bluuebunny/crossref_metadata_2025 huggingface dataset:
Outdoor Spaces, Transportation, and Environmental Justice: A Qualitative Interpretive Meta-Synthesis
Authors: Fields Noelle , Ravi Kristen , Dabelko-Schoeny Holly
Published: December 2020

Age-friendly environments aim to promote healthy and active aging by building and maintaining capacity across the life course and allow people who have a loss of capacity to continue engaging in activities that they value. Age-friendly community assessments are being conducted worldwide. This qualitative interpretive meta-synthesis (QIMS) aims to create a rich description of older adults’ experiences with outdoor spaces and buildings as well as transportation as part of an age-friendly assessment. The themes that emerged regarding older adults’ experiences with outdoor space and buildings included 1) accessibility and 2) appropriate infrastructure. Regarding transportation, the theme of accessibility included subthemes of 1) availability and 2) affordability. Further reduction indicated that age-friendliness can be conceptualized as environmental justice (EJ). The three areas of EJ including distributional justice, procedural justice, and recognition provide a helpful framework for social workers and their interdisciplinary partners to systematically document and evaluate their age-friendly community efforts.
Black-White Inequities in Perception of Access to Neighborhood Resources Among Older Adults
Authors: Esposito Michael , Sylvers Dominique , Clarke Philippa , Finlay Jessica , Jang Joy Bohyun , Tang Sandra
Published: December 2020

Drawing on insights from critical race scholarship, this study examines how access to neighborhood resources varies among black and white older adults. Using Bayesian multilevel models, we estimate how evaluations of one’s neighborhood environment (e.g., perceived access to parks) varies by race, conditional on objective environmental measures (e.g., park area in one’s neighborhood). Results suggest that within the same spatial areas, individuals occupying marginalized statuses are less likely to perceive their neighborhoods as providing sufficient/accessible collective goods. Conditional on living in tracts with equal public park infrastructure, for instance, black respondents are 15% [95-CI: 8%, 22%] more likely to describe their neighborhoods as “lacking accessible parks.” Results suggest that these inequities are further exacerbated by race-related structural features (e.g., residential segregation) and other markers of welfare and marginalization (e.g., cognitive function). Overall, findings suggest that access to neighborhood-resources—and the benefits they confer—are fashioned by broader systems of power and inequality.
Disability and Long-Term Care in Singapore
Authors: Huijun Cynthia Chen , Chia Ngee Choon
Published: December 2020

Public systems for long term care (LTC) redistribute resources between generations. Population aging is one of the most significant transformations in the 21st century, where the number of older persons aged 60 years and above is expected to double by 2050, rising to 2.1 billion. We used the Future Elderly Model (FEM) to project the impact of population aging in Singapore up to the year 2050. The FEM is a dynamic economic and demographic microsimulation model. By 2050, the total number of older adults with potential limitation in activities of daily living (ADL) was projected to increase to 275 thousand (18.9%). With the increasing prevalence of disability and chronic diseases, older adults might not have sufficient savings to meet future needs sustainably, despite the expansion of disability insurance from ElderShield to CareShield Life. Lessons and best practices for LTC could be transferred from our experiences to other aging cities globally. Part of a symposium sponsored by International Comparisons of Healthy Aging Interest Group.
Uncovering Promising Practices for Supporting Older People Experiencing Homelessness
Authors: Canham Sarah , Humphries Joe , Burns Victoria , Sussman Tamara , Walsh Christine
Published: December 2020

Montréal, Calgary, and Vancouver have seen a dramatic increase in homelessness among adults aged 50+. In order to identify ‘promising practices’ that promote aging-in-the-right-place for older people experiencing homelessness (OPEH) in Montréal, Calgary, and Vancouver, we conducted an environmental scan and three World Café workshops with 99 service providers and OPEH. We identified 53 promising practices managed or operated by 42 providers which we categorized across a shelter/housing continuum: 1) Emergency/transitional/temporary shelter/housing; 2) Independent housing with offsite supports; 3) Supported independent housing with onsite, non-medical supports; 4) Permanent supportive housing with onsite medical support and/or specialized services; 5) Long-term care; and 6) Palliative care/hospice. Study findings provide a template for existing solutions to the diverse shelter/housing needs of OPEH and insight into the gaps in shelter/housing and services that would support OPEH to age-in-the-right place. Policy and practice implications for scaling promising practices will be discussed. Part of a symposium sponsored by the Environmental Gerontology Interest Group.
Research to Strengthen Policy, Practice, and Advocacy on Housing for Aging Societies
Authors: Greenfield Emily , Berlinger Nancy
Published: December 2020

