bluuebunny/crossref_metadata_2025 huggingface dataset:
LIFE-COURSE MULTI-DISCIPLINARY PREDICTORS OF DEMENTIA AMONG OLDER ADULTS
Authors: Kuwayama Sayaka , González Kevin , Márquez Freddie , González Hector , Tarraf Wassim
Published: December 2022

The incidence of dementia is rapidly increasing. Identifying risk factors for dementia may help improve risk assessment, increase awareness for risk reduction, and identify potential targets for interventions. We use a life-course multi-disciplinary modeling framework to examine leading predictors of incident dementia (ID). We use the Health and Retirement Study (HRS) to measure 57 exposures across 7 different domains: (1) demographic, (2) adverse childhood socioeconomic and psychosocial, (3) adverse adulthood experiences, (4) adult socioeconomic status, (5) health behaviors, (6) social connections, and (7) adult psychological conditions. Our outcome is ID (over 8-years) operationalized using Langa-Weir classification for adults aged 65+ years who meet criteria for cognitively normal at the baseline when all exposures are measured (Nf 1,622 in testing set and Nf1,460 in validation set). We compare standard methods (Logistic regression) with machine learning (ML) approaches (Lasso, Random Forest) in identifying highly predictive exposures across the risk domains of interest. Standard methods identified lower education, childhood financial duress, and pessimism as among the leading factors associated with ID. Psychological factors explained the highest variance for ID, followed by adult socioeconomic and adverse childhood factors. However, ML techniques differed in their identification of (1) predictors and (2) factors predictive importance. The findings emphasize the importance of upstream risk factors and the long-reach of childhood experiences on cognitive health. The ML approaches highlight the importance of life-course multi-disciplinary frameworks for improving dementia risk assessment. Further investigations are needed to identify how complex interactions of life-course risk factors can be addressed through interventions.
CO-DESIGNED PERSON-CENTERED NARRATIVES FOR PEOPLE WITH ALZHEIMER’S AND RELATED DEMENTIAS
Authors: Flessa Sarah , Harrison James , Willard Tajalei , Chandler Michael , Rogers Stephanie
Published: December 2022

MemoryWell’s professional writers capture and share patient life stories with care teams and families in healthcare settings, with the goal of improving person-centered care. This mixed methods study employs participatory-design methods to assess the feasibility and acceptability of adapting this existing life story service to an acute care setting and implementing stories into the electronic health record (EHR) for older adults with Alzheimer’s and Related Dementias (ADRD). Through in-depth interviews and surveys, we engage patients, family caregivers and care providers to co-design the life story process adaptation and development of EHR wireframes to iterate and pilot in the acute care setting. We will present the co-designed EHR wireframes and data analyzed using qualitative content analysis. Results describe life story utility and potential impacts on outcomes for people with ADRD. Findings from in-depth interviews with 11 providers indicated high feasibility and acceptability, e.g. describing a high likelihood of daily use. Providers shared barriers and facilitators, e.g. time and accessibility, and potential impacts on person-centered care and patient outcomes, e.g. trust, cultural competency, and delirium. Patient and caregiver data collection is underway; one patient and one caregiver have been interviewed out of ten for each respective group. Interviews with all groups have suggested that life stories would be useful for helping patients in unfamiliar and disorienting environments and learning information such as hobbies and interests would be helpful for providers to better understand and engage with patients.
ARTISTIC ENGAGEMENT AT A MEMORY CARE FACILITY, VIA A TELEPRESENCE ROBOT
Authors: Carney Amy Knepple , Hillman Vanessa , Lehman Chloe , Holland Elizabeth , Gowin Lizzie
Published: December 2022

There is a growing body of research that shows participation in arts interventions (e.g., poetry, storytelling, music, and dance) can be beneficial for those living with dementia. The current study examines social interactions when the artist is not physically present, but in the room via a telepresence robot. Through the telepresence robot, dementia care residents were connected to a network of arts presenters. Using a checklist examining social behaviors (verbal and non-verbal), we assessed residents’ social engagement with the artist, other residents, and staff during these creative visits. Typical activities within the care facility were also observed. The observations were conducted on 10 individuals living within the memory care facility. Although the typical facility activities elicited social verbal behaviors, they tended to be more physical in nature and had a larger number of social nonverbal behaviors. When the behavior was verbal it tended to be more noises of excitement, such as “wooo” and “oh yeah.” Although the artist engagement activities elicited social nonverbal behaviors, they tended to be more verbally engaging and there were a larger number of social verbal behaviors during these activities. With the artist engagement we observed residents spontaneously singing songs, and helping to create poetry. The facility was already using activities that allowed the residents to become physically engaged and with the addition of artist visits there was an increase in verbal engagement. By having greater options for residents to create engagement we may see people who don’t typically engage become more involved.
A POLICY- AND PRACTICE-ALIGNED RESEARCH AGENDA FOR ENGAGING AND SUPPORTING DEMENTIA CAREGIVERS IN CARE DELIVERY
Authors: Riffin Catherine , Falzarano Francesca , Czaja Sara
Published: December 2022

