bluuebunny/crossref_metadata_2025 huggingface dataset:
RESEARCHERS BEWARE: CAUTIONARY TALES OF FRAUDULENT RESEARCH PARTICIPANTS AND WHAT TO DO ABOUT THEM
Authors: Sefcik Justine , Buck Harleah
Published: December 2023

This symposium presents a series of cases where gerontological researchers identified fraudulent participants and bots engaging in their studies. These presentations describe the complex nature of participants misrepresenting themselves and being creative to enroll in studies for financial incentives. Dr. Sefcik shares how a snowball sample led to participants enrolling in a study and misrepresenting themselves during virtual qualitative interviews. Dr. Boon illuminates how Facebook recruitment led to bot responses and steps taken to identify if participants were real. Dr. Frechman reveals how recruitment on social media platforms and email distribution lists led to bot attacks of the study survey. Dr. Carpenter explains a study involving a multi-methods approach in which a bot completed several surveys and an interviewee gave nonsensical responses. Dr. Wallace explains two types of fraudulent activity occurring, the first with bots completing an online survey and the second with deception during interviews. All presenters discuss their experiences of suspecting fraudulent research participation, approaches on how they verified participants, action steps to address misrepresentation, processes put in place to uphold the integrity of their studies, and tips to mitigate future fraud. This is a Nursing Care of Older Adults Interest Group Sponsored Symposium.
WHEN SNOWBALL SAMPLING LEADS TO AN AVALANCHE OF FRAUDULENT PARTICIPANTS
Authors: Sefcik Justine , Hathaway Zachary , DiMaria-Ghalili Rose Ann
Published: December 2023

The scientific literature has examples of how fraudulent respondents who gainfully access studies for financial incentives negatively affect the integrity of research results. However, there have been less examples shared of participant misrepresentation in qualitative research, the implications, and how to prevent deception. This session entails the presentation of a qualitative study where we believe participants misrepresented themselves during an interview for the financial incentive. For the study, we sought caregivers for individuals with a diagnosis of Alzheimer’s disease or Alzheimer’s disease related dementia with a history of chronic leg wounds. One of our recruitment efforts was through ResearchMatch. After one ResearchMatch interviewee completed the interview, he reached out to the project manager and asked if the study flyer could be shared with others that were “dealing with similar issues”. This resulted in an uptick of people being interested in study participation. Several of these participants were scheduled to complete individual interviews on one day with an experienced qualitative researcher. Clues indicating potentially fraudulent participants were vague and illogical responses to questions, and similar nonsensical responses shared across interviews. Once potential fraud was detected, interviews were paused for the following interview day so the study team could regroup and none of the interviews were used for data analysis. The lessons learned and steps for researchers to take to help reduce the number of fraudulent individuals participating in interviews will be shared. This includes two-step screening where the study staff interacts with the potential participants through methods other than over email.
USING PARADATA AND MANUAL REVIEW TO DETECT AUTOMATED ONLINE RESEARCH SURVEY PARTICIPATION
Authors: Boon Jeffrey , Maxwell Cathy
Published: December 2023

With an increase in health research recruitment on social media, there is also an increase in prevalence of software known as bots auto-enrolling in online studies. Despite efforts to prevent automated fraudulent enrollment, bots have become more sophisticated with some able to bypass a CAPTCHA and generate false email addresses. This session describes such fraudulent enrollment in one study and our efforts to detect it. For an online study of family caregivers of people with dementia, we recruited via family caregiver groups on Facebook. Potential participants could proceed to the online study and immediately answer screening questions and complete the study. A CAPTCHA was used to screen non-human respondents, but we detected rapid enrollment compared with other methods, raising suspicions. Paradata generated in the process of survey administration and unusual email addresses flagged suspected bot responses. To screen the responses, we reviewed the time to complete surveys compared with known human responses. We also noted email addresses that consisted of long alphanumeric usernames not common with most human respondents. After screening for suspicious respondents, we attempted to contact the email addresses of borderline cases to verify they were real respondents. Only one of 157 (0.006%) were determined to be a real respondent. Lessons learned from this experience include using paradata as part of data quality monitoring, using survey design methods to elude automated bots, and the value of researchers interacting with participants during enrollment.
INCENTIVES + SOCIAL MEDIA RECRUITMENT + MINIMAL SUBJECT INTERACTION = POTENTIAL FOR FRAUD!
Authors: Carpenter Joan , Jackson Casey , Behrens Liza
Published: December 2023

Social networking technologies create opportunities to recruit a more diverse and representative research sample. However, social media recruitment strategies with low researcher interaction for screening brings threats to data integrity, especially when incentives are involved. During a recent study designed to ascertain direct care nursing home staffs’ perceptions of risk during the COVID-19 pandemic, we experienced fraudulent research participants. We aimed to recruit, enroll, and collect survey and semi-structured interview data from N=30 participants between June 2021 through March 2022. Participants were compensated $25. Initial recruitment efforts targeted Facebook listservs for licensed and unlicensed nurses, social workers, and activity directors. Research staff provided participants who screened eligible for the study via email a link to initiate consent and complete the survey electronically. Four months into study recruitment, study staff discovered during an interview that one participant was unable to answer questions in the correct context as a direct care worker and responses were nonsensical. Additional quality control measures confirmed that “bots” had completed surveys (N=8). The fraudulent data were removed from the study database and corrective actions implemented into screening to rule out ineligible participants/bots including screening for repetitive language and grammatical errors in email conversations, verifying eligibility through phone communications, and adding a Captcha verification prior to electronic survey consent. Our experiences highlight the importance of creating study protocols that include social media recruitment with safeguards to fraudulent participants. This is especially important for investigators attempting to recruit hard to reach populations and participants who wish to remain anonymous.
CONNECTING COMMUNITIES: ROLES OF AGING ATTITUDES, PLACE ATTACHMENT, AND PSYCHOLOGICAL WELL-BEING
Authors: Hou Su-I , Liu Li-Fan
Published: December 2023

