bluuebunny/crossref_metadata_2025 huggingface dataset:
THE ASSOCIATIONS BETWEEN THE SOCIAL NETWORK, THE CARE NETWORK, AND THE WELL-BEING OF OLDER ADULTS IN THE NETHERLANDS
Authors: Van Groenou Marjolein Broese , Keating Norah
Published: January 2025

The increased demand for long-term care (LTC) and the drastic reforms of the LTC systems in western societies create uncertainty among families. It raises the question of whether and how families can provide appropriate LTC for their older relatives and maintain the wellbeing of the care recipient (CR). One solution is for core family members (partners and children) to organize care together with other informal and formal caregivers as much as possible in large and diverse care networks. Well functioning care networks could then possibly contribute to the wellbeing of the CR. The first contribution of this symposium focuses on the informal care potential of the older care recipient and investigates which characteristics of the social network are associated with a care network with many informal helpers. The second paper examines how different types of (informal) care networks contribute to CR’s psychological well-being, and to what extent loneliness, perceived control and care sufficiency play a role in this. The third paper links the theoretical models of both papers and investigates whether and how the associations between the social network, the care network and wellbeing vary in different societal and LTC contexts. All contributions use the Longitudinal Aging Study Amsterdam (LASA), a long-term study into the functioning and care use of older people in the Netherlands. Data are used from ten three-yearly waves between 1992 and 2022. The discussion focuses on which directions the studies provide for improving long-term care for the older care recipients and their informal caregivers.
THE ASSOCIATIONS BETWEEN SOCIAL NETWORKS, CARE NETWORKS, AND WELL-BEING COMPARED IN DIFFERENT TIME PERIODS
Authors: Van Groenou Marjolein Broese , Klokgieters Silvia , Abbing Jens , Swinkels Joukje
Published: January 2025

Objectives A well-functioning LTC network is important for the psychological well-being of older CRs. Yet, the use of formal and informal care depends on the allocation of LTC which may vary over historic time. This raises the question whether the links between social networks, care networks and psychological wellbeing differ between various LTC policy contexts in the Netherlands. Methods Data are from 65-plus in four waves of the LASA study that are ten years apart: 1992 (N=1794), 2002 (N=1284), 2012 (N=1183), 2022 (1011). Five care network types were considered (no care, partner care, informal, formal and privately paid care). Per wave regression analyses are used to analyze the associations between social networks, care networks and depressive symptoms, and effects are compared across waves using multigroup analysis. Results Preliminary results show that the prevalence of care network types differ over time, with a decrease in partner and informal care types and stability in formal and privately paid care types. Many of the effects appeared stable over time: in all waves social network composition contributed to informal care use; and partner care reduced depressive symptoms where formal care increased this. Care network types that fostered relatedness and sufficient care were important for wellbeing in all waves. Discussion Although the four waves represent varying LTC contexts, the findings support the robustness of the associations between social networks, care networks and wellbeing. Moreover, those who lack a partner and a social network risk dependency on formal care resulting in lower wellbeing in all times.
THE ROLE OF SOCIAL NETWORK CHARACTERISTICS IN LONG-TERM CARE NETWORKS AMONG OLDER ADULTS IN THE NETHERLANDS
Authors: Abbing Jens , Swinkels Joukje , Van Groenou Marjolein Broese
Published: January 2025

Objectives The increasing demand for long-term care (LTC) among western societies calls for a better understanding of how older adults build LTC networks consisting of informal and formal caregivers. Having supportive relationships is generally associated with receiving informal care, yet how specific characteristics of individuals’ social networks relate to LTC networks is not fully understood. Therefore, the present study investigated how the size, composition, and relationship quality of individuals’ social network influences what type of LTC network they have. Methods Data was used from the Longitudinal Aging Study Amsterdam that measured LTC use and social network characteristics of older adults (average age=70.88) in three-year intervals from 1992 to 2022. The sample contained 18,252 complete observations from 4,878 participants. Results Using multilevel latent class analysis, six LTC network types characterized by the main caregiver (co-residents, children, relatives, non-kin, publicly paid care and privately paid care) were identified. Cluster-robust multinomial logistic regression analyses revealed that social network size, composition and relationship quality all were associated with membership in the various informal care network types. In particular having a partner, and children and relatives living in proximity and/or with strong bonds contributed to an informal LTC network. Discussion Network composition was most important while the impact of relationship quality was relatively small. This suggests that older adults may refrain from using the full potential of their social network to build informal care networks, possibly because they prefer not to involve relatives or non-kin into caregiving or prefer formal or privately paid care.
EMERGENCY DEPARTMENT USE AND HEALTH CARE EXPENDITURES AMONG OLDER ADULTS AT END-OF-LIFE
Authors: Gettel Cameron , Kitchen Courtney , Rothenberg Craig , Song Yuxiao , Venkatesh Arjun , Hastings Susan
Published: January 2025