Population aging alongside other global trends—such as urbanization, widening economic inequality, and climate change—accelerate the need for systematic efforts to improve housing for diverse individuals, families, and communities as they age. This symposium features gerontological research explicitly designed to advance policy, practice, and advocacy on aging and housing. The first presentation demonstrates the use of data from U.S. surveys to better characterize the nature of current and future challenges in access to affordable, accessible, and safe housing for older adults. The second paper presents findings from a mixed-methods action research project in Toronto involving tenants living in properties managed by the second largest senior housing provider in North America. The paper indicates how findings on facilitators and threats to aging in place directly inform policy implementation on integrated services in Toronto. The third paper presents findings from a longitudinal, in-depth interview study with leaders of age-friendly community initiatives in suburban New Jersey, demonstrating the simultaneous challenges and opportunities of embedding housing advocacy at the local level within broader age-friendly community change efforts. The fourth paper presents three case studies based on interviews with key stakeholders involved with anti-displacement housing preservation and public housing organizing in New York City, highlighting the often invisible work of older, lower income, African American women at the center of advocacy efforts to preserve affordable housing. Guided by interdisciplinary critical work on ethical responses to population aging, the discussant will integrate themes from the papers to propose a framework for research, policy, practice, and advocacy.
Neighborhood Social Deprivation and Caregiving Intensity for Community-Dwelling Older Adults With Disabilities
Authors: Fabius Chanee , Mulcahy John , Okoye Safiyyah , Wolff Jennifer
Published: December 2020

There is growing interest in the role of “place” in the provision of long-term services and supports (LTSS) for older adults with disabilities, who receive ~16 billion hours of care per year from family and unpaid caregivers, but information is lacking. Using data from the 2015 National Health and Aging Trends Study (NHATS) linked to census-tract-level information from the American Community Survey, we described the association between caregiving intensity (hours of care received per week) and neighborhood social deprivation among N=2125 community-dwelling older adults with disabilities. Individuals receiving 40 hours or more of help per week had greater levels of functional impairment and dementia, and more often lived in neighborhoods at the highest quartile of social deprivation compared to those receiving fewer than 20 hours of care (26.8% vs. 21.7%, respectively). Findings have policy implications for targeting LTSS strategies toward addressing inequities in social determinants of health for vulnerable populations.
Home and Neighborhood Context and Fall Risk Among Older Americans
Authors: Okoye Safiyyah , Mulcahy John , Fabius Chanee , Wolff Jennifer
Published: December 2020

Falls result from complex interactions between individuals and their environment and are the leading cause of injuries among older adults. A nascent literature demonstrates an association between neighborhood characteristics and falls. However, available evidence is from small, nonrepresentative samples and generally focuses on individual, home, or neighborhood risk-factors rather than the contribution of all three. We link information from N=6,489 community-dwelling participants in the 2015 National Health and Aging Trends Study with the Social Deprivation Index (SDI), which yields a census-tract-level score of socioeconomic disadvantage, to assess associations between home and neighborhood context and falls in the previous year. Household financial strain was associated with a 31% increased risk of falling, and indoor trip hazards with a 14% increased risk, after adjusting for individual factors and neighborhood SDI (all p <0.05). Findings reflect the interplay between home and neighborhood context and fall-risk, and can inform community-based fall-prevention interventions.
Material Conditions and Well-Being in Old Age: the Role of Contextual Factors at Regional Level
Authors: Myck Michal , Brandt Martina , Garten Claudius , Oczkowska Monika , Schmitz Alina
Published: December 2020

In our Beethoven project “Age-well” we examine the role of regional contextual factors for the relationship between individual wellbeing and material conditions over time, using a unique combination of individual and regional level longitudinal data. The analyses consider a broad range of regional, community-level indicators for two countries, Germany and Poland, both characterised by rapid population ageing and significant regional variation in the standard of living. These variables, including local indicators of economic conditions and public services, are combined with detailed individual-level information on wellbeing from the Survey of Health, Ageing and Retirement in Europe (SHARE). This data match allows us to study the degree to which regional contexts affect the relationship between individual material conditions and wellbeing in later life. Local public services are shown to mediate the importance of individual level resources for wellbeing confirming an important channel through which public policy can improve welfare of older people.
Title II: Improving Grants for States and Community Programs on Aging
Authors: Kuhne Jamie
Published: December 2020

There are several noteworthy changes to the Improving Grants for States and Community Programs on Aging’s portion of the OAA. The reauthorization adds language requiring data collection on the needs of older adults and specifying additional populations on whom to focus outreach efforts, such as survivors of the Holocaust. The reauthorization also expands what States may fund with Supportive Services grants, adding screening for social isolation and traumatic brain injuries. The Act goes on extend Stated the option of funding programs to address both of these issues. The Act also requires the Assistant Secretary to study the supply and demand of home delivered and congregant meals and make recommendations to address the gap. Finally, there is expansion of the section on Caregiving, including a definition of caregiver assessment and the removal of a limit on funds States can use on support services to family caregivers.
State Variability in Assisted Living Regulations, Access, and Outcomes for Persons With Dementia
Authors: Thomas Kali
Published: December 2020

