bluuebunny/crossref_metadata_2025 huggingface dataset:
FOOD INTAKE WAS TEMPORALLY ASSOCIATED WITH STAFF MEALTIME CARE APPROACHES AND BEHAVIORS OF RESIDENTS WITH DEMENTIA
Authors: Liu Wen , Perkhounkova Yelena , Hein Maria , Bakeman Roger
Published: December 2023

Nursing home residents with dementia commonly experience low food intake, resulting in functional and nutritional consequences. Prior work supports associative relationships of resident behaviors and staff approaches with food intake, yet research on temporal relationships is limited. This study examined temporal associations of resident behaviors and staff approaches with food intake. Videotaped mealtime observations (N=160) involving 36 staff and 27 residents (53 staff-resident dyads) in 9 nursing homes were analyzed. Sequential analysis was conducted for resident behaviors and staff approaches as antecedents of resident successful food intakes in 5-, 10-, and 15-second time windows. Increased resident-initiated food intake was associated with preceding resident positive verbal behaviors, but not other resident behaviors or staff approaches. Decreased resident-initiated food intake was associated with preceding resident functional impairments and resistive behaviors, but not other behaviors or approaches. Increased staff-initiated food intake was associated with preceding staff person-centered verbal approaches, but not resident behaviors or other staff approaches. Decreased staff-initiated food intake was associated with preceding resident positive/neutral nonverbal behaviors and functional impairments, and staff task-centered care approaches. Findings confirm the importance of certain strategies in promoting food intake, including facilitating resident positive verbal communication, supporting functional impairments, responding to resistive behaviors, maximizing the use of person-centered care, and minimizing the use of task-centered care. Resident positive/neutral nonverbal behaviors which reflect resident active engagement during mealtime, do not facilitate staff-initiated food intake and may be an indicator of resident independence and readiness to initiate food intake. Further investigation is needed using larger diverse samples.
BUILDING THE RESEARCH PRACTICE PARTNERSHIP TO PROMOTE CONTINUOUS QUALITY IMPROVEMENT IN ADULT PROTECTIVE SERVICES
Authors: Davitt Joan , Becker Todd , Brown Jocelyn , Barry-Dutro Erin , Sesek Greg , Zhang Peiyuan
Published: December 2023

Maryland’s Department of Human Services, Office of Adult Services developed a multiyear plan to strengthen Adult Protective Services. This plan included the development of a partnership between OAS and the University of Maryland School of Social Work to develop, implement and sustain a Continuous Quality Improvement (CQI) review process for Adult Services Programs (APS) to improve outcomes for vulnerable, elderly, and disabled adults. This paper focuses on partnership development between state government and university researchers to engage collaboratively in continuous quality improvement and intervention efficacy evaluation. Challenges and strategies for building logic models, developing performance measurement strategies, translating existing administrative data into research ready formats, and engaging stakeholders at the state level and in local departments of social services will be discussed. Key challenges included, staffing issues, technology, access to administrative data, and inadequate system resources to engage in research. Strategies for overcoming these challenges will be discussed.
INCLUSION AND INTEGRATION OF COMMUNITY STAKEHOLDER PERSPECTIVES IN RESEARCH: INSIGHT FROM AND FOR GERONTOLOGISTS
Authors: Leach Carrie , Moss Karen
Published: December 2023

Engaging diverse stakeholders in research is increasingly required by funding agencies though training, skills and capacity building for engaged approaches have not kept pace. To advance the science of community engaged research (CEnR) we convene leading scholars who will provide insight on the inherent issues of engaging stakeholders in research and strategies for overcoming obstacles. The first presentation will summarize findings from a study of gerontologists and aging trainees to understand the needs and challenges of engaging patient and community stakeholders in research. The second will present strategies for engaging Certified Nursing Assistants (CNAs) in a communication program for people living with dementia in skilled nursing facility. The third will present findings from community discussions that informed adaptations to the development of remote sensing technologies and discuss the continuing role for community engagement in implementation. The fourth presentation will offer insight on integrating diverse perspectives in the development of a dementia-focused intervention in a nursing home. The final presentation will summarize the results of a tobacco exposure study to inform the development of a harm-reduction intervention among long-term renters in extended-stay hotels and the benefits of stakeholder partnerships in building trust and aiding in renter recruitment. We will conclude with an attendee inclusive discussion to envision a path that may empower people of all ages and at all career stages to engage diverse stakeholders as partners to catalyze scientific research that is responsive and relevant to those who have a stake in healthy aging and results in social change. This is a collaborative symposium between the Community-Engaged Research and Patient/Person Engagement in Research Interest Groups.
TRANSITIONING TO WIDOWHOOD: THE ROLE OF SOCIAL INTEGRATION IN MODERATING WELL-BEING OVER TIME
Authors: Kinkade Emily , Fuller Heather
Published: December 2023