Emergency department (ED) visits at end-of-life (EOL) may cause financial strain to older adults and serve as a marker of inadequate access to community services and health care. We sought to examine EOL ED use, total health care spending, and out-of-pocket (OOP) spending among Medicare beneficiaries. Using data from the Medicare Current Beneficiary Survey, we conducted a pooled cross-sectional analysis including Medicare beneficiaries aged 65 years and older with a date of death between July 1, 2015 and December 31, 2021. Our primary outcomes were ED visits, total healthcare spending, and OOP healthcare spending in the 7, 30, 90, and 180 days preceding death. We compared total and OOP healthcare costs for those with at least 1 ED visit prior to death vs. without any ED visits within each timeframe and estimated a series of zero-inflated negative binomial regression models to identify associations between key beneficiary characteristics and the primary outcomes. Among 3,812 older adult decedents, 610 (16%), 1,207 (31.7%), 1,582 (41.5%), and 1,787 (46.9%) Medicare beneficiaries, respectively, had ED visits in the final 7, 30, 90, and 180 days of life. For Medicare beneficiaries with at least one ED visit in the final 30 days of life, the median total and OOP costs were respectively $12,366 and $160, compared respectively to $160 and $0 for those without any ED visits (P <0.001 for both comparisons). These estimates of ED use and costs during the terminal phase of life highlight the importance of appropriate and timely EOL care.
EXPECTATION AND ENGAGEMENT IMPACT COGNITIVE TRAINING BENEFITS IN MID-TO-LATE LIFE
Authors: Curtis Ashley , Costa Amy , Musich Madison , Schmiedeler Anthony , Eberhardt Kenda , McCrae Christina
Published: January 2025

Lack of pharmacological agents for cognition has prompted research on behavioral treatments such as cognitive training (CT). Evidence regarding CT benefit is mixed. In accordance with the biopsychosocial model, we examined whether individual characteristics such as expectation for improvement and engagement levels impact CT benefits in middle-aged/older adults. In Study 1, older adults with insomnia (N=24) completed 6-week CT (Nintendo DS-Big Brain Academy; 60 mins/day, 3x/week) and waitlist control (WLC) in a cross-over design. At baseline and post-CT/post-WLC, participants completed NIH toolbox-cognitive tasks. In Study 2, middle-aged adults with generalized anxiety disorder (GAD; N=17) completed 8-week CT (Cognifit; 45 mins 3x/week). At baseline/post-CT, participants completed State-Trait Anxiety Inventory, Cognitive Failures Questionnaire, and computerized cognitive tasks. At mid-point, participants evaluated expectations of cognitive/anxiety improvement (0:none-100:extreme improvement). At post-treatment for both studies, participants completed the Game Engagement Questionnaire. Bivariate correlations evaluated associations between game engagement and improvement expectations on post-training proportional changes in cognitive (Study 1&2) and anxiety (Study 2) outcomes. In Study 1, greater perceived competence was associated with greater CT-related inhibition improvement (r=-.57, p=.008). In Study 2, greater expected level of cognitive improvement (r=-.58, p=.047) and sensory game engagement (r=-.730, p=.002) were associated with less CT-related working memory improvement. Greater CT perceived skill/competence was associated with more anxiety reduction (r=.59, p=.02). A biopsychosocial approach to intervention evaluation may be useful in CT trials in aging adults with insomnia and GAD. Psychological user characteristics such as expectation for improvement and perceived competence, as well as biological sensory engagement impact CT benefits.
IMPROVING WELL-BEING IN OLDER ADULTS: USING AN ITERATIVE PROCESS TO OPTIMIZE THE DESIGN OF A GROUP INTERVENTION
Authors: Cassidy-Eagle Erin , Gould Christine , Lin Feng Vankee , Makowski Maryam , Gallagher-Thompson Dolores
Published: January 2025

Psychological health and well-being definitions are moving beyond the goal of simply decreasing symptoms and disorder rates and moving towards a life enhancing and positive focus. Our multi-modal group program targets a broad range of well-being dimensions including cognitive, behavioral, emotional, social, and physical health parameters. The changes to design and implementation made to the intervention as part of an iterative process will be discussed. Participants were older adults (65+), absent a dementia diagnosis, referred from providers across the healthcare system. The intervention focuses on a collection of topics that support optimal psychological wellness and promote health and resilience (i.e. digital tools and mobile apps, value-based behavioral activation to improve your mood, eating for a healthy brain, introduction to mindfulness, improving your sleep and strategies for managing anxiety) that are held weekly, with modules ranging in duration from 2-4 weeks, over a 7-month period. The results across 2 groups (N=40), both process and outcome, will be presented. Positive psychiatry interventions have great potential to support and strengthen the psychological well-being of older adults who are faced with the myriad of challenges that come with increasing age. Considering the geriatric mental health provider shortages and the overwhelmed healthcare system, this program has improved access to psychiatric care. Program goals also include aims of boosting positive emotions, life satisfaction, purpose and meaning, along with decreasing loneliness, depression, and anxiety.
COMPASSIONATE LOVE AND INTERSECTIONAL INEQUALITIES IN LATER-LIFE MENTAL HEALTH IN THE US
Authors: Bhatta Tirth , Albert Jeffrey , Torres Stacy , Kahana Eva , Lekhak Nirmala , Goler Timothy
Published: January 2025

