bluuebunny/crossref_metadata_2025 huggingface dataset:
INTERDISCIPLINARY PERSPECTIVES ON THE INTERSECTION OF CANCER AND COGNITIVE DECLINE
Authors: Carroll Judith , Stratton Lauren , Small Brent
Published: December 2023

The population of older cancer survivors in the United States is rapidly growing. The long-term cognitive aging of older cancer survivors is not well understood, as large-scale epidemiological studies often show a paradoxical inverse association between cancer history and subsequent dementia; yet cancer survivors often experience cognitive impairment symptoms in the short-term following treatment. Further, the cancer diagnosis and care experiences of older adults experiencing cognitive impairments or dementia warrant further investigation as these are important issues for health care quality and equity amongst older adults experiencing cognitive limitations who are at risk for cancer. The novel findings presented in this interdisciplinary symposium will help to clarify the cognitive aging experiences of older cancer survivors, using innovative data sources. First, Brown will discuss the relationship between cancer and subjective cognitive decline, using the nationally representative Behavioral Risk Factor Surveillance System data. Second, Westrick will present the associations between cancer treatment types and subsequent mortality and cognitive decline for survivors of breast, prostate, and kidney cancer among Medicare beneficiaries in the nationally representative US Health and Retirement Study. Third, also using data from Medicare beneficiaries in the US Health and Retirement Study combined with a mixed-methods physician survey, Mullins will discuss differences in cancer treatment recommendations and receipt for older adults with a pre-existing cognitive impairment who are diagnosed with cancer. Finally, Todorova will take a deeper dive into the potential mechanisms linking cancer treatment with cognitive decline, by examining a biomarker of inflammation and cardiovascular toxicity among patients receiving doxorubicin. This is a collaborative symposium between the Alzheimer’s Disease and Related Dementias and Cancer and Aging Interest Groups.
RECEIPT OF CHEMOTHERAPY AND COGNITIVE DECLINE AMONG MEDICARE BENEFICIARIES IN THE US HEALTH AND RETIREMENT STUDY
Authors: Westrick Ashly , Kabeto Mohammed , Kobayashi Lindsay
Published: December 2023

Research on cancer and cognitive aging outcomes has been inconsistent, with clinic-based studies showing short-term cognitive declines after chemotherapy, and population-based epidemiological studies observing inverse associations between most cancers and subsequent cognitive aging. We aimed to determine the effect of chemotherapy on cognitive decline and mortality among Medicare beneficiaries in the population-based US Health and Retirement Study (HRS). Using data from HRS-Medicare linked participants ≥65, we identified 858 incident breast, prostate, and kidney cancer diagnoses from 2000 to 2016. Cognitive function was measured using the modified telephone interview for cognitive status (range 0 to 27). Cancer treatment (chemotherapy only, other treatments, and no treatment) was obtained from Medicare claims. We used joint modeling to simultaneously model the association between cancer treatment with cognition decline and mortality. Of 858 participants, 38.7% had breast cancer, 52% had prostate cancer, and 11% had kidney cancer. The mean age at diagnosis was 72.8 years (SD=7.62). 31.7% (n=272) received chemotherapy only, 39.5% (n=339) received other treatment, and 28.8% (n=247) received no treatment. In pooled analyses, receipt of chemotherapy (vs. no treatment) was not significantly associated with cognitive decline (β: 0.08; 95% CI: -0.59, 0.76) but was significantly associated with mortality (HR: 1.39; 95% CI: 1.04, 1.88). In joint modeling, the overall hazard ratio for the receipt of chemotherapy (vs. no treatment) was 1.38 (95% CI: 1.02, 1.88). We found that receipt of chemotherapy was associated with an increased hazard of mortality, but not cognitive decline, compared to those who received no treatment.
AGING AND DECISION MAKING: THE ROLES OF AFFECTIVE AND SOCIAL CONTEXT
Authors: Nolte Julia , Seaman Kendra
Published: December 2023

Age differences in many facets of decision making are well-established. However, a growing literature suggests that the occurrence and strength of these age effects are moderated by contextual factors. The individual talks in this symposium exemplify how age differences in decision making vary by domain, affective intensity, and social distance. First, Nolte and Löckenhoff demonstrate age-related increments in the avoidance of health-based and consumer choices, finding that perceived difficulty, but not affective responses to choice, increase avoidance. Frank and Pachur highlight that affective responses to choice differ across contexts: Younger and older adults exhibit “affect gaps” by making less beneficial, more risk-averse choices in “affect-rich” (health-based) versus “affect-poor” (consumer) contexts. Contrasting monetary and temporal outcomes, Strough, Bruine de Bruin, and Parker illustrate that the tendency to continue failing investments is more pronounced after investing money than time. Moreover, older adults’ decreased susceptibility to this “sunk cost bias” is more evident when making choices about their own investments versus others’ investments. Lu and Löckenhoff report age differences in how decision makers discount other’s financial well-being as social distance increases: Older adults’ willingness to share money with others declines more with increasing social distance than is the case for younger adults. Finally, Wild and Löckenhoff demonstrate that across domains, older versus younger decision makers are less willing to consult with distant social partners or experts and consult fewer people fewer times. To identify directions for future research, Seaman will contextualize the five presentations against the extant aging and decision-making literature.
TO CHOOSE OR NOT TO CHOOSE: CAN AFFECTIVE OR COGNITIVE MECHANISMS EXPLAIN AGE DIFFERENCES IN DECISION AVOIDANCE?
Authors: Nolte Julia , Löckenhoff Corinna
Published: December 2023