Prior studies indicate that widowhood may bring declines in both physical and mental health, but that social support may buffer against these declines. Social integration has also been found to alleviate widows’ depressive symptoms over time. However, less is known about whether social integration moderates the trajectory of well-being declines over longer periods of time post-widowhood. This study investigates whether social integration moderates the relationship between the transition to widowhood and changes in physical and mental well-being over time. A series of longitudinal multilevel models were run with data from participants (n=244-246) from five waves of the Social Integration and Aging study, collected every two years between 2013 and 2021. Depressive symptoms and subjective happiness were indicators of mental well-being, whereas basic and instrumental activities of daily living and total number of diseases were indicators of physical well-being. Social integration was assessed with the Social Integration in Later Life Scale (SILLS). Social integration moderated the relationship between widowhood and depressive symptoms such that increases in social integration resulted in greater reductions of depression scores over time among widows as compared to non-widows. Social integration similarly buffered against declines in physical functioning (i.e., increased basic activities of daily living) over time after widowhood occurred. No interaction effects of social integration on the relationship between widowhood and happiness or other physical well-being outcomes were found. These findings suggest social integration may be important for maintaining mental well-being and some aspects of physical health as older adults adjust to widowhood.
BUILDING AN ECONOMY THAT SUPPORTS WORKING WOMEN TO THRIVE
Authors: McCulloch Heather
Published: December 2023

Building on previous research about working women’s financial wellbeing, a provocative question arises: “What would the economy look like if were designed to work for women?” To answer this question, Heather McCulloch, entrepreneur in residence with the Aspen Institute Financial Security Program, conducted a translational research initiative called Women in the Economy. Intended to take a deep dive into the economic lives of working women across the U.S. who face one or more barriers, in addition to gender, to building their economic security, the project included in-depth interviews with 127 women across urban, suburban, and rural communities in 30 states and D.C. Participants were asked about the economic challenges they face, what they see as the most promising solutions, and their vision for a gender-equitable economy that enables women to strive, thrive, and reach their full potential. Findings revealed that working woman are struggling to make ends meet; they face a financial penalty - a loss of income and savings - due to caregiving; and they are not receiving the education they need to successfully navigate economic and financial systems. Building on qualitative results, a national survey (n=1224) was deployed to understand the scope of emergent topics. Among key findings are that four out of five respondents reported feeling economically insecure and only one in five reported feeling confident they would live comfortably in retirement. Together, findings based on the wisdom, voices, and experiences of working women point to policy, program, and market-based solutions that can build a gender-equitable society.
OLDER WOMEN ENTREPRENEURS ARE DRIVEN BY WANT RATHER THAN NEED
Authors: Choi-Allum Lona
Published: December 2023

During the COVID-19 pandemic, women ages 50+ pursued their dream of starting a business. This study contacted 278 women ages 50-plus by phone and online, examining the drivers and barriers of women entrepreneurs. Over a quarter (27%) of women said they always wanted to start a business, and 19% said they did it to follow their passion; another 17% were pursuing additional income, and 11% wanted flexible work options. Age, and perhaps the value of experience, has been an advantage in business ownership. Women entrepreneurs age 50-plus were less likely to have faced financial challenges since starting their business, with over two in five (45%) avoiding such challenges, compared to 29% of women entrepreneurs in their 40s. Nearly seven in 10 women (69%) surveyed poured their personal savings into their start-up. In addition, two in three agree that they face unique challenges in trying to access capital for their business that are different from men. Despite these challenges, most women were optimistic about their entrepreneurial path. The majority of women (97%) agreed that they made the right decision in starting their business – with about two in five (39%) saying their business is doing better than expected compared to when they first started. Respondents say they need resources on marketing, recruiting and hiring staff, and financing. And over two in five say they have not taken any type of training. Increasing awareness of business supports, funding sources, and training opportunities will help women as they grow their business.
DYNAMIC INTERPLAY BETWEEN STRESS AND POOR SLEEP AND THEIR CONSEQUENCES ON DAILY WELL-BEING
Authors: Lee Soomi , Almeida David
Published: December 2023

Stress impairs sleep. Poor sleep also increases the likelihood of stressful experiences. Importantly, there is the vicious cycle between stress and poor sleep, such that having either one increases the odds of the other. This is problematic in the context of aging, because midlife and older adults may have physiological vulnerability to stressors and age-related deterioration in sleep. This stalemate wherein aging individuals are exposed to daily stressors and degraded sleep but need to lower stress and improve sleep for long-term health calls for further research describing how stress and poor sleep co-occur in daily life and contribute to daily health and well-being. To respond to this call, this symposium brings together four rigorous studies. Paper 1 examines how recession hardships (financial, job, housing-related) are associated with daily sleep quality in midlife and older adults. Paper 2 focuses on exposure and reactivity to daily interpersonal stressors and reports their associations with daily sleep quality and physical activity in older adults. Paper 3 investigates daily links between worry and rumination and their implications for sleep in older adults. Paper 4 examines how consecutive poor sleep is associated with day-to-day trajectories of rumination and memory lapses in midlife and older adults. These papers use relevant theories and advanced analytic techniques to describe the nature, causes, and consequences of stress and poor sleep in the second half of life. The discussant, Dr. David Almeida will integrate key findings from these studies, discuss their theoretical and methodological contributions, and consider opportunities for future research.
DAILY STRESS PROCESSES, PHYSICAL ACTIVITY, AND SLEEP IN OLDER ADULTHOOD
Authors: Leger Kate , Charles Susan , Brown Colette , Fingerman Karen
Published: December 2023