As the global population ages, communities must find innovative ways to support older adults. This symposium focuses on the intersections of aging, community, and culture, particularly emphasizing the importance of place attachment, aging attitudes, psychological well-being, and engagement in promoting healthy aging. Leading experts from social gerontology, psychology, and public health across the globe will explore the complex relationships between aging, community, and culture. Drs. HM Chen from Texas A&M University–Central Texas (TAMCT) and Hou from the University of Central Florida (UCF) from the United States will start the symposium with a systematic literature review on culture and aging in the community among Chinese older adults. Drs. JJ Chen and Liu from the National Cheng-Kung University (NCKU) will examine the mediating effect of psychological place attachment, how older adults perceive their living environments, and (positive versus negative) attitudes towards aging and psychological well-being. Dr. Hou from UCF will further assess aging attitudes (engagement versus enjoyment) among older adults participating in neighborhood lunch versus lifelong learning programs to discuss the implications of tailored aging service development. Finally, Drs. Lin and Fung from The Chinese University of Hong Kong (CUHK) will discuss the association between activity diversity and psychological well-being among community-dwelling older adults in Hong Kong. Through interdisciplinary dialogue and sharing of lessons learned, this global symposium promotes a deeper understanding of the roles of aging attitudes, place attachment, culture, and psychological well-being among older adults to foster innovative approaches to promoting healthy aging and community engagement. This is an Aging Among Asians Interest Group Sponsored Symposium. This is a collaborative symposium between the Aging Among Asians and International Comparisons of Healthy Aging Interest Groups.
NEIGHBORHOOD AFFLUENCE AND RISK OF INCIDENT DEMENTIA: ROLE OF PHYSICAL ACTIVITY DESTINATIONS
Authors: Moored Kyle , Desjardins Michael , Crane Breanna , Donahue Patrick , Garg Parveen , Rosso Andrea , Lovasi Gina , Carlson Michelle
Published: December 2023

Neighborhood affluence encompasses the degree of high educational, occupational, and wealth concentration within residential communities. Highly affluent neighborhoods may reduce dementia risk in part by providing amenities that promote physical activity. We examined associations between neighborhood affluence, and specifically the quantity of nearby physical activity (PA) destinations (e.g., gyms), with incident dementia. Participants were 2,942 adults ≥65 years old from the Cardiovascular Health Cognition Study. Baseline neighborhood measures included 1) a 1990 Census-derived affluence index (percent with college education, percent with professional/managerial occupation, median home value) and 2) the count of PA destinations from the 1990 National Establishment Time Series (NETS) database that fell within a 1-km Euclidean buffer around the home. A total of 469 dementia cases (240 Alzheimer’s, 208 mixed/vascular, 21 other) were clinically adjudicated from neurological/neuropsychological examinations (Mean=5.3±1.8 follow-up years). In Cox proportional hazards models adjusted for clinic site and individual demographics (age, gender, race, marital status), each 1-SD higher neighborhood affluence was associated with 15% reduced hazard of all-cause dementia (HR=0.85, 95%CI: 0.77-0.94), largely driven by mixed/vascular subtype (HR=0.73, 95%CI: 0.64-0.86), but not Alzheimer’s subtype (HR=0.93, 95%CI: 0.81-1.07). Further, participants with ≥2 (versus no) nearby PA destinations had 37% reduced hazard of specifically mixed/vascular dementia (HR=0.63, 95%CI: 0.41-0.99). After also adjusting for individual health, income, and education, neighborhood affluence remained protective against mixed/vascular dementia (HR=0.77, 95%CI: 0.65-0.90), but number of PA destinations was no longer associated. Neighborhood affluence may reduce dementia risk via improved vascular health and operate through additional mechanisms beyond nearby PA amenities.
TOXIC CHEMICAL EMISSIONS AND DEMENTIA RISK: RESULTS FROM THE CARDIOVASCULAR HEALTH COGNITION STUDY
Authors: Crane Breanna , Moored Kyle , Donahue Patrick , Corrigan Anne , Curriero Frank , Rosso Andrea , Lovasi Gina , Carlson Michelle
Published: December 2023

