bluuebunny/crossref_metadata_2025 huggingface dataset:
FRIENDS WITH UNEXPECTED BENEFITS: COACHING CAREGIVERS OF PEOPLE LIVING WITH DEMENTIA
Authors: Jablonski Rita , Cleverdon Amy , Xiao Chunhong , Bratches Reed
Published: January 2025

Persons living with dementia (PLWD) often exhibit care-resistant behaviors (CRBs), including refusing to take medications or bathe. This randomized clinical trial is currently enrolling caregivers of people living with dementia, who receive nine one-hour coaching sessions designed to help them prevent and manage CRBs. Coaching is the application of evidence-based strategies delivered in a conversational manner; it is a bidirectional, problem-solving approach designed to improve the ability of family caregivers to recognize, prevent, and manage CRB in their daily interactions with their care recipients. We report qualitative findings from 13 caregivers who completed all coaching sessions. The results of the thematic analysis revealed unexpected benefits and feedback. Participants reported a renewed sense of hope and optimism “after nearly giving up.” They expressed feelings of relief that the dementia-related brain changes were responsible for behaviors, not “caregiver mistakes,” or “they are doing this on purpose,” which led to greater compassion for their care recipients. These new insights also contributed to a permanent adjustment of their expectations of their care recipients’ cognition, and re-established connections with PLWD. The participants applied newly learned skills and strategies in unexpected situations, such as improving cooperation during travel and medical appointments. Participants also shared that they taught secondary caregivers, such as sitters, specific techniques to maintain continuity of care. These findings support the need for future studies that emphasize targeted, personalized interactions inherent in this coaching intervention, versus passive presentation of generic information.
CHILDLESSNESS AND SUBJECTIVE WELL-BEING IN 88 COUNTRIES: THE ROLES OF STIGMA, DEVELOPMENT, AND REGION
Authors: Teerawichitchainan Bussarawan , Mair Christine , Sugimori Haruka
Published: January 2025

Although childlessness is often hypothesized to be associated with poorer subjective well-being among aging populations, cross-national empirical evidence suggests substantial variation across countries. Yet, the reasons for this variation have yet to be identified. We hypothesize that childless older adults have lower subjective well-being in country contexts with higher stigma against childlessness, net of region, fertility, and economic development. We use multilevel modeling to analyze recent data (2017-2022) from the World Values Survey, United Nations, and World Bank, focusing on 63,067 adults aged 45+ in 88 low-middle, middle-high, and high-income countries to examine individual-level associations between childlessness and subjective well-being (life satisfaction and happiness) and moderation of country-level variables (stigma, economic development, and region). Overall, childless respondents report lower subjective well-being (life satisfaction and happiness), but these associations vary by country-level factors. Childless respondents in countries with high stigma report the lowest life satisfaction, net of fertility rate, economic development, and other factors. Happiness increases with economic development for both childless and non-childless individuals, and does not appear to be associated with stigma against childlessness. Regional differences are also evident. We discuss these findings in light of heterogeneity in the experiences of childless aging populations cross-nationally. Additionally, we highlight the potential contextualizing role of country norms and stigma when considering childlessness and well-being, particularly in family-centered or low-middle income countries.
RELATIONSHIP BETWEEN CHILD MORTALITY, SOCIAL SUPPORT, AND PSYCHOLOGICAL DISTRESS AMONG WAR SURVIVORS IN VIETNAM
Authors: Kuy Kakada , Kim Korinek , Zimmer Zachary
Published: January 2025

Social support has been documented as a key factor contributing to improved well-being among grieving parents in the bereavement process. However, how different forms of support interact with the experiences of child death is less understood among aging populations in post-conflict settings. This study examined the psychological impact of child death on older Vietnamese with a focus on the mediating role of social support and the moderating effect of war exposure. Data came from the 2018 Vietnam Health and Aging Study of 2,447 older adults aged 60 and older. We assessed experience of child loss by enumerating the mortality and survivorship status for all children. Mental distress was measured using the Self-Reporting Questionnaire with nine items. Social support was conceptualized along two dimensions: 1) Received social support was divided into instrumental and emotional domains; 2) perceived social network support was broken down into functional and structural aspects. Path analysis substantiated a significant relationship between child death and heightened mental distress. Emotional and labor support significantly buffered the impact of child. Moderated mediation analysis suggested that individuals with higher levels of war exposure received a noticeable benefit from emotional support. However, other forms of support did not demonstrate a significant mediating role. Results underscore the value of emotional support in this context. Findings suggest the integration of mental health support within existing social services for older adults in Vietnam with an emphasis on providing emotional support to those who have experienced child loss.
FROM REACH TO MINDFULNESS: SHIFTING PARADIGMS IN SUPPORT OF CAREGIVERS OF VETERANS LIVING WITH DEMENTIA
Authors: Savla Jyoti , Sapra Mamta , Luci Katherine , Hagemann Lauren
Published: January 2025