Approximately one million individuals, an estimated40% with a diagnosis of Alzheimer’s disease-related dementias (ADRD), reside in assisted living (AL); yet, little is known about their experience or the quality of care provided in AL. Unlike other forms of long-term care (LTC), the licensing, operating, and enforcement requirements for AL falls to the states, which vary dramatically in their regulatory approaches. The overall objective of this symposium is to examine states’ AL regulatory environments and understand if and how access to AL and the health outcomes of AL residents with ADRD are impacted by states’ regulatory decisions. Presenters will highlight the state variability in the regulation, access, and outcomes of AL residents with ADRD. The first presentation will describe the within and between state differences in regulatory approaches as it relates to dementia care. The second presentation will describe the variation in Medicaid financing of services in AL and its potential impact on access to AL within those states. The third will present geographic disparities in access to specialized dementia care in AL. The fourth presentation will characterize differences in emergency department utilization among AL residents with ADRD across states. Finally, the fifth presenter will report on the effect of establishing or increasing state staffing requirements on outcomes of AL residents with ADRD. Results will ultimately inform policy-makers, organizational leaders, and clinicians as they seek the most effective ways to ensure equal access to AL and optimal outcomes for residents with ADRD. Assisted Living Interest Group Sponsored Symposium.
Geographic Disparities in Access to Specialized Dementia Care
Authors: Cornell Portia , Zhang Wenhan , Smith Lindsey , Fashaw Shekinah , Thomas Kali
Published: December 2020

With novel, previously undescribed data on the availability of dementia-specific assisted living communities (ALs), we analyzed variation among counties in the availability of this important service for persons with dementia. In twenty-one states, we identified 6,961 ALs (16%) with a dementia-specific license/certification. Counties with at least one AL providing dementia-specific care had substantially higher college attainment versus counties that had at least one AL, but no dementia-specific beds: 25% versus 18% (p<0.01). Counties with dementia care also had significantly greater median incomes ($54,000 vs. $46,400), and home values ($159,000 vs. $113,000), lower poverty rates (13.7 percent vs. 16.3 percent), and lower proportions of Black residents (7.8 percent vs. 8.7 percent). Our findings are suggestive of a mismatch in need and availability of residential care options for older adults with ADRD that are also low-income or racial/ethnic minorities. Part of a symposium sponsored by Assisted Living Interest Group.
Privatizing the Welfare State
Authors: Herd Pamela
Published: December 2020

The growth of the private sector in the Medicare and Medicaid programs is a sea change, leading many to argue that the old age welfare state is effectively becoming privatized. I examine these trends, but focus on the consequences for how older adults experience their interactions with government. In particular, I examine how privatization increases administrative burden for beneficiaries. Older adults must navigate hundreds of choices, leading to significant confusion. Most fail to pick policies that maximize their benefits and reduce their cost. This confusion harms beneficiaries. They end up with suboptimal coverage, with increased out of pocket costs and decreased access to care. The confusion, however, generates profits for insurers. Part of a symposium sponsored by the Women's Issues Interest Group.
Getting the Show on the Road! States Amp Up a Life Course Approach to Alzheimer's
Authors: Shean John , French Molly , Beatty Carissa
Published: December 2020

Alzheimer’s and other dementias are chronic conditions that disproportionately impact some populations. The dementia continuum spans decades, so life-course approaches by state health departments (SHDs) are crucial. SHDs’ implementation of the Healthy Brain Initiative Road Map (RM) represents policy/system/environmental actions to improve population-level dementia outcomes. METHODS. Alzheimer’s Association uses online reporting by affiliate chapters to monitor SHDs’ RM implementation. Association staff reviewed data and calculated frequencies by RM action and issue areas. Documentation from SHDs and national partners are supplementary data. RESULTS. Preliminary results from July-December 2019 indicate 34 SHDs were implementing 60 RM actions. Interventions clustered in risk reduction, early detection, workforce competencies, surveillance, and emergency preparedness. RM implementation lagged on access to community supports, attention to caregiving, and workforce supply analyses. A majority of states had multi-faceted initiatives. IMPLICATIONS. SHDs are deploying life-course approaches for dementia. SHD leaders must build towards a full response by expanding RM implementation.
The Intersection of Mental Health, Self-Reported Neurocognitive Functioning, and Education in Older HIV+ Gay Men
Authors: Krause Kristen
Published: December 2020