Air pollution is a modifiable risk factor for dementia. Yet, studies on specific forms of air pollution (e.g., toxic chemical emissions from industrial facilities) and dementia risk are underexplored. We examined associations between toxicity-weighted concentrations of industrial pollution and dementia outcomes among a large, multi-site cohort of older adults. Participants (n=2,770) were ≥ 65 years old (M=75.3, SD=5.1 years) from the Cardiovascular Health Cognition Study. Toxicity-weighted concentrations were estimated using the Risk Screening Environmental Indicator (RSEI) model which incorporates total reported chemical emissions with toxicity, fate, and transport models. Estimates were aggregated to participants’ baseline census tract, averaged across 1988-1992, and log10-transformed. Dementia status was clinically adjudicated in 1998-1999 (M=5.2 person-periods) by subtype (all-cause, Alzheimer’s, vascular, mixed). We assessed whether RSEI-estimated toxicity-weighted concentrations were associated with: 1) odds of prevalent dementia and 2) incident dementia risk by subtype. After adjusting for individual and neighborhood-level covariates, a 1-unit increase in log10-toxicity was associated with a 34% increase in the odds of prevalent dementia (OR=1.34, 95% CI: 1.01, 1.78). In discrete-time survival models, each 1-unit increase in log10-toxicity was associated with a 65% increased hazard of vascular dementia (HR=1.65, 95% CI: 1.04, 2.61) but was not significantly associated with all-cause, Alzheimer’s disease, or mixed dementia. Living in regions with higher toxic air emissions was associated with greater odds of prevalent dementia and a heightened risk of incident vascular dementia. Results suggest that the RSEI model may be a novel screening tool for examining associations between toxic chemical releases and dementia risk.
EMERGING PALLIATIVE CARE INTERVENTIONS FOR HOMELESS ADULTS IN 10 US CITIES
Authors: ODonnell Arden
Published: December 2023

America’s adult homeless population is growing older; its median age is now 50 years of age. Due to harsh living conditions of chronic homelessness, these individuals often experience geriatric conditions in their 50s and 60s and face premature mortality. Yet, little is known about palliative care for this population. A 2017 systematic review of scientific journals revealed only six palliative care intervention studies for homeless adults. Anecdotal evidence, however, suggests community responses are emerging. Focusing on the 10 U.S. cities with the largest adult homeless populations, this exploratory study had two objectives: 1) through a web-based search of the “grey literature,” the identification of organizations developing or adapting programs to serve the palliative care needs of homeless adults; and 2) through in-depth zoom interviews with directors, gaining an understanding of the programs’ core aspects as well as their successes and challenges in development, implementation, and sustainability. The 18 interviewed agencies fell into two distinct service categories, healthcare/palliative organizations and homelessness/housing organizations. Identified modifications included targeted advanced care planning (ACP) groups, the development of an ACP repository for unhoused persons, rapid re-housing for terminally ill patients, harm reduction strategies, and hospice options in shelters. Common themes were the challenges of working across multiple systems and the lack of dedicated resources and funding for initiatives to support the population’s multiple and complex needs. The discussion highlights the need for greater organizational resources and flexibility in both the healthcare and homeless systems to promote value-based-goal concordant care for homeless adults.
OPPORTUNITIES AND BARRIERS IN INTEGRATING PALLIATIVE CARE SERVICES INTO PERMANENT SUPPORTIVE HOUSING
Authors: Johnson Ian , Traver Anthony , Light Michael
Published: December 2023

Despite well-known inequities in rates of serious illness and premature mortality among people experiencing homelessness, as well as the unique biopsychosocial and spiritual care needs of people with homelessness histories, there is a lack of translational research focused on palliative care service delivery within permanent supportive housing. This presentation will present data from the Research, Action, & Supportive Care at Later-life for Unhoused People (RASCAL-UP study) to describe the current practices, perceived barriers, and recommendations in providing support to older permanent supportive housing residents during serious illness and end-of-life. Through a thematic analysis of interviews with direct care providers (n=30) across multiple care settings, themes were identified: 1) the importance of on-site relationships; 2) cross-sector collaboration barriers; 3) interdisciplinary communication barriers within permanent supportive housing teams; 4) environmental and spatial considerations; and 5) missing levels of care between supportive housing and higher levels of medical care. From these results, we put forth recommendations for translational research, supportive housing policy, and capacity-building efforts for interdisciplinary and cross-sector healthcare and housing teams.
GAIT PARAMETERS IN OLDER BREAST CANCER SURVIVORS WITH PERSISTENT CHEMOTHERAPY-INDUCED PERIPHERAL NEUROPATHY
Authors: Visovsky Constance
Published: December 2023

