bluuebunny/crossref_metadata_2025 huggingface dataset:
THE CULTURE OF FAMILY CAREGIVING OF OLDER ADULTS AMONG AFRICAN AND AFRO-CARIBBEAN IMMIGRANTS TO THE US AND CANADA
Authors: Kum Cleopatra , Phillips Casey , Warner Lynn , Banisalman Islam , Roche-Dean Maria
Published: January 2025

An increasing number of African and Afro-Caribbean immigrants to the United States and Canada are aging. Older adults are dealing with various health conditions, which makes them increasingly dependent on family members and friends for their health and social needs. The assistance they receive includes help with physical care, transportation, medication assistance, and emotional and social support, amongst others. Caregivers play a pivotal role in maintaining the health of older adults of African and Afro-Caribbean immigrants in the United States and Canada. However, very little is understood about the expectations and culture of family caregiving within this group. This study explores the culture of family caregiving of older adults amongst African and Afro-Caribbean immigrants in the United States and Canada. We conducted a scoping review of the literature with the assistance of two experienced health science librarians using CINAHL, PubMed, Embase, and OVID MEDLINE. Preliminary findings show that while some articles discussed aspects of family caregiving on the African continent, none were specific to family caregivers of older adults living in the United States and Canada. While it is important to understand the cultural implications of family caregiving within African communities, there are nuances of the African and Caribbean diaspora that have serious implications for the health of older adults. This study adds to our understanding of family caregiving among African and Afro-Caribbean immigrants. It points to a need for tailored intervention for supporting family caregivers within African and Afro-Caribbean immigrant communities.
EQUITABLE ACCESS TO LATE-LIFE DEPRESSION CARE: A STEPPED WEDGE RCT WITH COMMUNITY ORGANIZATIONS
Authors: Andres Lanvin , Steinman Lesley , Mitchell Mary , Haruo Emy
Published: January 2025

For the past several years, our community-academic partnership has been collaborating with community-based social service and mental health organizations in Washington and California on the PEARLS Equity Study. The goal of this five-year study is to improve equitable access to late-life depression care (PEARLS) among older adults experiencing poverty who are linguistically diverse, BIPOC, and/or rural dwelling, recognizing many older adults are multiply marginalized by intersecting identities. In phase one (2020), we conducted formative research (39 interviews) with both current and potential PEARLS adopters that reach priority populations. Using a social marketing framework, our guide explored barriers, benefits and process for PEARLS adoption; organization capacities and needs; PEARLS acceptability and adaptations; and preferred communication channels. We conducted thematic analysis using the rapid framework method to develop strategies, collaborations, and adaptations to integrate depression care in ways that aligned with these contexts. In phase two (2021-2023), we evaluated these new dissemination and implementation strategies and tools in a stepped wedge Randomized Controlled Trial (swRCT) to test improvement in equitable access to mental health care. Our primary and secondary outcomes are new PEARLS adopters and reach of priority populations, respectively. We randomized counties into three waves or steps, choosing a stepped wedge design as more feasible for community-engaged research with all organizations ultimately receiving the intervention. We engaged over 500 organizations and 700 providers in outreach, webinars, community conversations, 1:1 support, and training. We are currently analyzing RCT, process and cost evaluation data to present findings and lessons learned at GSA.
BEST PRACTICES FOR COMMUNITY-ENGAGED RESEARCH AND PRACTICE WITH CBOS THAT ENGAGE DIVERSE OLDER ADULTS
Authors: Haruo Emy , Mitchell Mary , Andres Lanvin , Steinman Lesley
Published: January 2025

PEARLS partner organizations will share best practices on integrating PEARLS into routine service delivery to reach historically marginalized older adults, and how they have partnered with researchers to strengthen study feasibility, equity and sustainability to translated learnings into practice. The PEARLS Equity Study guided new dissemination and implementation strategies that aligned with the strengths, priorities, and needs of community-based social service organizations (CBOs) including cultural organizations, area agencies on aging, senior centers, and family and human services agencies. New communication approaches included proactive group and 1:1 outreach to organizations; a new peer-to-peer video with PEARLS organizations sharing how they have reached underserved communities; and updated PEARLS messaging that resonated with values of CBO leadership, staff and clients. For example, new messaging included downplaying “evidence-based program” which has often been used to promote programs that were not designed with diverse older adults, and instead amplifying stories of impact that highlight both quantitative and qualitative changes in outcomes that mattered. New supports for program adoption included 1:1 support calls for tailored guidance for different CBO, staff, and community contexts; distance on-demand training with trainers from diverse CBOs to improve accessibility and sustainability; and Zoom webinars and community conversations co-led by PEARLS partners (including local partners featured during this GSA Symposium) and our research center that targeted what CBOs are looking for to address depression and disconnectedness in their communities. Our community-academic partnership and PEARLS community of practice continues to engage regularly to share adaptations as an implementation strategy for health equity.
LONG-TERM CARE INSURANCE AND OVERLOOKED LONG-TERM CARE EXPENSES AMONG OLDER ADULTS WITH COGNITIVE IMPAIRMENTS
Authors: Long Chengxu , Yang Wei , Glaser Karen
Published: January 2025

