bluuebunny/crossref_metadata_2025 huggingface dataset:
AGING AND UTILITARIAN EMOTIONS FOR SOLVING SOCIAL PROBLEMS
Authors: Behrend Abigail , Allard Eric , Stanley Jennifer
Published: January 2025

Literature suggests a preference for pro-hedonic orientations in older adulthood (Carstensen et al., 2006). Although this is consistent with Socioemotional Selectivity Theory (Carstensen et al., 1999), evidence suggests contra-hedonic motives are viable, particularly in interpersonal scenarios (Allard et al., 2021). We aimed to determine whether young and older adults consider specific emotions useful for accomplishing socially-relevant goals. In an online study, 112 young adults (18-35 years; 29.5% men; 68.8% White) and 72 older adults (64-83 years; 25% men; 93.1% White) viewed 8 interpersonal scenarios with associated social goals. Participants rated how much they would like to engage in emotion-inducing activities on a scale of 1 (not at all) to 7 (extremely) to prepare for each interpersonal interaction. A 4 Goal (Confront, Approach, Avoid, Help-seeking) x 4 Emotion (Happy, Afraid, Angry, Sad) x 2 Age Group (young, old) repeated measures ANOVA revealed a significant Goal x Emotion interaction F (3.82, 695.86) = 210.633 p <.001. Follow-up analyses showed all predicted emotions were endorsed within their intended goal condition (e.g., Approach-Happy, p <.001), with the exception of sadness within the “Help-seeking” condition (p <.001). This partially supports our hypothesis. These results provide additional evidence for age-similarity in utilitarian emotional endorsement. Future research should investigate whether such age similarity remains when experiencing emotions to achieve utilitarian goals.
DISCUSSION AND DOCUMENTATION OF HEARING DIFFICULTY IN THE PRESENCE OF DEMENTIA: STUDY OF THE ANNUAL WELLNESS VISIT
Authors: Powell Danielle , Wu M J , Nothelle Stephanie , Smith Jamie , Oh Esther , Reed Nicholas , Wolff Jennifer
Published: January 2025

How clinicians document and discuss health concerns within a visit shapes patient health perception. This study investigates clinician documentation of hearing concerns and whether this varies for older adults with dementia/cognitive concerns. We use patient-level health and demographic information from the electronic medical record and associated clinician visit notes for Medicare beneficiaries who indicated index hearing concerns at an Annual Wellness Visit (AWV) between 2017-2022. We text analyzed a random sample of AWV clinical notes to evaluate documentation of hearing concerns/loss and placement of hearing-related referrals. Logistic regression models investigate odds of clinician documentation of hearing concerns by diagnosed dementia or cognitive concerns. Among 2,593 beneficiaries who reported hearing concerns at an AWV (mean age 78.8 years, 56.6% female), 6.5% had a concurrent dementia diagnosis, nearly 40% indicated congruent cognitive concerns, and 20% had an existing hearing loss diagnosis. Text analysis of clinician visit notes (n=474) found hearing concerns were documented less frequently for those with (versus without) dementia (44.2% vs 30.2%) and clinicians were half as likely to elaborate on hearing (OR:0.51; 95% CI:0.34,0.76) or acknowledge known hearing loss in the AWV note (OR:0.56; 95% CI:0.38,0.84. Regardless of dementia status, only 50% received a hearing diagnosis following the AWV. Clinicians are less likely to document or incorporate hearing concerns into the AWV for patients with dementia. The complex care needs of dementia may inhibit clinician ability to attend to hearing concerns, suggesting opportunity for embedded educational intervention to support clinicians in addressing patient-collected health risks can improve dementia care.
METHODOLOGY FOR ANALYZING MEDICAID NURSING HOME PAYMENT RATES AND COSTS
Authors: Simpson Elizabeth , Bowblis John , Miller Edward , Karon Sara , Oliveira Iara , Dey Judith , Squillace Marie , Cohen Marc
Published: January 2025