The Cornell Institute for Translational Research on Aging (CITRA) Research-to-Practice Consensus Workshop Model is an evidence-based method for generating practice- and policy-informed research agendas on aging-related topics. The model aims to bridge the gap between research-based knowledge and practice-based insight by involving multidisciplinary stakeholders in all aspects of the agenda-setting process. Using the CITRA model as a guiding framework, we convened an NIA-funded Conference on Engaging Family Caregivers of Persons with Dementia in Healthcare Delivery, with the goal of generating actionable research priorities that will lead to improvements in dementia caregiver identification, assessment, and support in health and long-term care settings. Conference attendees were multidisciplinary thought leaders representing five stakeholder groups: family caregivers of persons with dementia, healthcare providers, researchers, payers, and policy advocates. This symposium will describe the CITRA model, using our caregiver conference as an example, and provide practical guidance on how to use the model to promote cross-disciplinary dialogue and integrate research, policy, and practice perspectives. The first presentation will provide an overview of the CITRA model and its 5-step method (Pillemer). Subsequent presentations will describe the model’s application to the topic of improving caregiver identification and support in care delivery (Griffin) and discuss how novel technology-based adaptations to the model helped to facilitate hybrid participation of virtual and in-person attendees (Falzarano). The final presentation will delineate the major priorities that resulted from the conference, discuss ongoing and future dissemination activities, and offer practical suggestions for leveraging the CITRA model in future consensus efforts (Riffin).
RACIAL AND ETHNIC DIFFERENCES IN LUNG CANCER SCREENING ELIGIBILITY AND HEALTH CARE UTILIZATION AMONG OLDER SMOKERS
Authors: Avila Jaqueline , Nwanaji-Enwerem Ugoji , Williams Randi , Robbins Hilary , Ahluwalia Jasjit
Published: December 2022

The United States Preventive Task Force (USPSTF) expanded the lung cancer screening guidelines with low-dose CT scan (LDCT) to narrow racial and ethnic screening disparities. However, there is a need to examine if eligible individuals can access and use health care. The objective was to examine racial and ethnic differences in LDCT eligibility and health services access and utilization among LDCT-eligible individuals. Data comes from adults 50 to 80 years old in the 2018 Health and Retirement Study (HRS), with at least a 20 pack-year smoking history who currently smoke, or have quit < 15 years ago (n=7,624). The outcomes were LDCT eligibility, access to health care (health insurance and usual place of care), and health care use (visits to the doctor). White individuals were more likely to be LDCT eligible than Black and Hispanic individuals. Among those LDCT eligible, Hispanic individuals were less likely to have insurance (OR:0.43, [95%CI: 0.21; 0.86]) and to visit the doctor than White individuals (OR: 0.38 [0.19; 0.76]). Compared to White individuals, Black individuals were more likely to say their usual place of care was the ER or “other” place (OR: 2.65 [1.63; 3.32] and Hispanic individuals were more likely to say they do not have a usual place of care (OR: 1.94 [1.10; 3.41]). Expanding the criteria for lung cancer screening may not be enough to reduce racial and ethnic disparities. More efforts should address racial and ethnic disparities in the implementation of lung cancer screening, including access and use of health care.
CANNABIS USE PERCEPTIONS, PATTERNS AND SYMPTOM MANAGEMENT IN OLDER VS. MIDDLE AGE AFTER A CANCER DIAGNOSIS
Authors: Fahey Margaret , McClure Erin
Published: December 2022

Prevalence of cannabis among U.S. older adults (> 65 years) is increasing and is also common among cancer patients of all ages. Less is known how cannabis beliefs and use differ in older vs. middle-age after cancer diagnosis. This NCI-funded P30 administrative supplement included a cross-sectional survey in a state with illegal access to cannabis. Participants (Nf1,038) had past cancer diagnosis (< 2 years). Comparisons were run between older (> 65 years; n=509) and middle-aged adults (45–64; n=378) relating to cannabis perceptions, patterns of use, and symptom management (among those endorsing use) with chi-square and t-test analyses. There were no age-group differences in prevalence of ever or current use, nor likelihood of discussing cannabis with provider. Use after diagnosis was less likely in older vs. middle-age (21% vs. 33%). Of those using after diagnosis, there were no age-group differences in reasons for use, but older adults reported less neuropathy relief and less digestive improvement from cannabis. When asked about potential benefits of cannabis, older adults were less likely to expect relief from neuropathy and nausea, increased appetite, decreased medication use, cancer cure, and treatment of another condition and more likely to expect improved sleep. When endorsing potential risks, older adults were more likely to report addiction and increased use of other substances and less likely to report legal reasons, job loss, and negative reactions. Findings indicate unique expectations and symptom management in older age, highlighting importance of oncology providers to discuss cannabis with this age group as rates rise.
MEASURING SPECIALTY CARE UTILIZATION AMONG MEDICALLY FRAGILE, LOW-INCOME OLDER OR DISABLED ADULTS
Authors: Goo Kelly , Silberberg Mina , Eisenson Howard , Johnson Fred , Stinnett Sandra
Published: December 2022