Older adults who engage in healthy behaviors such as being physically active and sleeping well report lower levels of stress. Less is known about the links between exposure and reactivity to stressful events in daily life and their relationship with physical activity and sleep. The current study examined within-person associations between daily physical activity, sleep, and exposure and affective reactivity to naturally occurring interpersonal stressors. Older adults (N = 180) from the Daily Experiences and Well-being Study completed ecological momentary assessments (EMAs) every 3 hours for 5-6 days where they reported negative affect throughout the day and interpersonal tensions at the end of the day. They also reported their nightly sleep quality and wore Actical accelerometers to capture physical activity. Older adults reported greater numbers of stressors on days when they spent less time being sedentary and engaged in more light physical activity. On days when older adults experienced more stressors, they reported higher levels of negative affect, but this association was attenuated when they were more physically active that day. Additionally, older adults reported lower sleep quality the night after they reported higher numbers of stressors. These findings underscore the importance of assessing physical activity, sleep and stressful events in daily life and have implications for both physical and psychological well-being.
HISTORICAL REDLINING AND COGNITIVE FUNCTIONING AMONG US OLDER ADULTS
Authors: Fisk Calley , Ailshire Jennifer , Walsemann Katrina
Published: December 2023

Historical redlining disproportionately harmed Black and disadvantaged communities by designating them as less desirable for mortgage lending. Residence in neighborhoods historically designated as less desirable is associated with worse health outcomes, though little research exists on older adults. Redlined neighborhoods often have characteristics that increase risk for poor cognitive function among older adults (e.g., greater air pollution and less greenspace). We examine differences in cognitive function trajectories by redlining status over 18 years (1998-2016) using data on 5,527 respondents ages 50 and older from the nationally representative Health and Retirement Study that have been linked to National Community Reinvestment Coalition Historic Redlining Scores Data. Results from multilevel linear regression models - adjusted for individual sociodemographic characteristics - show that baseline level of cognitive function is lower in neighborhoods historically designated as “Declining” (b=-0.61, p<.001) or “Hazardous” (b=-0.95, p<.001) compared with “Best or Desirable”. We do not find any association with cognitive change over time. Baseline differences were explained by educational attainment and income for residents of “Declining” neighborhoods, and tract-level affluence and disadvantage for residents of “Hazardous” neighborhoods. Race-stratified analyses showed that the impact of historical redlining on cognitive function was generally similar for Black and White adults, though we found no association between historical redlining and cognitive function for Black residents of “Declining” neighborhoods. Our findings suggest that redlining, as both an historical practice and process affecting the socioeconomic trajectories of individuals and neighborhoods, can shape cognitive health in older adults.
USING A SOCIOCULTURAL LENS TO EVALUATE CANCER SURVIVORSHIP IN BLACKS AND LATINX IN THE US
Authors: Nwakasi Candidus , Esiaka Darlingtina , Pierre-Louis Saamantha , Ekwebene Onyeka
Published: December 2023

Background

A sociocultural lens such as the PEN-3 Cultural Model offers an opportunity to better understand the extreme psychosocial, physical, emotional, and financial challenges of Black and Latinx cancer survivors in the community experience. By focusing on cultural identity, relationships and expectations, and cultural empowerment, the PEN-3 Cultural Model applied in this study aims to offer a unique insight into cancer survivorship in the Black and Latinx communities in the U.S. Method. A qualitative descriptive approach was used on a purposive sample of 46 Black and Latinx participants recruited. Each of the 19 participants who are cancer survivors including 7 Blacks and 13 Latinx (Mage = 62 years), was interviewed using a semi-structured interviewing style. We also conducted 5 focus group discussions with 27 participants, 2 Latinx groups and 3 Black groups (Mage = 61 years). The focus group participants identified as caregivers of cancer survivors.

Results

Thematic analysis resulted in the following themes: culture and dealing with cancer, conflict and control, health care access barriers, and rethinking survivorship in the community. The themes offer insight into sociocultural factors that influence the quality of life of cancer survivors and those in their communities.

Conclusion

To better understand and address issues of cancer health inequity in the country, the findings of this study will offer an opportunity to advance knowledge on sociocultural factors influencing cancer survivorship in Black and Latinx communities.
THE THINGS WE KEEP: AN EXAMINATION INTO THE USE OF MATERIAL POSSESSIONS IN QUALITATIVE GERONTOLOGICAL INTERVIEWS
Authors: Van Vleet Samuel
Published: December 2023