Older people living with HIV/AIDS (PLWHA) face different mental and neurocognitive challenges related to their health and well-being. Using data from a cross-sectional study (n=250) on older (age 50-69) gay men living with HIV/AIDS in NYC, this study examined the multi-level associations between self-reported neurocognitive functioning, mental health, and key sociodemographics (age, race/ethnicity, financial situation, and education). Findings suggest those who have higher self-reported neurocognitive functioning have higher levels of education, better self-rated health, and lower levels of PTSD and depression (p<0.01). Differences were not observed based on race/ethnicity, financial situation, and age. The overall findings demonstrate educational differences in self-reported cognitive functioning among older HIV+ gay men and highlight the importance of enhancing interventions and policies to promote better cognitive and mental health outcomes. More research is warranted to understand the intersection of education and cognitive performance among other sub-groups of PLWHA to understand whether these findings are consistent.
Socioeconomic Status and Long-Term Care Provision to Parents in Japan
Authors: Ibuka Yoko , Ohtsu Yui
Published: December 2020

Socioeconomic status (SES) is generating considerable interest in terms of health of individuals, but how it is associated with long-term care has not been established yet. We study the relationship between SES and long-term care provision to parents among the Japanese adults using JSTAR. We use the following six measures of SES for the analysis: income, asset, expenditure, living condition, housing condition and education. We find a greater probability of care provision to parents among those in higher SES categories for some SES measures, compared to the lowest category. However, after considering the survival probability of parents, the relationship is reversed and the probability of care provision is found to be greater among lower SES individuals. The association is more pronounced among males. The association is likely to be partly mediated by care needs of parents. These results suggest a higher burden of care disproportionately falls in low SES individuals.
Socioeconomic Inequality in Long-Term Care: A Comparison of Three Time Periods in the Netherlands
Authors: Abbing Jens , Suanet Bianca , van Groenou Marjolein Broese
Published: December 2020

This study aims at investigating to what extent inequalities in the use of formal, informal and privately paid care have changed over time. Data from the Longitudinal Aging Study Amsterdam (LASA) was used from three points in time (1995, 2005 and 2015) that capture distinct periods in the recent development of the Dutch long-term care system. In particular, the reforms of 2007 and 2015 might have impacted care uses. All participants (N = 1810) were living at home and between the age of 75 and 85 at measurement. The results indicate that, adjusted for health and partner status, formal, informal and privately paid care have decreased over time. Socioeconomic differences in informal care use have increased over time, but no change was found for privately paid or formal care use. These findings suggest that changes in the LTC system and long-term care resources in particular benefit lower socioeconomic groups.
The Aging Network and the Older Americans Act Reauthorization
Authors: Gotwals Amy
Published: December 2020

This presentation will cover a range of OAA reauthorization proposals - successes and what was not possible this year. As a leader in the aging network, n4a played a major role in the legislative process, and the discussion will include top priorities for improving the ability of the network to serve older adults with community-based supports and services.
New Pieces for the Older Americans Act Puzzle
Authors: MacPherson Andrew
Published: December 2020

With the passage of the new “Supporting Older Americans Act of 2020,” Congress acknowledged and address several under appreciated issues -the growing social isolation and loneliness of older adults, and the significant role that the aging network does and can play in providing supportive services to older adults with advanced illness (also known as serious illness). This presentation will provide information on these and other pieces of the OAA puzzle.
Understanding Driving as an Everyday Activity: International Perspectives
Authors: Dickerson Anne , Gelinas Isabelle , Choi Moon
Published: December 2020

This international symposium brings together leading occupational therapy researchers from around the world with a shared focus is on evaluating and improving the driving performance of older adults to decrease their crash risk and facilitate their community participation. In this session, five groups of international scholars will share their collective and individual research outcomes for driving as a means of community mobility. The first presentation will outline their collective international, cross-sectional study of 247 older adults from seven countries where the impact of driving on out-of-home mobility was compared. Each presentation that follows will then present results from innovative studies of ways in which to assess and address fitness to drive in older adulthood. Our discussant will summarize the potential expansion of the current work and engage the audience through interactive questions. Transportation and Aging Interest Group Sponsored Symposium.
International Comparison of Older Drivers and Non-Drivers for Activity Access and Quality of Life
Authors: Harries Cilla , Unsworth Carolyn , Vrkljan Brenda , Dickerson Anne
Published: December 2020

Driving is crucial for many people to age in place, as it is the most convenient option, and somtimes the only option for personal transport. This international, cross-sectional, cohort study of older adults (n=246) compared drivers’ and non-drivers’ quality of life and levels of community participation. Following ethical approval, data were collected across seven countries. The EQ-5D-5L was used to measure health related quality of life and a modified version of the Participation in Activities and Places Outside the Home (ACT-OUT) was used to measure community participation (T-ACT-OUT). Drivers accessed more out-of-home activities than non-drivers, suggesting higher community participation among this group. Health related quality of life was generally high among all participants, but slightly higher for drivers (U=3186, z=-2.78, p=.005, r=0.18). These findings resonate with recent evidence, which suggests supporting older drivers to continue to drive for as long as possible provides critical access to their communities (O’Neill et al., 2019). Part of a symposium sponsored by Transportation and Aging Interest Group.
Evaluating Older Drivers in Their Everyday Driving Environments
Authors: Gelinas Isabelle , Mazer Barbara , Chen Yu-Ting , Vrkljan Brenda , Marshall Shawn , Charlton Judith , Koppel Sjaanie
Published: December 2020