Enhancing interventions to alleviate stress among caregivers is a key area of focus for the Veterans Health Administration, especially given the anticipated tripling of dementia cases among Veterans in the upcoming years. Existing programs, like REACH-VA, have focused on cognitive behavioral approaches to reduce caregiver strain. However, mindfulness practices, known for stress reduction, psychological well-being improvement, and relationship enhancement, have not been extensively explored for caregivers of Veterans. This study evaluated the comparative effectiveness of a four-session, multi-faceted mindfulness-based intervention called Practice of Acceptance, Awareness, and Compassion in Caregiving (PAACC) to REACH-VA program for family caregivers of Veterans living with dementia. PAACC combines mindfulness with caregiver skill-development to improve the caregiving experience. It aims to assist caregivers in developing immediate awareness of stressors and their responses to stressors, while fostering empathy towards their relative with dementia. This approach differs from strategies that challenge or replace negative or unrealistic stress-related thoughts, considering the often progressive and unchangeable nature of such stressors. A randomized-controlled trial involving 133 family caregivers (Mage = 67 years; 81% White; 89% co-residing) assigned to either REACH-VA or PAACC demonstrated significant reductions in perceived stress, caregiver burden, and rumination after participating in either of the interventions. However, multi-level models revealed that caregivers who received PAACC showed lower anxiety (B=-2.76, p<0.001) and depressive symptoms (B=-2.50, p<0.01), and higher mindfulness (B=6.04, p<0.01) compared to caregivers who received the REACH-VA intervention. Findings will be discussed in the context of the intervention’s mechanisms, lessons learned, and alternative avenues for utilizing PAACC.
SUCCESSFUL AGING AND FACTORS ASSOCIATED WITH IT AMONG OLD PEOPLE LIVING IN OLD AGE HOMES IN NEPAL
Authors: Chalise Hom Nath , Singh Satya
Published: January 2025

This study aimed to assess Successful Aging (SA) and its association with Nepali older people. A cross-sectional analytical study was conducted among 206 elderly people of seven old age homes in the Kathmandu district. The interview technique using a structured questionnaire was taken after informed consent. The data collection tool was based on the determinants of SA and the Successful Aging Inventory (SAI) tool. The Geriatric Depression Scale (GDS) was used as an indicator of success in mental health. The ethical review board of Nobel College in Nepal permitted this study. The majority of the respondents (63.5%) were successful agers according to SAI Indicators and represented the SA components such as 90.4% in SP, 87.5% in PC, 93.3% of respondents self-rated health (SRH), 55.8% were involved in mind diversional activities(MDA), 99% have resilience with illness and almost two third of the respondents were mentally healthy according to GDS analysis. Most of the SA was from the 71+ age group (60.6%)with the odds of having success in the 71+ age group being 2.45 times more compared to the 60-70 years age group. Mann Whitney-U test for a non-normally distributed population showed a statistically significant difference found between the Female and Male group for SA, the difference was also found in PC and MDA among SA and Usual Aging. Although the majority of the respondents were successful agers, there needs to be improvement in all aspects especially the mental health of SA components to achieve better SA among older people.
ANNUAL WELLNESS SCREENING AND COVID-19: A MISSED OPPORTUNITY TO ADDRESS HEALTH DISPARITIES
Authors: Allen Nancy , He Yao , Foster Norman
Published: January 2025

The COVID-19 pandemic had the greatest effect on the most vulnerable. Medicare annual wellness visits (AWV) are the best opportunity for early detection of cognitive impairment and could address inequities in dementia care. We examined how preventive care through AWV changed as our healthcare system responded to pandemic disruptions. We hypothesized that disruptions would exacerbate pre-existing disparities in AWV administration. We conducted an observational retrospective chart review of AWV of Medicare-eligible adults ≥65 years of age in our health system from Jan 2018 to Dec 2022. In 2020 at the beginning of the COVID-19 pandemic, there were 32.9% fewer AWV performed than in 2019. A month-by-month analysis showed a sharp 91% decline in AWV when clinic operations were most restricted. When operations largely resumed by June 2020, AWV returned to the pre-pandemic proportion of January 2020. However, previous disparities in AWV performance continued or were exacerbated. Post-pandemic, AWV were more frequent in younger (< 75 years; 32.5%) rather than older individuals (>75; 21.4%), in white (30.9%) rather than non-white patients (24.2%), and in non-Hispanic (30.5%) rather than Hispanic individuals (23.7%). Patients without diabetes had more AWV (31%) than those without (31% vs. 27.6%). Success in resumption of AWV occurred by the continuation of conscious and unconscious scheduling biases, rather than addressing previously recognized disparities. This represents a missed opportunity and highlights the need for policy changes to address health equity in AWV. The disparities in AWV mirror the disparities in dementia diagnosis and treatment.
IMPACT OF OLDER ADULT PATIENTS AND CAREGIVER ATTITUDES AND PERCEPTIONS AND LOCAL CULTURE ON IN-HOSPITAL MOBILITY
Authors: King Barbara , Zisberg Anna , Brown Cynthia
Published: January 2025