Qualitative interviews are a useful research method because they allow researchers to gather in-depth data beyond the use of traditional survey methods. In this way, qualitative research is an effective method to understand complex and intricate aging-related concepts because there is room for developing new methodological ways for gathering data. A possible way to expand data collections is through the incorporation of material possessions as research aids. Older adults likely accumulate a series of material objects throughout their life course. These objects can take on a supportive role for older adults by conveying important aspects of meaning and are often attached to their identity. Some items have direct associations with later life changes (canes, glasses, etc) while other items (photographs and mementos) are linked with an individual’s identity and accrue a sense of meaning. While previous researchers have documented the importance of objects in later life through material convoys, little has been done to incorporate these meaningful objects into qualitative interview methodology. This paper assesses how incorporations of material possessions into qualitative interviews can assist researchers in gathering rich data. Through a structured literature review, this paper highlights the key findings, past incorporations, and benefits for qualitative interview methodology. Findings suggest that positive outcomes and enriched data result from incorporating material possessions as aides to qualitative interviews. Future researchers should consider how their studies can benefit from the incorporation of meaningful objects in later life.
UNDERLYING CAUSES OF DEMENTIA-RELATED ANXIETY AMONG COGNITIVELY-HEALTHY INDIVIDUALS
Authors: Maxfield Molly , Peckham Allie , James Dara
Published: December 2023

Alzheimer’s disease and related dementias (ADRD) are prevalent, without cures, and contribute to declining functional independence. Their widespread effects make managing ADRD financially, socially, and psychologically difficult, and present challenges for the diagnosed individual as well as their family, friends, and caregivers. These features represent at least some of the reasons ADRDs are feared diagnoses. Dementia-related anxiety (DRA) is anxiety about a current or potential ADRD diagnosis. In a mixed methods study designed to identify causes of DRA, we used semi-structured interviews to assess participants’ thoughts, feelings, and reactions regarding ADRD. Participants included 50 cognitively healthy adults aged 58 to 89 (M = 70.80, SD = 6.02; 64% female). Interviews were analyzed using an inductive iterative thematic approach. All transcripts were coded by two researchers. Relying on this iterative process, we adopted and revised themes as more responses and codes were reviewed. The thematic analysis revealed participants described how the progression of symptoms would destabilize their independence, thereby undermining their identity and relationships in ways that were anxiety provoking. Participants also noted various coping strategies that help manage DRA: making care plans for the future, engaging in healthy, feeling supported by family and friends, and accepting that disappointments, including ADRD diagnoses, are simply a part of life. Results offer insight into factors that contribute to and help reduce DRA, which can be used to inform public health messaging and develop applicable and clinically relevant interventions to meet the needs of individuals experiencing DRA.
ASSOCIATIONS BETWEEN WALKING SPEED AND GUT MICROBIOME DIVERSITY IN OLDER MEN FROM THE MROS STUDY
Authors: Farsijani Samaneh , Cauley Jane , Cawthon Peggy , Langsetmo Lisa , Orwoll Eric , Newman Anne , Kado Deborah
Published: December 2023

While gut dysbiosis has been linked to frailty in aging, its association with early mobility impairments is unclear. Here, our primary goal was to determine the cross-sectional associations between walking speed and gut microbiome in 740 older men (84±4y) from MrOS with available stool samples and 400m walking speed measured in 2014–16. We also analyzed the retrospective longitudinal associations between changes in 6-meter walking speed (from 2005-06 to 2014-16) and gut microbiome composition among participants with available data (702/740). The gut microbiome composition was determined by 16S sequencing (DADA2 and SILVA). We examined diversity, taxa abundance (by ANCOM-BC), and performed network analysis (by NetCoMi) to uncover microbial communities interactions by walking speed levels. Higher walking speed (m/s) was associated with greater microbiome Shannon α-diversity (R=0.11; P=0.004). Decline in walking speed was associated with lower Shannon α-diversity (R=0.07; P=0.054). Faster walking speed and less decline in walking speed were associated with higher abundance of genus-level bacteria that produce short-chain fatty acids, and possess anti-inflammatory properties, including Paraprevotella, Fusicatenibacter, and Alistipes, adjusting for age, race, site, education, health, marital status, weight, height, physical activity, batch, medications, energy, and fiber intake (P< 0.05). The gut microbiome networks of participants in the first vs. last quartile of walking speed (≤0.9 vs. ≥1.2 m/s) exhibited distinct characteristics, including different cluster numbers, hubs, and centrality measures (P< 0.05). Faster walking speed and its less decline were associated with higher gut microbiome diversity, suggesting potential role of microbiome in preserving mobility in aging.
TRANSCRIPTOMIC SIGNATURES FOR AGING AND EXTREME OLD AGE IDENTIFIED IN THE LONG LIFE FAMILY STUDY
Authors: Li Mengze , Monti Stefano , Sebastiani Paola , Song Zeyuan , Karagiannis Tanya , Perls Thomas , Brent Michael
Published: December 2023