Developing tools that accurately detect at-risk driving behaviors is a public-health priority. There is a need for a measure that accurately assesses older drivers’ level of competence on familiar roadways. The objective of this presentation is to describe the development of the procedures and scoring of a new approach, the Electronic Driving Observation Schedule (eDOS), to observe everyday driving in the community. The eDOS was used to record and compare the driving environment and performance of older drivers and low-risk younger drivers during their everyday driving. Older (n=160, >74y) and younger (n=60, 35-64y) drivers completed a 20-30-minute drive from their home to destinations of their choice. Older drivers drove on simpler routes with fewer intersections and lane changes. Both groups made few driving errors, which were mostly low-risk. Younger drivers tended to demonstrate poor driving habits (not signaling, speeding, poor lane position) and compliance with road rules. Part of a symposium sponsored by Transportation and Aging Interest Group.
The Impact of Public Benefits on Low-Income Older Adults’ Financial Well-Being
Authors: Popham Lauren
Published: December 2020

Nineteen percent (13 million) older adults have incomes below 150% of the Federal Poverty Level, leaving them with limited means to afford basic living expenses. Public benefits can help bridge the gap allowing older adults to afford food, home energy, and health expenses. There are studies demonstrating the positive health outcomes associated with public benefits in older adults. It remains unclear how benefits may also improve subjective measures of well-being in older adults. To examine this question, baseline measures of well-being including the CFPB Financial Well-Being Scale were administered to older adults before they enrolled in benefits and again six months after receiving benefits to examine changes in well-being as a result of accessing benefits to help ease some of their financial burdens. Results revealed that older adults experience subjective, psychological improvements from benefits. These findings have implications for the social and behavioral determinants of health in older adults.
Challenges of Caring for an Acute Population in a Disaster
Authors: Peterson Lindsay , Hyer Kathryn , Dosa David , June Joseph , Dobbs Debra
Published: December 2020

The U.S. Gulf Coast hurricanes of 2004-08 led to research and policy reports highlighting the need for more emergency preparation among nursing homes (NH). In 2016, the federal government issued final rules requiring Medicaid and Medicare providers to develop comprehensive preparedness plans. The state of Florida previously imposed its own long-term care (LTC) preparedness requirements. Hurricane Irma tested the readiness of LTC facilities that care for disabled and vulnerable residents. This research examined the experiences of NHs (N=30) affected by the hurricane through qualitative interviews with administrative staff. Research team members analyzed the transcripts, identified codes, and met to reach consensus on themes. Three major themes emerged, 1) managing the unexpected, including last-minute evacuation orders, 2) caring for vulnerable residents amid the crisis, and 3) the struggle of maintaining staff. Results suggest LTC preparation has increased but long-standing problems continue, including conflicts with emergency management priorities.
Hurricane Irma’s Impact on Assisted Living Residents’ Rates of Hospitalization, Nursing Home Placement, and Mortality
Authors: Hua Cassandra , Hyer Kathryn , Zhang Wenhan , Ogarek Jessica , Dosa David
Published: December 2020

Little is known about the impact of hurricanes on the large and increasingly vulnerable population residing in assisted living communities (ALs). The objective of this paper was to leverage a novel methodology to identify Medicare beneficiaries residing in Florida ALs and determine their outcomes associated with Hurricane Irma in 2017. With Medicare enrollment records, claims, and the nursing home Minimum Data Set, we identified a cohort of AL residents in 2015 (n=45,505) and 2017 (n=42,306) and compared their rates of 30-day hospitalization, nursing home placement, and mortality in the two years. AL residents in 2017 had a 10% increase in their 30-day hospitalization rates (3.96 in 2015, 4.34 in 2017), 16% increase in their 30-day nursing home placement rates (1.61 in 2015, 1.87 in 2017), and 22% increase in their 30-day mortality (0.54 in 2015, 0.66 in 2017). Findings suggest Florida AL residents experienced adverse outcomes following Hurricane Irma.
Why Do Age and Bias Matter? Historical, Social, and Biological Impacts Across Generations of LGBTQ Older Adults
Authors: Emlet Charles , Goldsen Karen Fredriksen
Published: December 2020