This study required the construction of a unique facility-by-facility national database that links Medicaid nursing home (NH) payment, cost, staffing, and quality information from a variety of sources to enable detailed analysis of key financial and other metrics. Medicaid cost data were obtained from Medicare Cost Reports and Medicaid payment rates were constructed from statutory rates collected from the states. Medicaid costs were adjusted to capture only services provided to Medicaid residents. The final sample consisted of 9,543 NHs, representing 67% of all freestanding NHs in 2019 in the 44 states analyzed. The analysis focused on distributions, means, medians, and payment-to-cost ratios, where a ratio of 1.0 indicates that Medicaid payments matched reported NH costs. The impacts of NH characteristics and state payment methods on Medicaid costs, payments, and payment-to-cost ratios were explored. Regression analyses further investigated the impact of NH and state policy characteristics, accounting for state fixed effects.
MAJOR STUDY FINDINGS ON THE ASSOCIATION BETWEEN MEDICAID PAYMENTS AND COSTS
Authors: Miller Edward , Cohen Marc , Simpson Elizabeth , Karon Sara , Oliveira Iara , Dey Judith , Squillace Marie , Bowblis John
Published: January 2025

In 2019, Medicaid payment rates covered about 82 cents per dollar of estimated nursing home (NH) reported Medicaid costs. Roughly 40% of NHs had Medicaid payments covering 80% or less of their reported costs; 51% of NHs had 80-100% of their reported Medicaid costs covered; 8% of NHs had payments exceeding reported costs. Not-for-profit NHs had the lowest Medicaid payment-to-cost ratio (.76) compared to for-profit (.83) and government-owned (.80) NHs. NHs with the highest Medicaid payer mix (80-100%) had a higher Medicaid payment-to-cost ratio (.86) than NHs with the lowest Medicaid payer-mixes below 50% (.75). NHs with total nursing staff levels below 3.00 hours per resident day had the highest average Medicaid payment-to-cost ratio (0.85); NHs with nursing staff levels above 4.0 hours had the lowest (0.77). NHs with the lowest (1-star) quality ratings had the highest average Medicaid payment-to-cost ratio (0.83); NHs with 5-star ratings had the lowest (0.80).
COLLABORATIVE RESEARCH DEVELOPMENT: ESTABLISHING A RESEARCH-AGENDA AT A UNIVERSITY-BASED RETIREMENT COMMUNITY
Authors: Guest M Aaron , Maxfield Molly , Beagley Lindsey , Schaffer Sigourney , Owens Becky , Coon David
Published: January 2025

University-Based Retirement Communities (UBRCs) represent a novel trend toward creating age-inclusive environments. These emerging housing options for older individuals generally function as continuing care retirement communities but stand out due to their close ties and university integration. They strive to foster intergenerational exchanges and offer older adults the chance to engage in university life and community. At Arizona State University, Mirabella at ASU is uniquely situated at the heart of the Tempe, AZ Campus, and is one of the few UBRCs physically located on a campus. Mirabella’s integration into the university has opened doors for collaborative research projects that add to broadly the nascent literature on UBRCs and aging. Residents expressed interest early in partnering with researchers to understand more about the UBRCs and aging in a university setting. To further these goals, a joint panel of residents and researchers was formed to pinpoint mutual research interests. This initial gathering prompted a series of focus groups to fine-tune topics, eventually leading to an annual resident health survey and the establishing of a Community Research Advisory Board. Transitioning from idea to implementation required navigating complex considerations beyond those typically encouraged in community-based research. In this presentation, we will share our experience in developing a collaborative research partnership while navigating the at-times competing interests of the researchers, university, operators, and residents. Furthermore, with the increasing prevalence of these communities, we offer guidance on sustaining engagement and sharing best practices derived from our experiences.
DUAL PRIORITIES: DIGITAL TWINS AND HEALTH CARE DESIGN THAT SUPPORTS OLDER ADULTS IN THE CONTEXT OF STAFFING SHORTAGES
Authors: Kabo Felix , Morrison Jake , Ritsema Chad
Published: January 2025