Chemotherapy-induced peripheral neuropathy (CIPN) results from chemotherapy for breast cancer treatment. CIPN symptoms persist causing significant loss of functional abilities and increased risk of falls. This study aimed to assess the spatiotemporal gait parameters in breast cancer survivors with CIPIN using an IMU system. We hypothesized that spatiotemporal gait parameters will differ between patients with persistent CIPN as compared to normative values. Thirty-two women who completed taxane-based chemotherapy for breast cancer and who have symptomatic neuropathy >6 months following completion of chemotherapy. Gait was assessed using seven Inertial Measurement Unit (IMU) sensors positioned at the sacrum, upper and lower leg, and foot. Participants completed a 2-minute walk at a comfortable walking pace. The outcome variables assessed included gait speed, single limb support, stride length, gait cycle time, stance percent, swing percent, double support percent, and cadence. Mean age 65(10) years, gait speed was 0.95(0.2) meters/second, single limb support 37.9(2.2) % of gait cycle, stride length 1.1(0.2) meters, gait cycle time 1.2(0.1) seconds, stance percent 62.1(2.2)% GC, swing percent 37.9(2.2)% GC, double support percent 23.9(4.3)% GC, and cadence 104.6(12.3) steps/min. Gait parameters assessed in this study showed an excellent test-retest reliability (r >0.86; ICC > 0.90). This is the first study to assess gait parameters in older breast cancer survivors with CIPN. Breast cancer survivors with CIPN showed reductions in all gait parameters. Reduced gait speed and stride length are critical indicators of fall risk for women with CIPN. Our study confirmed differences in spatiotemporal parameters between patients with persistent CIPN.
THE “GOOD” CAREGIVER: DOES FILIAL PIETY NECESSITATE SELF-SACRIFICE?
Authors: Maulod Ad , Rouse Sasha , Lee Nur ’Atiqah , Malhotra Rahul
Published: December 2023

Family caregiving policies that amplify the enactment of ‘filial piety’ – respect and care towards parents, grandparents and older persons – are especially pronounced in Asian societies, where caring for older family members is culturally expected and appraised yet is associated with stress and burden. Numerous studies have shown that fulfilment of filial piety contributes to better psychological outcomes for caregivers while mismatched filial expectations contribute to poorer psychological outcomes. However, few studies acknowledge how filial care varies according to individual resources and socio-cultural contexts. We seek to understand how family caregivers negotiate their self-determination through filial care, which contributes to positive and negative caregiving experiences. We conducted in-depth interviews with 34 caregivers of older persons with functional limitations in Singapore, purposefully selected based on varying positive and negative caregiving experiences. For caregivers with predominantly negative caregiving experiences, filial care was seen as an act of sacrifice and expectation of duty, with low autonomy to exercise self-determination. In comparison, caregivers with predominantly positive caregiving experiences described filial care as an act of sincere love cultivated through close relationships with their care-recipient, and aligned to their self-determination. Strong family support was also evident in the latter. Treating filial piety as a ‘natural desire to care for parents’ obscures efforts required to amplify positive caregiving experiences while normalisation of self-sacrifice and suffering hinders caregivers from expressing burden and accessing support. A nuanced understanding of how caregivers negotiate filial care can inform policy interventions to empower caregivers and care-recipients and enhance intergenerational relationships.
WORKING THROUGH IT: EMPLOYMENT DISCRIMINATION, LABOR FORCE OUTCOMES, AND MENTAL HEALTH AMONG OLDER BLACK AMERICANS
Authors: Brown Lauren , Abrams Leah , Zhang Yuan
Published: December 2023

We examine lifetime experiences of employment discrimination as one pathway by which racism impacts Black older adults’ well-being. We use data from the Health and Retirement Study’s (HRS) leave behind questionnaire to characterize lifetime experiences of being unfairly fired, not hired, or not promoted among Black older adults (N=2,948) and test associations of employment discrimination with labor force status at age 62, job satisfaction among those working, and depressive symptoms. Employment discrimination was commonly reported by Black older adults, especially among men and those with any college education. Employment discrimination was not associated with employment status but was associated with job dissatisfaction (OR=2.00, p=0.001) and depressive symptoms (Beta=0.34, p< 0.001). Findings demonstrate the detrimental impact of employment discrimination on Black older adults’ work experiences and mental health, while highlighting the limitations of HRS’s discrimination items. This research points to racism in the workplace as an obstacle to healthy aging for Black adults in America.
ACCEPTANCE AND COMMITMENT THERAPY INTERVENTION FOR PARENT CAREGIVERS: A STRENGTH-BASED APPROACH
Authors: Frederick Miranda , Lee Jeong Eun , Zarling Amie
Published: December 2023

ACT has emerged as a behavioral change approach that has been applied to address a wide range of challenges. Empirical research has shown that ACT can deliver positive long-term effects across various populations, including caregivers. Using six core principles of ACT, we have revised an acceptance and commitment therapy program (ACT) for custodial grandparents and their grandchildren. Our intervention program emphasized the importance of acceptance and promoting resilience among participants. This approach is particularly valuable for this population as the focus of the program is to strengthen their competencies, life skills and emotional resilience. The program consists of a web based ACT program with online coaching meetings across four sessions delivered for each age group. This program is unique in the sense that it utilizes both individual and group session techniques to facilitate the learning process. The main purpose of the program is to promote effective coping strategies, to reduce parenting stress among grandparents and to increase life skills (i.e., decision-making, proactivity) among children. Preliminary findings suggest that participating in ACT programs could help custodial, foster and biological parents improve self-efficacy, emotional well-being, higher self-confidence, social competence, lower depressive symptoms, and parenting distress, thereby leading to positive outcomes such as improved mental health and higher resilience.
BUILDING INTERDISCIPLINARY COLLABORATIONS ACROSS THE AGING CONTINUUM: ROLE OF CENTERS ON AGING
Authors: Shippee Tetyana
Published: December 2023