Older adults are more likely to avoid decisions, which puts them at risk of experiencing negative consumer or health outcomes. Because the underlying reasons remain unclear, this pre-registered online study assessed the roles of (1) affect (especially regret), (2) subjective difficulty, and (3) cognitive ability in explaining age-related differences in decision avoidance. In addition, half of all participants were randomized to a writing intervention aimed at reducing avoidance tendencies. An adult lifespan sample (N = 432, Mage = 50.94, SDage = 19.53 years, 50% women, 62% Non-Hispanic White) chose between making or avoiding four consumer and health-based decisions. Affect, including regret, was assessed before (pre-decisional), during (peri-decisional), and after making decisions (post-decisional). Subjective difficulty was measured during the decision process. Finally, participants completed assessments of demographic background, socio-emotional experience, health, personality, and cognitive ability. We found that older adults were more likely to avoid decisions (p<.001), but age was unrelated to peri-decisional affect and subjective difficulty. Peri-decisional and post-decisional affect were not consistently related to avoidance, but participants who reported more difficulty were more likely to avoid decisions (p=.002). Covariates and cognitive measures could not explain age-related differences, but lower growth-goal-orientation and stronger maximization tendencies predicted decision avoidance after accounting for age (ps<.05). The intervention was successful at improving peri-decisional cognitive load and peri-decisional affect (ps<.05) but did not reduce decision avoidance. In sum, none of the assessed mechanisms could explain age-related increases in decision avoidance. Across age groups, perceived difficulty but not actual cognitive ability predicted avoidance tendencies.
FACTORS ASSOCIATED WITH ELECTRONIC HEALTH RECORD ADOPTION AMONG ADULT DAY SERVICES IN THE US
Authors: Li Yawen , Chok Jay , Chui Geoffrey , Roosan Don , Shultz Ken
Published: December 2023

Successful adoption of Electronic Health Records (EHR) is becoming increasingly important for Adult Day Service Centers (ADSC) to function effectively and competently, particularly in care coordination with other healthcare providers. Therefore, in the present study, we assessed the EHR adoption among ADSC and its associated organizational characteristics using the 2018 National Study of Long-Term Care Providers (NPALS). The sample included 4,035 ADSC from a national representative sample. Directors or managers of ADSC completed the survey that included questions on organization characteristics, staffing, practice procedures, services, technology use, etc. Findings reveal that the adoption rate of EHR among ADSC was less than thirty percent and less than twenty percent of ADSC used EHR for health information exchange with either physicians or pharmacists. In addition, we found that an ADSC located near other healthcare providers, with Medicaid authorization and a higher percentage of Medicaid patients, and various computer capabilities such as recording participants’ demographic information, clinical notes, medications, service plans, and lab results were related to a higher likelihood of EHR use and EHR exchange. However, possibly due to privacy concerns, the capabilities to record participant problems and view lab results, negatively predict EHR exchange with physicians or pharmacists. The findings are discussed in terms of challenges and strategies to promote EHR adoption in ADSC.
TECHNOLOGY AS A CATALYST FOR SUPPORTING AGING WITH DISABILITY
Authors: Mitzner Tracy
Published: December 2023

Individuals aging with long-term disabilities may need support to perform and participate in everyday activities associated with well-being and quality of life. Technology solutions have potential to effectively promote autonomy and aging-in-place for this population. This symposium will highlight technology research and development efforts from the Rehabilitation Engineering Research Center on Technologies to Support Aging-in-Place for People with Long-Term Disabilities (RERC TechSAge). TechSAge is dedicated to understanding the needs of, and developing supportive technologies for people aging with long-term vision, hearing, and mobility disabilities. Mumma et al. will present insights from interviews of adults aging with vision loss due to glaucoma and macular degeneration regarding their challenges and response strategies for everyday activities. Lee et al. will discuss findings from interview data exploring how wisdom is manifested from the lived experiences of individuals aging with disability (i.e., hearing, vision, and mobility). Mitzner et al. will describe characteristics of the participant sample from a clinical trial examining the effect of a Tele Tai Chi intervention on physical activity and social connectedness for adults aging with long-term mobility disabilities. Sanford et al. will present the findings from three TechSAge pilot projects focused on the use of technology to support in-home rehabilitation for individuals aging with long-term upper extremity disabilities: DigiHand, KeyStroke, and 3DP for AT. Together these studies illustrate the needs and coping strategies of older adults with disabilities and the potential of technology to support those needs. This is a collaborative symposium between the Lifelong Disabilities and Technology and Aging Interest Groups.
EXPLORING WISDOM IN PERSONS AGING WITH DISABILITY
Authors: Lee Hye Soo , Dye Maya , Rogers Wendy
Published: December 2023