Aging populations are associated with a growing need and demand for specialized care, including healthcare environments that accommodate unique needs such as mobility assistance, chronic disease management, post-acute care, and mental health support. Currently, there are more than 46 million Americans aged 65 or over, and this number is projected to double by 2060. This demographic aging calls for an increased focus on design solutions like creating age-friendly spaces and ensuring accessibility. Designing healthcare environments that better support older adults is complicated by the staffing shortages in the American healthcare system. For example, there are significant projected shortages of both essential support staff (over 3 million in the next five years) and physicians (roughly 140,000 by 2033). These staffing shortfalls pose critical challenges to patient care, workplace culture and cohesion, and safety. The design of healthcare environments that better support older adults must mitigate the negative impacts of inadequate staffing levels and facilitate more efficient workflows e.g., enhancing interdisciplinary staff collaboration, promoting novel training opportunities, etc. This presentation examines the use of digital twins, effectively indistinguishable virtual representations of real-world physical objects (e.g., the human body, buildings, etc.), as part of a holistic design process that considers older adult patients, staffing and care delivery, and facility optimization. Digital twins have high fidelity and are linked to real-time data. They hold significant potential for designing age-friendly healthcare environments, optimizing staff and resource allocation, asset tracking, accelerated risk assessment, real-time decision support, and novel training simulations, thus improving care for older adults.
PROMOTING THE PATIENT EXPERIENCE AND WELL-BEING: LESSONS FROM GROUNDBREAKING PROJECTS IN HEALTH CARE DESIGN
Authors: Perreault Elisabeth , Kaminski Margi
Published: January 2025

The speakers will discuss how the built environment can and should support older adults in healthcare, rehabilitation, and long-term care facilities. They will share two case studies that showcase design solutions for older adults informed by the Living-Centered Design approach and focusing on long-term care and memory care for veterans, and recovery and rehabilitation, respectively. They will discuss current best practices in healthcare and long-term care design for older adults, and how the built environment can actively assist patient recovery and well-being. The first case study is the Veterans Home of California-Yountville (VHC-Yountville), which is under construction and nearing completion. This is a new 240-bed and 285,000 square feet (SF) skilled nursing and memory care facility by the California Department of Veterans Affairs (CalVet) and is located on CalVet’s historic campus in Napa Valley. Evidence-based design principles for older adults, including those with dementia and traumatic brain injuries, were applied to create a supportive, long-term care environment that effectively balances medical needs with the need for comfort and community. The second case study located in the state of New York is a new 9-story, 168-bed, and 189,600 SF urban rehabilitation facility for older adults focusing on patient-directed care. The patient services provided include medical care, physical, occupational, and speech therapy, diagnostic/ lab services, palliative care, social work, and mental health services. “Greenhouse” design principles were applied to create a post-acute rehabilitation facility that showcases how the building can be designed to actively catalyze and support patient recovery and rehabilitation.
ENGAGING COMMUNITY HOSPICE PROVIDERS TO SUPPORT VETERANS AND THEIR FAMILIES AT END-OF-LIFE
Authors: Dragan Deanna , Hagemann Lauren , Jarmul Cynthia
Published: January 2025

The VHA’s Empowering Community Hospices Initiative was developed to help strengthen the VHA’s coordination of care practices with non-VA providers. It is imperative that community hospice providers (CHP) be privy to the unique experiences of Veterans as their needs may be significantly different than those of a non-veteran at end-of-life (EOL) like specialized care and benefits for conditions such as PTSD, Moral injury and suicidality. For this project we completed a formal program evaluation study in collaboration with CHPs to explore the potential barriers and facilitators for creating and sustaining partnerships. Data collection included semi-structured interviews with stakeholders (n = 18) across multiple disciplines (e.g., Social Workers, Psychologists, Physicians, etc.) at the National, VISN, and local levels. Also, we conducted outreach efforts to local CHPs (n = 8), completed semi-structured interviews (n = 4), and coordinated face-to-face site visits (n = 4) for the VHA team to meet with the teams at each agency. These interviews revealed themes related to perceived barriers to and facilitators for achieving the goals of the initiative. Themes identified included: point of contact, timeline of hospice care, differences per agency, and need for resources to support Veterans’ families. CHPs collaborated with VHA to develop feasible partnerships with plans for sustainability using a consultation model of care. It is anticipated that the demand for EOL services may soon exceed the supply of care that VA facilities can provide; thus, these efforts may improve the access to services for Veterans in community hospice care settings.
CHALLENGES AND BENEFITS OF HOSTING US STUDY ABROAD STUDENTS AT THE COLLEGE OF HEALTH AND WELFARE
Authors: Bielsten Therése
Published: January 2025