Transcriptional studies of blood have previously identified changes in gene expression profiles associated with age. Centenarians, a rare population of individuals that reach 100 years of age, experience delays in aging-related diseases and mortality. Thus, the analysis of their blood transcriptome may help shed light on mechanisms contributing to healthy aging and extreme longevity, as well as enable the discovery of candidate molecular therapeutic targets. In this project, we analyzed RNAseq-based blood transcriptomic data and genetic data from 1,286 participants in the Long Life Family Study age ranged from 25 to 108. To identify transcripts with different abundances at different ages, we used linear mixed-effect models and included relevant covariates to control for genetic, socioeconomic, and technical confounders. We also estimated a genetic relationship matrix (GRM) from the genotype data to account for familial relatedness. We used the same models and covariates to compare transcripts’ abundance between the extreme old and younger participants to discover markers of extreme old age. Among the 11k RNA transcripts tested, we identified 5,249 aging markers (FDR ≤ 0.01) and 761 extreme old age markers (FDR ≤ 0.01). We successfully replicated our aging signature with previously published aging signature in another cohort with comparable Z-scores. Currently, further investigation is ongoing to distinguish markers that contribute to extreme longevity from markers that represent extreme old age. This study found large signatures of age and extreme old age and will serve as a valuable reference for future research to identify molecular mechanisms of healthy aging.
THE ROLE OF MISSINGNESS IN DAILY DIARY DATA
Authors: Yildiz Mustafa , Winstead Vicki , Pickering Carolyn
Published: December 2023

Objections are often raised to using intensive daily diary research methods with family caregivers of persons with dementia. These objections include the daily lack of time, stress associated with dementia caregiving, in particular, and depression and anxiety associated with the demands of the caregiving process. It is argued that these factors may deter caregivers from consistent compliance and lead to bias in the data. The aim of this paper is to describe and predict missingness in daily diaries using the data from three micro-longitudinal studies that include 10,680 days of diaries across all three studies. Key indicators and demographic variables were used to predict missing days, which was quantified from compliance data using a latent variable within the framework of a multiple indicators-multiple causes model. Missingness was random and not predicted by demographics or key outcome variables (e.g. stress, depression, race, ethnicity). Findings suggest despite the time demands and stressors of caregiving, caregivers do complete diaries without systematic patterns of missingness. Researchers should not be deterred from doing intensive daily diary protocols with caregivers experiencing psychopathology who may benefit the most from real-time assessment of symptoms.
A LIVE ONLINE EXERCISE INTERVENTION FOR OLDER ADULTS: A MIXED METHODS RANDOMIZED CONTROLLED TRIAL
Authors: Coletta Giulia , Noguchi Kenneth , Beaudoin Kayla , McQuarrie Angelica , Griffin Meridith , Tang Ada , Phillips Stuart
Published: December 2023

Regular physical activity (PA) and exercise alleviate mental health and age-related physical declines in older adults; however, strategies are needed to help older adults engage in PA and exercise. Live online video may be a viable mode of delivery for exercise programs. Thirty-one sedentary community-dwelling older adults (65-80 years) were randomized to an 8-week live online exercise program (ACTIVE, n=16; age 70±4 years; 69% women) or waitlist control (CON, n=15; age 72±5 years; 87% women) group. Quantitative effectiveness data were collected pre-and post-intervention and included accelerometry-derived PA levels and mental health (depression, anxiety, and loneliness). Feasibility outcomes included attendance and participant satisfaction. Semi-structured interviews were optional for all participants after completing the online exercise program (n=22; ACTIVE=12; CON=10; 73% women). The ACTIVE group attended 97% of the online classes, and 98% reported satisfaction with the program. Post-intervention, there were no differences between groups on daily steps (ACTIVE=4336 ± 2638 steps/d; CON=3125 ± 1250 steps/d), daily activity energy expenditure (ACTIVE=227 ± 249 kcal/d; CON=119 ± 166 kcal/d), and moderate-to-vigorous physical activity (ACTIVE=42 ± 44 min/d; CON=23 ± 30 min/d). An effect of the intervention was observed in the ACTIVE group for symptoms of depression (3.9±2.4 to 2.0±1.7; p=0.015). There was no intervention effect compared to CON on anxiety or loneliness. Common themes identified from qualitative interviews included satisfaction with the program and perceived health improvements. A live online exercise program was a feasible approach to delivering physical activity to older adults.
IMPLEMENTATION OF A DIGITAL COGNITIVE SCREENING PROGRAM FOR DEMENTIA IN PRIMARY CARE
Authors: Fowler Nicole , Mullavey Judy , Swartzell Kristen , Hammers Dustin , Brosch Jared , Murray James , Willis Deanna
Published: December 2023

Early identification of Alzheimer’s disease and related dementias (ADRD) has become paramount given the emergence of disease modifying therapies. Integration of rapid, scalable tools to identify early cognitive impairment in primary care is essential because most at-risk individuals have limited access to specialty care. Yet, competing demands on primary care practices can make integration challenging. This demonstration project is being conducted to understand the feasibility, acceptability, and implementation of digital cognitive screening in primary care. Patients ≥65 years presenting to one of six primary care sites between 06/01/2022 and 06/30/2023 are asked to complete the Linus Health Digital Clock and Recall (DCR™) cognitive screening. Data regarding number of screening attempts that were refused, incomplete, or completed was collected. Results of the first completed screening-results were analyzed using descriptive statistics. As of 2/15/23, there are 3,920 screening attempts. DCR™ screenings were completed 40.8% of the time, refused 57.4%, and attempted but incomplete 1.8%. Thirteen-percent of attempts were positive for cognitive impairment, 37% were borderline, 44% were unimpaired, and 6% were unanalyzable. Average patient age is 73.2±6.0 years, 58% female, and 6% report less than high school education. Patients with positive screenings are older, slightly more female, and reported less education. Cognitive screening via DCR™ is ongoing and has been completed in nearly half of those approached, with half scoring cognitively impaired or borderline. This approach appears to have utility in early detection of cognitive impairment in primary care. By November 2023 we will have follow-up data for patients who screened positive.
LONELINESS IN OLDER ADULTS LIVING IN PUERTO RICO DURING THE COVID-19 PANDEMIC: AN UNDEREXAMINED PUBLIC HEALTH CONCERN
Authors: Camacho David , Morgan Matthew , Burnette Denise
Published: December 2023