We do not live in a stagnant world, politically, historically or socially - neither are the life experiences of lesbian, gay, bisexual, and transgender (LGBTQ) older adults. Their physical, psychological and social lives are impacted by their present and past historical contexts and generational identity, as well as the sociopolitical environment, social pressures, support and experiences of biases. This symposium draws upon data from Aging with Pride: National Health, Aging and Sexuality/Gender Study, the first longitudinal study of LGBTQ older adults in the United States, in order to examine how environmental, interpersonal and intrapersonal structures impact the lives of the three oldest generations of LGBTQ adults. Emlet and colleagues examine the generational and historical forces across the life course among 205 transgender older adults in order to illuminate how historical context and gender influences social life and physical health. Prasad and colleagues explore differences between various constructs of bias including lifetime discrimination, victimization, everyday discrimination and microaggressions on LGBTQ older adults and how those experiences impact depression, general health and quality of life. Lastly, Hoy-Ellis and colleagues explore how life course predictors including interpersonal violence, legal marriage, and identity management are associated with allostatic load (AL) in a sample of 317 LGBTQ older adults who range in age from 50-97. We will address the intersectionality of generational identity, experiences of bias and biomarkers, as well as the implications for policy and practice.
The Future of Aging Research
Authors: Helfand Stephen , Taylor Jackson
Published: December 2020

We are at a particularly propitious time in the history of the biology of aging and the science of health and humanity. It is a time for us to “Honor the Past, Enrich the Future”. Not long ago the study of the biology of aging was exclusively one of description of what happened with age—how do organisms, including humans, change with age at the level of proteins, cells, tissues and physiology. The identification of major genetic factors that substantially increase life span in model organisms ushered in the advent of a highly exploratory period focusing on the molecular, cellular and genetics mechanisms of aging. The convergence of many different streams of basic and clinical research have brought us to today, where we stand on the cusp of new environmental, molecular genetic and pharmacological breakthroughs in the biology of aging that presage new interventions that promise a healthier lifespan. The presentations in this Presidential Symposium will be from four Early Career Investigators presenting their own pioneering research in some of the most important areas of research in the biology of aging.
Sources and Importance of Mitochondrial NAD
Authors: Baur Joseph , Luongo Timothy , Eller Jared , Lu Mu-Jie , Perry Caroline , Cambronne Lulu
Published: December 2020

Nicotinamide adenine dinucleotide (NAD) levels fall with age or disease, and rise with exercise or caloric restriction. Moreover, the demonstration that supplemental NAD precursors drive beneficial effects in rodent models has driven a resurgence in interest in the basic biology of this molecule. Although NAD is present in the mitochondrial matrix and critical to the function of the organelle, the source of mitochondrial NAD has been debated. We recently used isotopic labeling to demonstrate that direct uptake of intact NAD is one mechanism by which mitochondria are able to obtain this nucleotide. Here, we show that this activity is sufficient to restore respiratory capacity in NAD-deficient isolated mitochondria, and identify SLC25A51 as a carrier that can mediate the transport of NAD across mitochondrial membranes. Understanding the compartment-specific regulation of NAD will be crucial to understanding how cells and tissues adapt their metabolism to changes in NAD availability. Funding: DK098656 to J.A.B., GM126897 to L.A.C.
Cognitive Aging: New Insights Into How Our Brains Age
Authors: Murphy Coleen , Villeda Saul
Published: December 2020

Maintaining quality of life with age is as important as slowing human aging. Slowing cognitive decline will be a critical aspect of keeping older adults healthy as we extend lifespan. To that end, identifying the molecular regulators of neuronal health, including learning and memory, in model systems that can later be applied to humans is an important step. In this symposium, we will hear about work on cognitive decline and its prevention being done in a variety of model systems.
Aging and Neurodegeneration: New Approaches to Neurodegeneration and Aging
Authors: Bonini Nancy
Published: December 2020

Model organisms like C. elegans and Drosophila are powerful systems to help dissect molecular genetic aspects of complex biological processes. Here we will present a number of biological questions and approaches that have been used to study questions of neural integrity and healthful aging using these systems.
Physiology and Aging: New Understanding of Organs That Affect the Physiology of Aging
Authors: Drummond-Barbosa Daniela
Published: December 2020

As organisms age, many changes occur to their physiology, which in turn impact the function of multiple tissues. It is therefore critical to investigate the fundamental mechanisms of how endocrine organs shape our physiology, and how changes in our physiology affect stem cell lineages, which generate new cells for maintenance and repair of tissues/organs throughout life. This symposium will highlight the research in the laboratories of Dr. Gerard Karsenty (Columbia University) on the multiple endocrine functions of bone, of Dr. Nicholas Buchon (Cornell University) on the role of host-microbe interactions in intestinal homeostasis, of Dr. Jane Hubbard (NYU/Skirball Institute) on the physiological control of the germline, and of Dr. Daniela Drummond-Barbosa (Johns Hopkins University) on how diet and adipocyte factors regulate oogenesis. As research by these and other groups illustrate, the complex physiological regulation of tissue/organ maintenance and function is not only a fascinating biological problem, but it also has implications for many diseases and other conditions that are tightly linked to our endocrine state, including aging.
The Impact of Bone on the Biology of Aging
Authors: Karsenty Gerard
Published: December 2020