Interdisciplinary collaborations and team science are essential in advancing research across the aging continuum. This involves bringing together experts from different disciplines to work together to address complex topics related to aging. Yet, despite the value of building interdisciplinary collaborations, multiple barriers often exist, that include finding the time to connect, developing shared goals by faculty dispersed across different departments, and developing a commitment to learning from each other and having open communication. This symposium will review multi-pronged strategies to build interdisciplinary collaboration in aging as part of the Center for Healthy Aging and Innovation at the University of Minnesota. In particular, we will discuss the formation of Special Interest groups (SIGs), which have become one key way to encourage interdisciplinary collaborations. SIGs are member driven and are meant to encourage collaboration via joint publications, presentations and grant applications as well as other shared initiatives agreed upon by the group (e.g., resource identifications, book club). Each special group has its own sense of community and draws on members from different disciplines. The symposium will include presentations from four of the seven SIG chairs, focused on the Financial Decision Making SIG, Alzheimer’s Disease and Related Dementias SIG, Transportation SIG, and Aging and Chronic Disease Management SIG. Importantly, the symposium includes perspectives from faculty at different career ranks as well as PhD students.
EARLY-LIFE ORIGINS OF LATER-LIFE HEALTH AMONG OLDER BRAZILIANS: DIFFERENCES IN ASSOCIATIONS BY HEALTH CONDITION
Authors: Farina Mateo
Published: December 2023

Background

A rich body of literature has linked poor childhood health to adverse adult health outcomes in later life. This association, however, has largely been studied in high-income countries. Less attention has been given to other country contexts where childhood exposures and adulthood socioeconomic conditions are vastly different. Brazil represents an important context due to the significant growth in older adult population, significant rise in life expectancy, and rapid industrialization that occurred since the 20th century. Method. Data come from the ELSI-Brazil Study, a nationally representative sample of older Brazilians. Logistic regression was used to predict the association between childhood conditions (socioeconomic adversity and poor health) and adult health conditions (heart conditions, heart failure, diabetes, and stroke).

Results

Poor child health was positively associated with stroke, heart disease, and heart failure, but was not associated with diabetes or high blood pressure. Poor child socioeconomic status was associated with diabetes and stroke but not associated with heart conditions, heart failure, or high blood pressure.

Discussion

The importance of childhood conditions for later life remained important in Brazil, but questions remain as to why certain conditions were found to be significant while others were not. Differences may stem from larger contextual changes such as the impact of globalization on food choices during adulthood for these cohorts. This study highlights the significance of contextual and conditional factors in comprehending the multifaceted dynamics underlying the association between early life conditions and later life health.
MID-LIFE FINANCIAL STRESS AND COGNITIVE AND PHYSICAL PROBLEMS IN OLDER AGE: THE ROLE OF POTENTIALLY MODIFYING FACTORS
Authors: Kåreholt Ingemar , Nilsen Charlotta , Finkel Deborah , Sindi Shireen
Published: December 2023

Financial stress is an important source of chronic stress and has been associated with cognitive and physical impairments. This study investigates whether midlife financial stress is associated with the combination of cognitive and physical impairment, the role of potentially modifiable factors, and sex differences.

Methods: The Cardiovascular Risk Factors, Aging, and Dementia population-based cohort study from Finland was used (n=1497) (baseline collected 1972-1987, mean age 50 years). There were two late-life re-examinations (mean total follow-up 25 years). Midlife financial stress was measured using two questions on financial situation. Cognitive impairment was based on six cognitive domains. Physical impairment was self-reported. Potential modifying factors investigated were smoking, alcohol, physical activity, cohabiting/not, non-manual work, and sleep disturbances. Sex differences were investigated. We used path analyses with full information maximum likelihood estimation.

Results: Among women and men, midlife financial stress associated with cognitive impairment, physical impairment and their combination. Smoking and sleep disturbances mediated associations between financial stress, physical impairment, and combined impairments. Among men: manual/non-manual work mediated the association to cognitive impairments; cohabitation mediated to cognitive impairment; financial stress was associated with cognitive impairment only among smokers and stress had a stronger association to physical and combined impairments among non-drinkers. Among women, sleep seems to have role in the association between financial stress and cognitive impairment.

Conclusions: Midlife financial stress associates with late-life impairments, and lifestyle/sociodemographic factors may modify these associations. Sex differences were observed. Interventions promoting healthier lifestyle and psychosocial factors may buffer against the deleterious role of financial stress.
REVOLUTIONIZING COGNITIVE ASSESSMENT: THE POWER OF DIGITAL BIOMARKERS AND ECOLOGICALLY VALID METHODS
Authors: Roque Nelson , Sliwinski Martin , Katz Mindy , Anderson-Hanley Cay
Published: December 2023