The purpose of this research was to quantify the rates of specialty care referral completion and identify variables associated with successful completion among a population of low-income, elderly and/or disabled homebound patients with barriers to accessing office-based care. This was a cross-sectional study using descriptive and multivariate predictive analysis of specialty care referral completion, operationalized as attending an appointment of the same specialty care type within 6 months of being referred. Independent variables include patient age, sex, race, marital status, health insurance, blood pressure, and body mass index. Patient characteristics, referral information, and appointment information from July 1, 2014 to July 1, 2019 were extracted from electronic health record data of patients enrolled in the Just for Us primary care home visiting program in Durham, NC. Specialty care referrals were restricted to those for office-based consultations for chronic disease co-management originating from an outpatient primary care provider. Of 443 total referrals identified from 162 patients, 36% were successfully completed. Being married and female gender were found to be associated with successful referral completion. Of the 217 total patients in the study sample, 25% were identified as not having any referrals. No included patient characteristics were found to be significantly associated with being referred to specialty care. This study demonstrates that the specialty care needs of a medically and socially vulnerable population of homebound patients are not being adequately met.
WOMEN’S HEALTH: PARADOXICAL HEALTH DISPARITIES AMONG ASIAN AMERICAN WOMEN
Authors: Camp Janella , Bernstein Laura , Patrick Julie Hicks
Published: December 2022

Asian Americans are among the fastest growing ethnic minority groups in the U.S (Budiman & Ruiz, 2017), but women’s healthcare is understudied. This may allow potential health disparities to go unnoticed. Our study aims to determine whether Asian American women are utilizing preventative health care services and to examine relations with self-reported health. We used data from a national sample of American women (Nf 58,934; mean age = 47.3 years; range 18 to 80+) from the 2020 Behavioral Risk Factor Surveillance System (BRFSS) data of the Centers for Disease Control and Prevention (CDC). We examined the recency of receiving a PAP smear, a mammogram, and the HPV test, along with subjective assessments of health. Asian American women reported less recent PAP smears, mammograms, and HPV tests, relative to their counterparts. However, Asian American women reported better general and physical health than non-Asian American women. To examine whether Asian American status contributed to health reports above and beyond that accounted for by the preventative tests and age, we conducted a 3-step hierarchical regression. Even after controls, Asian American status accounted for unique variance in health outcomes [F (1, 58,928) = 36.51, p < .001]. Post hoc exploratory analyses further examine the role of race in women’s preventative health care. Our findings indicate that Asian American women report less use of medical services, but better general and physical health. These results suggest that further studies are needed to explore other health behaviors that may account for better health reports among Asian American women.
TRANSITION OF HEALTH PROFILES IN COGNITIVELY INTACT NURSING HOME RESIDENTS WITH SUICIDAL IDEATION
Authors: Yuan Yiyang , Barooah Adrita , Mack Deborah , Lapane Kate , Rothschild Anthony , Ulbricht Christine
Published: December 2022

For older adults entering nursing homes with self-reported suicidal ideation (SI), little is known about how their health profiles change during the first 90 days post admission. Using the 9th Patient Health Questionnaire-9 item on Minimum Data Set 3.0, we identified 5,397 cognitively intact, older adults with SI at admission, 29% of whom continued to report SI at 90 days. Latent transition analysis identified five health profiles at admission: (1) frail, severe pain, all depressive symptoms (prevalence: 25%); (2) frail, moderate pain, depressed mood, insomnia/hypersomnia, fatigue (27%); (3) frail, no pain, depressed mood, fatigue, and worthlessness (18%); (4) pre-frail, no pain, depressed mood (15%); (5) robust, no pain, depressed mood, insomnia/hypersomnia, fatigue (15%). At 90 days, while the profiles remained mostly the same, improvement in depressive symptoms and pain were observed: (1) frail, severe pain, most depressive symptoms (17%); (2) frail, no pain, depressed mood, and fatigue (28%); (3) frail, no pain, depressed mood, fatigue, and worthlessness (15%); (4) pre-frail, no pain, no depressive symptoms (25%); (5) robust, no pain, depressed mood, and fatigue (16%). Most residents remained in the same profile over time. Of those who were in Profile (1) at admission, 20% transitioned into Profile (2), 12% to Profile (4), and 7% to Profile (5). This work highlights the need to now investigate the potential drivers for specific profile transitions among nursing home residents presenting with SI on admission, thereby informing interventions for improved identification and treatment of SI in the nursing home setting.
POSITIVE AFFECT AND SOCIAL SUPPORT SATISFACTION AMONG NEWLY ADMITTED LONG-TERM CARE RESIDENTS
Authors: Simon Darby , Mast Benjamin , Ertle Emilee , Meeks Suzanne
Published: December 2022

Social support serves as a protective factor against depression and other negative outcomes among older adults. Satisfaction with social support among long-term care residents has not received as much attention, and the experience of support among newly admitted long-term care residents has not been investigated. The current study examines what variables influence a long-term care resident’s satisfaction with their social support. This sample consists of 48 individuals newly admitted into long-term nursing home care. This study used the Social Support Questionnaire (SSQ6) to gather information on social support network size and overall satisfaction of perceived social support. Correlations were estimated between social support satisfaction, social support network size, and psychosocial factors including depression (PHQ-9), anxiety (RAID), religious involvement, cognitive status (BIMS), positive and negative affect (PANAS). Satisfaction with support was significantly correlated with social network size (r = .328, n = 48, p < .05) and positive affect (r = .437, n = 24, p < .05). In a regression model with support satisfaction as the dependent variable, both social network size and positive affect contributed significantly to model R2 F(2,21) = 2.441, p = .049 R2 = .250. Satisfaction with support depends upon the number of supporters available, but also on levels of positive affect.
BARRIERS AND FACILITATORS FOR FOREIGN EDUCATED NURSES TO PROVIDE QUALITY LONG-TERM CARE
Authors: Thompson Roy , Corazzini Kirsten , Konrad Thomas , Cary Michael , Silva Susan , McConnell Eleanor
Published: December 2022