Wisdom can benefit one’s well-being and lead to a more fulfilling life. One pathway is using wisdom as a resource for coping with adversities in life. At the same time, wisdom can be fostered from experiencing adversities in life. The TechSAge ACCESS interview study explored the challenges and coping strategies of individuals aging with disability (i.e., hearing, vision, and mobility), providing us the opportunity to investigate the wisdom fostered from participants’ lived experiences. Studying wisdom in a population with disability has at least two practical implications for the intersectional field of aging, disability, and technology. First, we can gain and disseminate the knowledge regarding how to cope with aging with disability, which would benefit individuals with similar disability and their care networks. Second, we can utilize participants’ wisdom to guide our research. Focusing on their strengths and coping strategies instead of their weaknesses would offer us additional ways to support individuals aging with disability. There are specific merits to utilizing the ACCESS data for wisdom research. The sample of individuals aging with disability allows us to explore wisdom that manifested as an interaction between a person and a situation. We are exploring participants’ answer to the question regarding the advice they would give to others with similar disability as a wisdom assessment task. This is a contribution to the wisdom literature as it is rare to be able to administer assessment tasks that are relevant to participants’ lives and interests.
HYPOTHALAMIC MICROSTRUCTURE IN OLDER ADULTS IS ASSOCIATED WITH CORTICAL ATROPHY AND NEUROCOGNITION
Authors: Aleksic Sandra , Fleysher Roman , Tal Noa , Darby Timothy , Weiss Erica , Barzilai Nir , Lipton Michael , Milman Sofiya
Published: December 2023

The hypothalamus is emerging as an important regulator of aging. Hypothalamic inflammation in mice shortens lifespan and accelerates neurocognitive decline. However, the role of the hypothalamus in systemic and neurocognitive aging in humans is unresolved. We studied the cross-sectional relationships between hypothalamic microstructure, cortical atrophy and neurocognition in community dwelling older adults (n=124, median age 78.7 (IQR 74.3-83.4) years, 58% women). Hypothalamic microstructure was assessed using magnetic resonance imaging (MRI)-diffusion tensor imaging (DTI) parameters that included mean diffusivity (MD) and fractional anisotropy (FA), obtained using a novel automated image processing pipeline. Greater MD and lower FA were indicative of compromised microstructural integrity. Neurocognitive assessments included a battery of 11 tests that were used to quantify standardized domain-specific (executive, memory, language, attention and visuomotor) and overall neurocognitive scores. Age was positively associated with hypothalamic MD (beta=0.037 SD per year of age, p=0.005). In linear models adjusted for age, sex, education, white matter hypointensities, and total intracranial volume, hypothalamic MD was negatively associated with cortical thickness in the cingulate, frontal, and parietal lobes (betas -0.07, -0.06, -0.07 respectively, all FDR-adjusted p≤0.01). On the other hand, in a multivariable adjusted model that included cortical thickness, hypothalamic FA was positively associated with the overall and all domain-specific neurocognitive scores (betas ranged 0.14 - 0.18, FDR- adjusted p values< 0.05). Hypothalamic microstructure is independently associated with cortical atrophy and neurocognition in the aging brain. Longitudinal studies can establish temporality and potential mechanisms by which hypothalamic dysfunction may accelerate systemic and neurocognitive aging in humans.
IDENTIFYING AND PREVENTING RESIDENT-TO-RESIDENT AGGRESSION IN LONG-TERM CARE: EMERGING GLOBAL PERSPECTIVES
Authors: Chang E-Shien , Mosqueda Laura
Published: December 2023

Resident-to-resident aggression (RRA) is a widespread form of mistreatment in long-term care facilities, affecting 1 in 5 residents every month. Despite its high frequency and adverse consequences for residents, staff, and family members, RRA remains under-recognized and insufficiently studied. Several reasons exist for this, including challenges in obtaining high-quality data to inform evidence-based prevention and intervention strategies. Improved understanding of RRA aligns with recent national policy imperatives to increase nursing home safety and quality of care. To accelerate knowledge-to-practice translation, this symposium highlights expertise from North America and Asia to review the latest evidence and experiences that characterize and improve RRA. Dr. E-Shien Chang will identify the role of racial and ethnic conflicts in RRA using data from the largest RRA prevalence cohort study of U.S. nursing home residents. Dr. Elsie Yan will examine resident and environment risk factors of RRA in Hong Kong, illustrating the needs for improved dementia care training among direct care workers. Dr. David Burnes will discuss barriers, successes, and lessons learned in replicating and adapting a gold standard U.S. based RRA prevalence study in the unique context of Canada. Dr. Karl Pillemer will describe a novel dissemination model to expand program reach of Improving Resident Relationships in Long Term Care (IRRL), an evidence-based RRA intervention program. Finally, Dr. Laura Mosqueda, as policy expert of long-term care services and discussant, will moderate a discussion on translating RRA research to practice and policy changes within the global contexts of long-term care. This is a collaborative symposium between the Abuse, Neglect and Exploitation of Older Persons and Research in Quality of Care Interest Groups.
A COMMUNITY-BASED APPROACH TO REFINING THE ENHANCING ACTIVE CAREGIVER TRAINING (ENACT) INTERVENTION
Authors: Eaton Jacqueline , Neller Sarah , Cajavilca Moroni Fernandez , Johnson Julene , Ellington Lee
Published: December 2023