We investigate catastrophic health and long-term care expenditures (CHLTCE) among older adults with cognitive impairments in China and the role played by long-term care insurance (LTCI). Drawing on data from the 2013, 2015, 2018, and 2020 waves of the China Health and Retirement Longitudinal Study, we exploit the rollout of LTCI pilots across different cities and employ a difference-in-differences approach. Our findings indicate that a significant proportion of CHLTCE among older adults with cognitive impairment is attributed to long-term care costs (i.e., both formal and informal). After considering long-term care expenditure, both the incidence and intensity of CHLTCE increase significantly compared to when only healthcare expenditures are taken into account. Our research underscores the importance of considering long-term care costs when examining catastrophic expenditures due to both health and long-term care expenditures among older adults with cognitive impairment. We also find that the implementation of LTCI reduces both the incidence and the intensity of CHLTCE among older adults with cognitive impairment. Moreover, this effect is more pronounced among individuals with more severe cognitive impairment and those who live alone. These findings suggest that the introduction of LTCI, may, to some extent, alleviate CHLTCE among older adults with cognitive impairments. Our findings support the extension of the LTCI pilot as well as the broadening of the insurance’s scope to ensure adequate protection for older adults with cognitive impairments.
COHORT DIFFERENCES IN PENSION AND JOB SECURITY OF OLDER UNION WORKERS: EVIDENCE FROM HRS
Authors: Oh Yun taek
Published: January 2025

The influence of the declining number of unions and their bargaining power on older workers’ quality of work lives, such as pension eligibility and job security, is an understudied field. I use the first six waves of the initial HRS cohort (born 1931-1936, recruited in 1992, N = 3,134) and Mid Baby Boomers (MBB, born 1954-1959, recruited in 2010, N = 2,886) from the Health and Retirement Study (HRS) from 1992 to 2020. I examine the changes in the association between union membership and the quality of later work lives by using the interaction terms between birth cohorts, union membership, and employment sector (private or public). The results from logistic regressions show that the proportion of pension eligibility from current jobs declined over time while the expectation of job loss at ages 57-62 is stable for union members. Furthermore, the predicted probability of actual job loss increased among non-union workers in the private sector while that for union workers was unchanged. These results suggest that the union’s declining bargaining power may influenced pension eligibility although expectations and actual job security remain unchanged for union workers. The results from competing risk analysis show that MBB union workers are more likely to change job titles while less likely to move to different employers or to directly exit the workforce than the previous cohort. This result suggests the prevalence of bridge employment among union workers as well as the preference changes in the type of bridge employment.
THE DYNAMICS OF ECONOMIC INSECURITY THROUGHOUT LATER LIFE: DISPARITIES BY GENDER AND RACE/ETHNICITY
Authors: Kim Seokmin , Park Sung , Mutchler Jan
Published: January 2025

Older Americans face significant economic hardships, and their risk of poverty increases with age. But it remains unclear whether the 65+ population, which includes a sizable number with incomes too high to qualify for means-tested public assistance programs, has the resources to meet an adequate standard of living. Using 2010-2020 data from the Health and Retirement Study linked to the corresponding years of the Elder Index (EI), this project investigates heterogeneity in economic insecurity among older adults aged 65+ as they age, by gender and race/ethnicity. We examine transitions in living above/below the EI and time spent living below the EI. We also study the dynamic relationship between respondents’ employment activity and their trajectories of economic insecurity. Results suggest that at least half of respondents live below the EI at some point in later life, and a quarter of them experience sustained economic insecurity throughout the entire observation period. Individuals in these economically insecure categories are more likely to be female, non-White, and have limited or no work experience. These disparities grow over time as individuals approach their 80s, driven partly by the intensity of work experience prior to age 60, despite increasing employment activity in later life. The findings illustrate the growing disadvantage in economic well-being for older females and racial/ethnic minorities, and the influence of earlier life economic activity on financial insecurity and instability in later life.
IMPLEMENTATION BOOSTER: REFLECTION AND ACTION AT THE FRONTLINE
Authors: Dolansky Mary , Little Kevin , Pino Lilia , Nabong Jennifer , Bender Anna
Published: January 2025