Digital technologies have allowed neuropsychologists to utilize process-based approaches to assess cognitive function and change. Traditional methods of neuropsychological assessment involve obtaining single scores (often composites) to represent cognitive function. However, modern process-based techniques involve the use of digital data collection to acquire insights into both the manner and reasoning behind an individual’s performance. The present study will share insights into the task development and validation of active and passive digital cognitive assessments from two longitudinal studies of aging: (1) a study of non-dementia participants (N=322), ultra-brief mobile cognitive tests were administered up to six times per day for two weeks; and (2) a neuro-exergaming study (N=31) enrolling patients with MCI and their co-residing study partner, where participants used a study-provided tablet to complete a neuro-exergaming protocol and digital cognitive assessments (e.g., digital trailmaking and eStroop). We analyzed both traditional and process-based metrics in two studies, including mean response time and patterns of inaccuracy. Study one found significant correlations between MCI status and metrics for survey completion time, working memory, and processing speed. Study two found weak to moderate correlations between cognitive function measures from digital and paper-based neuropsychology. Our findings suggest that remote self-administered digital measures can detect subtle cognitive changes. The event-level data, which is collected through a process-based approach, has enormous untapped potential for discovering and confirming novel digital biomarkers of cognitive health and progression that can be monitored beyond clinical settings.
CATCHU: A NOVEL VISUAL-SOMATOSENSORY INTEGRATION TOOL FOR PREDICTING FALLS
Authors: Mahoney Jeannette , George Claudene , Verghese Joe
Published: December 2023

Ability to integrate information across sensory systems is a vital aspect of human functioning in the real world. While multisensory integration effects are measured across a wide array of populations using various sensory pairings and different neuroscience techniques, a gold standard for quantifying multisensory integration was seemingly lacking. We recently established a standardized protocol for administering and calculating behavioral multisensory integration effects across diverse clinical populations and age-ranges. Our previous work has linked the magnitude of visual-somatosensory integration (measured behaviorally using simple reaction time tasks) to important cognitive (attention) and motor (balance, gait, and falls) outcomes in healthy and cognitively impaired older adults. Given the paucity of extant translational multisensory integration tools in clinical settings, we recently developed a novel digital health app grounded in over 15 years of multisensory research. CatchU® (Before You Fall…) quantitatively measures visual-somatosensory integration performance, while considering medical comorbidities, to detect one’s fall propensity. Our goal is to facilitate the identification of patients who are at increased risk of falls and promote physician-initiated falls counseling in routine practice (e.g., annual wellness, sick, or follow-up visits). This will thereby raise awareness of falls and foster physician efforts to alleviate disability, promote independence, and improve the well-being of older adults, all while aiming to reduce the significant societal cost of falls in older adults and others at high risk.
AN INTEGRATIVE LITERATURE REVIEW ON SPIRITUAL NEEDS FROM THE PERSPECTIVE OF OLDER ADULTS LIVING WITH DEMENTIA
Authors: Zhao Hui , Boateng Augustine , Ezeokonkwo Francesca , Federwitz Chad , Epps Fayron , Britt Katherine
Published: December 2023

Spirituality is a part of successful aging, promoting better sleep, well-being, and cognitive function. Persons living with dementia (PLWD) are reported to have greater needs related to their spirituality (spiritual needs) compared to persons without dementia; however, support for spiritual needs is minimally present or absent in dementia care. Unmet spiritual needs may lead to depression, anxiety, and greater physical pain; thus, addressing the spiritual needs of PLWD is essential to support well-being and inform personalized care. Our integrative literature review explored characteristics of spiritual needs of PLWD and how to support them. ATLA Religion, CINAHL, PsychInfo, PubMed, and SocIndex were searched between 2000 and 2022, resulting in five original research articles meeting inclusion criteria focusing on spiritual needs of PLWD, including PLWDs’ perspectives. Most studies (n=4) were qualitative design, conducted worldwide in various settings, and included mild to moderate stage dementia. Components of spiritual needs covered the importance of connection and meaning for a sense of peace to support their identity and values. Connection to elements of spirituality included religion, meaningful relationships, nature, art, and self. Meaning was connected to past sources and experiences, supported by spiritual and religious activities. A sense of peace is supported through meaningful activities and religious rituals to help them rely on their faith through fear and memory loss. Support for spiritual needs may facilitate meaningful engagement for PLWD, leading to a sense of peace. Healthcare providers may utilize complementary, low-cost holistic care to promote personhood, values, and well-being among PLWD.
RELATIONSHIP BETWEEN CEREBRAL MICROINFARCTS AND DEMENTIA BY GENDER AMONG COMMUNITY-BASED OLDER ADULTS
Authors: Sin Mo-kyung , Cheng Yan , Roseman Jeffrey , Zamrini Edward , Ahmed Ali
Published: December 2023

Cerebral microinfarcts are common in older adults and associated with cognitive impairment. Less is known about sex-related variation in the relationship between microinfarcts and dementia in older adults, the examination of which was the objective of this study. This case-control study was based on 727 participants (308 men, 419 women) in the Adult Changes in Thought (ACT) autopsy data. Microinfarcts (presence, number, and location) were ascertained by blinded board-certified neuropathologists, and dementia diagnoses (yes, no) were made by the ACT Consensus Diagnosis Conference per DSM-IV criteria. Multivariable logistic regression analyses were conducted to examine the relationship. Microinfarcts were present in 356 (49%) participants (144 had one; 211 ≥2, 257 cortical, 216 subcortical), and 381 (52.4%) had dementia. More participants with dementia had ≥2 microinfarcts, although there was no difference in the distribution of a single microinfarct. Adjusted OR (95% CI) for dementia associated with any microinfarct was 1.36 (0.97–1.91). Respective ORs (95% CIs) in women and men were 1.45 (0.91–2.30) and 1.24 (0.75–2.06; p for interaction, 0.34). Adjusted OR (95% CI) for dementia associated with cortical and subcortical microinfarcts were 1.19 (0.83–1.69) and 1.65 (1.14–2.38), respectively, without any evidence of heterogeneity (p for interaction, 0.96 and 0.55, respectively). The presence of subcortical microinfarcts, but not cortical, had a significant association with dementia in older adults, but there was no evidence of a sex-related heterogeneity in that association. Future studies need to examine strategies to delay and manage vascular risk factors contributing to subcortical microinfarcts.
OBJECTIVE SLEEP AND CIRCADIAN REST–ACTIVITY RHYTHMS AND MULTIPLE DOMAINS OF COGNITIVE FUNCTION IN OLDER ADULTS
Authors: Stone Katie , Barnes Haley , Blackwell Terri , Glynn Nancy , Esser Karyn , Newman Anne , Cummings Steven , Cawthon Peggy
Published: December 2023