Several interventions for dementia caregivers target the negative effects of behavioral symptoms. Evidence suggests that actively engaging caregivers in training and preparation improves outcomes, such as reduced caregiver burden, depression, and improved subjective well-being. However, there is little information on the best approaches to optimize active engagement. Enhancing Active Caregiver Training (EnACT) is an arts-based intervention that facilitates active engagement using participant-informed vignettes that portray caregiving experiences. This presentation will describe the process of partnering with dementia caregivers to iteratively develop the EnACT intervention in preparation for a randomized controlled trial (RCT). We conducted three iterative focus groups in partnership with dementia caregivers (n=9). Feedback was incorporated into intervention design and materials following each meeting. During focus group one we reviewed and identified video vignettes for inclusion. In focus group two, we tested intervention activities. In focus group three, participants provided feedback on the facilitator guide developed during this process. Focus groups were audio-recorded, transcribed, and analyzed in three cycles using structural, descriptive, and pattern coding. Across all focus groups, we coded 679 items as what went well and 358 items as needing to change. Intervention revisions focused on narrowing vignette topics, removing confusing components (such as engagement activities that were too burdensome), enhancing accessibility, simplifying instructions, and adding facilitator training. A facilitator guide was developed with four main components: Letter to facilitator, Introduction, Preparation to Begin, and Instructions. Partnering with caregivers improved our ability to enhance acceptability and fidelity in preparation for future testing in a wait-list RCT.
LATER-LIFE EXPERIENCES OF VETERANS AND THEIR CAREGIVERS
Authors: Wilmoth Janet
Published: December 2023

Military service is a defining life-course event that is consequential for the well-being of older adults and their caregivers. Although there has been increased attention to veteran status differences in later-life experiences, critical gaps in knowledge persist. This symposium features four presentations that address existing gaps from various perspectives. Kurth and colleagues use data from an online survey of community-dwelling combat veterans. They find that Vietnam Veterans exhibit more PTSD symptoms than veterans in two younger cohorts, and observed cohort differences are explained by military and post-service experiences. Spiro and colleagues examine later-adult trauma re-engagement (LATR) across multiple samples of Vietnam-era veterans and find that there is variation in LATR by gender and warzone experience. London and colleagues analyze data from adults aged 50+ in the 2021 National Health Interview Survey and find that: non-combat and combat veterans have more difficulty remembering/concentrating than nonveterans; hearing difficulty mediates some of the association between military service experiences and remembering/concentrating; and combat experiences moderate the relationship between hearing difficulty and difficulty remembering/concentrating. Haverhals and colleagues assess the Redefining Elder Care in America Program (RECAP) piloted recently in two VA health care centers and find that combat veterans and their caregivers reported shortcomings and challenges associated with program participation even though they were satisfied overall. Collectively, these papers underscore the enduring influence of combat exposure on older adults and the importance of innovative health care service models that are designed to provide support to caregivers. This is an Aging Veterans: Effects of Military Service across the Life Course Interest Group Sponsored Symposium.
DIGITAL TWIN NEIGHBORHOODS FOR PRECISION POPULATION HEALTH: INITIAL RESULTS OF COMMUNITY CONVERSATIONS
Authors: Perzynski Adam , Berg Kristen , Dalton Jarrod
Published: December 2023

Neighborhood socioeconomic inequality leads to lower use of preventive services, increased incidence and severity of disease, reduced quality of life, and higher mortality across multiple age groups. To accelerate discovery and prioritize population health strategies, we introduced Digital Twin Neighborhoods (DTNs): digital replicas of real communities that include biological, social, and geographic data and algorithms. We implemented a series of community engagement studio sessions (CES) that aim to elicit and clarify community members’ preferences and concerns about DTNs in order to most inclusively and ethically align DTN investigators’ research with community priorities. More than 30 participants have attended quarterly sessions. At CES sessions, researchers summarize the DTN framework and then engage with questions from (i) community experts and (ii) scientific experts, and (iii) open dialogue to guide project decision-making. To date, salient community experts’ concerns include: potential harms of DTNs for real-life communities; data privacy; selection of spatial indicators; and consequences for vulnerable populations. Suggestions for making DTN work more community-resonant have included: data transparency directly with residents; reconciling data definitions with local meanings of health; recognizing biases in electronic health records; and conducting shared activities within neighborhoods. CES sessions revealed foci for future DTN analyses including: how social isolation and togetherness influence health; identification of spatially defined targets for remediating structural racism; analysis of health-promoting assets’ (e.g., green space, churches) differential benefits; and examining how resilience creates practical advantages amidst difficult socioenvironmental circumstances. Conversing with community members, we are now developing implementation plans for each of these areas.
TRENDS IN SUPPORTS FOR FAMILY CAREGIVERS OF OLDER ADULTS THROUGH MEDICAID HOME AND COMMUNITY-BASED SERVICES IN THE US
Authors: Miller Katherine , Parrish Elise , Thunell Johanna
Published: December 2023