We hypothesized that bone may secrete hormones that regulate energy metabolism and reproduction. Testing this hypothesis revealed that the osteoblast-specific secreted protein osteocalcin is a hormone regulating glucose homeostasis and male fertility by signaling through a GPCR, Gprc6a, expressed in pancreatic β bells and Leydig cells of the testes. The systematic exploration of osteocalcin biology, revealed that it regulates an unexpectedly large spectrum of physiological functions in the brain and peripheral organs and that it has most features of an antigeromic molecule. As will be presented at the meeting, this body of work suggests that harnessing osteocalcin for therapeutic purposes may be beneficial in the treatment of age-related diseases such as depression, age-related memory loss and the decline in muscle function seen in sarcopenia.
Interventions to Drive Improved Functional Potential of Aged or Dysfunctional Hematopoietic Stem Cells
Authors: Beerman Isabel , Zong Le , Tanaka-Yano Mayuri , Yanai Hagai , Tekan-Turhan Ferda
Published: December 2020

Stem cell dysfunction is a hallmark of aging, associated with the decline of physical and cognitive abilities of humans and other mammals. Therefore, it has become an active area of research within the aging and stem cell fields, and various techniques have been employed to mitigate the decline of stem cell function both in vitro and in vivo. We have examined changes in the hematopoietic system after interventions and show modest, but positive effects on the aged system as well as the aged stem cells
Regulation of Autophagy in Aging and Disease
Authors: Hansen Malene
Published: December 2020

The cytosolic recycling process of autophagy plays an important role in many age-related diseases and has been directly linked to aging, including in the nematode C. elegans where autophagy appears beneficially induced in many conserved longevity models. As a critical process to ensure cellular homeostasis, autophagy is regulated at multiple levels, yet it remains a challenge in the field to understand how the regulation of autophagy is integrated at the cellular and molecular level to ensure health- and lifespan benefits. I will here discuss our progress on understanding the different molecular mechanisms employed by cells and organisms to regulate autophagy in response to stressors such as aging and disease.
3D Team Care Management Trial for Cognitively Vulnerable Older Adults: Who Participates and How Does the Team Work?
Authors: Fortinsky Richard , Stephens Caroline
Published: December 2020

Community-dwelling older adults often experience cognitive symptoms, and three common conditions that contribute to changes in cognition are dementia, depression and delirium. Despite the clinical inter-connectedness among these medical conditions, hereafter referred to collectively as cognitive vulnerability, little is known about the potential for success of clinical interventions that simultaneously address these conditions. From the perspective of older adults with cognitive vulnerability and their families, hospital admissions and emergency department (ED) visits are disorienting and often lead to declines in functional capacity and well-being, and significant family distress, threatening continued independent living. In this Symposium, we present details about an ongoing clinical trial testing a novel in-home, multidisciplinary team care management intervention for older adults with cognitive vulnerability and their families. This care management intervention led by nurse practitioners, called the3D Team care model, aims to help reduce ED visits and hospitalizations and achieve other health-related outcomes. The first presentation will provide study background and design features as well as characteristics of study participants. The next two presentations by the3D Team nurse practitioners will provide details about how the multidisciplinary team works, and how each team member provides interventions intended to address risk factors for adverse health outcomes. The fourth presentation by the3D Team community health educator will explain how needs related to social determinants of health are addressed. The Discussant will place this clinical trial within the broader context of multidisciplinary team care for older adults with cognitive vulnerability led by nurse practitioners trained in geropsychiatry.
Attitudes About Brain Donation Among African American Research Participants
Authors: Dyslin Deborah , Dunlop Sara , Aldridge Brenda , Tillotson Robin , Morhardt Darby
Published: December 2020

Alzheimer’s and related dementias (ADRD) disproportionately affect the African American community. Brain donation, a crucial part of translational research, is less common among African American research participants compared to White research participants at Alzheimer’s Disease Research Centers (ADRCs) across the US. Existing literature suggests three categories of contributory factors for African Americans: concerns and misconceptions about brain research and brain donation; religious beliefs; and the role of the family. Existing knowledge of community interventions is limited. We conducted seven focus groups, stratified by brain donation intent and cognitive status, to capture the perspectives of African American research participants. Qualitative content analysis reveal the following contributory themes: personal connection to memory loss or dementia; altruism; spirituality/religion; historical and current racism in health care and research; trauma and objectification; trust; representation; understanding the purpose and process of brain donation; and fluidity in decision-making. Future research will explore trauma-informed and culturally responsive interventions. Part of a symposium sponsored by the Alzheimer’s Disease Research Interest Group.
Gender Differences in How the American Public Reacts to a Person With Mild-Stage Dementia
Authors: Stites Shana , Largent Emily , Gill Jeanine , Johnson Rebecca , Harkins Kristin , Karlawish Jason
Published: December 2020