Unprecedented registered nursing shortages in long-term care (LTC) threaten the provision of person-centered care for older adults in the United States (US). LTC facilities recruit Foreign Educated Nurses (FENs) to address shortages, which raises concerns about care quality due to cultural, linguistic and communication differences among nurses; yet studies have not thoroughly explored FENs’ perspectives on these issues. The purpose of this study was to advance our understanding of FENs’ professional experiences as they began employment in LTC by exploring factors that inhibit or facilitate their provision of quality care. This qualitative descriptive study used purposive sampling to recruit FENs through professional organizations. Eligible FENs were ≥ 18 years old, worked ≥1 year in LTC, and represented racial and ethnic minority groups from Low and Middle Income Countries. In-depth narrative interviews, ranging from 45–60 minutes, were conducted. Applying content analysis, a priori and inductive coding generated themes. Participants (n=12) interviewed were all married females. Most were 50–59 years old (41.7%), Asian (75.0%), BSN-prepared (58.3%), and reported 31–50 years of nursing experience (50%). Positive facility characteristics, acculturation, effective workplace integration and positive support from colleagues, residents, and their families facilitated the provision of quality care. Conversely, negative facility characteristics, cultural barriers, discrimination and ineffective workplace integration were barriers to providing quality care. FENs highlighted culturally-sensitive strategies such as providing structured mentorship and preceptorship programs that supported them in providing person-centered care. FENs confirmed the need to address racial and anti-immigrant discrimination for achieving more equitable and inclusive workplaces.
EXPLORING DEPRESSION AND ITS CORRELATES AMONG RESETTLED BHUTANESE OLDER ADULTS IN OHIO
Authors: Ghimire Saruna , Chapadia Bunsi , Karmacharya Isha , Shrestha Aman , Subedi Janardan , Applebaum Robert
Published: December 2022

Following the “ethnic cleansing” by the Bhutanese government in the 1990s, Nepali-lingual Bhutanese fled from southern Bhutan and spent about two decades in refugee camps in Nepal before resettlement in the US and other countries. During post-resettlement, this population had a high rate of suicide and mental health problems. However, studies specifically among resettled older Bhutanese are lacking. This study aims to estimate the prevalence of depression and explore its correlates among resettled Bhutanese Older Adults in Ohio. A cross-sectional survey was conducted in Ohio (Columbus, Akron, Cleveland, and Cincinnati). The exploratory study surveyed 275 participants between January-June 2022, using snowball sampling, given the absence of a sampling frame. Study participants include adults 55 years and above, identified with the help of local community-based organizations. Depression was measured using the Geriatric Depression Scale, and life satisfaction, social support and resiliency were measured using validated standard tools. The prevalence of depression was 31.8%. In the adjusted model, factors associated with lower odds of depression were better self-reported health, satisfaction with life (OR=0.08, 95%CI: 0.01–0.46) and high social support (OR=0.23, 95%CI: 0.07–0.78). Resiliency was inversely associated with the odds of depression (low resiliency: OR=4.98, 95%CI: 2.02–12.28; high resiliency: OR=0.21, 95%CI: 0.07–0.64). Given the lack of a basic health profile of this population, this exploratory study is a necessary stepping stone and the first of its kind. This study will help to inform the relevant stakeholders and community leaders and provide baseline evidence for further research and programmatic actions.
EXAMINING THE IMPACT OF FAR-INFRARED TECHNOLOGY ON QUALITY OF LIFE IN OLDER ADULTS
Authors: Balingit Arianna , Guggenheimer Joshua
Published: December 2022

The purpose of this study was to examine the effects of far-infrared heat (FIR) on pain management and quality of life (QOL) in older adults (OA). FIR utilizes a long-wave light that simulates dry sauna-like conditions. Examining the relationship between FIR and pain is important due to the increased prevalence of chronic pain associated with aging and the impact it has on QOL and physical performance. 9 OA completed the study, 8 of whom were women. Our intervention consisted of assigning participants to either a convective (CON) or a convective and far-infrared heat (FIR) group, with convective heat set to 60oC. Participants received 6, 30-minute heat sessions over 3 weeks. Pre- and post-test assessments included physical measures such as range of motion, gait speed, timed up-and-go, and hand grip strength. Additionally, we conducted standardized questionnaires to determine pain severity and interference on daily life, and the impact such has on overall QOL. T-tests were used to compare the groups’ pre- and post-assessment responses. Results indicated that pain severity was significantly reduced (from 3.31 to 2.5, P < 0.05) in the FIR group from pre-to-post, and that pain inference was significantly reduced (from 1.26 to 0.43, P < 0.05) in the CON group from pre-to-post. There were no significant differences from pre-to-post testing for any other measures. These findings suggest that heat therapy was successful in reducing pain over time for OA, but that FIR heat specifically, was not superior to that of convective heat alone.
ADVANCING COMMUNITY-BASED SOCIAL INNOVATIONS FOR AGING THROUGH ENGAGED RESEARCH
Authors: Greenfield Emily , Kunkel Suzanne
Published: December 2022