The aging population in the United States, combined with the dominant preference of older adults to remain in the home and community, has increased the demand for unpaid (family) caregivers - a role often undertaken by spouses. Despite known adverse effects of caregiving on health and economic well-being, few systematic policies financially supporting caregivers exist. Medicaid Home- and Community-Based Services (HCBS) 1915(c) waivers are a primary mechanism for paying family caregivers. Our objective is to systematically document and describe supports for family caregivers through Medicaid HCBS 1915(c) waivers. To accomplish our objective, we scrape data directly from approved waivers (2010-2019) serving adults aged 65+ including, but not limited to: approval date, services provided, limitations of services, allowed payments to relatives and legally authorized representatives, and the unique number of enrollees to be served by each waiver. We then describe training/education and payments available to family caregivers. Approximately 62 waivers across 15 states provide training and education to family caregivers. Waivers across 41 states (n=241) allow for payments to legally authorized representatives through 1915(c) waivers. However, upon examining the restrictions of these waivers, 67.6% of these waivers effectively exclude spouses from receiving payments. Despite growing reliance on family caregivers, supports are not widespread and existing supports reach a limited group of family caregivers. This research further contributes to Medicaid research by creating a database of waiver services; thereby contributing to our understanding to the depth and generosity of HCBS, which can be systematically updated as new waivers are approved.
EVERYDAY DISCRIMINATION AND RACIAL/ETHNIC DISPARITIES IN COGNITIVE FUNCTIONING
Authors: Lai Wen-Hua “Zoey”
Published: December 2023

Alzheimer’s disease and related dementias are expected to triple from 5 million to 13.7 million by 2050 in the U.S. Black, and Latinx older adults experience poorer cognitive health and a 1.5 to 2 times higher rate of dementia than their white counterparts. Due to the structural racism in the U.S., chronic exposure to everyday discrimination may contribute to cognitive health inequalities, yet limited empirical research examines this association. This study uses parallel linear growth curve modeling to assess the impact of long-term exposure to everyday discrimination on the initial level of cognition (i.e., latent intercept) and change in cognition (i.e., latent slope) among older adults and examines whether such association varies among Black, U.S.-born Latinx, foreign-born Latinx, and white older adults. Using data from the 2006-2012 Health and Retirement Study (N=8,195), these findings show that racial/ethnic minority older adults, especially Blacks, experience greater everyday discrimination and poorer cognitive health than their white peers. Greater exposure to everyday discrimination was associated with lower initial levels of cognitive function and a faster decline in cognitive function. Results from multiple groups analysis further indicate that everyday discrimination shaped cognitive trajectories only for white and Black older adults but not for U.S. -born and foreign-born Latinx older adults. These findings suggest that white and Blacks older adults who experience a higher level of everyday discrimination may be vulnerable to cognitive decline. This study discusses the implication of these unexpected findings and future research directions.
BIODEMOGRAPHY OF AGING: INSIGHTS FROM TWINS AND THE OLDEST-OLD IN DENMARK
Authors: Christensen Kaare
Published: December 2023

The Danish Twin Registry holds health information from surveys and registers on more than 180,000 twins born in Denmark since 1870. Life course studies of the oldest twin cohorts show moderate heritability of lifespan but a substantial genetic influence on physical and cognitive functioning throughout life, i.e., twins are growing old but not growing apart, in terms of health phenotypes. Twins experience substantial growth restriction in the last intrauterine trimester. The generalizability of aging studies of twins hinges on whether this early life exposure has long-lasting health consequences. Generally, after the infant period, twin-singleton health differences are small, and during the 20th century, they have vanished. In the older twin cohorts, sex differences in the association between number of offspring and oral health late in life provided support for the proverb known in many countries: “A tooth per child”. Twin studies of biomarkers of aging revealed that perceived age estimated by lay assessors based on photos is a strong biomarker of aging. The 1895, 1905, 1910 and 1915 Danish Birth Cohort Studies of the oldest old were established to study secular trends in the health and functioning of the very old. Among the main findings of the studies are: Exceptional longevity does not lead to exceptional levels of disability; summed over cohorts, more people are living to the highest ages and are functioning better – and this progress is seen across the spectrum of health and functioning – offering hope for continued progress in health and survival among the oldest in society.
AGING IN THE RIGHT PLACE: HOUSING AND SOCIAL SUPPORTS FOR OLDER ADULTS EXPERIENCING HOMELESSNESS
Authors: Traver Anthony , Dabelko-Schoeny Holly
Published: December 2023