Evidence suggests that sleep and circadian rest-activity rhythms (RAR) play a key role in dementia and Alzheimer Disease (AD) pathology. Studies with objective measures of sleep and RAR and multiple domains of cognition remain limited. We studied 820 older adults enrolled in the Study of Muscle, Mobility and Aging (SOMMA). Actigraphs were worn for one week, and processed for sleep-wake measures including total sleep time (TST) and sleep efficiency (SE); and parametric (acrophase, pseudo-F) and non-parametric (interdaily stability [IS], intradaily variability [IV], and relative amplitude [RA]) 24-hour RAR variables. Cognitive assessments included global cognition (the Montreal Cognitive Assessment), executive function (Trails B test), memory (California Verbal Learning Test-short form; and psychomotor performance (Digit-Symbol Coding Test). Adjusting for age, sex, clinic site and education, we examined adjusted mean cognitive test scores by categories of sleep and RAR exposures. Mean age was 76 years, 58% were female, and 15% were non-white. Higher RA, reflecting a more robust 24-hour RAR, was associated with better cognition on all tests (p for trend <0.05). Reduced SE was related to lower cognitive function (psychomotor performance, global cognition, memory; p<.05). There were no associations with TST and any cognitive measures examined. SE and RAR were variably associated with both global and specific domains of cognition in older men and women. The RA in particular was strongly related to multiple domains of cognition related to AD, and may be useful in identifying individuals at risk. Additional analyses will explore sex differences and longitudinal associations.
DEFINING AND CHARACTERIZING MAINTENANCE: RESULTS FROM A LITERATURE REVIEW
Authors: Ajja Rahma , Thorpe Anna , Smeekens Bridget , Hughes Jaime
Published: December 2023

Leading models of health behavior change define maintenance as sustainment of the target behavior over time. Although behavior change interventions for physical activity have shown to be effective in older adults, maintenance of activity levels after an active intervention period is rarely examined. This literature review aimed to identify the following: (1) frequency with which maintenance is described and measured in the scientific literature; (2) intervention techniques utilized to promote maintenance; and (3) common barriers and facilitators to maintenance. Systematic searches of electronic databases (Embase, CINAHL, PubMed) identified 20 eligible studies (conducted in United States, single component physical activity intervention with 1+ follow-up period(s) beyond post-treatment assessment). Six studies reported maintenance in the title and only 8 included a theoretical model or framework [Social Cognitive Theory (N=5), Theoretical Domains Framework (N=1), Attribution Theory (N=1), Three-Level Hierarchical Framework (N=1)]. No studies defined maintenance. The majority of studies (N=16) provided only 1 follow-up after the post-treatment assessment (range: 4 weeks – 18 months). One-half of studies described specific intervention strategies to support maintenance, including goal-setting, personalized feedback, and social support. Six studies described barriers, including costs, aversion to activity or environment, low motivation, time constraints, and self-efficacy. Only two studies reported facilitators to maintenance, including knowledge, confidence, self-efficacy, and social support. These findings highlight the gap in health behavior scientific literature addressing maintenance of physical activity behaviors following structured interventions for older adults.
MAINTAINING WALKING THROUGH WALK ON!: A COMMUNITY-BASED WALKING PROGRAM FOR OLDER ADULTS
Authors: Nicklas Barb , Kemp Elizabeth Chmelo , Gordon Michelle , Hughes Jaime , Ajja Rahma , Moore Justin
Published: December 2023

The NIA-funded LIFE study showed that a walking-based intervention prevents mobility disability, even in those with compromised walking ability. However, increases in activity were not maintained following cessation of the intervention, suggesting novel approaches and accessible opportunities are needed to provide continued support for this population to maintain increased walking. We previously reported high feasibility and acceptability from a pilot of a supervised, group-based, and fee-for-service walking program (Walk On!) for adults with mobility challenges. The program focuses on walking stamina, and takes place two days/week for 12 weeks. Walk On! was offered for a total of ten consecutive sessions from late 2017 until March 2020 at a local church. The majority of attendees were >75 years (71%), female (65%), and had low levels of physical function (usual gait speed=0.79±0.16; 31% used an assistive device). Of the 49 unique (first-time) attendees who registered for Walk On!, only 18 (37%) did not re-register for at least one subsequent session. Thus, 63% (n=31) registered for at least 2 sessions, 51% (n=25) for at least 3 sessions, 20 (41%) for at least 4 sessions, and 15 (31%) for at least 5 of the 10 sessions. Mean attendance at scheduled group walking days for all attendees was 77%±21% for all attendees and did not decrease substantially for those attending multiple sessions. The safe, social, and accessible community-based Walk On! program may be one approach to sustain walking for older adults with mobility challenges. Future research will focus on measuring individual characteristics associated with maintenance.
MAINTENANCE OF HEALTH BEHAVIOR CHANGE: RECOMMENDATIONS FOR FUTURE RESEARCH
Authors: Hughes Jaime , Randazzo Aliza , Ajja Rahma
Published: December 2023