Community-based social innovations (CBSI) for aging are programs, initiatives, and other structures that support healthy aging and aging in community in ways that complement traditional health and human service systems. This symposium features research on several manifestations of CBSIs in the US. The first paper orients to innovation among aging services agencies, drawing on data from local Councils on Aging in Massachusetts to examine variation in their levels of engagement with age-friendly community (AFC) work. Findings elucidate the importance of community context and organizational capacity for deepening involvement in AFC work over time. Addressing innovation within communities as a whole, the second paper applies social network analytic methods to examine the constellations of connections among AFC core teams and their key partners across nine localities in New Jersey. Focusing on housing, the third paper presents findings from an evaluation of a national demonstration program to enhance the capacity of service coordinators within senior housing communities. This paper implicates the important role of services staff in systems innovation. Finally, with attention to creating age-friendly communities, the fourth paper presents findings from a project in Ohio that equipped older adults with a tablet-based transportation “diary” app. The findings demonstrate ways in which this technology facilitated deeper insight on users’ experiences in terms of their mood, with implications for transit design and programs. Collectively, the studies make evident the importance of leveraging the tools of research alongside engaged partnerships to strengthen the knowledge base for continued innovation in community supports for aging.
PHYSICAL ACTIVITY, BALANCE, AND BICYCLING IN OLDER ADULTS
Authors: Baughn Maya , Arellano Victor , Hawthorne-Crosby Brieanna , Grimes Amanda , Lightner Joey , King Gregory
Published: December 2022

Falls are a critical public health issue among older adults. One notable factor contributing to falls in older adults is a deterioration of the structures supporting balance and overall balance control. Preliminary evidence suggests older adults who ride a bicycle have better balance than those who do not. Cycling may be an effective intervention to prevent falls among older adults. This study aims to objectively measure the relationship between bicycling, physical activity, and balance for older adults. Older adult cyclists (n=19) and non-cyclists (n=27) were recruited to (1) complete a survey that assessed demographics; (2) wear an accelerometer for 3 weeks to objectively assess physical activity; and (3) complete balance-related tasks on force platforms. Mann-Whitney U-tests were performed to understand differences in balance and physical activity between cyclists and non-cyclists. Cyclists are significantly more physically than non-cyclists (U = 102.00, p = .015; U = 81.00, p=.002). Cyclists had less sway velocity in eyes open conditions than non-cyclists (U = 360.00, p=.009), indicating a more tightly regulated postural control strategy that may relate to higher stability in cyclists. Task duration among cyclists in single-leg stand was longer than non-cyclists (left leg: p < .001 and right leg: p < .005) indicating increased postural stability. This study demonstrates the possible implications for cycling on balance and reducing fall risk.
OLDER ADULT ONLINE EXERCISE CLASSES DURING THE COVID-19 PANDEMIC: A SURVEY OF SERVICE PROVIDER PERSPECTIVESS
Authors: Murphy Dallas , Porter Michelle , Barclay Ruth , Cornish Stephen , Ripat Jacquie , Sibley Kathryn , Webber Sandra , Dunn Nicole
Published: December 2022

COVID-19 rendered the availability of exercise facilities sporadic and online exercise programs subsequently became more common. This research explored online exercise classes delivered to older adults during the pandemic from the perspective of service providers. Sixty-seven service providers completed the survey (88% female). The majority (54%) of respondents had worked in the fitness industry for greater than 10 years, and 66% were fitness class instructors, while fewer were managers (9%) and personal trainers (8%). Three participants had experience providing online exercise classes prior to the pandemic, while 43 more had experience providing online exercise classes since the pandemic began. Of these 46 service providers, 87% offered classes live through Zoom. The majority (64%) offered classes through an organization, and 61% charged a fee for participants to take part. The most common type of class was a general fitness class (63%), followed by yoga and flexibility classes (39%), and strength training (17%). Regarding equipment used, weights were most frequently required (69%), followed by resistance bands (49%) and mats (44%). Most classes lasted 40–60 minutes (59%) and were low intensity (74%). Of the 21 respondents who did not provide online exercise classes, 43% indicated this was because of a lack of interest, and 19% cited not knowing how to use technology to deliver classes online, though most (71%) indicated they would consider offering online classes in the future. This research reveals the adaptability of service providers and may serve to inform the continued development of online exercise programs for older adults.
AGE-FRIENDLY TRANSFORMATION: AN EXAMINATION OF COMMUNITY MECHANISMS INFLUENCING INVOLVEMENT
Authors: Coyle Caitlin , Somerville Ceara
Published: December 2022

Age-friendly community initiatives (AFCIs) have become key policy efforts aimed at improving quality of life for older residents, but there is limited evidence about the process. This mixed methods study draws on survey and demographic data from 350 municipalities in Massachusetts to characterize communities by these categories: 1) not interested in AFCIs (n=109); 2) interested in learning more about AFCIs (n=84); 3) planning for age-friendly action (n=71); and 4) maintaining an AFCI (n=86). Interview data from key-informants contextualize the process of developing an AFCI. Thematic analyses suggest that progression through AFCIs is self-defined by the accumulation of momentum. Communities committed to AFCIs have higher proportions of vulnerable residents (e.g., living with disability, living alone, non-English speaking). Municipal resources (e.g., budget, aging services) correlate with more advanced stages of AFCIs. Implications of the variability across AFCIs, including the effort required for moving from concept to execution of AFCIs, will be discussed.
PERCEPTIONS OF ADRD CARE PARTNERS IN A VIRTUAL CO-DESIGN PROCESS
Authors: Werner Nicole , Jolliff Anna , Parks Reid , Linden Anna , Elliott Christian , Zuraw Matthew
Published: December 2022