The Aging in the Right Place (AIRP) framework recognizes that secure housing for older adults should support one’s unique vulnerabilities and lifestyles. Applying the AIRP framework to older people experiencing homelessness (OPEH) reveals limited access to the types of living environments and supportive services that promote dignity, health, and inclusion in later life. This symposium aims to use the AIRP framework to examine the places, meanings, and opportunities experienced by diverse groups of OPEH striving to secure housing and promote their well-being. The first paper uses photovoice interviews and thematic analysis to broaden the current conceptualization of AIRP by exploring how feelings, actions, and place inform the meaning of AIRP for older adult residents of one temporary housing program in Vancouver, CA. The second examines the housing and support needs of older adult veterans in Calgary, CA residing in temporary congregate housing through a multi-methods approach involving document reviews, environmental audits, and in-depth interviews. The third paper uses interviews with OPEH and service providers in Columbus, OH to look across the continuum of housing occupied by older adults before, during, and after an episode of late-life homelessness and to investigate the mechanisms that allow OPEH to identify and access the housing they consider optimal. Finally, the discussion positions AIRP for OPEH within the broad context of Age-Friendly ecosystems to highlight the role of coordination between housing providers, government leaders, health services, university researchers, and residents to ensure that AIRP is achievable for precariously housed older persons.
MEANINGS OF AGING IN THE RIGHT PLACE FOR HOUSING INSECURE OLDER ADULTS IN TEMPORARY HOUSING
Authors: Mahmood Atiya , Canham Sarah , Weldrick Rachel , Patille Rachelle , Erisman Morgan
Published: December 2023

The concept of aging in place (AIP) is widely acknowledged as the preference of older adults. However, AIP without consideration of the intersections of diversity in later life is critiqued as lacking an equity lens. This gave rise to the exploration of what is needed to age in the right place (AIRP). Building on existing research, we examined the meaning of AIRP to older adults (aged 55+ years) who have experienced homelessness. We conducted photovoice interviews with 11 residents of a temporary housing program in Metro Vancouver (Canada). Using thematic analysis, we investigated the meanings of AIRP based on 1) How one feels, 2) What one does, and 3) Where one lives. Findings demonstrate that meanings of AIRP follow a similar pattern as Maslow’s Hierarchy of Needs. That is, when basic needs of shelter are met, participants’ considerations of the ‘right’ place to live extends beyond affordable housing to include having access to meaningful activities – in urban districts and nature-scapes – enabled by affordable transportation. This consideration includes higher-order factors such as opportunities for meaningful engagement and looking forward to a stable life, being at peace, feeling safe and comfortable in one’s home and neighborhood. Our examination of what AIRP means to this group of older adults broadens current conceptualizations. Given the increase of older adults who are homeless it is imperative that policymakers and practitioners be cognizant of meanings of AIRP to enable diverse groups of older adults to thrive in housing that is more than a shelter.
POTENTIAL MECHANISMS THROUGH WHICH INDUCING HEART RATE OSCILLATIONS AFFECTS PLASMA AMYLOID BETA LEVELS
Authors: Min Jungwon , Rouanet Jeremy , Cole Steve , Nashiro Kaoru , Yoo Hyun Joo , Cho Christine , Head Elizabeth , Mather Mara
Published: December 2023

Alzheimer’s disease-related protein amyloid beta (Aβ) plasma levels increase with age, and Aβ40 levels are associated with greater mortality. Most plasma Aβ40 is produced via platelets. Platelet activity is regulated by endothelial cells, which are stimulated by blood flow. Slow paced breathing with a 10-second cycle maximizes heart rate oscillations, which may stimulate endothelial-platelet interactions that affect Aβ production. We investigated this idea by randomizing healthy adults (54 younger and 54 older adults) into two groups with the opposite goals: increasing (Osc+) or decreasing (Osc-) heart rate oscillations. Four weeks of daily practice (20-40 min) resulted in large changes in plasma Aβ40 and Aβ42 levels. We also found that changes in Aβ were not associated with changes in resting-state physiology including heart rate variability. But the Aβ changes were associated with a frequency measure of heart rate oscillations induced during practice, suggesting that the Aβ changes were more driven by blood flow changes during practice. P-selectin is an indicator of endothelial activity. We found a significant intervention effect where the Osc+ intervention increased p-selectin and the Osc- intervention decreased p-selectin in older adults. Changes in p-selectin also showed strong negative correlations with changes in Aβ40 and Aβ42 in older adults. The results suggest that blood flow oscillations caused by high amplitude heart rate oscillations stimulated endothelial cells, which suppressed platelet activity and consequently reduced the production of Aβ in older adults. In follow-up research, we are investigating relationships between plasma Ab changes and changes in brain and cognition.
THE EMOTION PARADOX IN THE AGING BODY AND BRAIN
Authors: Mather Mara
Published: December 2023