Frontline feedback during the implementation of the Age-Friendly Health System (AFHS) 4Ms Framework at MinuteClinic, indicated some providers faced barriers and challenges in delivering 4Ms care. In response, an interdisciplinary team of educators, providers, and other quality improvement experts devised the Reflection and Action strategy, aimed to enhance both competency and confidence among providers in delivering the 4Ms—namely, Mobility, Medications, Mentation, and What Matters Most. Leveraging the well-established “Plan, Do, Study, Act” model for improvement, the team conducted three small-scale experiments to test the Reflection and Action strategy. Each experimental cycle sought to clarify provider expectations, raise awareness of current performance, and catalyze actions for performance improvement during weekly tests of change (inspired by Juran’s Model for Improvement, 1961). Cycle 1 demonstrated a notable 12.5% increase in eligible visits with comprehensive documentation of all 4Ms. Cycle 2 built upon this progress, yielding a further 9.8% increase. Cycle 3 achieved a substantial 27.7% increase in adherence to the 4Ms. Between cycles, the implementation team dynamically adjusted strategies, refined targets, and fine-tuned educational materials and coaching messages to optimize effectiveness. Providers actively participated by completing weekly surveys, providing valuable feedback that informed strategic adjustments. Across all cycles, providers reported heightened confidence in completing the 4Ms assessment, coupled with a reduction in the time required for documentation.
FUELING SCIENTIFIC INNOVATION: NIA’S ENTREPRENEURIAL DEVELOPMENT PROGRAMS FOR AGING RESEARCHERS
Authors: Haim Todd
Published: January 2025

The symposium panel will offer a comprehensive overview of National Institute on Aging (NIA) programs designed to foster entrepreneurship and facilitate the commercialization of aging-related innovations. Central to the discussion are initiatives such as NIA Startup Challenge and Accelerator which has been demonstrated to provide first-time entrepreneurs with essential training in evidence-based technology development and position them for success. Additionally, the panel will highlight the NIA Research and Entrepreneurial Development Immersion (REDI) funding opportunities, which aim to expose researchers in gerontology and related fields to entrepreneurship.

A key focus of the panel is the pivotal role of Small Business Innovation Research (SBIR) funding as a primary source of early-stage seed funding in aging research. Panelists will elucidate how SBIR funding empowers startups to reach critical value inflection points by supporting data collection and validation processes.

Moderated by NIA entrepreneurial program leadership, the panel features representatives from Challenge finalists, SBIR-funded startups, and key stakeholders in the Aging Research-related startup ecosystem. Through diverse perspectives and real-world experiences, attendees will gain valuable insights into navigating the entrepreneurial journey, leveraging NIA resources, and harnessing the power of collaboration to enable the impactful commercialization of innovations that would enhance the health and/or care of older adults.

In summary, the panel will provide a dynamic exchange of ideas, strategies, and success stories, as we illuminate the path from research innovation to market transformation in the realm of aging research. Business and Aging Interest Group Sponsored Symposium
INSTRUMENTS MEASURING SELF-CARE BEHAVIORS OF OLDER ADULTS WITH CHRONIC KIDNEY DISEASE: A SCOPING REVIEW
Authors: Jeamjitvibool Thanakrit , Tanglai Wirampa
Published: January 2025

Promoting self-care behavior among older adults with chronic kidney disease (CKD) is critical for preventing kidney deterioration, particularly in the early stages, as symptoms often become noticeable only in later stages. Numerous assessment tools exist, but their suitability and quality remain uncertain. This review aims to identify, assess methodologies, and consolidate psychometric properties of self-care assessment instruments for older adults with CKD. We followed Askey & O’Malley’s (2005) scoping methodology and PRISMA-ScR guidelines. PubMed, Scopus, CINAHL, PsycInfo, and Embase were searched until October 5, 2023. Included studies tested measurement properties of self-reported instruments assessing self-care behaviors in older adults with CKD, were published in English, and appeared in peer-reviewed journals. The COSMIN framework was used to appraise study quality. Ten articles addressing instruments for self-care behaviors in older adults with CKD were included. Based on COSMIN, no article reported complete measurement properties. Six instruments were developed with theory support, while no theoretical underpinning was identified for three instruments. Only one instrument was developed based on qualitative research. Some instruments were applied to a combined population, such as patients with diabetes and CKD. Although there have been advances in creating tools for assessing self-care behaviors in older adults with CKD, no single instrument fully reported measurement properties. Decision-making regarding which of the available tools is appropriate for practice or research should consider their intended purpose, scope, and any underlying theoretical principles. Future research should focus on developing a comprehensive instrument for CKD self-care behaviors that exhibits high methodological quality.
THE ROLE OF GENDER AND POLYSUBSTANCE USE IN ABUSIVE BEHAVIORS EXHIBITED BY DEMENTIA FAMILY CAREGIVERS
Authors: Hernandez Jessica , Browning Wesley , Yildiz Mustafa , Winstead Vicki , Pickering Carolyn
Published: January 2025