Participatory design, or co-design, is an effective method for creating useful digital products with older adults. However, little is known about older adults’ perceptions of virtual co-design. The purpose of this study was to explore ADRD care partner perceptions of their participation in virtual co-design, including the degree to which participants felt their participation influenced the design. After participating in a 5-session virtual co-design process, care partners completed individual semi-structured interviews and surveys focused on exploring their perceptions of the co-design process. Surveys used three sliding scale items and open text responses. Interview transcripts and survey data were analyzed using thematic analysis and descriptive statistics, respectively. Co-designers were Nf7 older adults (71% female) with a mean age of 65. On a scale of 1–100, co-designers rated the extent to which their own participation influenced the design process at a mean of 88, their fellow co-designers at 90, and the research team at 82. Thematic analysis identified five design process perceptions: 1) the process built community among co-designers; 2) sessions were well-facilitated and organized; 3) the prototype would be helpful to other care partners like them; 4) co-designers felt ownership over the prototype; and 5) co-designers had long-term goals for the product. Results suggest that care partners perceived themselves as having considerable influence on the final prototype. Those designing interventions for ADRD care partners should be encouraged that involving them in the design process may provide unanticipated benefits to care partners and build an intervention responsive to care partner needs.
IMPROVING MEDICATION MANAGEMENT FOR HOME-DWELLING OLDER ADULTS WITH COGNITIVE IMPAIRMENT: END-USER INPUT
Authors: Zadeh Rana , Reid Cary , Wethington Elaine , Czaja Sara , Capezuti Elizabeth , Shields Wendy , Traunstein Deb
Published: December 2022

HOPES™ Program is a joint community-university partnership, intended to build capacity for improving medication adherence and reducing medication mistakes, misuse, and abuse for community-dwelling older adults with reduced cognitive functioning (CWCs) in New York State (NYS). The goal of this program is to contribute to the health and safety of older adults, empower them and their caregivers to reduce medication non-adherence consequences and risks, and enable older adults to continue living at home while managing their health conditions. This program applied a collective user-centered approach to connect resources, identify and address barriers, and reach the most vulnerable groups. One aspect of our user-centered approach included a medication management and safety training module video that was adapted from the Medication Use Safety Training for Seniors™ (MUST for Seniors™) and underwent alpha and beta testing. A qualitative analysis was also conducted on input from home-care providers, CWCs, and their designated caregivers about the current practices, challenges, and solutions related to medication management. Our preliminary findings demonstrated a need for research on reducing the steep estimated national costs of medication non-adherence. Thus, a sub-team has developed a methodology to build an economic perspective on the scope and magnitude of interventions to enhance medication management practices for CWCs. A NYS-specific survey was also developed in close collaboration with providers, university partners, and state-level advocacy organizations according to our preliminary findings to document the state and magnitude of medication non-adherence, discern risk factors and determinants of non-adherence, and explore solutions and barriers.
NEUROFILAMENT LIGHT CHAIN (NFL) AND GENERAL COGNITIVE ABILITY IN ADULTS APPROACHING MIDLIFE
Authors: Reynolds Chandra , Smolen Andrew , Link Christopher , Evans Donald , Bruellman Ryan , Evans Luke , Wadsworth Sally
Published: December 2022

Neurofilament light chain (NfL) is a biomarker indexing axonal integrity where small NfL variations may be associated with cognitive performance in early adulthood and high values associated with neurodegenerative disorders such as Alzheimer’s disease. In the Colorado Adoption/Twin Study of Lifespan behavioral development and cognitive aging (CATSLife1) individuals were tested at 28–49 years (M=33.1, SD=4.9). Quanterix Simoa assays of plasma NfL (pNfL) were measured in duplicate, and we included values for 1159 individuals where 1098 had available general cognitive ability scores and sociodemographic covariates. Unadjusted NfL values were consistent with other studies of early-mid adulthood (M = 5.9, SD = 3.1, range = 1.14 – 40.1 pg/mL) and 6% showed values outside expected normal reference limits (>10 pg/mL). After adjusting for technical covariates and skew, higher natural log-transformed pNfL was associated with age (r = 0.27) and female sex (r = 0.07). Moreover, adjusting for sociodemographic covariates, higher pNfL was associated with lower general cognitive ability (GCA) (r = -.06), where associations were more pronounced above the mean pNfL value (r = -.08). Multi-level regression analyses suggested that GCA-NfL associations were modified by age, whereby the worse performance was observed at higher ages and pNfL values (p <= 0.03), accounting for sibling relatedness and sociodemographic covariates. We observed small negative associations of higher plasma NfL and lower cognitive performance, where associations may become magnified with increasing age in early- to mid-adulthood.
MUSCLE MITOCHONDRIAL ENERGETICS ARE ASSOCIATED WITH GREATER MULTIMORBIDITY IN MEN
Authors: Mau Theresa , Blackwell Terri , Newman Anne , Cawthon Peggy , Cummings Steve , Kramer Philip , Hepple Russell T , Kritchevsky Stephen
Published: December 2022

