AND THE QUALITY OF CARE RECEIVED BY OLDER ADULTS
Authors: Shang Yongxin , Patterson Sarah
Published: January 2025

Older adults can rely on multiple caregivers for support in later life and the characteristics of caregivers are closely related to the care received by older adults. This study aims to explore the association between caregiver functions and quality of care, asking if having a caregiver who also functions as a confidant can improve the care received by older adults. Using the baseline data from the National Health and Aging Trends Study (NHATS) in 2011, we construct an analytic sample of Medicare beneficiaries aged 65 or above with at least one caregiver to help with self-care (eating, bathing, toileting, dressing), mobility (going outside or inside, getting out of bed), or household activities (laundry, shopping, preparing meals, banking, medications) due to health or functioning reasons in the last month (N = 1,875). About 76% of these older adults identify at least one of their caregivers as their confidants, with whom they can discuss important things in the last year. OLS regressions on the care hours (log-transformed) suggest that older adults with at least one caregiver as a confidant are significantly more likely to receive more hours of care (p < 0.001). Logistic regressions on the binary outcomes of reporting any unmet care needs show that having a caregiver as a confidant is associated with a lower likelihood of having unmet care needs in household activities (p < 0.05), but not in self-care or mobility. These findings demonstrate the potential benefits of having a close tie as a caregiver in later life.
A POOL OF INTERESTED PARTIES: COMMUNICATION, ENTRYWAYS, AND USER INVOLVEMENT IN AGING RESEARCH IN A SWEDISH CONTEXT
Authors: Jonsson Oskar , Iwarsson Susanne , Schmidt Steven
Published: January 2025

Established in 2007, the Centre for Ageing and Supportive Environments (CASE) is an interdisciplinary research environment at Lund University, Sweden. The center’s activities are led by a steering committee in close collaboration with the CASE User Council, which provides input, ideas and poses research questions for various research projects. Between 2018-2024, CASE was responsible for one of Lund University’s thematic collaboration initiatives – Social Rights and Housing for the Ageing Population, which is a partnership for knowledge mobilization contributing to solutions for key societal challenges. As one forward-looking way to prolong the established initiative with a long-term ambition, we have launched a national registry, which will be used as a pool of interested parties with the aim to raise awareness about aging research and the possibility to engage in research, mobilize knowledge and utilize research results. The approach is to offer people with an interest in research on aging and health to register in a nationwide online person register/database to systematize and facilitate communication, entryways to research studies, and user involvement. The development of the pool has been fraught with issues related to terminology, ethics, legal requirements for handling personal data, and providing necessary information without being overwhelming but instead attractive for the diverse individuals and groups within the civil society, business, and public authorities that we target. This presentation will provide an overview of the multiple strategies and tactics we employ to tailor the information flow and interactive process based on individual and group-specific needs and preferences.
MOBILIZING UNTAPPED LIVED EXPERTISE TO ASSESS ACCESSIBLE AND AGE-FRIENDLY INFRASTRUCTURES
Authors: Terashima Mikiko , Clark Kate , Deturbide Katherine
Published: January 2025

Many rural municipalities in Canada have been experiencing steady population declines overall, while vulnerable population groups such as older adults and persons with disabilities tend to remain in their communities. With shrinking tax bases, municipalities must make smarter choices in provisions of accessible and age-friendly services and amenities. However, exact conditions and needs of accessible and age-friendly infrastructures in rural communities are increasingly becoming difficult to evaluate, as their planning departments do not have sufficient human and financial capacities to monitor them. The Planning for Equity, Accessibility, and Community Health (PEACH) Research Unit is situated in a planning school at a university in Nova Scotia, Canada. In partnership with two rural municipalities, PEACH Research Unit conducted in-person and online consultations with persons with lived expertise to develop key indicators that can inform municipalities on priority accessible and age-friendly infrastructure needs. This presentation will highlight lessons learned from our engagement processes, including considerations for accessibility and inclusive recruitment, engagement venues, and communication methods that maximize participation of a hard-to-reach group in rural communities. An example tool especially useful for our purpose was an online mapping platform, which helped the participants articulate their insights and better share stories of their experiences. It facilitated discussion beyond simply inventorying what types of infrastructure matter to them—while also soliciting their suggestions on solutions to the design of specific sites in real settings, which were often relational to surrounding environments.
ADVANCE CARE PLANNING IN DEMENTIA VERSUS NORMAL COGNITION: A DEMOGRAPHIC AND PSYCHOSOCIAL STUDY
Authors: Rahemi Zahra , Bacsu Juanita , Adams Swann
Published: January 2025