Older adults commonly lose functional ability during a hospital stay, often cause by limited ambulation. This phenomenon has been identified globally as a hospital associated disability (HAD). Multiple barriers related to how care is delivered in hospitals have been identified that prevent hospital staff from getting patients up to walk. Only recently have studies explored other factors that may prevent or influence whether older patients ambulate, including older adults’ experiences and perceptions of in-hospital ambulation, the impact of patient and or family caregiver attitudes on in-hospital mobility, and influence of local unit culture on patient mobility. This symposium will present results from hospitalized older adult mobility studies conducted in 3 countries. Paper 1 will describe older adult patient perceived Value for Walking during hospitalization; paper 2 will discuss the impact of patient and family attitudes on patient mobility; paper 3 will present how diversity and cultural difference of family caregivers impacts patient mobility; and paper 4 will describe how local unit culture mediates mobility of older adult patients. HAD in older adults is a global health epidemic. Designing effective person-centered mobility interventions need to be multifactorial and include patient and family/ caregiver perspective and unit culture in order to improve older adult patient ambulation and decrease the incidence of HAD. Additional research is needed to understand the impact of patient and family caregiver factors and local unit culture on whether older adult patients are engaged in walking during their hospital stay.
CULTURAL DIFFERENCES IN CAREGIVERS’ ATTITUDES TOWARD IN-HOSPITAL MOBILITY OF OLDER ADULTS
Authors: Shulyaev Ksenya , Zisberg Anna , Smichenko Juliana , Shadmi Efrat , Gur-Yash Nurit
Published: January 2025

Older adults are often accompanied by their family caregivers during hospitalization and their attitudes could influence care processes and outcomes. However, little is known about the cultural differences of family-caregivers attitudes. We aim to explore cultural differences in family-caregivers’ attitudes toward in-hospital mobility of hospitalized relatives. In this study participated 156 pairs of hospitalized older adults and family caregivers, included 23(15%) Israeli Arabs, 33(21%) - ex-USSR migrants and 100(64%) native, or veteran Israeli Jews. Socio-demographic, health, functional and physical status were collected at admission. Caregivers’ Attitudes Toward Mobility (ATM) were collected during their hospital visits. In all cultural groups caregivers tend to be positive toward mobility of older adults, attitudes (measured 1 for negative, 5 for positive) of the caregivers were: 3.48±.80 for Arab, 3.69±.64 for ex-USSR migrants and 3.82±.70 for Jews. Significant differences in caregivers’ attitudes between the groups were found (F(146,2)=4.02, p=.02) even after controlling for patients’ characteristics including age, gender, functional status, level of independence in ADL, severity of illness, comorbidities and previous falls. Multivariate regression analysis included all mentioned covariates demonstrated that being an Arab family-caregiver significantly predicted worse attitudes toward in-hospital mobility (β=-.214, p=.009). To conclude, cultural differences exist in attitudes of the family-caregivers regarding the mobility of their older family members. Arab caregivers tend to prefer that their relatives will be less mobile during hospitalization. Clinical practices should address cultural difference that influence mobility.
EXPERIENCES OF CARE TRANSITIONS FROM HOSPICE: ADRD FAMILY CAREGIVERS SOCIAL CONTEXTS
Authors: Washington Karla , Wladkowski Stephanie , Coccia Kathryn , Berg-Weger Marla , Wallace Cara
Published: January 2025

Patients with ADRD are the largest group of Medicare hospice beneficiaries. They are also more likely to experience a live discharge than any other diagnosis, particularly after 6 months of care without presence of an acute event, indicating removal due to decertification. Although expected prognoses have changed, patients still require substantial care and caregivers often struggle to process feelings of abandonment and uncertainty. Increased burden is placed on primary caregivers who may be unprepared for this transition and are more likely to be socially isolated and lonely. This study interviewed caregivers of patients with ADRD who experienced a live discharge from hospice (n=32). Using the ecological model of resilience for caregivers, this presentation examines how caregivers describe their circle of support (CoS), the way their CoS functions (or does not function) when caregivers need help, and the attributes that impact how and when they utilize members in their supportive network. Results suggest that experiences of care transitions are buffered by patient’s location of care (home versus facility) and by availability of resources (both financial and fulfillment of core functions by CoS members). Understanding the way support systems help caregivers during this time of transition provides important implications for assessment during a live discharge to help hospices identify caregivers that may need additional support and resources during the discharge. With a growing population of patients living with ADRD and the rates in which live discharge impacts patients with ADRD-related diagnoses, supporting caregivers during this critical care transition is of utmost importance.
NIH: THE SIMPLIFYING REVIEW FRAMEWORK
Authors: Ortenberg Elia
Published: January 2025