Objectives: Despite the emerging evidence that compassionate love has a positive effect on mental health, its distribution across race, gender, and socioeconomic status and its subsequent role in mediating the effect of socioeconomic status on later life mental health across race and gender have yet to be examined. Methods: Based on our nationwide web-based survey of adults aged 50 years and older (n=1861), we conducted a mediation analysis to estimate the direct and indirect effects (via feeling love) of financial strain on depressive symptoms and anxiety across race and gender. Results: Our regression estimates indicate an average.09-point (p=.002) lower feeling of compassionate love among individuals experiencing increased financial strain. Women reported greater feeling of love (β=.22, p<.001) than men. Despite experiencing higher levels of financial strain, Black adults reported greater feelings of love (β=.42, p<.001) than white adults. Findings show an average.14-point (p<.001) and.21-point (p<.001) higher depressive symptoms and anxiety, respectively, among individuals experiencing increased financial strain. We found a statistically significant path-specific effect on both depressive symptoms (indirect effect=.018, p-value=.003) and anxiety (indirect effect=.196, p<.001) (from financial strain) through love. Statistically significant indirect effects through love on both depressive symptoms and anxiety were found for women and white adults, but not for men and Black adults. Discussion: Our study opens up a new avenue of research by investigating the role of compassionate love in transmitting the effects of financial strain on later-life mental health across race and gender.
HAPPINESS LOVES COMPANY? OLDER ADULTS’ POSITIVE AFFECT ACROSS LAYERS OF THE MOMENTARY SOCIAL CONTEXT
Authors: Goldman Alyssa , Moorman Sara
Published: January 2025

Positive affect supports physical and mental health as well as longevity. Ecological momentary assessments (EMAs) have been used to demonstrate that positive affect is significantly shaped by the quality and quantity of momentary social interactions that take place during everyday activities. We consider that positive affect may also be a function of the broader momentary interpersonal social environment, including the presence of acquaintances and unfamiliar others in everyday social spaces – social actors whose presence is typically not explored in studies of the social context. Using 15,379 EMAs from 378 older adults in the Chicago Health and Activity Space in Real-Time study in mixed effects regression models, we find that older adults experience more positive affect when they are with a social companion versus being alone, consistent with prior research. More novel, however, we find that when older adults spend time in social spaces where other people are present, they report significantly higher levels of momentary positive affect, regardless of whether they are with a personal social companion or alone, and regardless of the activity in which they are engaged. The magnitude of the effect of being in more occupied social spaces is approximately half the size of the effect of being in the presence of a social companion. We discuss the implications of the results for ongoing efforts to address social isolation among the older adult population and consider how the relevance of social actors beyond interpersonal ties could inform theory on the social climate of well-being and aging.
APPROACHES FOR INCORPORATING OLDER ADULT PERSPECTIVES IN ELDER MISTREATMENT PREVENTION
Authors: Froberg Ruthann , Campetti Randi
Published: January 2025

This presentation discusses an approach for engaging older adult feedback on elder mistreatment (EM). EM can be a challenging topic to engage communities with due to the stigma and the sense of futility around solving this social issue. Despite these obstacles, a local community coalition to address EM successfully elicited feedback from older adults and service providers to create recommendations for their ongoing work. Collaboratively, member organizations developed three focus groups composed of participants aged 60 and above who were familiar with existing community resources for older adults. Member organizations also identified service providers to participate in an additional focus group in order to improve understanding of the services available to older adults. Interviewers conducted hour-long sessions with each group to gather feedback and insights on EM and related issues. Participants highlighted the importance of community engagement, addressing isolation, increasing digital literacy, and improving access to social services. Healthcare providers were recognized for their role in detecting EM, but challenges in accessing services persist. Service providers underscored the importance of collaboration and addressing barriers such as staffing and funding. The resulting recommendations, including accessible healthcare services, digital literacy initiatives, and integrated community care, reflect practical feedback to guide the coalition’s endeavors. This feedback has spurred renewed commitment within the coalition to address these recommendations in their ongoing work, highlighting the actionable insights garnered through community engagement.
A COMMUNITY APPROACH TO REDUCE AND PREVENT ELDER ABUSE
Authors: Marrs Sarah , Arnette Shannon , McIntyre Madeline , Clardy Aisling
Published: January 2025