This study investigates the impact of polysubstance use on the likelihood of abusive and neglectful behaviors among dementia family caregivers, with a particular focus on how these relationships differ by gender. Utilizing Generalized Linear Mixed Models (GLMM), we analyzed data from 453 caregivers, assessing substance use and behavioral outcomes measured daily over a 21-day period. Our findings reveal that polysubstance use significantly increases the risk of both psychological and physical aggressive behaviors. When examining the interaction effects, we observed that the combination of being male and engaging in polysubstance use was particularly associated with a heightened risk of these behaviors, underscoring the importance of considering gender in caregiver assessments. The final models, refined through a stepwise selection process, incorporated key covariates such as caregiving hours, relationship type, emotional regulation difficulties, caregiver age, and ethnicity. These models offered a more comprehensive picture, showing that the dynamics of the caregiver/care-recipient relationship and the caregiver’s emotional regulation capabilities were significant factors influencing the likelihood of neglect and psychological aggression. In contrast, gender significantly modulated the association between polysubstance use and physical aggression. These nuanced insights highlight the complex interplay between caregiver demographics, substance use behaviors, and the potential for harmful caregiving practices. Our study emphasizes the need for targeted interventions that address the specific stressors and risks associated with male caregivers, as well as the broader implications for support programs that account for the multifaceted challenges faced by dementia family caregivers.
WHEN AND HOW PERCEIVED CONTROL BUFFERS AGAINST COGNITIVE DECLINES: A MODERATED MEDIATION ANALYSIS
Authors: Hamm Jeremy , Lachman Margie , Duggan Katherine , Mogle Jacqueline , McGrath Ryan , Parker Kelly , Klepacz Laura
Published: January 2025

People vary widely in their rates of age-related cognitive decline. Slower rates of decline have been linked to individual differences in perceived control, but less is known about how (mechanisms) and at what stage in the lifespan (moderators) this modifiable psychological resource is linked to preserved cognitive functioning. Our study examined changes in light physical activity (LPA) as an unexplored mechanism that may link changes in two facets of perceived control (personal mastery, perceived constraints) to 9-year trajectories of cognitive aging. We also examined whether mediated pathways were moderated by age (i.e., differed across the adult lifespan). We analyzed 9-year data from the Midlife in the United States Study (n=2,456; age= 56±11 years) using autoregressive mediation and moderated-mediation models. Mediation models showed that changes in personal mastery and perceived constraints predicted changes in LPA (βs=.06-.08, ps<.01), which in turn predicted 9-year changes in episodic memory and executive functioning (βs=.05-.13, ps<.02). Moderated-mediation models showed that, for episodic memory, the mediated pathways were strongest in old age and emerged only for constraints: For only older adults, declines in constraints predicted less decline in LPA (β=.11, p<.001), which in turn predicted slower declines in episodic memory (β=.05, p=.001). Results were consistent in sensitivity analyses that controlled for levels and changes in moderate-to-vigorous physical activity. Our findings inform lifespan theories of control and provide initial evidence that changes in a largely overlooked health behavior (LPA) may underlie the influence of perceived constraints on cognitive functioning, with this pathway becoming more pronounced in late life.
PSYCHOSOCIAL PROTECTIVE FACTORS FOR COGNITIVE AGING: THE MORE THE BETTER
Authors: Taylor Morgan , Schiloski Kylie , Lachman Margie
Published: January 2025

Research demonstrates that demographic (e.g., age, education) and behavioral variables (e.g., physical activity, smoking) are related to individual differences in cognitive aging. Although some work has examined modifiable psychosocial factors (e.g., control beliefs, purpose in life, social contact) in relation to cognitive aging, they are typically examined separately. To examine their additive rather than net effects, we standardized and averaged three psychosocial factors to create a continuous composite of sense of control, purpose in life, and social support in a sample of adults (N = 2,497, ages 28-85) from the second (2004-2006) and third (2013-2014) waves of the Midlife in the United States study. Using multiple regression, we tested the composite as a predictor of 9 to 10 year changes in episodic memory and executive functioning. Results showed that those higher on the psychosocial composite demonstrated less decline in both cognitive measures, even after controlling for established demographic, health, and behavioral risk factors of cognitive aging. We then assigned participants a score of 0 if they were below the median or a 1 if equal to or above the median on each psychosocial factor, such that total scores varied from 0 to 3. Those high on all three factors were better able to maintain their cognitive health compared to those who had fewer. These findings suggest that interventions that focus on a combination of psychosocial factors could be protective in reducing the rate of cognitive decline in middle and older adulthood.
SUBMAXIMAL CONTROL AND EXPLOSIVE STRENGTH MAY BETTER DETECT COGNITIVE IMPAIRMENT THAN MAXIMAL STRENGTH
Authors: McGrath Ryan , Parker Kelly , Hamm Jeremy
Published: January 2025

Electronic handgrip dynamometry presents novel opportunities to feasibly collect muscle function attributes that are amenable to healthy behavior modification, which may have implications for identifying and delaying cognitive impairment. We sought to evaluate differences in electronic dynamometry derived aspects of muscle function by cognitive impairment status in older adults. Cognitive function was assessed with the Saint Louis University Mental Status exam, and standard scoring was used to categorize cognitive impairment. Participants squeezed an electronic handgrip dynamometer with maximal effort for determining strength capacity. Thereafter, participants attempted to squeeze the dynamometer at 25% of their maximal handgrip strength (HGS) for 10-seconds, and the coefficient of variation quantified submaximal control. Participants then squeezed the dynamometer as hard and fast as possible for calculating rate of force development (RFD): (delta force/delta time). The analytic sample included 125 adults aged ≥65-years (age: 70.83±4.79; 66.4% female). Submaximal control was significantly poorer in persons with a cognitive impairment (6.91±5.89) compared to those that were cognitively intact (4.80±3.42; p<0.05). Similar differences for submaximal control were observed in females with a cognitive impairment (7.97±6.70) compared to females without cognitive impairment (5.41±3.91; p<0.05). RFD was significantly lower in males with a cognitive impairment (51.0±25.7) relative to males without (72.94±26.51; p<0.05). No significant differences were observed for maximal HGS. Although several muscle indices are important for health, engaging in modifiable lifestyle behaviors, including physical activities that emphasize RFD and force control at different levels and durations, may serve as an intervention target for muscle and cognitive function.
ASSOCIATIONS BETWEEN NEIGHBORHOOD QUALITY AND COGNITIVE FUNCTION ARE MODERATED BY INTERPERSONAL STRESSOR CONTROL
Authors: Cerino Eric , Goldtooth Amanda , Livingston Raechel , Horowitz Chloe , Witzel Dakota , Rush Jonathan , McCoy Megan , McCarthy Michael
Published: January 2025