Loneliness is a critical public health problem, yet it is under-examined among older adults in Puerto Rico. We explored sociodemographic and health-related risks for loneliness using data from a Knowledge, Attitudes and Practices COVID-19 study of Older Adults in Puerto Rico study. We conducted telephone and face-to-face interviews (January - December 2021) with a nonprobability sample of adults aged 60+ in Puerto Rico (n= 213). Data collection included measures of objective and subjective physical and mental health. We used generalized linear regression analyses to explore main effects of salient demographic and health factors on loneliness. Missing data were treated with Multiple Imputation. Prevalence of loneliness (3-item TILS) was 36.3% . Widowhood (β=.832, SE=.38, p=.029), low household income (<$12,500; β=.691, SE=.23, p=.003), psychological distress (β=.141, SE=.03, p<.001) were positively associated with greater loneliness. Living alone (β=-.664, SE=.27, p=.015) and higher sense of community (β=-.067, SE=.01, p<.001) were negatively associated with loneliness. Pandemic specific challenges (e.g., someone close diagnosed or hospitalized with COVID-19) and other common predictors (e.g., age, female, self-rated health) were not significant. We consider that contextual (e.g., outmigration, under-resourced aging and healthcare infrastructure) and cultural factors (e.g., familism) may help shape predictors and their effects on loneliness. Mainland US and Puerto Rican researchers and practitioners should collaborate on examining loneliness narratives, their impact on health, and implementation of culturally appropriate and contextually feasible interventions in Puerto Rico.
SOCIAL ENGAGEMENT IN OLDER PEOPLE LIVING WITH HIV
Authors: De Main Atami , Glesby Marshall , Johnston Carrie , Brennan-Ing Mark , Siegler Eugenia
Published: December 2023

More than 50% of people with HIV (PWH) are at least 50 years old. PWH experience a high prevalence of multiple chronic conditions and fragile social structures. Although social engagement may be protective against detrimental physical, cognitive, and mental health outcomes, there is limited evidence on older PWH’s social engagement and associated factors in engaging with family, friends, and community. This study sought to examine social engagement in a population of older PWH, using the 13-item Frequency of Leisure Activities Scale from the Research on Older Adults with HIV (ROAH 2.0) study at the Weill Cornell Campus in New York City. We conducted factor and regression analyses to characterize social engagement activities and examine their relationships with AIDS diagnosis, social vulnerability index (SVI), financial strain, loneliness, HIV-related stigma, and depressive symptoms, controlling for demographic factors. PWH (n=349, age range=50-84) were less engaged in social (Mean=1.31; SD=0.71) and cultural-physical (e.g. attending cultural events) (Mean=1.55; SD=0.78) than media-based activities (Mean=3.09; SD=0.72), with Omega reliability estimated at 0.716, 0.651, and 0.620 respectively. Having AIDS, experiencing increased HIV-related stigma, loneliness, and depressive symptoms were associated with low social activity engagement (F(6, 316) = 9.87, p < .001). High SVI score and financial strain were negatively associated with engagement in cultural-physical activities (F(5, 317) = 2.61, p < .001). Increased depressive symptoms were negatively associated with engagement in media-based activities (F(4, 318) = 5.88, p < .001). The findings provide foundations for future research to improve our understanding of social engagement in older PWH.
THE CONFIDENCE FINANCIAL WELL-BEING INTERVENTION FOR LATINO FAMILY CAREGIVERS: PILOT STUDY RESULTS
Authors: Meyer Kylie , Mage Susanna , Benton Donna
Published: December 2023

Family caregivers to people living with dementia encounter an average of $10,697 per year in out-of-pocket caregiving costs that exert long-term material and psychological consequences. Latino caregivers encounter higher out-of-pocket caregiving costs relative to their income than non-Latino caregivers. There is an unmet need for programs to alleviate financial hardship among caregivers, particularly those culturally tailored to Latino caregivers. The Confidently Navigating Financial Decisions and Enhancing Financial Wellbeing in Dementia Caregiving (CONFIDENCE) program draws on successful intervention approaches identified within nursing and gerontological research to manage out-of-pocket caregiving costs and prevent financial hardship among caregivers to persons living with dementia. Between May 2022 and February 2023, CONFIDENCE was delivered to six cohorts of Latino caregivers at an academic-service center. This symposium will discuss preliminary pilot study results. Donna Benton, PhD, will describe how the intervention was developed with a community advisory council to ensure a culturally-tailored program. Kylie Meyer, PhD, will share the preliminary efficacy of the intervention based on interim analyses of outcomes, including caregiver resourcefulness and financial strain. Alexander Gonzales, BSG, will describe challenges related to recruitment and retention, and considers registration and fidelity data to understand possible causes of low attendance. Lastly, Susanna Mage, PhD(c), MA, will present the findings from the preliminary evaluation of the program to examine the acceptability, including participant satisfaction surveys and one-on-one interviews. Initial success of the pilot phase suggests opportunities for future efficacy testing. If efficacious, CONFIDENCE could help alleviate financial hardship experienced by family caregivers to persons living with dementia.
WE BUILT IT, BUT THEY DIDN’T COME: CHALLENGES WITH RECRUITMENT AND RETENTION IN THE CONFIDENCE PILOT STUDY
Authors: Gonzalez Alexander , Rhodes Shane , Benton Donna , Meyer Kylie
Published: December 2023