This presentation will discuss NIH’s current initiative, which will be implemented for applications submitted after January 25, 2025, to simplify the peer review framework for most research project grant applications. NIH’s ultimate goal through this effort is to identify the best, most innovative science with the potential to improve human health or advance our scientific understanding. The initiative involves reorganizing the existing review criteria in a way that will help reviewers focus on the key questions needed to assess scientific merit of applications: Can and should the proposed research be conducted? We will present a brief history that drove the changes and provide an overview of the new review criteria as well as the impact on the scoring method and arrangement of the summary statement that applicants will receive.
PAIN MANAGEMENT FOR OLDER ADULTS LIVING WITH DEMENTIA IN NURSING HOME COMMUNITIES
Authors: Resnick Barbara
Published: January 2025

Pain is a commonly reported symptom among older adults living with dementia with 30 to 80% of those in nursing homes experiencing pain. For over 50% of these individuals the pain is moderate to severe. Pain often results in a decline in function and quality of life, exacerbates behavioral symptoms associated with dementia, contributes to delirium and increases the risk of emergency room visits. For those with moderate to severe dementia verbal reporting of pain may not be reliable. Multiple systematic reviews concluded that self-report tools should be used when possible and observational measures used for supplementation of self-report. Other challenges associated with pain assessment, diagnosis and management among residents living with dementia include: (1) variations in pain with pain being more intense some days and during certain activities; (2) acceptance of pain as normal; (3) fear of pharmacological interventions; (4) lack of belief in nonpharmacological approaches; (5) lack of knowledge; (6) communication challenges between providers; and (7) desensitization to pain as experienced by residents and observed by staff. The State Operations Manual for Long Term Care, specifically F-Tag F697, requires that nursing homes must ensure that pain management is provided to residents who require such services. This symposium provides an overview of the Pain Management Clinical Practice Guideline (CPG) for nursing homes residents, results from pilot testing of a pragmatic implementation approach to help integrate use of the CPG into the community, and a review of the facility factors associated with pain among nursing home residents living with dementia.
ARE FEDERAL GUIDELINES HELPING TO IMPROVE PAIN ASSESSMENT, DIAGNOSIS, AND MANAGEMENT IN NURSING HOMES
Authors: Levy Sorah
Published: January 2025

The State Operations Manual for Long Term Care, specifically F-Tag F697, requires that nursing homes must ensure that pain management is provided to residents. The management should be consistent with professional standards of practice, the person-centered care plan, and the residents’ goals and preferences. Although these regulations are required there are many pain related issues not well addressed in the guidance such as recognition of the challenges to pain assessment and management, ways to overcome challenges, how the community incorporates assessment, diagnosis and management of pain using professional standards of practice, the most current standards of practice for long-term care residents, the best ways to manage different types of pain (e.g., neuropathic, chronic), and how to make decisions about changing, adding or stopping an analgesic among others. Further, there are no processes by which the communities or regulatory agencies evaluate if there is a person-centered care plan and if the plan matches the resident’s pain goals. In our pilot work implementing the Pain Management CPG we noted that the majority of the care plans related to pain were generic and not personalized and we were able to help staff make pain care plans more personalized care. The purpose of this paper is to address the mismatch between the requirements and measures within the Minimum Data Set around pain assessment, diagnosis and management and issues and concerns with this approach. We will describe how the Pain Management CPG can help guide communities to overcome these issues and adhere to F-Tag F697.
THE LONG-TERM EFFECTS OF EARLY SENSORY IMPAIRMENTS ON LATER-LIFE DISABILITY AND LONELINESS
Authors: Kim Eunbea , Lee Gina , Martin Peter , Lee JeongEun
Published: January 2025

We focus on the long-term consequences of childhood sensory impairments on physical disability and loneliness in later life, examining the mediating roles of childhood parental relationships in the association between childhood sensory impairments and later life sensory difficulties. We further investigated whether childhood socioeconomic factors (i.e., family income and parents’ educational attainment) moderate these relationships. Data from the Health and Retirement Study (HRS; 2012 and 2016; n = 2,116, Mage = 71.47), combined with the HRS Life History data, was utilized. Using path analyses in R, the analysis revealed that childhood vision impairment was related to higher late-life physical disability and loneliness through higher vision difficulties in late adulthood. These relationships were not influenced by the moderators (family income and parents’ educational attainment). Conversely, early hearing impairment was linked to greater older adulthood loneliness, mediated by poor childhood parental relationships. The negative impact of poor parental relationships on loneliness was lessened with a higher childhood family income and parental education for those with childhood hearing problems. Notably, mothers’ higher education level significantly alleviates the risk of later-life hearing difficulties for those with childhood hearing problems. This research underlines the lasting effects of childhood experiences and parents’ background on well-being in later life as well as the different consequences of vision and hearing difficulties. These findings shed light on the understanding of how childhood experiences can shape disability and loneliness later in life, underscoring important implications for prevention efforts in public health and policy.
RE-EXAMINING THE ISSUE OF FALSE POSITIVES IN THE ERA OF BIG DATA AND HIGH-FREQUENCY HEALTH MEASUREMENT TECHNOLOGIES
Authors: Haines Terry , Beare Richard , Srikanth Velandai
Published: January 2025