Older adults from minority groups often face higher rates of chronic diseases and cognitive impairment, along with lower rates of advance care planning and comfort care at end-of-life. This study aimed to explore patterns of advance care planning among older adults in the U.S., focusing on various demographic and psychosocial factors and cognition levels. We utilized data from the 2018 Health and Retirement Study to investigate the association between these factors and the likelihood of having a living will, a durable power of attorney for healthcare (DPOAH), or both, stratified by cognition (dementia/impaired cognition vs. normal cognition). Variables such as race, ethnicity, rurality, marital status, gender, education, age, and discrimination were included in the models. Among the 17,698 respondents, 71.6% exhibited normal cognition, while 28.4% had been diagnosed with dementia or impaired cognition. In both cognition groups, Black and Hispanic participants, as well as younger individuals with lower educational attainment, were less likely to have established a living will. Hispanic participants and younger individuals with lower educational attainment were also less likely to have a DPOAH and both a DPOAH and living will. Significant predictors of having a living will, DPOAH, or both that were not consistent among groups included rurality, marital status, and experiences of everyday discrimination. These findings underscore the importance of addressing disparities in advance care planning among older adults with diverse identities and levels of cognition. Understanding these differences is crucial for designing advance care planning for a diverse aging population facing health and cognitive decline.
SELF-REPORTED DISCRIMINATION AND BRAIN STRUCTURAL ABNORMALITIES: THE MULTI-ETHNIC STUDY OF ATHEROSCLEROSIS
Authors: Forrester Sarah , Tanley Jordan , Bancks Michael , Luchsinger José , Rapp Stephen , Jiminez Marcia P , Bryan Robert , Hughes Timothy
Published: January 2025

Black and Hispanic adults have greater risk for developing Alzheimer’s disease (AD) and related dementias (ADRD) compared to White adults. These disparities might be at least partially attributable to adverse social determinants of health (SDoH) such as experienced interpersonal discrimination. This study examines racial/ethnic differences in the association between self-reported discrimination and brain imaging findings associated with aging and AD/ADRD. We used data from the MESA study, which initially enrolled 6814 participants in 2000-02. when they self-reported their race/ethnicity (38% White, 28% Black, 22% Hispanic, 12% Chinese Americans) and instances of lifetime discrimination. The primary exposure was experiencing racial discrimination. During Exam 6 (2016-18) and ancillary study MIND A (2019-21), brain imaging with 3-Tesla MRI (n=1430) and amyloid PET (n=315) was completed. Multivariable linear (brain MRI measures) and logistic (amyloid PET positivity [centiloid >12.2]) regression models were adjusted for covariates including age, race/ethnicity, gender, education, site, smoking status, blood pressure, diabetes, APOE-ε4, income, health insurance, (all models) and intracranial volume (for brain volumes). Race/ethnicity stratified analyses were completed to assess moderation. Racial discrimination was positively associated with greater white matter hyperintensity volume (WMHV), but not gray matter volume (GMV) or fractional anisotropy (p = 0.008). Racial discrimination was also significantly associated with higher odds of amyloid positivity [OR (95%CI) = 2.24(1.07, 4.70)]. Stratified analysis revealed stronger associations between racial discrimination and GMV and WMHV in Black participants (p = 0.008 and 0.003, respectively). Instances of racial discrimination over a lifetime may be detrimental to brain health, especially for Black adults.
CURRENT PRACTICES OF DRIVING REHABILITATION SPECIALISTS: IS FITNESS TO DRIVE EVALUATIONS USING THE BEST EVIDENCE?
Authors: Dickerson Anne
Published: January 2025