Studying modifiable psychosocial risk factors for dementia is crucial to inform approaches for dementia prevention, especially among those with lower neighborhood quality. Perceived control is an important psychosocial resource for cognitive health. Most prior work, however, focuses exclusively on global aspects of control, ignoring influences of more dynamic aspects of control over specific experiences in daily life, such as daily stressor control. Therefore, we used data from the Midlife in the United States study and the National Study of Daily Experiences (N=1,651, Mage=62.09, SE=12.11, 56.65% Female) to address this gap and examine associations of stressor control and neighborhood quality with cognitive function. Over two waves of eight consecutive days of data collection, respondents reported perceived control over interpersonal and non-interpersonal stressors they had experienced. Respondents also completed assessments of neighborhood quality, executive function (EF), and episodic memory (EM). We employed linear regressions to assess concurrent (wave 2) and prospective (ten years later at wave 3) associations of stressor control and neighborhood quality with cognitive function. Concurrent associations between better neighborhood quality and better cognitive function (EF, EM) were amplified among those with lower interpersonal stressor control. No prospective associations with cognitive function ten years later emerged. Results indicate that better neighborhood quality may be beneficial for cognitive health, especially for individuals with lower perceived control over interpersonal stressors such as arguments and avoided arguments. We discuss the value of promoting better neighborhood quality as an important social determinant of cognitive health and aging when psychosocial resources are comparatively limited.
DEVELOPMENT AND VALIDATION OF A PREDICTION MODEL FOR SIX-MONTH SURVIVAL OF MEDICARE BENEFICIARIES IN ASSISTED LIVING
Authors: Huang Andrew , Dionne Laura , Reddy Ann , Serina Peter , McCreedy Ellen
Published: January 2025

Prediction of mortality risk is a prognostic tool for identifying who may benefit the most from timely and appropriate end-of-life care. However, few mortality risk prediction models have been developed for community-dwelling older adults in assisted living centers (ALCs). To estimate individual risk of all-cause mortality for Medicare beneficiaries in assisted living, we used data extracted from electronic health records (EHR) and linked with Medicare claims from 2015-2022 to develop and validate a multivariable logistic regression on the outcome of all-cause mortality occurring within six months. Eligible residents had at least one year of Medicare enrollment, six months of continuous Medicare fee-for-service and Part D drug coverage, and no history of hospice at the time of prediction. Candidate predictors included individual-level demographics, healthcare costs and utilization, and available clinical features, including diagnoses, medications, and assessments of physical and cognitive function. Final predictors were identified with stepwise selection procedures and expert opinion. A k-fold cross-validation scheme with stratified sampling was used and model performance was assessed on discrimination and calibration statistics. We identified 31,274 residents from 1,228 ALCs eligible for mortality risk prediction. At baseline, the mean (sd) age was 85.3 (7.7) years, 69.0% were female, and 87.2% identified as non-Hispanic White. Dementia was prevalent among 11.5% of residents and 6.3% of residents died within six months. The final model returned an AUROC of 0.74 and calibration plots showed consistency between predicted and observed mortality outcomes. This EHR and claims-based model may help residents in ALCs receive better targeted end-of-life care.
SEXUAL ORIENTATION AND THE ONSET AGE OF CHRONIC DISEASES AND DISABILITIES
Authors: Chen Jen-Hao
Published: January 2025