Aging in a Welfare State is a course with the aim of student exchange of knowledge about the Swedish and US healthcare systems. The campus week’s main purpose is to stimulate students’ reflection on their own country’s healthcare system. The week is initiated with a day of perspectives of and study visits on Growing up in Sweden to introduce US students to Sweden’s welfare system. However, most of the week focuses on Aging in a Western Country, Old Age Care and Perspectives of Aging. Prior to the campus week students have prepared for discussions involving a case study of the US system and a paper with reflections on current and future challenges within old age care. Discussions and comparisons of Sweden’s universal high-state regime and US mixed system for older people are a valued feature of campus week. Along with lectures, discussions and study visits related to the welfare system, leisure activities are offered in the form of excursions to Swedish sights. Planning for the campus week requires high coordination. Some of the challenges associated with coordinating campus week involve recruiting Swedish students, getting students from different countries and campuses to interact, logistics of traveling, scheduling lectures and site visits. This presentation contributes challenges and success factors for internationalization in education. Campus week is a valued feature of the course and opens opportunities for students to gain theoretical knowledge at the same time as they have the opportunity for increased understanding through real life experiences of the study visits.
EVIDENCE-INFORMED ONLINE PLATFORMS FOR DEMENTIA CAREGIVERS
Authors: Stevens Alan , Czaja Sara
Published: January 2025

Online platforms for dementia care have emerged in response to the expressed desire of family caregivers for on-demand, self-paced education and dementia care skills training. Given the wealth of evidence-based dementia caregiver interventions, there is a unique opportunity to provide evidence-informed online services for family caregivers. Four online platforms for dementia caregivers will be discussed. Dr. Stevens will present an overview of two online platforms, GamePlan4Care (GP4C) and Resoures4Care (R4C). Preliminary findings suggest positive benefits to caregivers who engaged in either platform. The GP4C online platform has been modified to address the needs of family caregivers who experience the hospitalization of a Veteran living with dementia by Dr. Horstman. Preliminary findings from Dr. Horstman’s pilot study of GP4-Hospital in a VA hospital will be presented. Dr. Laura Gitlin’s presentation will focus on WeCareAdvisor, an online platform that provides daily tips to caregivers. Dr. Gitlin will present findings on the impact of multiple techniques used to engage family caregivers in using WeCareAdvisor. Dr. Eric Jutkowitz will provide an overview of Plans4Care, a translation of therapeutic strategies that address caregiver challenges from multiple in-person evidence-based dementia caregiver interventions into a single digital format. His presentation will focus on innovative online methods of tailoring therapeutic content to family caregivers. Dr. Sara Czaja, an international leader in developing, implementing, and evaluating technology-based solutions to late-life autonomy and caregiving support, will frame the findings of the four presentations within the US landscape of online support services for dementia caregivers.
GAMEPLAN4CARE AND RESOURCES4CARE: PRELIMINARY OUTCOMES ASSOCIATED WITH TWO ONLINE DEMENTIA CAREGIVING PROGRAMS
Authors: Stevens Alan , Cho Jinmyoung , Reese Jordan , Han Gang , Ory Marcia
Published: January 2025

GamePlan4Care (GP4C) and Resources4Care (R4C) are online dementia caregiver programs. GP4C consists of rules-based conditional logic algorithms and real-time assessments of caregiving risks to tailor and prioritize educational and skills content. R4C provides a searchable database of vetted online educational and resources focused on dementia and family caregiving. The content of R4C was chosen to parallel GP4C educational content but does not include tailoring of content based on real-time caregiver assessments. Other program similarities were the self-paced format for caregivers’ engagement with brief educational videos and skill-building exercises and access to a Dementia Care Specialist to further support caregivers’ engagement. Two hundred forty family caregivers of persons living with dementia (PLWD) were randomly assigned to either GP4C or R4C. Nearly 70% of enrolled caregivers lived with a PLWD. Half were adult child/child-in-law caregivers (52%) and 39% were spousal caregivers. Preliminary results are reported on three standardized assessments conducted at baseline and a 6-month follow: Zarit Caregiver Burden Interview (ZBI), Positive Aspects of Caregiving (PAC), and Social Provision Scale (SPS). Caregivers assigned to either GP4C or R4C reported a significant (P<.05) reduction in ZBI and improvement in PAC after 6 months of self-paced engagement in GP4C and R4C. Caregivers in GP4C also reported a significant increase in perception of receiving guidance support from family or friends (SPS). Both GP4C and R4C show promise as online platforms for dementia caregivers. Feedback from participants of this study suggest the need for improved functionality and revision of content to better meet diverse caregiver needs.
ADAPTATION OF GAMEPLAN4CARE FOR HOSPITAL CARE AND CARE TRANSITIONS
Authors: Horstman Molly , Evans Tracy , Guo Crystal , Sonnenfeld Mandi , Naik Aanand , Stevens Alan , Kunik Mark
Published: January 2025