Technologies that monitor patient health parameters create abundance of data, enabling multiple comparisons to be easily undertaken within the same dataset. This increases the risk of spurious significant findings being reported (type 1 error). Previous work has identified this problem for situations where there is i) one explanatory and multiple outcome variables, 2) multiple explanatory and one outcome variable, and 3) multiple explanatory and multiple outcome variables. We introduce discussions of where there is one explanatory and one outcome variable, but multiple measurement points permitting multiple ways to “slice” data for analysis. We conducted 1,000 Monte Carlo simulations of a pre-post intervention study with additional parallel control site, with each phase having 24 data points per site. We analysed the data as runs of a pre-post study (period), a post-only parallel control (site) and as the full design examining a period-by-site interaction effect. We analysed the full 24 data points per period / site, then 20, 16, 12 using data adjacent to the pre-post transition time point within each run. We then repeated this procedure with 1000x these numbers of data points. We calculated the family-wise type 1 error rate for each analysis run. The cumulative type 1 error rate across all runs based on the 24 data point set was 26.8%, while the rate was 21.9% for runs based on the 24,000 data point set. This means an analyst with enough data can spuriously manufacture a significant finding for one in four to five studies.
RACIAL/ETHNIC GROUP DIFFERENCES IN REPORTED SELF-NEGLECT AMONG OLDER ADULTS
Authors: Steinman Kenneth , Pellerin Jim , Shi Yang
Published: January 2025

Self-neglect is a pernicious problem and represents the most common type of report investigated by adult protective services (APS). Calls for culturally competent approaches to addressing self-neglect in older adults have been undermined by the lack of research on racial/ethnic group differences and how they may vary across communities. Analyses of 101,015 reports of self-neglect among people 65+ years old validated by the Texas APS system from 2021 through 2023 found the incidence was nearly twice as high for (non-Hispanic) African Americans as for other older adults (IRR=1.91, 95%CI: 1.88, 1.94), whereas the difference for Hispanics was modest (IRR=0.95, 95%CI: 0.93, 0.96). Stratified analyses, however, found marked variation across the state’s 11 regions. In rural regions of West Texas, the higher reporting rates for African Americans were especially pronounced: three to four times the rates for other older adults. And in rural regions of East Texas, reporting rates for Hispanics were only one half to one third those of other older adults. Less variation was observed across major metropolitan regions. Further analyses assessed how regional population demographics and the racial/ethnic composition of APS staff may explain these divergent results. Efforts to understand and address racial/ethnic group differences in self-neglect should reconsider the propriety of describing groups as “underserved” when they may be disproportionately more likely to be investigated by APS. When addressing self-neglect in a diverse client population, agencies should consider the background of staff and whether distinct approaches for are needed in rural areas.
CHANGE IN UNMET NEEDS STATUS FOR DAILY MOBILITY AND SELF-CARE ACTIVITIES
Authors: Sands Laura , Zhu Xiaofan , Khan Maham , Du Pang
Published: January 2025

Unmet need occurs when older adults with difficulties completing daily activities cannot complete an activity because no one is available to help. Prior research has not considered whether unmet need status changes over time, nor assessed characteristics of older adults whose unmet needs worsen or resolve. Changes in unmet needs status across three pairs of consecutive annual interviews were assessed using 2011-2014 data from the National Health and Aging Trends Study. Findings revealed that that 57% of older adults who needed help with mobility activities and 62% of older adults who needed help with self-care activities did not experience unmet needs across the three consecutive pairs of occasions. Only 3% who needed help with mobility activities and 1% who needed help with self-care activities consistently reported unmet needs. Worsening of mobility unmet needs occurred for 25% and 16% resolved their mobility unmet needs. Worsening of self-care unmet needs occurred for 25% and 11% resolved their self-care unmet needs. Those who experienced worsening of mobility and/or self-care unmet needs were more likely to be female and have multiple chronic conditions. Those who experienced resolution of mobility unmet needs were more likely to be female and have multiple mobility difficulties and chronic conditions. Those who experienced resolution of self-care unmet needs were more likely to be white race, have zero or one self-care difficulties, and have multiple chronic conditions. The findings inform the need for frequent assessment of unmet needs to identify opportunities to reduce worsening and increase resolution of unmet needs.
SLEEP CONCORDANCE AMONG CARE DYADS OVER TIME: DOES IT VARY BY CAREGIVING CONTEXTS?
Authors: Kong Dexia , Li Chihua , Xiang Xiaoling , Lu Peiyi
Published: January 2025