One key to increasing healthy lifespan and reducing health disparities is delaying the onset of chronic conditions and associated disabilities, especially among marginalized groups. Despite this understanding, relatively few research studies investigate the onset age of chronic diseases and disabilities by sexual minority. This study analyzed pooled data from the 2013-2019 U.S. National Health Interview Survey (NHIS) to investigate the relationships between sexual orientation (i.e., heterosexual, homosexual, bisexual, and other sexual minorities) and the onset of chronic diseases and disability. The study first calculated the onset age for a wide range of chronic conditions and disabilities (i.e., vision and hearing problems, hypertension, diabetes, cancer, intellectual disabilities, etc.), then used weighted regressions to link sexual orientations to the age of chronic disease and disability onset, controlling for a wide range of sociodemographic characteristics. Results suggest that there are considerable disparities in the onset age of chronic diseases and disabilities between heterosexual individuals and sexual minorities. Bisexual and homosexual individuals were significantly more likely to have chronic diseases and disabilities earlier in life than their heterosexual counterparts, with bisexual individuals being the most disadvantaged. These disparities were not accounted for by the higher education and income levels observed in some sexual minority groups. However, there was no difference in terms of disease and disability onset between heterosexual individuals and other sexual minorities. Some cohort differences were found. Given the historical discrimination against sexual minorities and challenges related to HIV, these findings underscore the need for policy interventions to improve sexual minorities’ healthspan.
HYPOTHETICAL INTERVENTIONS ON LONELINESS AND MEMORY FUNCTION AMONG US MIDDLE-AGED AND OLDER ADULTS
Authors: Ikesu Ryo , Rojas-Saunero L Paloma , Hayes-Larson Eleanor , Mayeda Elizabeth Rose
Published: January 2025

Evidence has shown that middle-aged and older adults who experience persistent loneliness have lower memory function compared to those with transient loneliness or those who never feel lonely, but it remains unclear whether sustained interventions on loneliness, as opposed to a one-time intervention, are more effective in preserving late-life memory function. Researchers are increasingly using hypothetical intervention approaches to estimate the impact of population-level interventions with observational data. Using the nationally-representative Health and Retirement Study in 2006–2016 (n=16,977; median baseline age, 68), we estimated the population-level effects of two hypothetical interventions of loneliness on memory scores 8 years after baseline: [A] preventing loneliness at baseline and 4 years after baseline (sustained intervention at two time points) and [B] preventing loneliness only at baseline (one-time intervention). We used targeted maximum likelihood estimation to account for censoring and both baseline and time-varying confounding (health-related behaviors, working status, household wealth, social relationships, and health conditions). In this approach, we accounted for the possibility that people with lower memory function feel lonely more often than those with higher memory function. Compared to the natural course (i.e., no intervention), both sustained and one-time interventions were associated with slightly higher memory scores 8 years after baseline (0.026 standardized units [95% CI: 0.003–0.048] for the sustained intervention; 0.021 standardized units [95% CI: 0.005–0.037] for the one-time intervention). Our findings suggest that both sustained and one-time interventions on loneliness may preserve memory function at the population level.
REASSESSING POSITIVE RESULTS: DETECTION BIAS IN EPIDEMIOLOGIC DEMENTIA STUDIES OF ELECTRONIC HEALTH RECORD DATA
Authors: Wang Jingxuan , Choi Minhyuk , Zimmerman Scott , Chen Ruijia , Schaefer Cathy , Blacker Deborah , Glymour M Maria
Published: January 2025

Many epidemiologic studies of dementia use electronic health record (EHR) data, which are vulnerable to detection bias. Dementia is more likely to be detected when patients have more contact with the healthcare system. Using EHR data from the UK Biobank (UKB) and All of Us (AoU), we evaluated potential detection bias by estimating associations of three negative control exposures with dementia. We included 298,784 UKB participants and 105,836 AoU participants aged ≥ 55 without baseline dementia and estimated associations of kidney stone, forearm fracture, and urinary tract infection (UTI) with incident dementia. All diagnoses were ascertained from EHR data. We used Cox models to evaluate associations of binary exposure with all-cause dementia overall and in 4 time intervals after the exposure (0–1, >1–5, >5–10, and >10 years) compared to individuals with no prior exposure. All models adjusted for demographic and socioeconomic factors. Our results showed that all three exposures were associated with an elevated risk of dementia, especially in the first year after exposure diagnosis. The association attenuated in subsequent years. It suggests the chance of receiving a dementia diagnosis increases sharply in the first year following a diagnosis of kidney stone, forearm fracture, or UTI, although the influence of these conditions on dementia pathology is likely to be small or null. These short-term increases likely represent detection bias, i.e., they would not have received a dementia diagnosis at that time in the absence of the medical attention necessitated by kidney stone, forearm fracture or UTI.
NURSE WAGES IN NURSING HOMES: ANTECEDENTS AND CONSEQUENCES
Authors: Pradhan Rohit , Banaszak-Holl Jane
Published: January 2025

A substantial body of research has established that nurse staffing intensity and skill mix have a consequential impact on nursing home (NH) care quality. Unfortunately, NH staffing has been marked by multitudes of challenges including high levels of turnover and absenteeism. The literature suggests that an important reason why NHs have struggled with nurse staffing is the relatively lower wages vis-à-vis other important areas of the U.S. healthcare system, such as hospitals. These challenges underscore the importance of examining nurse wages within the NH setting, as wages not only affect staff retention and satisfaction but overall performance. Despite the apparent need for competitive wages to attract and retain skilled nurses, NHs operate in a resource-constrained environment, making wage increases a complex issue for administrators. The overarching goal of this symposium is to explore the antecedents and consequences of nurse wages in NHs. As part of the symposium, we include studies examining nurse wages and quality, the organizational and market-level factors associated with nurse wages, and the impact of nurse wages on financial performance. The findings and discussions may offer valuable insights for both managerial decision-making and policy formulation, aiming to address the systemic challenges of nurse staffing in NHs and improve NH performance, particularly quality of care.
PLACE AND AGING WITH DEMENTIA: NEW ASSESSMENTS FOR PERSON-ENVIRONMENT PROCESSES
Authors: Oswald Frank , Chaudhury Habib , Wahl Hans-Werner
Published: January 2025