Modifying poor health behaviors can enhance function, improve quality-of-life, and reduce morbidity and mortality among older adults. However, achieving and sustaining behavior change can be difficult. A growing body of research suggest that initiation and maintenance are unique constructs within health behavior change; each requiring unique skills and each associated with unique outcomes. Although some leading health behavior change models (e.g., Transtheoretical Model of Change) include maintenance as a construct, maintenance is often overlooked in the scientific literature. As part of a NIA Research Centers Collaborative Network (RCCN) pilot award, this project utilized a series of qualitative activities to explore the concept of maintenance and identify future recommendations for advancing the field. Three unique listening sessions were conducted with clinician-researchers (1 group) and community-based service organizations (2 groups). An interdisciplinary expert think tank was then convened to reflect on key findings. All sessions were conducted virtually; transcripts were reviewed using a priori themes with additional themes generated by an open coding approach. Major themes included the following: (1) To date, there is no consensus definition of maintenance nor is there agreement on maintenance across behaviors. (2) Few behavior change models consider how health behaviors must shift to accommodate for age-related changes in cognition and/or physical function. (3) Existing funding mechanisms and timelines may not allow sufficient follow-up periods to examine maintenance over time. (4) Although the terms maintenance and sustainment are used interchangeably, community leaders emphasized the importance of sustaining health promotion programs in order to enable maintenance to occur.
RISK OF ALZHEIMER’S DISEASE AND RELATED DEMENTIA IN PATIENTS WITH SLOW PROGRESSIVE CANCERS
Authors: Akushevich Igor , Yashkin Arseniy , Nalawade Vinit , Kravchenko Julia
Published: December 2023

Evidence is accumulating that individuals with cancer diagnoses exhibit Alzheimer’s disease (AD) and related dementia (ADRD) risk profiles that differ from the general population of U.S. older adults. In this study we used SEER-Medicare data to compare the relative risk of AD/ADRD between individuals with slow-progressive cancers and the non-cancer general population. The study cohort included individuals age 65+ (N=2,023,054) with a primary diagnosis (1999-2017) of one of nine slow progressive cancers (breast, colorectal, prostate, uterine, kidney, ovarian, and urinary bladder cancers, as well as lymphomas and melanoma) and no clinical record of AD/ADRD prior to cancer diagnosis. This cohort was then matched by age to a comparable non-cancer population (N=1,142,641). The hazard ratios of AD/ADRD for each cancer compared to the non-cancer cohort were evaluated individually in 29 age-specific groups for each cancer type. All cancers had similar patterns of dependence for post-cancer AD/ADRD risks. We found that the presence of cancer was associated with higher risk of AD/ADRD at age at diagnosis 65-75; the relative risks decline with age at diagnoses becoming protective at advanced ages. Furthermore, for any given age at diagnosis the relative risk of AD/ADRD (i.e., cancer vs. non-cancer) also declines with time. Detailed discussion of possible causes of these effects including cancer treatment, genetic variation, possible trade-off effects, common risk and protective factors, possibly lower administration and adherence of AD/ADRD diagnostic procedures for individuals with cancer, and the roles of competing risks (first of all due to death cases) is presented.
THE RELATIONSHIP BETWEEN 10-YEAR CHANGES IN COGNITIVE ABILITY AND SUBSEQUENT MORTALITY: FINDINGS FROM THE ACTIVE
Authors: Chen Diefei , Gross Alden , Willis Sherry , Rebok George
Published: December 2023

Cognitive ability and cognitive decline have been linked with mortality in older adults. However, little was understood about the role of cognitive interventions on mortality outcomes in this population. Using twenty-year follow-up data from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) trial, we examined the association between cognitive change and mortality risk, and the effect of ACTIVE cognitive training (memory, reasoning, and speed of processing) on mortality risk. Mortality was ascertained through linkage to the National Death Index database. To model time to death as a function of cognitive change and training effect, we used shared growth-survival models with simultaneously estimated latent intercepts and slopes as predictors. Among the 2802 participants, 2021 died on or before the year 2019 (72.1%). Both higher baseline level and slower decline in global cognition were associated with lower hazards of all-cause mortality after adjusting for covariates (HR = 0.68, 95% CI 0.58, 0.79; HR = 0.42, 95% CI 0.40, 0.44, respectively). We did not observe any significant effects of ACTIVE cognitive training in memory, reasoning, or speed of processing on all-cause mortality. Our findings demonstrated the association between the trajectory of cognitive change and mortality among older adults, independent of cognitive training interventions. More work is needed to identify relevant timing as well as modalities of non-pharmaceutical interventions that can promote healthy longevity.