It is well established that social participation is essential for maintaining quality of life and in the US, driving is the primary mode of community mobility for older adults. Research has established the importance of fitness-to-drive (FTD) evaluations for those older adults with medical conditions. These medically-at-risk drivers, at any age, are generally evaluated by specialized driver rehabilitation specialists (DRS) to determine FTD. In the last 10 years, much research has established which assessments best determine FTD with cognitive assessments being the primary determinant. The aim of this research study was to compare assessment tools with the best evidence with the actual tools being currently used by DRSs. A comprehensive review of tools was completed by 321 practicing DRSs. Results show that cognitive tools such as Trails A, Trails B, and clock drawing are being used by 91%, 92%, and 74% respectfully. However, other tools with strong evidence are being used much less (MOCA-46%, UFOV-30%). Additionally, assessment with limited or no evidence (e.g., Traffic signs-66%, brake reaction-71%) or with vehicle technology changes, are not essential to FTD (e.g., muscle strength-91%, ROM-95%) are used extensively. Highlights from the research will include how the on-road assessment is used as a determining factor for FTD with statements. For example: If a driver with moderate dementia passes the on road, he/she should be able to continue driving. While 71% indicted this was probably/definitely false, 29% felt it was probably/definitely true. Implications of these results will be discussed.
FEW OLDER DRIVERS TAKE REFRESHER COURSES: IDENTIFICATION OF FACILITATORS AND BARRIERS
Authors: Bedard Michel , Maxwell Hillary , Gelinas isabelle , Naglie Gary , Vrlkjan Brenda , Porter Michelle , Tuokko Holly , marshall Shawn
Published: January 2025

Older drivers may benefit from driver refresher courses, particularly from courses with on-road training. Yet, the uptake of refresher courses and the factors associated with the decision to enroll is poorly documented. We examine these issues using the Candrive prospective cohort (recruitment stated in 2009; N = 927), a representative sample of older Canadian drivers. We operationalized our outcome variable as having taken any non-mandatory refresher course within the last 10 years (yes/no). We developed a conceptual model that includes sociodemographic factors (e.g., age), health-related factors (e.g., medical conditions), and driving-related factors (e.g., driving comfort), and identified the contribution of these factors using logistic regression. Participants’ mean age was 76.21 (SD=4.85) and 576 (62.1%) were males. Ninety-eight participants (10.6%) reported having taken a non-mandatory refresher course within the last 10 years; roughly half reported the course included an on-road component. The multivariable regression model (-2 log likelihood = 518.41, p <.001, Nagelkerke R-square =.17) identified six of 13 variables entered into the model as statistically significant. The odds of having taken a course differed by province of residence, and was higher with increasing age, if their driving was important for others, were a volunteer, and spoke to a physician about driving, but was lower if they enjoyed driving. Our results indicate that the uptake of refresher courses is limited but is associated with potentially modifiable factors. Deepening our understanding of these facilitators and barriers will help support older adults to drive safely for longer.
“I WOULD LIKE TO BE IN CONTROL”: PERSPECTIVES OF OLDER ADULTS ON AUTONOMOUS DRIVING
Authors: Arthanat Sajay
Published: January 2025