Many studies show that caregivers for those with Alzheimer’s Disease (AD) are disproportionately female, but few studies have investigated how public attitudes influence this gender disparity. We analyzed secondary data from an experimental study of public reactions to AD dementia. Analysis included 944 respondents who read a vignette about a man with mild stage dementia and completed a modified Family Stigma in Alzheimer’s Disease Scale (FS-ADS), which assesses 7 domains of stigma. Multivariable ordered logistic regression compared men and women on FS-ADS ratings. Women were less likely than men to endorse stronger negative aesthetic attributions (OR=0.75) and negative feelings (OR=0.76) and more likely to endorse stronger feelings of pity (OR=1.33; all p<0.05). No other differences were observed in FS-ADS domains (all p>0.05). The findings offer insights into relationships between gender and AD stigma, which may influence who is willing to become a caregiver for persons with AD and related dementias.
Breathing Well Across the Lifespan: Pulmonary Aging and Geroscience-Targeted Therapies
Authors: Sanders Jason
Published: December 2020

Excellent pulmonary function is one of the strongest predictors of longevity across animal models and human populations. Unfortunately, none of the major age-associated pulmonary diseases – obstructive lung disease, pulmonary fibrosis, and increased susceptibility to pneumonia – have strongly effective disease modifying therapies. There is growing evidence that normal age-associated decline in pulmonary function and major age-associated pulmonary diseases are linked to the hallmarks of aging including senescence, nutrient signaling dysregulation, mitochondrial dysfunction, and telomere disorders. This presents opportunities for collaboration between gerontologists and pulmonologists to unravel age-associated developmental mechanisms and design novel treatments. In this symposium, leaders in pulmonary aging research will present novel data on links between aging and pulmonary health and geroscience-based interventions under study. Dr. Sanders will provide an overview of the scientific and clinical space and present epidemiologic associations between aging biomarkers, early pulmonary fibrosis, and mortality. Dr. Le Saux will discuss senescence and specifically how eicosanoid biology may explain organ-specific patterns of senescence-associated fibrosis. Dr. Thannickal will discuss age-associated perturbations in metabolism and mitochondrial function and targeting these pathways to improve lung function and treat pulmonary diseases. Dr. Newton will discuss mechanisms and clinical applications of telomere biology to pulmonary aging. Symposium attendees will (1) be poised to generate collaborations between gerontologists and pulmonologists to address existing knowledge gaps in mechanisms of pulmonary aging, and (2) develop a better understanding of translational opportunities to design geroscience-based diagnostics and therapeutics to improve pulmonary health with aging.
VA’s Life-Sustaining Treatment Decisions Initiative: First 20 Months of National Implementation
Authors: Ersek Mary , Scott Winifred , Carpenter Joan , Kononowech Jennifer , Phibbs Ciarian , Cohen Jennifer , Foglia Mary Beth , Levy Cari
Published: December 2020

This retrospective observational study describes the first 20 months of implementing the Life-Sustaining Treatment Decisions Initiative. We examined patient and facility characteristics associated with life sustaining treatment (LST) orders template completion, including the association between template completion and the Care Assessment Need (CAN) score, which quantifies Veterans’ risk of hospitalization and mortality. As of February 29, 2020, over 274,200 Veterans received at least one goal of care conversation and LST preferences documented on a template. Eighty-two percent of deceased Veterans with the highest risk of hospitalization or mortality had an LST note and order documented prior to their death. Factors that predicted a greater likelihood of LST template completion included higher CAN score, older age, nursing home stay, and being white non-Hispanic. Findings suggest that clinicians are engaging older, sicker veterans in goals of care conversations. Research is needed to understand potential disparities in LST template completion.
Cultural and Institutional Considerations in Advance Care Planning in Long-Term Care Settings
Authors: Gutman Gloria , de Vries Brian
Published: December 2020

Advance Care Planning (ACP) is a process that supports individual’s understanding and sharing of personal values, life goals, and preferences regarding future medical care, so that they obtain care consistent with these during serious and chronic illness. While ACP is important for all, it is especially so for people who fall outside traditional, western, heteronormative contexts (e.g. who belong to ethnic, racial and/or sexual/gender minorities). This symposium draws from research conducted by the Diversity Access Team [part of a national project iCAN-ACP Improving Advance Care Planning for Frail Elderly Canadians]. The first paper presents results from focus groups conducted with loved ones of South Asian, Chinese and Lesbian, Gay, Bisexual, and Transgender (LGBT) older adults living in care homes; issues identified as barriers include starting ACP conversations too late (“my husband has severe dementia”), lack of consideration of cultural traditions and, in the case of LGBT older adults, their non-family support networks. The second paper draws from focus groups with care home staff, implicating their own training as a barrier to assisting residents/families with ACP as well as resident, family, institutional and cultural influences. A third paper reports on an educational intervention designed to increase staff understanding of ACP and comfort in assisting residents/families with ACP. The fourth paper reports feedback received on two ACP planning tools, reflecting the importance of minority group representation in visuals and text. Together, these papers underscore the importance of taking culture into consideration in framing and discussions of fostering ACP among minority populations.