Research on elder mistreatment mostly focuses on improving individuals’ skills in recognizing, screening, and reporting abuse that has already occurred, typically considered secondary prevention. This is critical for effective and timely intervention. However, increasing awareness of and accessibility to resources and supports that safeguard older adults is an effective and necessary strategy for primary prevention. Unlike child abuse victims and their families, who have access to various wrap-around resources and services, these resources are highly limited for older adult victims. The purpose of this study was to conduct focus groups with older adults, caregivers of older adults, and various aging service providers to inform the development of the Safety Connector, an online tool designed to link older adults, caregivers, and professionals to services, resources, and educational materials to prevent elder mistreatment. A mock-up of the Safety Connector was created by the research team and presented during focus groups to garner feedback and perceptions of usability and effectiveness. Findings revealed a need for simplicity, accessibility and clarity on the purpose and intended users of the Safety Connector; and to distinguish it from similar websites. The resulting Safety Connector has been integrated into our state’s existing No Wrong Door suite of websites. In this session, we will discuss research methods and results, and introduce the Safety Connector. We will also showcase other resources available on the Safety Connector’s website and discuss this as a model for linking systems of care beyond our home state.
USING FUNCTIONAL BRAIN IMAGING DATA TO PREDICT FALLS IN OLDER ADULTS WITH MULTIPLE SCLEROSIS
Authors: Holtzer Roee
Published: January 2025

Background: Falls are common and debilitating among older adults with multiple sclerosis. However, literature concerning modifiable risk factors of falls in this population is scarce. The current study was designed to address this gap in knowledge. We examined whether brain hemodynamic responses during dual-task-walking predict falls during longitudinal follow-up in older adults with multiple sclerosis with relapsing-remitting and progressive subtypes. Methods: Participants with relapsing-remitting (n=53, mean age=65.02±4.17ys, %female=75.5) and progressive (n=28, mean age=64.64±4.31ys, %female=50) multiple sclerosis subtypes completed a dual-task-walking paradigm. In addition, participants reported falls during longitudinal follow-up using a well-validated structured monthly telephone interview. Functional-near-infrared-spectroscopy (fNIRS) was utilized to assess oxygenated hemoglobin (HbO) in the prefrontal cortex during active walking under single and dual-task conditions. Results: General Estimating Equations models, adjusted for confounders, indicated that higher HbO under dual-task-walking was significantly associated with a reduction in the odds of reporting falls among participants with relapsing-remitting (OR=.472, p=.004, 95%CI=.284 to.785), but not progressive (OR=1.056, p=.792, 95%CI=.703 to 1.588) MS. In contrast, faster stride velocity under dual-task-walking was significantly associated with a reduction in the odds of reporting falls among progressive (OR=.658, p=.004, 95%CI=.495 to.874), but not relapsing-remitting (OR=.998, p =.995, 95%CI=.523 to 1.905) MS. Conclusion: Compensatory reallocation of brain resources under dual-task walking may provide protection against falls for older adults with multiple sclerosis, relapsing-remitting subtype. These findings have important implications for fall risk assessment and intervention procedures in older adults with multiple sclerosis.
SELECTIVE GREY MATTER PATTERNS OF MOBILITY IN OLDER ADULTS WITH AND WITHOUT MULTIPLE SCLEROSIS
Authors: Wagshul Mark
Published: January 2025

Background: Both healthy aging and multiple sclerosis (MS) are associated with changes in cortical grey matter (GM), notably frontal grey matter atrophy consistent with the last in-first out hypothesis, but its relationship to mobility impairments is unknown. We sought to identify brain patterns of cortical GM associated with walking performance, as measured by single- and dual-task walking speed, in older adults with and without MS. Methods: In a cohort of 97 MS and 105 healthy older adults, we measured cortical volume from T1-weighted MRI images and Freesurfer software, along with quantitative gait assessment during natural walking (single-task) and walking while reciting alternate letters of the alphabet (dual-task) conducted within a few weeks of the MRI. Principal components (PC) analysis identified significant latent patterns of GM volume, from the bilateral 68 Freesurfer cortical regions, and pattern scores were entered into regression analyses of gait velocity vs pattern scores, unadjusted and adjusted for demographics variables. Results: The first two PCs showed a significant association with single-task (p = 0.027/0.0025), but only PC2 was associated with dual-task (p=0.082/0.027). In group-stratified analyses, only PC1 was associated with single-task in healthy controls but just below the significance level (p=0.057), and only PC2 was associated with single-task in MS participants (p=0.0052). PC1 consisted of mostly posterior regions (medial occipital, inferior parietal), while PC2 consisted of mostly anterior regions (frontal, cingulate). Conclusion: Grey matter pattern analysis may distinguish between older adults with and without MS, corresponding to anterior, cognitive-control vs posterior, visual/automated control of mobility.
IMPACT OF RELIGION ON FRAMING AND CARING FOR DEMENTIA AMONG MUSLIM ARABS IN QATAR: A QUALITATIVE STUDY
Authors: Daher-Nashif Suhad , Hammad Suzanne , Kane Tanya
Published: January 2025