There has been growth in research addressing stability and change in the relationship between the physical environment and older persons, particularly people living with dementia. However, differentiated assessments to examine or measure person-environment relationships are limited. Additionally, there is a lack of resources to inform development of physical environments supportive of people living with dementia. This symposium addresses creative measures, and application strategies to advance understanding of the role of place for people living with dementia. First, Florack and colleagues present a three-step modification of the Meaning of Home Questionnaire (MoH) for use with people living with dementia by means of simplification and addition of specific items, an initial evaluation of psychometric characteristics, and the development of a final version and its validation. Second, Niedoba and Oswald present findings from walking interviews with people living with dementia, highlighting that these interviews allow to observe and discuss everyday life person-environment processes and provide a comfortable atmosphere promoting personal reflections on the experience of living with dementia. Third, Margot-Cattin and Gaber provide evidence from the Participation in ACTivities and Places OUTside Home (ACT-OUT) questionnaire based on a transactional perspective of the person-environment relationship, showing that people with dementia experience a higher rate of abandonment of places than people without dementia. Four, Chaudhury and colleagues introduce three knowledge mobilization resources that can inform and engage with various stakeholders, including municipalities, community-based organizations, advocacy groups, planning and design professionals, persons living with dementia and care partners. Finally, Wahl serves as the session’s discussant.
TRANSITIONS INTO DEMENTIA: REFLECTIONS ON WALKING INTERVIEWS AND THE PHOTO-ELICITATION METHOD IN DEMENTIA STUDIES
Authors: Niedoba Simone , Oswald Frank
Published: January 2025

Environmental gerontology highlights behavioral and experiential processes between a person and the environment in relation to different outcomes. However, how people living with early dementia experience and shape their environment is still poorly understood and how these processes could be best assessed is still being debated. Walking interviews promise to combine observation of everyday interactions, and discussion of meanings of environments. Pictures taken by participants along the way may give further insights into personal relevant environments. During nine walking interviews people living with early dementia were accompanied on a routine walk through their local environment. Participants decided where to go and were invited to take pictures of their environment, which were discussed at the end of the interview. The interviews highlight the importance of environments for the experience of living with dementia. During the interviews real-time interactions with places, objects, and people were observed and functioned as prompts for discussion, highlighting not only how people living with dementia shape their environment, thus conducting subtle forms of participation, but also how environments were connected to memories and identity. The combination of walking interviews and the photo-elicitation method allows to assess relevant person-environment exchange processes, such as agency and belonging, in early dementia. Moving through familiar environments can enhance a comfortable and trustful atmosphere in which personal reflections on living with dementia are shared. In the talk we will critically reflect on the experiences with these methods, including challenges, limitations and ethical considerations, and discuss how these methods could benefit future research.
INTERPERSONAL STRESSORS, AWARENESS OF AGE-RELATED CHANGES, AND ARTHRITIS ON DAILY MEMORY FUNCTION
Authors: Mukherjee Shalini , Neupert Shevaun
Published: January 2025

The current study examined the interaction between daily awareness of age-related changes (AARC) losses and daily interpersonal stressors in predicting daily memory failures among 440 older adults in the U.S. (50-85 years) with and without arthritis. Participants reported their arthritis diagnosis on the first day of the study and then completed daily AARC and stressor questionnaires for the subsequent 13 days. Multilevel modeling analyses revealed a 3-way interaction for Daily Interpersonal Stressors X Daily AARC Losses X Arthritis. Among people with arthritis, high daily AARC losses were consistently associated with a high level of memory failures, irrespective of exposure to interpersonal stressors. However, individuals with arthritis who experienced low levels of AARC losses showed a significant increase in daily memory failures when exposed to interpersonal stressors. The findings suggest that interpersonal stressors are particularly powerful for individuals with arthritis when they experience low levels of AARC losses. Conversely, for those without arthritis, interpersonal stressors are linked to an increase in memory failures, regardless of AARC losses. Further research is recommended to understand the underlying mechanisms of the interaction and develop targeted interventions to improve memory function in individuals with arthritis, as well as those without the condition who are experiencing stress. Overall, the study’s findings have significant implications for clinical practice and highlight the importance of addressing psychosocial factors in the management of arthritis and other age-related conditions.
SPOUSAL COMBINATIONS OF EMPLOYMENT STATUS AND SHARED HEALTH RISKS AMONG OLDER MARRIED COUPLES
Authors: Choi Ha Young , Mejia Shannon
Published: January 2025