Autonomous driving technology is projected to have major implications on transportation safety, independence and aging-in-place of older adults. However, are older adults ready to embrace driving automations? This mixed-method research study explored the perspectives and readiness of older adults for autonomous driving, and underscored the demographic and age-related factors that potentially influence the adoption. The study involved two aims and employed the Levels of Autonomous Driving developed by the Society of Automotive Engineers to gauge readiness for the technology. In Aim 1, semi-structured interviews were conducted with nine older adults (purposively sampled) following a tutorial depicting the autonomous driving levels. The interviews were guided by the Unified Theory of Acceptance and Use of Technology (UTAUT) primarily focusing on the affinity of the participants to each automation level. A survey was also pilot tested with the participants using cognitive interviewing. In Aim 2, the survey was completed by 528 older adults (65+). The survey uniquely presented 16 realistic driving scenarios with respondents choosing the level of automation preferred for their car in each. Thematic analysis of the qualitative data underscored the perceived benefits, facilitators, barriers and mistrust associated with driving automation. The readiness for automation was generally low in the survey sample and ranged from no automation to driver assistance (52.7%), partial to conditional (35.9%) and high to full automation (11.3%). Pearson correlations showed that readiness significantly varied by income, living status, geographical location and perceived usefulness for aging-in-place. Multivariate analyses is underway to explore causal pathways in the study data.
TRADITIONAL AND NONTRADITIONAL FAMILY DEMENTIA CAREGIVING AMONG SEXUAL AND GENDER MINORITIES
Authors: Flatt Jason , Kittle Krystal , Pickett Andrew , Dowling Maritza , Anderson Joel
Published: January 2025

Few studies on dementia caregiving have examined the unique needs of sexual and gender minority dementia caregivers (SGM-DCs) who self-identify as lesbian, gay, bisexual, transgender, queer, intersex, asexual, and/or additional identities. The Alzheimer’s Association estimates that over 350,000 SGM older adults in the U.S. are currently living with dementia, a number projected to increase to over a million by 2050. At least 1 in 10 SGM caregivers are providing care to someone with dementia. This paper synthesizes findings about traditional (i.e., biological) and non-traditional (i.e., chosen) family structures from several studies led by our research team examining the health of SGM-DCs. We found 10-20% of SGM-DCs report caring for non-traditional (i.e., chosen) family members with dementia. We also found over half of SGM-DCs report not living with their care recipient. Using population-based data, we found a larger number of SGM-DCs who report caring for a grandparent with dementia compared with non-SGM–DCs (17% vs. 4%, respectively). SGM-DCs of chosen family members were more likely to report providing care for fewer than five years and fewer than 8 hours per week. Our analyses did not find significant differences in physical or mental health outcomes between traditional and non-traditional SGM-DCs. We highlight areas for future research exploring divergent support needs between traditional and non-traditional family caregivers, as well as related implications for health policy and intervention efforts to promote the health of SGM-DCs. Historical changes in dementia caregiving related to changes in family structure should also be examined in future research.
GSA STUDENT CHAPTERS: A BROAD APPROACH TO MAKING THIS NEW INITIATIVE SUCCESSFUL AT YOUR INSTITUTION—US AND GLOBALLY
Authors: Gugliucci Marilyn
Published: January 2025

The Gerontological Society of America (GSA) Board of Directors approved the formation of a committee to explore the creation of GSA Student Chapters. As of academic year 2023-24, Phase II of the GSA Student Chapter project is underway and going strong. In this symposium, four GSA student chapter advisors will be presenting on their journey as an advisor in their second year of this project, or just starting up a chapter. The topics will cover undergraduate, post-graduate, and graduate students, as well as students focused on gerontology and health professions education. Presentations include: (1) Opportunities for Integrating Sigma Phi Omega Honor Society Chapter with a GSA Student Chapter; (2) Starting a GSA Student Chapter with Post-Graduate Students in the UK: Opportunities and Challenges; (3) GSA Student Chapter as a Gateway to Undergraduate Student Understanding of Professional Organization Involvement; and (4) Health Professions and Medical Education: How the GSA Student Chapter Enhances Professionalism and Networking.