Studies have examined how religion plays a major role in framing mental disorders and in shaping caregiving practices. This presentation sheds light on dementia care among Muslim Arabs in Qatar. The presentation will examine how old age and dementia are framed in the Islamic religious resources, i.e., the Quran and Sunnah Nabawiyyah (statements and behaviours of Prophet Muhammad). Then it explores how these texts feed into the belief systems distributed within the community by sharia scholars, and later uncovers how these both sources are transformed to social behaviours in caring for older adults with dementia. The study uses descriptive qualitative methodology and is based on three data sources: Islamic religious texts i.e., the Quran and Sunnah, eight semi-structured interviews with Sharia scholars, and semi-structured interviews with 37 Arab-Muslim families from different Arab countries living in the state of Qatar. Thematic analysis has been applied to analyse the texts and the interviews. Compassion and honouring parents are commandments in the Islamic holy texts. The Quran and Hadith include definition and characteristics of ageing, of cognitive deterioration and give clear instructions on how and why older adults must be cared for. These values are expressed in the beliefs system constructed by sharia scholars that play a major role as motivators to caring for dementia patients by the families. Families used religious practices as diagnostic and treatment tools. Gaps between the holy text and the social beliefs were found in explaining dementia and Alzheimer. Moreover, religious practices played role in coping with caregiving-burden.
CAREGIVER BURDEN AMONG LEBANESE OLDER ADULTS: FINDINGS FROM LSAHA (LEBANON STUDY ON AGEING AND HEALTH)
Authors: Abdulrahim Sawsan , Chaaya Monique , Sammak Aya El , Nassif Alexandra Abi , Kabalan Mayssan , de Leon Carlos Mendes
Published: January 2025

This study examines correlates of caregiver burden in a sample of older adults (≥60years) in a rural district in Lebanon who provide care to other older adults. Utilizing baseline data from the new Lebanon Study on Ageing and Health (LSAHA), we assessed associations of the Zarit Caregiver Burden Scale with sociodemographic characteristics of the care provider, relationship to care recipient, and type of care provided. Of a total of 1,345 participants, 216 (16%) reported providing care. A higher percentage of women (17%) than men (14%) were caregivers, while a higher percentage of men (47%) than women (37%) provided care to their spouses. After dichotomizing the Caregiving Burden Scale, high burden was more common among women (37%) then men (20%), and among the non-married/widowed (41%) than the married (28%). High burden was lowest among participants with more than 12th grade education. In multivariable logistic regression analysis, high education was significantly associated with lower odds of high burden (OR=0.18; %95 CI=0.04; 0.73) while caregiver gender and marital status were not. Those who provided care for healthcare-related issues were also significantly more likely to report high burden (OR=2.78; 95% CI=1.01; 7.65). In the setting of a mostly rural Lebanese population, the findings point to the burden associated with providing care to other older adults dealing with healthcare issues, possibly due to lack of access or proximity to healthcare facilities. Further analysis will focus on burden associated with characteristics of the care recipient and care provided to others inside versus outside the household.
SUPPORTING ARAB AMERICANS FAMILIES LIVING WITH DEMENTIA: TESTING A CULTURALLY ADAPTED INTERVENTION
Authors: Ajrouch Kristine , Barada Fatmeh , Janevic Mary , Antonucci Toni
Published: January 2025

Culturally adapted interventions are needed to address unique challenges faced by minoritized groups who care for people living with Alzheimer’s disease and related dementias (ADRD). Among Arab Americans, limited access to support services due to language and cultural barriers often results in a belief that family alone is the only option during times of need. We test 1) whether participation in an adapted ADRD care intervention is associated with positive outcomes for Arab American care partners (N=58) and 2) evaluate program satisfaction. We present a single group design using paired t-tests that demonstrate reduced care burden and increased care satisfaction from pre- to post-intervention. A measure of family conflict trended downward after program participation. Following the program, each participant completed a short evaluation survey sent vias email where they (N=43) rated their experience with the program on multiple dimensions: usefulness of the program, materials, language of delivery, and Alzheimer’s Association resources. Respondents were also asked to explain their ratings, which were coded into four themes: Resources, Information regarding diseases, caregiving, and self-care. Data were analyzed descriptively and showed strong positive reactions to the program as well as areas for improvement. Findings provide preliminary data to illustrate that culturally adapted ADRD care intervention programs hold promise to help family members caring for a person living with dementia even when such programs not generally accepted by cultural norms.
APPLYING IMPLEMENTATION SCIENCE FRAMEWORKS TO DELIVER INTERVENTIONS IN THE NURSING HOME SETTING
Authors: Abbott Katherine , Unroe Kathleen
Published: January 2025