The well-being of care recipients (CR) and informal caregivers (CG) is intricately interconnected. However, research on sleep concordance among caregiving dyads is scarce. Leveraging longitudinal dyadic data and a cross-lagged panel design, this study aims to investigate whether: 1) sleep patterns are concordant among caregiving dyads over time; and 2) the extent of sleep concordance differs by caregiving contexts (i.e., dementia caregiving versus non-dementia caregiving) or by living arrangements (i.e., living together versus living apart). Longitudinal data from the National Health and Aging Trends Study (NHATS) and the National Study of Caregiving (NSOC) were included (N = 2,204 care dyads). Cross-lagged panel models and multiple group analysis were used. Sleep problems of CR and CG in 2015 were significantly associated with their own sleep problems in 2017. The partner effects were statistically insignificant (P>0.05). However, CR sleep problems in 2015 were associated with more CG sleep problems in 2015 (β=0.141, 95% CI=0.015, 0.268), which were further linked to more CG sleep problems in 2017 (β=0.504, 95% CI=0.431, 0.577). Furthermore, these relationship patterns remained significant among dementia care or co-residing dyads, but not among non-dementia or living apart care dyads. CR sleep problems could affect CG sleep synchronously, potentially leading to long-term deterioration of CG sleep. This can be attributed to the cumulative physical exhaustion and psychological strain associated with caregiving. Our findings highlight the importance of early intervention in mitigating CR sleep problems and targeted assistance to CG of persons with dementia and those co-residing with their CR.
THE PROMISE AND CHALLENGES OF DIGITAL INNOVATIONS TO SUPPORT OLDER ADULTS AND CAREGIVERS
Authors: Gitlin Laura , Boot Walter
Published: January 2025

Online platforms are promising scalable approaches for delivering interventions addressing critical public health needs. As most older adults and caregivers utilize smartphones, tablets or computers, this approach can improve access to on-demand support. However, there are numerous challenges for advancing digital innovations. This symposium showcases five digital platforms that target different populations (caregivers, socially isolated, individuals with emotional needs); address different needs (monitoring, support, care strategies); have different developmental approaches, and are in different testing phases (feasibility, usability, acceptability, efficacy). Ms. Webster first presents national recruitment efforts to enroll 262 caregivers to evaluate an online platform, WeCareAdvisor, that provides strategies to manage dementia-related behavioral symptoms. She illustrates the volume needed for enrollment and biases of recruitment approaches. Next, Dr. Czaja discusses processes for developing PRISM, an effective online program addressing social isolation. Highlighted is the importance of end-user engagement throughout development and testing. Dr. Sadarangani presents CareMobi, which enables families using adult day services to track their relatives care in that setting. She highlights the feasibility of staff and families to use the app to improve communications. Dr. Jain next presents on adapting late-life psychotherapies for delivery via mobile devices. His study demonstrates the effectiveness of adapting approaches for delivery in this modality and opportunities for symptom monitoring. Finally, Dr. Stevens, presents utilization patterns of his online platform, GamePlan4Care, which adapts the NIH REACH caregiver intervention for delivery online. Our nationally recognized expert on technology and aging, Dr. Walter Boot, will discuss the promises and challenges of digital solutions. Behavioral Interventions for Older Adults Interest Group Sponsored Symposium
CHALLENGES AND OPPORTUNITIES BRINGING DIGITAL INNOVATION TO ADULT DAY CENTERS: FEASIBILITY TESTING WITH CAREMOBI
Authors: Sadarangani Tina
Published: January 2025

CareMobi is an mhealth application that allows adult day services centers to exchange information with their clients’ family caregivers and health care providers. CareMobi enables adult day center staff, who possesses in-depth knowledge of clients based on their day-to-day observations, to be active members of the care team. The application was developed using a user-centered design thinking approach that prioritized the needs of end-users. Initial prototype testing, which combined qualitative interviews followed by individual completion of the Technology Acceptance Model questionnaire, showed that likelihood of adopting CareMobi was high among adult day center staff (n=31). CareMobi was also perceived as having significant clinical value. We now present the results of preliminary feasibility and acceptability testing with the app itself in a rural Tennessee adult day center (n=9). We also identify factors that support successful implementation of technology within ADCs, including comprehensive support and education, as well as challenges to widespread adoption.
VOLUNTEERING AMONG ECONOMICALLY MARGINALIZED OLDER ADULTS IN THE US: A SCOPING REVIEW
Authors: Ryu Byeongju , Matz Christina , Halvorsen Cal , Baek Jihye
Published: January 2025

The 2015 White House Conference on Aging highlighted civic and volunteer activities for healthy aging. While the benefits of volunteering in later life are well-documented, the experiences of economically marginalized older adults are less understood. This study systematically reviewed evidence on volunteering among this group in the U.S., focusing on their factors and outcomes. The study reviewed empirical research published since 2015, obtained from five electronic databases, selecting 11 studies focusing on older volunteers with low income or assets. The selection was based on 1) Samples predominantly aged 50+ or defined as older adults and 2) A focus on volunteering among low-income or asset older people. Reported facilitators included personal values, perceived technology utility and accessibility, linguistic and cultural adaptations in program designs, skill acquisition opportunities, post-retirement work, and living in senior housing. Barriers encompassed low technological and English proficiency, limited resources, and social distancing policies. Outcomes involved enhanced purpose and engagement in life, skill development, expanded social networks and community connectedness, improved self-reported health, and fewer depressive symptoms. This scoping review focuses on an under-researched group: economically marginalized older volunteers—underscoring the need to encourage their volunteerism. Volunteering could improve their health and well-being, potentially reducing dependence on social insurance, boosting the gross domestic product, and strengthening the nonprofit sector. Given the primary focus on formal volunteering and cross-sectional study designs in the reviewed literature, future investigations may examine informal volunteering and utilize longitudinal or experimental methodologies to examine the causal relationships of their volunteering with factors and outcomes.
PERSON-CENTERED CARE PLANNING FOR PERSONS WITH MCC: LESSONS FROM LEARNING COLLABORATIVE DISCUSSIONS
Authors: Miller Lyndsey , DeMarchis Emilia , Michaels LeAnn , Jaskson Christie , Dorr David
Published: January 2025