Older adults who have poorer muscle mitochondrial energetics tend to have lower cardiorespiratory fitness—which is associated with the risk of cardiovascular disease, cancer, and dementia. In the Study of Muscle, Mobility, and Aging (SOMMA), we tested the associations of muscle mitochondrial energetics (MME) with a multimorbidity index in this cohort of women (Nf507) and men (Nf349) 70+ years of age. The index included 13 age-related chronic conditions (arthritis, cancer, cardiac arrhythmia, chronic kidney disease, chronic obstructive pulmonary disease, coronary artery disease, congestive heart failure, dementia, depression, diabetes, osteoporosis, stroke, and aortic stenosis). Participants were grouped by 0, 1, 2, or 3+ conditions and were on average 76.3 years old, 59.2% women, 12.5% Black, 85.5% White, with 2.0% reporting other identities. MME were measured in permeabilized muscle fibers by high-resolution respirometry in vitro (Leak and MaxOXPHOS) and in vivo by 31P-magnetic resonance spectroscopy (ATPmax). The gender interaction p-value with MME was 0.04 (Leak), 0.34(MaxOXPHOS), and 0.09(ATPmax). In men, we found that for every 1 SD decrease of mitochondrial respiration, there was a significant increase of proportional odds ratio (POR) for higher multimorbidity count: POR (95%CI) for Leak was 1.47(1.18, 1.86), p < 0.001 and for Max OXPHOSCI+CII was 1.35(1.08,1.68), p < 0.01. For ATPmax, was 1.22(0.98,1.52), p=0.08. These were adjusted for age, race, site, education, smoking status, weight, height, weight*height, and self-reported physical activity. These trends were absent in women (Leak=0.97(0.79, 1.20), p=0.79, MaxOXPHOS=1.05(0.86, 1.28), p=0.66, ATPmax=0.98 (0.82, 1.17), p=0.81), and future analyses will deconstruct the multimorbidity index to determine gender-specific associations with each condition.
REEXAMINING RACE AND ETHNICITY FROM A STRUCTURAL RACISM AND SOCIAL DETERMINANTS OF HEALTH LENS IN COHORT STUDIES
Authors: Follis Shawna
Published: December 2022

To advance research on the role of race, ethnicity, and structural racism in health disparities, recent calls-to-action have described methods to correct race and ethnicity categorization and to measure structural and social determinants of health (SSDOH). Following the rapid advance in the understanding of race and SSDOH, long running cohort studies typically lack access to this novel data, which has limited SSDOH evidence to cross-sectional and ecological associations. We implemented methods to rectify this data gap in prospective cohort studies, using The Women’s Health Initiative (WHI) cohort of women age 50–79 years at baseline as a case study. We evaluated the quality, precision, and representativeness of race, ethnicity, and SSDOH data compared with the target US population and operationalized methods to quantify structural determinants in cohort studies. The use of a revised race and ethnicity categorization aligned with theory-based recommendations and improved measurement precision, including decreasing missing data and participants reporting “other” race. The revised categorization was harmonized to the US Census permitting description of the generalizability of WHI race and ethnicity groups in relation to the target population of US women. We found that WHI women reflected broader trends to the target population in relation to structural racism between race and ethnicity groups, while mean rates of SSDOH were systematically more advantageous in WHI. These results underscore the need to implement theoretically justified race and ethnicity measurement to accurately investigate the intersectional role of SSDOH underlying racial and ethnic health disparities among older age women.
SASP PROTEIN ASSOCIATIONS WITH HUMAN AGING HIGHLIGHTS THE ROLE OF GDF15, CST3, AND IGFBP2
Authors: Evans Daniel , Young Danielle , Tanaka Toshiko , Basisty Nathan , Ferrucci Luigi , Campisi Judith , Schilling Birgit
Published: December 2022

Cellular senescence is a hallmark of aging and can result in a Senescence-Associated Secretory Phenotype (SASP). SASP is characterized by an increased production of proinflammatory cytokines and damage to surrounding tissues. There is substantial evidence from non-human models demonstrating that SASP contributes to tissue dysfunction and pathogenic effects of aging. However, there are relatively fewer studies on the relationship between SASP and aging in humans. In this report, we determined the relationship between SASP circulating proteins and a wide range of aging-related clinical traits in two human cohort studies (BLSA and InChianti) using aptamer-based proteomics. Clinical traits examined were waist circumference, glucose levels, systolic and diastolic blood pressure, C-reactive protein, Interleukin-6, alkaline phosphatase, blood urea nitrogen, gait speed, grip strength, albumin, and red blood cell distribution width. In the meta-analysis of regression model results from both studies, 38 of the 77 SASP proteins examined were significantly associated with age. Of the 38 age-associated SASP, 26 were associated with one or more age-associated clinical traits. A cluster of three SASP proteins (GDF15, CST3, and IGFBP2) showed significant associations with inflammatory markers, renal function and hematological traits. A second cluster was significantly associated with grip strength and gait speed, two measures of physical function that are both strongly associated with mortality. Taken together, these results support the relevance of SASP proteins to human aging and point to specific protein components of the SASP that should be further examined for the potential to be biomarkers of human aging.
ARE WE GOING TO FEEL COMFORTABLE THERE?: EMERGENT FINDINGS FROM THE DIVERSITY IN LIFE PLAN COMMUNITIES STUDY
Authors: Khan Mushira , Desai Pankaja , O’Brien Catherine
Published: December 2022