Approximately 1.2 million people reside in more than 15,000 nursing homes (NH) in the United States. The 2022 NASEM report on NH quality identified persistent issues to the provision of high-quality NH care in the United States. To improve NH quality, implementation science (IS) theories, methods, and frameworks are necessary to close the gap in delays of evidence based therapies and models of care reaching NH residents. This symposium highlights IS work in the NH setting that seeks to improve the quality of care delivered. Our first presentation reports findings on the pre-implementation work of a five-year VA funded study to ensure documentation of life sustaining treatment with over n=50 clinical and administrative staff. The second presentation utilizes the Practical, Robust Implementation and Sustainability Model (PRISM) to identify factors to consider before intervention implementation with results from n=5 focus groups with 27 NH Staff. The third presentation describes the modifications n=23 NH providers made to the Individualized Positive Psychosocial Interaction as well as their motivations behind the modifications via the Framework for Reporting Adaptations and Modifications to Evidence-Based Implementation Strategies. The fourth presentation reports findings from n=6 focus group sessions representing n=23 people living with dementia, their care partners and NH staff using the Readiness Assessment Pragmatic Trial Model to inform what mattered to them when implementing and evaluating a remote format of Me & My Wishes. The Discussant, Dr. Kathleen Unroe, will discuss the implications to advancing IS as well as the applicability of IS in the NH setting. Research in Quality of Care Interest Group Sponsored Symposium
“YOU HAVE TO USE YOUR IMAGINATION”: NURSING HOME PROVIDER MODIFICATIONS TO IMPLEMENTING THE IPPI
Authors: Kunkel Miranda , Akter Nahida , Kasler Kamryn , Keiser Cassie , Noble Molly , Talmage Alexis , Van Haitsma Kimberly , Abbott Katherine
Published: January 2025

Understanding modification motive can help improve intervention protocols and future implementation efforts. The core components of the IPPI that should not be modified include that staff approach one-to-one resident interactions with a positive intent, use good communication skills, and base interactions on a preferred activity of the resident living with dementia. We sought to understand what was modified and motivations behind the modifications from implementation champions. We utilized the Framework for Reporting Adaptations and Modifications to Evidence-Based Implementation Strategies (FRAME-IS) to track and characterize modifications using data from a total of n=78 interviews with n=23 NH provider champions who were implementing the IPPI in their community as part of a quality improvement project. Interviews were audio recorded, transcribed, and coded via the FRAME-IS in Dedoose. Over half of champions (61%; n=14) reported unplanned, fidelity-consistent modifications to IPPI content (e.g., loosening structure) or implementation context (e.g., setting). Motivation ranged from organizational (e.g., time constraints) to recipient (e.g., cognitive capacity), with many citing resident preferences. Modifications are a necessary aspect of evidence-based implementation efforts and should be embraced by implementation researchers. Many champions in the present study reported creative modifications previously unexplored by the IPPI research team. Available resources, COVID-19 regulations, and resident preferences can highly impact implementation efforts in the NH setting. Future implementation efforts should build flexibility into intervention protocols and welcome the influence of recipient preferences in order to reach a wider range of users and achieve greater satisfaction.
A NEW ERA IN ASSESSING THE BURDEN OF HEARING LOSS IN LATER LIFE USING PATIENT RECORDS AND IMPLICATIONS FOR HEALTHY AGING
Authors: Tsimpida Dialechti
Published: January 2025

Hearing loss is a significant global health concern and a leading cause of disability in later life. While conventionally considered an inevitable consequence of aging, recent evidence highlights modifiable risk factors challenging this notion. Nevertheless, epidemiological estimates, including Global Burden of Disease studies, overlook the actual hearing health needs of populations, relying instead on projected age demographics. This study aimed to provide a fresh perspective, quantifying hearing loss burden and distribution in older adults by analysing anonymised longitudinal medical records of 2.7 million registered patients in the Cheshire and Merseyside Integrated Care System (ICS) in England from 2013 to 2022. Using advanced spatial analysis techniques, including Cluster and Outlier Analysis and Geographically Weighted Regression, socio-spatial inequalities in hearing loss prevalence and incidence were investigated. Surprisingly, findings revealed hearing health disparities unrelated to population age, with residents of similar age experiencing worse hearing outcomes in different areas of the ICS. Deprivation emerged as a significant determinant, explaining up to 35% of the variance in hearing loss. These findings underscore the need for a paradigm shift in health policy-making, moving beyond age-based projections to more accurately estimate and address hearing health needs. Hearing health indicators are already available in existing patient records and should be systematically reported, analysed, and interpreted to create equitable long-term care models according to populations’ actual needs. This novel data-driven approach is particularly important in the context of healthy aging initiatives, given that hearing capacity lies at the core of the Integrated Care for Older People (ICOPE) approach.
CROSS-NATIONAL DIFFERENCES IN AGE AND EDUCATION GRADIENTS FOR DECLINE IN VERBAL FUNCTIONING
Authors: Han Chengming , Bramajo Octavio , Downer Brian
Published: January 2025