This presentation considers reasons for low attendance in a psychoeducational intervention developed to reduce financial strain and manage out-of-pocket caregiving costs. From May 2022 until February 2023, the CONFIDENCE Financial Education Intervention was delivered to six cohorts of family caregivers to persons living with dementia. Delivery of the 5-week, group-based Zoom intervention occurred at an academic service center in Los Angeles, CA that regularly provides caregiver education. Whereas the program team anticipated 192 caregivers to attend over 10 months, 72 caregivers registered in this time, among whom just 38 attended at least one session. The average number of sessions attended was 3.0 (SD=1.5) of five. To understand possible reasons for low participation, the investigators conducted bivariate comparisons of the demographic characteristics of attendees versus non-attendees from registration forms and reviewed fidelity reports. Fidelity reports were completed using a standard form using Likert-scale responses ranging from 0 (Strongly Disagree) to 5 (Strongly Agree). Forms were completed by facilitators after delivering sessions and by an independent observer who reviewed a lesson recording. Evaluation of registration forms showed no statistically significant difference among caregivers who attended at least one session versus those who did not attend according to caregiver age, ethnicity, race, or income. Further, fidelity reports revealed high overall quality of delivery (M=4.0, SD=0.86) and that caregivers were, on average, engaged across lessons (M=4.0, SD=0.4). Based on initial findings and facilitator input, the study team is considering additional reasons for non-participation by surveying those who did not attend after registering.
STAR CAREGIVERS: IMPLEMENTATION OF AN EVIDENCE-BASED PROGRAM IN REAL-WORLD SETTINGS
Authors: McCurry Susan , Penfold Robert , Karel Michele
Published: December 2023

Evidence-based non-pharmacological community programs to improve care of older adults with dementia are growing. However, many programs have historically been tested in research studies that fail to reach medically underserved populations or communities with unique service needs. STAR-Caregivers (STAR-C, also known as STAR-Community Consultants) is an evidence-based psychosocial support and skill training program designed to teach family caregivers how to identify and increase pleasant events, improve communication, and use behavioral problem-solving skills to reduce the problems experienced by their family member with dementia while improving quality of life for both persons in the caregiver-care receiver dyad. Since its original randomized controlled trial in 2005, STAR-C has been translated in a variety of real-world settings, including in Area Agencies on Aging throughout Oregon and Washington state. This symposium describes three recent new translation efforts: (1) implementation of STAR-C as a virtual training program (STAR-VTF) for caregivers of persons with dementia who are part of the Kaiser Permanente Washington health care system; (2) cultural adaptation of STAR-VTF for Latino caregivers, and (3) incorporation of STAR-C into a largely rural community care setting in Illinois during the COVID-19 pandemic using Amazon Echo technology to conduct telehealth community dyad STAR-C sessions and connect clients to supplemental services. Each presenter will discuss the dementia care needs in their respective populations, the challenges encountered in translation of STAR-C to serve target caregiving dyads, and lessons learned regarding treatment effectiveness and program sustainability.
VIRTUAL TRAINING FOR MANAGING SYMPTOMS OF DEMENTIA: A CULTURAL ADAPTATION FOR LATINO CAREGIVERS
Authors: Ramirez Maggie , Penfold Robert
Published: December 2023

STAR-Caregivers Virtual Training and Follow-up (STAR-VTF) is an evidence-based intervention that teaches family caregivers how to manage behavioral and psychological symptoms of dementia. The study objective was to identify what adaptations to STAR-VTF are needed to improve cultural relevance for Latino caregivers. Thirty caregivers of people living with dementia who self-identify as Hispanic/Latino and 14 providers of healthcare and social services were interviewed. Interview transcripts were analyzed using thematic analysis methods. The Cultural Treatment Adaptation Framework guided data collection and analysis. Three themes were identified: (1) there was a need to increase awareness about dementia and decrease stigma; (2) semantics mattered as certain words and phrases could be stigmatizing, offensive, or culturally inappropriate; and (3) there was a need to incorporate into program materials the traditional family structure and nature of caregiving in Latino families. Adaptations were performed on STAR-VTF, including expanding content to improve understanding of dementia, revising language that was viewed as problematic, and adding cultural examples to reflect the range of family involvement in caring for people living with dementia and multigenerational living. Findings from this study advance understanding of the Latino caregiver experience and how to modify programs to better serve their needs.
RECRUITMENT AND BASELINE RESULTS FOR THE STAR CAREGIVERS VIRTUAL TRAINING AND FOLLOW-UP PRAGMATIC TRIAL
Authors: Penfold Robert , Johnson Eric , Ramirez Maggie , Ralston James , McCurry Susan , Teri Linda
Published: December 2023