Continuing employment has been shown to protect health into old age. However, within marriages, the decision to retire or work is jointly negotiated which may be differentiated by socioeconomic resources. This study explores how spousal combinations of employment status differentiate individual and shared manifestations of cumulative health risk. Utilizing data of 3,143 older couples (aged 51-79) from the 2008/2010 Health and Retirement Study, we first conducted latent class analysis of husbands’ and wives’ combined employment statuses (age range fully/partially working: 51-79). We identified five classes of spouses’ combined statuses: (1) one unemployed, another not fully working (8.15%), (2) retiree couples (34.36%), (3) one unemployed, another fully working (3.63%), (4) one fully working, another partially working (45.28%), and (5) fully working couples (8.59%). Latent dyadic models parsed the outcome variables, cumulative indicators of physiologic reserve and metabolic syndrome, into individual and shared components, which were then regressed on predicted cluster membership, and adjusted by age and functional limitations. Physiologic reserve was lowest in the one underemployed/other fully working class and highest in both fully working class. Meanwhile, systematic differences in metabolic syndrome across classes were only observed in couples where neither spouse had attended some college. In these couples, metabolic syndrome was highest in the two classes where either spouse was partly or fully working. Our findings imply that the effects of extended work life on health risks are contextualized within marriage and socioeconomic resources, where the shared health of couples in lower socioeconomic status rely more on combined employment status.
PREDICTING MORTALITY IN ADULTS USING TRANSFORMERS: INSIGHTS FROM THE HEALTH AND RETIREMENT STUDY
Authors: Weiss Jordan , Azhir Alaleh , Ram Nilam , Rehkopf David
Published: January 2025

We introduce a natural language processing (NLP)-based prediction model to predict next-wave mortality in respondents from the US-based Health and Retirement Study (HRS). Akin to how NLP models can be used to predict future words in a sentence, we use a transformer architecture to build embeddings of a respondent’s demographic, social, behavioral, and health histories which we then use to predict their probability of death at subsequent waves. Our model surpasses performance metrics established by conventional statistical models (average precision score = 0.900 versus 0.395), and provides new avenues for personalized healthcare in an observational setting.
THIS IS THE YEAR THAT WAS: THE BEST OF THE JOURNAL OF GERONTOLOGY BIOLOGICAL SCIENCES
Authors: Duque Gustavo , Haynes Laura
Published: January 2025

This session features the authors of the most influential papers published in the Journal of Gerontology, Biological Sciences, based on the highest impact in 2023. The authors will present the most exciting findings of the year on aging biology. Six authors of Editor’s Choice papers will be invited to summarize their paper and the future implications of their discoveries for 10 minutes, followed by 5 minutes of Q&A from the audience.
POLYGENIC RISK SCORES FOR ALZHEIMER’S DISEASE AND GENERAL COGNITIVE FUNCTION ARE ASSOCIATED WITH MEASURES OF COGNITION IN OLDER SOUTH ASIANS
Authors: Zhao Wei
Published: January 2025

TBD
INTERLEUKIN-6 DRIVES MITOCHONDRIAL DYSREGULATION AND ACCELERATES PHYSICAL DECLINE: INSIGHTS FROM AN INDUCIBLE HUMANIZED IL-6 KNOCK-IN MOUSE MODEL
Authors: Abadir Peter
Published: January 2025

TBD
WHAT MATTERS MOST FOR PERSON-CENTERED DEMENTIA CARE: PERSPECTIVES FROM STAKEHOLDERS IN LOW-RESOURCE LONG-TERM CARE
Authors: Wang Jing , Lepore Michael , Kusmaul Nancy , Holmes Sarah , Davie Laura , Rataj Alison , Kim Yoon Chung , Corazzini Kirsten
Published: January 2025

One of the initial steps in supporting quality dementia care for residents living with dementia (RLWD) in low-resource long-term care (LTC) settings is to elucidate stakeholder perspectives on what matters most for providing person-centered dementia care in such settings. We conducted community-based, participatory research across four LTC facilities situated in federally designated medically underserved areas (two rural and two urban) to describe what matters most to key stakeholders in achieving person-centered dementia care in low-resource LTC settings through their own journeys. In-depth semi-structured interviews were conducted with administrative leaders (n=7), direct care staff (n=20), RLWD (n=16), and family/care partners (n=16), with transcripts thematically analyzed using NVivo14 software. Administrators and staff members acquaint themselves with dementia care principles, participate in daily huddles, and establish rapport with residents and families. As they progress, they acquire skills to observe residents’ behaviors, empathize with their experiences, cultivate trust, delivering intuitive care that honors individual preferences, routines, and past experiences. RLWD transitioning to LTC settings seek environments resembling private homes that foster self-advocacy and rely on staff members who understand their needs and promote a sense of belonging. For family members, the journey involves supporting their loved ones’ transition, advocating for their preferences, and maintaining open communication with staff. They play a crucial role in reinforcing resident preferences and ensuring the delivery of quality care. Throughout these journeys, stakeholders identify key quality measures, including odor, cleanliness, resident happiness, and the quality of relationships, as benchmarks for assessing person-centered care.