Background. Despite the well-established associations of education and higher cognition in old age, the patterns of education gradient in different social contexts have not been adequately explored. Objective. This paper explores cross national differences in cognitive decline between adults older than 50 years in the U.S., Mexico, and China. Methods. Data were drawn from Health and Retirement Study (HRS, 2012-2020), Mexican Health and Aging Study (MHAS, 2012-2021), and China Health and Retirement Longitudinal Study (CHARLS, 2011-2020). Multilevel models were used to estimate the change in verbal function across six age groups (50-55, 56-60, 61-65, 66-70, 71-75, and 76+) and six education groups. We compared the education gradients adjusting for physical health, residence, and gender. Results. HRS respondents had the highest levels of education, whereas respondents from CHARLS had the lowest. Higher educational attainment was associated with higher verbal functioning, but the education gradient was the most pronounced in CHARLS. The slopes of verbal functioning decline were steeper in respondents aged over 60 years in MHAS and CHARLS compared to HRS. However, MHAS and CHARLS respondents in the age groups of 50-60 and 76+ showed slower cognitive decline after adjusting for education. Conclusion. Middle-aged and older adults in Mexico and China experienced faster decline in verbal functioning after age 50 than in the US. These differences can be partly explained by the lower levels of education in Mexico and China. The education gradient displayed different patterns across countries. Future studies should pinpoint heterogeneity and make policies according to different social contexts.
THE LONGITUDINAL INFLUENCE OF MENTAL DEMANDS OF OCCUPATION ON COGNITIVE FUNCTION AMONG MEXICAN OLDER ADULTS
Authors: Gutierrez Mariela
Published: January 2025

This study addresses the role of occupation as a determinant of cognitive health in low-middle income countries (LMICs), focusing on Mexico. While high-income countries have established links between cognitively stimulating jobs and preserved cognitive functioning, research in LMICs is limited. The aim is to investigate the association between lifetime mental work demands and memory changes from 2001 to 2018 in Mexican older adults. We used data from the Mexican Health and Aging Study (MHAS), a nationally representative study of individuals aged 50 and above. Participants main lifetime occupation is classified according to the Mexican Classification of Occupations. MHAS data was linked to the Occupational Information Network (O*NET), which provides descriptors for various job domains, including cognitive abilities. A mental demand index was created from ten O*NET items, and a memory score was derived from immediate and delayed recall of an 8-word list. Linear mixed effect models with random intercepts were conducted to analyze the association between mental demands of work and memory scores, adjusting for demographic, health, and job-related variables. While the association between mental work demands and memory changes was not statistically significant, estimates indicate a decline in memory scores over time. The findings reveal more memory decline among agricultural and domestic/service workers compared to professionals and administrative workers. Other work factors associated declines in memory are receiving benefits from work, age at which individuals began their work. This research contributes to understanding the complex interplay between occupation, cognitive health, and aging in LMICs, particularly in the Mexican context.
EMANCIPATORY GERONTOLOGY IN THE 21ST CENTURY—STRUCTURE, ACTION, AND IDEOLOGIES: A SYMPOSIUM HONORING CARROLL ESTES
Authors: Dannefer Dale , Phillipson Chris , Kelley Jessica
Published: January 2025

Emancipatory gerontology (Estes, 2020) envisions possibilities of moving toward a society where citizens of all ages experience dignity and access to essential resources. Such possibilities require transforming institutional configurations and dominant ideological narratives around class, race, gender, and age. Yet the longstanding resistance to such ideals has been further aggravated recently by the effects of neoliberal policies and by renewed forms of racist and other exclusionary ideologies, as well as ageism itself. The symposium presents critical work across a range of key gerontological domains. Papers explore the stratification of longevity and related issues, especially in urban settings, ideological and practical consequences of the intersection of age and race, and ongoing conceptual and ideological issues in life-course and gerontological theorizing. Maya Rockeymoore Cummings elaborates the fresh concept of rageism - the intersection of ageism and racism - and the ways in which various levers of power are used to undermine life chances of non-European racial and ethnic groups across the life course and generations. Jan Baars explores inequalities affecting ageing over the life course, arguing that long lives are increasingly a privilege for wealthier members of society. Chris Phillipson and Tine Buffel consider new social divisions emerging between and across age groups, with large cities driving distinctive forms of inequality associated with gentrification and class and race segregation. Dale Dannefer interrogates the continuing uncritical use of the concept of agency, exploring how discourses of life-course and gerontological scholarship may have ideological components that contributes to the legitimation of destructive social arrangements.
EMANCIPATORY GERONTOLOGY AND THE POLITICAL ECONOMY OF THE CITY: NEW INEQUALITIES AND POLICY RESPONSES
Authors: Phillipson Chris , Buffel Tine
Published: January 2025