With age, parasympathetic activity decreases while sympathetic activity increases. Thus, the typical older adult has low heart rate variability (HRV) and high noradrenergic activity. Younger adults with this physiological profile tend to be chronically unhappy and stressed. Yet, with age, emotional experience tends to improve. Why doesn’t older adults’ emotional well-being suffer as their HRV decreases? To address this apparent paradox, I present the autonomic compensation model. In this model, failing organs and initial phases of Alzheimer’s pathology trigger noradrenergic hyperactivity in older adults. Older brains attempt to compensate by increasing autonomic regulatory processes in ventromedial prefrontal (vmPFC) cortex. Age-related declines in nerve conduction reduce the ability of these compensatory attempts to reduce hyperactive noradrenergic activity and increase peripheral HRV. However, despite their muted effects on peripheral autonomic activity, these autonomic compensation attempts bias brain processing in favor of stimuli that tend to increase parasympathetic activity and against stimuli that tend to increase sympathetic activity. The autonomic compensation model can account for the “age-related positivity effect” in which, compared with younger adults, older adults show attentional and memory biases favoring positive over negative stimuli. Consistent with the autonomic compensation model, the age-related positivity effect is associated with vmPFC activity and functional connectivity and is evident even in early attention processes resistant to goal-directed processing. The autonomic compensation model posits that the aging brain responds to sympathetic hyperactivity in ways that amplify on-going automatic emotion regulation processes and so help maintain emotional well-being.
PROTECTING COGNITION AND INCREASING EQUITY THROUGH “COGNITIVE IMPACT ASSESSMENTS”
Authors: Leist Anja , Bertogg Ariane , Zanaj Skerdi
Published: December 2023

Today’s societies are characterized by increasing complexity, in which unimpaired cognitive performance is vital to navigate and participate, as well as to retain independence at older ages. Addressing the challenge of improving population brain health has mostly been considered from a dementia risk reduction perspective as identified by the Lancet Commission on dementia. However, risk factors with immediate harm to cognitive functioning, such as shift work or insufficient sleep are currently not explicitly accounted for. As exposure to these risk factors accumulates across the life course, we can expect substantial consequences for later-life brain health. We argue that, in policy and practice, systematic measures should be introduced to protect individuals from harms to their everyday cognitive functioning, and enable them to optimize cognitive performance throughout the life course. On behalf of the international multidisciplinary BRAINHEALTH-POLICY group, we explore the concept of a ‘cognitive footprint’ of policies with exemplars from current legislation and policy that either implicitly affect cognition, or explicitly address effects on individuals’ cognition. We suggest recommendations for systematic pre-intervention ‘cognitive impact assessments’ in fields such as medicine, where drug trials should include cognition as important secondary endpoint, and work, where labour laws should explicitly account for possibly harmful effects of certain work conditions to cognition. Besides immediate protective effects, we expect ‘cognitive impact assessments’ to have potential for long-term cognitive benefits on a population level as well as improve brain health equity by enabling individuals to reach optimum cognitive performance, with associated wider health benefits.
HOSPICE USE AND END-OF-LIFE EXPERIENCE BY RACE AND GEOGRAPHY: A LATENT CLASS ANALYSIS
Authors: Decker Autumn , Weaver Raven
Published: December 2023

Long existing inequalities near the end-of-life (EOL), including the death experience, have been uncovered because of increased attention during the COVID-19 pandemic. Hospice may be an avenue to equalize EOL experiences. This study aimed to 1) understand the profiles of hospice use and EOL experience in a national representative sample of decedents and 2) uncover how race and/or geographic location predict class membership. We conducted a latent class analysis with covariates using Waves 9-11 (n=1050) from the last month of life interview in the National Health and Aging Trends Study. Based on fit statistics, response probabilities, class separation, interpretability, and fit with theory, a four-class model was ultimately selected. The four latent classes were: well-rounded hospice care; no hospice, goal concordant care; no hospice, poor overall care; and complex hospice care. We found that geographic location was not a significant predictor of latent class membership but being non-White was significantly associated (p < .001) with 8.79 times higher odds of being in the no hospice, poor overall care group and 1.85 times higher odds of being in the no hospice, complex care group compared to the reference class (well-rounded hospice care). The current study’s findings paint a complex picture of hospice use and EOL experience in a nationally representative sample. Hospice use alone does not make a “good death” experience, particularly for people of color. Rather, there are unique profiles of hospice use and experiences at EOL. Future research should explore the impact of geographic location on the death experience.
THE IMPACT OF HOME HEALTH CARE UTILIZATION ON SUBSEQUENT HOSPICE USE AMONG MEDICARE BENEFICIARIES
Authors: Jarrín Olga , Zafar Anum , Duberstein Paul , Wu Bei , Lin Haiqun , Kim Hyosin , Lopez Maria , Harvey S Marie
Published: December 2023