The Learning Collaborative invites person-centered care planning (PCCP) innovators, implementation experts, and front-line providers to share and discuss successes and challenges they have experienced in PCCP with the goal of generating a framework for increasing the uptake of and scaling PCCP as an integral component of routine practice. The Learning Collaborative reviews promising models of PCCP and describes feasible solutions to common implementation barriers. Participants engage in deliberative dialogue based on the collective experiences of the group to generate new knowledge and identify best practices and strategies to deliver high-quality PCCP for persons with MCCs. This task involves a series of 5 Learning Collaborative sessions to review and discuss case studies of PCCP. The Learning Collaborative includes 25-30 participants affiliated with partner Practice-Based Research Networks (PBRNs), recommended from the Technical Expert Panel, and identified by AHRQ. Learning Collaborative participants include individuals with front-line experience implementing PCCP; health system or practice clinicians preparing to implement PCCP; and implementation science researchers with experience implementing PCCP. Gathering all these partners will permit shared learning to accelerate progress, iterative, collective discussions to develop a framework for successful implementation of PCCP for people living with or at risk for MCC. The synthesis of learnings and reporting from the Learning Collaborative will provide key information for change agents, such as policymakers, clinical teams, and health care system leaders wishing to implement and research PCCP.
BEST PRACTICES AND DATA EXEMPLARS IN DESIGN AND EVALUATION OF EARLY-PHASE DYADIC INTERVENTIONS
Authors: Lyons Karen , Monin Joan , Zarit Steven
Published: January 2025

Despite growing numbers of early-phase dyadic interventions, few move beyond early-phase and often lack intentional plans for development and evaluation to optimize success. This session includes four data-based papers that will discuss essential elements of design and evaluation of early-phase dyadic interventions with older adults and their care partners in both cognitive impairment and chronic illness contexts. First, Dr. Joan Monin and colleagues will describe the advantages of, and phases involved in, using an Appreciative Inquiry Workshop approach to develop an attachment-based communication intervention with dyads living with dementia. Second, Dr. Kalisha Bonds Johnson and colleagues will present phase I data from a study to develop and test a formal care decision-making intervention for African-American parent-adult child dyads living with dementia. The paper will discuss the importance of intentional community engagement, use of theory, and type of dyad (e.g., mother-daughter) when designing dyadic interventions. Third, Dr. Michael McCarthy and colleagues will use data from several studies to exemplify the advantages of mixed-methods designs in developing dyadic interventions, particularly in rural samples (e.g., strengthening participant engagement, maximizing resources, surfacing new questions). Finally, Dr. Karen Lyons and colleagues will present two approaches to evaluating dyadic benefits of interventions in small samples, the importance of assessing pre-test risk status within care dyads, and the need to assess relational impact of behavioral interventions. Speakers will share best-practices in developing, designing and evaluating early-phase dyadic interventions followed by a discussion of key take-homes by Dr. Steve Zarit.
DAILY EXPERIENCES OF SOCIAL CONNECTION: REAL-WORLD ASSESSMENT STRATEGIES TO UNDERSTAND MECHANISMS
Authors: Van Orden Kimberly , Donovan Nancy
Published: January 2025

Social connection is multifaceted construct that encompasses structural, functional, and subjective (quality) dimensions of relationships, all of which are associated prospectively with health, functioning, well-being, and longevity. Despite clear evidence linking social connection to health in later life, there are no clear evidence-based interventions and available community programs are under-utilized. One barrier to effectively intervening is the inability to tailor programs to person-specific contributors to disconnection. This symposium will describe findings from studies of social connection in later life that use innovative methods to examine person-specific and proximal causes, contributors, and consequences of social connection, including passive sensing via smartphones, analysis of social behavior (including speech patterns), and ecological momentary assessment. These methods allow for frequent measurement of indices of social connection in real-time (reducing recall bias) and in real-world contexts. Dr. Lee will present on the assessment of loneliness and social isolation among older adults using unstructured speech data in comparison to research surveys. Ms. Zhou will present on associations between sleep, social encounters, and momentary loneliness in older adults’ everyday life. Ms. VanBogart will present on associations between momentary loneliness and indices of stress (diurnal cortisol). Dr. Bower will present on momentary experiences of belonging in a sample of older adults with subjective cognitive decline. Dr. Van Orden will describe procedures and design considerations for EMA and passive sensing indices of social connection as outcomes in clinical trials to promote social connection. Dr. Donovan will facilitate a discussion to integrate findings and identify opportunities for future research.
DAILY HEALTH PROCESSES IN POPULATIONS OF DIVERSE DEMOGRAPHIC BACKGROUNDS
Authors: Roecke Christina , Luo Minxia , Bielak Allison
Published: January 2025