Life Plan Communities (LPCs), formerly known as Continuing Care Retirement Communities, offer an array of amenities as well as a continuum of care where residents may live independently or access assisted living or skilled care if needed. Racial/ethnic minority older adults are under-represented among LPC residents. One likely contributor to this lack of diversity is that racial/ethnic minorities make up a relatively small proportion of higher income groups. However, there may be additional reasons for their relative absence in most LPCs. The purpose of the ‘Diversity in Life Plan Communities’ study is to (1) identify barriers that impact the decision to move into an LPC for racial/ethnic minorities, and (2) identify strategies to increase resident diversity in LPCs. In this presentation we share preliminary findings from in-depth, semi-structured, qualitative interviews with community-dwelling Black, Latinx, and South Asian adults (n=10) living in Chicagoland and case study interviews with current LPC ‘resident champions’ (n=3) who are actively involved in efforts to increase resident diversity at their respective LPCs. Thematic analysis of the data showed that lack of awareness about LPCs, concerns about racism, desire to age-in-place among loved ones, and perceived non-availability of culturally-congruent activities were key barriers to moving into an LPC. These findings suggest that in order to increase resident diversity within their communities, LPC operators, staff, and current residents may consider targeted outreach efforts in racial/ethnic communities, take steps to create a welcoming environment and engage in more culturally congruent activities, and involve adult children/grandchildren in the decision-making process.
ASSOCIATION OF RELIGIOUS ATTENDANCE WITH NEUROPSYCHIATRIC SYMPTOMS, COGNITION, AND SLEEP IN COGNITIVE IMPAIRMENT
Authors: Britt Katherine , Richards Kathy , Kesler Shelli , Acton Gayle , Hamilton Jill , Radhakrishnan Kavita
Published: December 2022

Neuropsychiatric symptoms (NPS), cognitive decline, and sleep disturbances are common among older adults with cognitive impairment. Religious practices may protect mental and physical health, yet few studies have been reported in older adults with cognitive impairment. Utilizing the Health and Retirement Study in 2006 and 2008 and sub study, Aging, Demographics, and Memory study in 2006–2007 and 2008–2009, we examined the association of religious attendance with NPS, cognition, and sleep disturbances controlling for social interaction in older adults with cognitive impairment (N = 63). Bootstrapped Spearman’s partial Rho correlation was conducted separately for time points one (T1) and two (T2); Wilcoxon signed-rank tests were used to examine significant change over time. Mean age was 81.89(5.26) years, 65.9% were non-Hispanic White, 50.1% were female, and mean cognition (Clinical Dementia Rating) was .94(.228). Significant changes over 1.5 years were found for sleep disturbances but not for NPS and cognition. Significant associations were found for religious attendance and NPS (T1: rs (97)= - .103, 95% CI [-.108, -.098], p < .0005 and T2: -.243, 95% CI [-.246,-.239], p < .0005), cognition, (T1: rs (97) = - .119, 95% CI [-.122, -.115], p < .0005, and T2: rs (97) = -.104, 95% CI [-.107,-.102], p < .0005), and sleep disturbances, (T1: rs (97) = .028, 95% CI [.023, .033], p < .001, and T2: rs (97) = -.051, 95% CI [-.056,-.047], p < .001). Increased religious attendance was associated with lower NPS and cognition at both time points and greater sleep disturbances at T1 but lower at T2. Longitudinal studies are needed to examine associations further.
THE EFFECT OF DEPRESSION AND SUBJECTIVE HEALTH CONDITION ON INTRA-INDIVIDUAL COGNITIVE VARIABILITY
Authors: Lin Shayne , Allen Rebecca
Published: December 2022

Intra-individual cognitive variability (IICV) is defined as variability in performance across cognitive domains during neuropsychological assessment. High cognitive variability (i.e., IICV) is associated with Alzheimer’s disease diagnosis and mortality among older adults (Anderson et al., 2016; Watermeyer et al., 2021; Vaughan et al., 2013). To date, no research has explored, to the author’s knowledge, the effect of depression and physical health on IICV among older adults. The current investigation used the nationally represented Health and Retirement Study (HRS) data set and explored the effect of depression, measured by Center for Epidemiological Studies Depression (CESD), and subjective health, rated on a 5-point Likert scale, on IICV. Data from 39,800 participants and 11 time points were analyzed. IICV was calculated by the individual t score standard deviation divided by the individual mean t score. Dependent variables were centered before being entered into a multilevel model that took time of data collection into consideration. With multilevel modelling, after controlling for demographics (i.e., gender, race, ethnicity, and age), both depression, b = 0.003, SE = 0.0001, p < .001, and subjective health condition, b = 0.006, SE = 0.0002, p < .001, were associated with IICV. This study has implications about the use of IICV in neuropsychological assessment with older adults. In addition to one’s cognitive functioning, both depression and physical health have direct effect on IICV, which may be more than merely a cognitive marker for Alzheimer’s disease as researchers have previously found.