Carroll Estes identifies a central aim of an ‘emancipatory gerontology’ as ‘advancing knowledge and the realization of dignity, access, equity and social justice through individual and collective agency and social institutions.’ Wright argues that the word ‘emancipation’ signals a central moral purpose in the production of knowledge, with ‘the elimination of oppression and the creation of conditions for human flourishing’. But the achievement of these aims has been undermined with the dismantling of the welfare state, extremes of economic inequality, and the expansion of precarious employment. The impact of such trends on groups such as older people continue to be the subject of extensive research. However, of additional concern are divisions created by economic and social forces operating within urban environments. Savage argues that large cities are not just products but drivers of inequality, with many European and North American cities no longer serving people from a wide range of communities, reflected in the decline of affordable housing, and the impact of gentrification. The presentation will consider how a political economy of the city, drawing on research in urban sociology, can re-vitalise a critical gerontology, bringing new perspectives on ageing and the life course. The paper will explore how this approach can be used as a framework for understanding new forms of inequality affecting later life. It will conclude by arguing that different ideas are needed for ‘thinking about’ ageing within cities, highlighting how innovations produced by urban environments can serve as a catalyst for emancipation and liberation from oppression.
AGE, AGING, AND SOCIAL JUSTICE
Authors: Baars Jan
Published: January 2025

The concept of Emancipatory Gerontology goes back to the early work of Habermas. An emancipatory human interest was presented as constitutive for a critical social science that reflects on its own social and methodological presuppositions and on the practical consequences of scientifically based actions. This program has lost nothing of its urgency. Studies of aging need to consider that they are part of a society where Long Lives are for the Rich (Baars, 2024). Even in a relatively egalitarian society as The Netherlands persons with a low SES live eight years shorter than the more advantaged and live 23 years longer with chronic disease. This widely spread phenomenon in Western countries qualifies not only institutionalized aging processes as deeply unequal but also changes the significance of ‘middle age’, education or work. Studies of aging cohorts need to include those who have already died of causes that can hardly be seen as autonomous choice or genetic misfortune. This profound inequality over the life course is constituted by a neoliberal society in which the rich become richer and the life course is increasingly organized as an entrepreneurial challenge. Besides the injustice that is inflicted upon disadvantaged citizens these structural inequalities are beginning to rip societies apart. However, social justice theories of aging, with their naturalization of ‘age’ and ‘age groups’ have hardly noticed the effects of social inequality on aging processes. These shortcomings will be analyzed and confronted with more adequate theories of social justice and aging.
RAGEISM: RACISM, AGEISM, AND THE QUEST FOR LIBERATION DEMOCRACY
Authors: Cummings Maya Rockeymoore
Published: January 2025

Structural discrimination subjects people from low-income and historically marginalized racial and ethnic groups in the United States to an anomalous aging process that exacerbates their exposure to social and environmental harms, deprives them of essential resources, and increases their levels of health-harming chronic stress. Although not typically referred to as such, this can also be considered a form of ageism. But the combination of racism and ageism, or “rageism,” should be considered a unique phenomenon because of the compounded effects of both forms of discrimination on the lives of those who experience it. In this formulation racism still means a system of oppression enacted against people with darker skin—and can be extended to the intersecting isms associated with class, gender, sexuality, etc.—but the term ageism, which typically refers to discrimination against older adults aged fifty and over, is redefined to describe the systematic effort to deprive black and brown people by deliberately sabotaging their quality of life at every stage of the life course. This reconceptualization helps us to understand age discrimination in its most complete and pernicious form. The official definition of rageism, therefore, is a systematic and persistent form of race, ethnic, and age-based discrimination that uses political institutions, public policy, and other levers of power to undermine the quality and length of life of low-income and non-European racial and ethnic groups from pre-birth to death and across generations. This talk will describe and provide examples of rageism while offering a framework to overcome it.
ESPO AND ACADEMY FOR GERONTOLOGY IN HIGHER EDUCATION SECTION SYMPOSIUM: INTERGENERATIONAL ENGAGEMENT IN HIGHER EDUCATION: SUCCESSES, SETBACKS, AND BEST PRACTICES
Authors: Stephan Abigail , Fassi Janelle , De Fries Carson
Published: January 2025

Connecting generations through experiential learning opportunities in higher education provides promise for mutually beneficial outcomes. While the theoretical underpinnings (i.e., the “why”) are clear, the practical application (i.e., the “how”) of bringing undergraduate students and older adults together can be more messy. This session focuses on lessons learned, strategies for success, and setbacks to be aware of, with the goal of enhancing our fortitude as educators who value and strive to incorporate impactful intergenerational experiences into the student experience. The first presentation explores the perspectives of students and older adult participants engaged in an intergenerational team-based learning course for first-year undergraduate students, framed by Age-Friendly University principles. The second presentation shares lessons learned from a new service-learning model in which students assessed the transportation needs of older adults engaged with the university-affiliated Osher Lifelong Learning Institute. The third presentation examines the experience of undergraduate students engaged in hands-on gerontology research and highlights takeaways based on students’ intergenerational connections with older adult participants. The final presentation sheds light on sustainable program development through describing their creation of a checklist that aids in intergenerational technology program implementation within higher education. In addition to drawing on the perspectives of scholars across the academic career-span, this symposium session highlights the many contexts within higher education in which intergenerational connections can be facilitated. Aligning with the Annual Scientific Meeting 2024 theme, these presentations demonstrate fortitude in refining processes to ensure we are building optimal experiences that connect students and older adults.