Home health care may increase the use of hospice among Medicare beneficiaries by providing improved access to care, enhanced care coordination, and earlier identification of the need for hospice. This study evaluated home health care use during the last three years of life as a predictor of death in the care of hospice for a cohort of 2,169,496 Medicare beneficiaries who died in 2019. The cohort included beneficiaries continuously enrolled in Medicare for 5 or more years, aged 40 and older, and living in the U.S. fifty states, District of Columbia, U.S. Virgin Islands, or Puerto Rico at death. Co-variates included acute hospitalizations during the look-back period, age at death, sex, race/ethnicity, comorbidities, insurance, rural/urban area, and state of residence. Overall, 46% of beneficiaries used home health care during the lookback period, and 62% died at home. Among beneficiaries who used home health care, 59% died in the care of hospice, compared to 45% who never used home health care. Beneficiaries who received home health care at any point during the lookback period were more likely to later die at home (OR 1.10) or in the care of hospice (OR 1.07) compared to their counterparts without a history of using home health care. Additionally, persons with dementia had greater odds of home death (OR 1.21) and death with hospice (OR 1.68) compared to their counterparts without dementia. This study provides strong evidence of the value of home health care as a strategy to improve end-of-life care quality for Medicare beneficiaries.
THE IMPACT OF STROKE ON TRAJECTORIES OF LONELINESS
Authors: Rule Payton , Willroth Emily , Graham Eileen , Nicholas Marjorie , Hattori Robin , Thompson Tess , Connor Lisa
Published: December 2023

While prior research has identified loneliness as a risk factor for stroke, less is known about whether stroke may increase the risk of loneliness. We examined this question using three large representative panel studies of middle-aged to older adults in the U.S., Europe, and Israel. Specifically, we used harmonized data from the Health and Retirement Study (n=23,834, 10.3% stroke survivors), the English Longitudinal Study of Aging (n=15,779, 5.1% stroke survivors), and the Survey of Health, Aging and Retirement in Europe (n=106,480, 3.6% stroke survivors). Multilevel modeling was used to examine trajectories of loneliness across middle and older adulthood and the impact of stroke on trajectories of loneliness. Across all three samples, loneliness followed a quadratic trajectory, decreasing or remaining stable prior to age 60 and then increasing throughout older adulthood. In individuals who experienced stroke, loneliness increased more sharply after stroke onset. In follow-up analyses conducted within the subsample of stroke survivors, loneliness was higher post-stroke compared to pre-stroke. Moreover, the effect size suggests that the impact of stroke on loneliness trajectories is greater than the impact of normative developmental processes. In this talk we will discuss these results as well as the implications of this work. Specifically, these results highlight the need for loneliness prevention efforts in stroke survivors. Interventions targeting stroke survivors’ social participation and autonomy may help prevent or decrease loneliness post-stroke. Additionally, programs aimed at educating stroke survivors’ social network on ways to provide effective support may also help promote social connection in this population.
CHALLENGES IN THE COMMUNITY-DRIVEN RECRUITMENT OF BLACK OLDER ADULTS TO A HEALTH RESEARCH REGISTRY
Authors: Perry Tam , Key Kent , Flores Elena , Rorai Vanessa , Mitchell Jamie
Published: December 2023

Black older adults are underrepresented in health research. Community members representing diverse aging-focused organizations in Flint, Michigan desired more accessible health discoveries, and formed a Community Advisory Board (CAB) in partnership with three local universities. With a grant from the National Institute on Aging (NIH), the CAB sought to promote research engagement through free community health programming and launching a Participant Research Pool (PRP) to connect Black older adults with non-invasive IRB-approved health research at participating universities. Despite extensive recruitment efforts by this academic-community partnership, including monthly virtual health seminars, a new website, tailored print and video promotional materials, a minority aging newsletter, and a community research symposium, the PRP remains severely under-enrolled after a year. An evaluation of recruitment strategies revealed a need for more frequent in-person programming, leveraging the social and professional networks of CAB members, increased intentionality in community partnerships, and more intensive and traditional modes of advertising to reach and recruit the target population. Lessons indicate that Black older adults in the community trust this research endeavor but require tailored and consistent outreach to engage with the participant research pool.
FORWARD STEPS AND MISSTEPS: WHAT WE’VE LEARNED THROUGH THE PROCESS OF COMMUNITY-ENGAGED RESEARCH
Authors: Lewis Jordan
Published: December 2023

Historically, research with Indigenous populations has disregarded community input, creating mistrust among tribal communities toward researchers, and resulting in communities limiting their involvement in research projects. Today, Indigenous communities are becoming more engaged in the research process, including developing their own tribal review boards, partnering with researchers throughout entire research process, as well as exercising their tribal sovereignty and housing their own data. These efforts have resulted in the development of rigorous Indigenous approval processes, increased engagement of Indigenous people and communities in research, and studies that have direct impacts on those engaged, as well as future generations, as well as protect both the Indigenous communities and the researchers. As a researcher trained to conduct culturally respectful and culturally safe research with Indigenous communities in Alaska, my team and I have gained first-hand experience with tribal research protocols, research processes, and the iterative process of developing relationships, navigating research ethics, as well as ensuring that findings are reflective of the community, its individual members, and the region. Despite our best efforts, research does not go as written in our grant proposals. This presentation will outline the complexities of navigating tribal approval processes in Alaska, highlight some of the challenges we have faced while conducting community-engaged research in Alaska; our lessons learned by doing it incorrectly. We will also share recommendations for researchers interested in working with Indigenous communities and how to work collaboratively with to avoid pitfalls, but also how to get back on track and develop lasting relationships.