The STAR-Caregivers program is efficacious in reducing the behavioral and psychological symptoms of dementia (BPSD). In this pragmatic trial, we are testing a 6-session, self-directed, online version of the program that leverages secure email, an online learning management system, and brief coaching telephone calls to expand access to training. This paper reports on issues related to recruitment and baseline levels of psychosocial measures collected. Caregivers and persons living with dementia (PLWD) were randomized to intervention or usual care. Baseline measures were collected via REDCap and included standardized measures for PLWD dementia severity and functioning and caregiver measures for anxiety, stress, depression, and caregiving mastery. The study recruited 67 dyads. Recruitment increased greatly when we removed the inclusion that subjects be on antipsychotic medications. Baseline clinical showed the average score on the Dementia Severity Rating Scale was 22.2 (mild) and 28.8 on the Revised Memory and Problem Behavior Checklist (mild). The average Functional Activities Questionnaire was 22/30. Caregivers reported low levels of stress (KCSS), depression (PHQ8), and anxiety (GAD2) with mean and standard deviation: KCSS = 22.8 (6.6), PHQ8 = 4.9 (4.65), and GAD2 = 1.3 (1.4). The mean Caregiver Mastery Score was moderate at 20.4 (3.28). Virtual delivery of the STAR Caregiver training program is feasible. Caregivers of PLWD with mild to moderate cognitive and functional decline seem most amenable to intervention. We are currently analyzing outcome date to determine the efficacy of this program and plan to investigate the optimal timing of caregiver outreach and support programs.
RATE OF CHANGE IN DEPRESSIVE SYMPTOMS OVER THE FINAL MENSTRUAL PERIOD
Authors: Avis Nancy , Colvin Alicia , Chen Yuqing , Joffe Hadine , Kravitz Howard
Published: December 2023

Studies have shown that women are more vulnerable to elevated depressive symptoms during the menopause transition (MT) then before. This study evaluates change in depressive symptoms, as measured by the Center for Epidemiological Studies-Depression (CES-D) score, over the final menstrual period (FMP), a more precise measure of menopause timing compared to MT stages. The sample consisted of 1,783 women in the SWAN cohort with an observed FMP and at least one CES-D assessment from baseline through follow-up (1996 – 2017). Piecewise linear growth curves were fit to repeated measures of CES-D scores as a function of time from FMP (+/- 10 years). Results showed two places with a change in slope. CES-D scores decreased by 0.22 annually (95% CI: -0.41, -0.04) until 36 months prior to FMP (Period 1). From -36 months until the FMP (Period 2), there was a non-statistically significant increase in CES-D, followed by a decline (-0.19 annually, 95% CI: -0.34, -0.03) after FMP (Period 3). We examined a range of predictors (sociodemographic, health-related, psychosocial, hormonal) of change in CES-D score during each period. Upsetting life events were related to CES-D change at periods 1 and 2, social support at periods 1 and 3, and smoking at periods 2 and 3. Baseline CES-D was related at period 1, and anxiety was related to CES-D change at period 2. These results provide a more nuanced picture of change in depressive symptoms over the FMP and the variables related to depressive symptoms at different time points over the FMP.
THE ASSOCIATION OF URINARY INCONTINENCE AND DISABILITY AMONG A DIVERSE SAMPLE OF MID-LIFE SWAN WOMEN
Authors: Dugan Sheila , Crawford Sybil , Wente Karla , Waetjen L , Karvonen-Gutierrez Carrie , Harlow Sioban
Published: December 2023

Few studies have examined the prospective association between urinary incontinence (UI) and disability in midlife women. We assessed associations between UI type, frequency and amount with reported disablity in a racially/ethnically diverse cohort of community dwelling midlife women. Data was from longitudinal analyses of questionnaires from the multi-center, prospective cohort Study of Women’s Health Across the Nation. We used multivariable ordinal logistic regression to examine if UI type, frequency and amount at the 13th follow-up were associated with the World Health Organization Disability Assessment Schedule (WHODAS) at the 15th follow-up (controlling for other factors, e.g. menopause status, body mass index, lifestyle and psychosocial factors) and disability at Follow-up 13. UI was associated with subsequent reports of disability in participants, particularly in the WHODAS domains of mobility, communication, and societal participation. Associations were strongest for mixed UI type compared to stress UI or urge UI, daily frequency of UI compared to monthly or weekly, and larger amounts of urine leakage compared to drops of leakage. UI appears had a strong association with multiple domains of disability in midlife women after two years of follow-up. It is important for clinicians to address UI earlier in symptom onset. Screening for mixed UI and UI that occurs more frequently and it larger amounts, more specifically, may yield better information regarding a patient’s future disability risk.