Health processes are studied increasingly commonly in older adults’ daily life. This symposium includes four studies that investigated daily health processes in populations of diverse demographic backgrounds and explored differences in the daily processes between individuals. First, with seven-day data from 207 adults aged 18-82 years, Ferguson, Corley, and Scott found that negative affect was associated with occurrence of stressors at both the within-person momentary and between-person levels, but age or neuroticism did not moderate the association. Second, Ng, Kratz, and Birditt conducted a five-day study on effects of interactions with care recipients and with friends on cardiovascular functioning in 159 Black and White dementia caregivers. In particular, they found that negative interactions with care recipients were linked to momentary increases in HR in Black but not in White caregivers. Third, Luo, Röcke, and colleagues investigated the short-term time-lagged associations between leisure activities and cognitive performance over hours and the differences across age, gender, education, and ethnicity. They analyzed data from two two-week studies from a total 542 young and older adults with diverse ethnicity backgrounds, but did not find any time-lagged associations. Fourth, Hartung and Hülür examined daily subjective memory lapses in relation to cognitive activity and mood in 325 university students over 10 days. Their results showed that memory lapses were associated with more cognitive activity and worse mood both momentarily and between individuals. Finally, Allison Bielak will discuss all papers about generalizability of observations of daily health processes across populations of different demographic backgrounds.
DIFFERENTIAL EFFECT OF LIMITED SOCIAL NETWORK AND SOLITARY LIVING ON HEALTH IMPLICATIONS: PARADOX OF ISOLATION
Authors: Murayama Hiroshi
Published: January 2025

In this presentation, I will discuss the distinct effects of a limited social network (SN) and solitary living on health outcomes in later life, drawing on findings from two studies. While both a limited SN and solitary living indicate forms of social isolation, their health implications, especially those associated with solitary living, remain controversial. A limited SN was characterized as engaging in contact with family members living separately or with friends less than once a week, and solitary living was defined as residing without cohabitants. Utilizing extensive cohort data from older adults residing in the Tokyo metropolitan area, we examined the factors modifying the relationship between cognitive decline (CD) and all-cause mortality. The Cox proportional hazard model indicated the CD-mortality association was stronger among those with a small SN than a large SN. Conversely, the association was weaker in living-alone individuals than in cohabiting individuals. The variance in effect was also evident in brain volume metrics. Employing data from a separate cohort study of older Japanese adults, we assessed the impact of social isolation on hippocampal volume changes. Participants with a smaller SN exhibited a more significant reduction in hippocampal volume than those with a larger SN. Surprisingly, solitary living was associated with a lesser decline in hippocampal volume. Although both a small SN and solitary living are indicators of social isolation, they appear to have opposite effects on health. Our results underscore the necessity of differentiating types of isolation when designing and implementing interventions for social isolation.
THE EMPOWERED CAREGIVER: A SCALABLE AND PRAGMATIC EVIDENCE-BASED PROGRAM FOR DEMENTIA CAREGIVERS
Authors: Judge Katherine , Grant Claire , Stratton Lauren , Moreno Monica , Fazio Sam
Published: January 2025

Informal caregivers provide the bulk of care to older adults with dementia. Few studies have evaluated pragmatic and scalable on-line educational programs for caregivers. An RCT (N=247) was used to evaluate a new program, Empowered Caregiver, across 3 timepoints (T1/baseline; T2 after program completion; and T3 45 days after T2.) The program included two 90-minute sessions delivered online via community educators and addressed communication, dementia-related behaviors, caregiver stress/support, and person-centered care. Materials provided pragmatic and easy to implement caregiver strategies. Program acceptability also was assessed. Participants were M=46.41 years old (SD=16.23), female (63.6%), Caucasian (54.3%), married (47%), heterosexual (80.2%), and worked part- or full-time (50.4%). Separate 2 (condition) x 3 (time) repeated measures GLMs were conducted. Program participants (n=131), compared to control (n=116), reported significant improvements with: Caregiver Self-Efficacy, Emotional Health Strain, Role Captivity, Caregiver Mastery, Personal Gain, Unmet Needs, Unmet Needs Distress, Anxiety Symptoms, Depression Symptoms, Behavioral Intentions, and Behavioral Actions. Mean ratings of program acceptability using a 5-point Likert scale ranged from 4.17 to 4.58. Participants indicated they would very likely recommend the program to others (91.5%). Results indicated the Empowered Caregiver program was efficacious in improving a wide range of caregiver outcomes along with being highly acceptable. Overall, findings address a significant gap in the literature and a current limitation in providing caregivers with timely evidence-based information, tools, and resources. Discussion will highlight key implementation issues, alignment of program dosage with measures, the need for pragmatic and scalable programs, and future directions.