Adults with dementia rely on family caregivers after hospital discharge. Increased caregiver stress following discharge may lead to worse outcomes for caregivers and adults with dementia. Our aim was to adapt GamePlan4Care, a community-based caregiver support intervention, to support caregivers of hospitalized adults with dementia. GamePlan4Care combines online, self-directed skills training with four phone calls from a dementia care specialist. Potential adaptations were identified through a literature review and semi-structured interviews with health professionals and caregivers. Adaptation prototypes were presented to caregiving research consultants, a stakeholder panel with a caregiver and health professionals, and individuals who implemented GamePlan4Care in the community. All adaptations were reviewed with the GamePlane4Care developer. We used the Framework for Modification and Adaptations-Expanded (FRAME) to describe the adaptations. Initial adaptations were planned and made during the pre-implementation stage. Adaptations included: 1) adding training content for care transitions (medication review, clinical red flags, delirium, functional decline, and medical tasks), 2) modifying the intervention content to improve caregiver engagement, and 3) modifying the context of intervention delivery. Additional adaptations will be made based on caregiver feedback from an ongoing feasibility and acceptability pilot. The recruitment target of 30 caregivers should be reached in June 2024. Preliminary results will be presented at the symposium. Evidence-based interventions designed for outpatient and community settings need to be adapted before they can be implemented as part of hospital care. Using insights from multiple sources, we developed HospitalGamePlan4Care, a new intervention that combines care transitions training with an evidence-based dementia caregiver support intervention.
HOW DOES THE NEIGHBORHOOD-BUILT ENVIRONMENT CONTRIBUTE TO SOCIAL HEALTH FOR PEOPLE LIVING WITH DEMENTIA?
Authors: Altona Janissa , Mena Emily , Schüz Benjamin , Wolf-Ostermann Karin
Published: January 2025

Several studies point to the importance of the neighbourhood-built environment (NBE) for the social health of community-dwelling people living with dementia (PlwD). Indicators of dementia-friendly urban planning can be identified in the literature, but little is known about which specific factors of the NBE are important for PlwD and family carers. In order to examine relevant indicators, the following questions were analyzed by a qualitative research approach in the German DEN-HB study: 1. Which places in the residential and living environment are subjectively perceived as positive or negative by PlwD and their carers, and how satisfied are they with the dementia-friendliness of their social space? 2. What is the role of social aspects of the NBE and which aspects are conducive to social health? Based on a systematic review of NBE factors and a subsequent empirical study on evaluating existing wayfinding structures in the federal state of Bremen, Germany, we will conduct individual interviews with PlwD and their informal carers to discuss the relevance of these factors. Additionally, a focus group with dementia coordination centres and responsible persons from ministerial institutions in Bremen, Germany, will be conducted to discuss possible actions in urban planning. Results of both qualitative research approaches will be presented and discussed to promote participatory approaches to the design of the NBE for PlwD and, in particular, to focus more strongly on social health factors.
FEASIBILITY OF A VIRTUAL CARE FARM FOR OLDER ADULTS WITH COGNITIVE AND PHYSICAL LIMITATIONS
Authors: Anderson Keith , Mauldin Rebecca , Westmore Megan , Tulloh Anna
Published: January 2025

Nature-based activities provide an array of physical, emotional, social, and spiritual benefits for people of all ages. Older adults with cognitive and physical limitations, however, are often excluded from these activities due to environmental, functional, and financial barriers. In this study, the researchers evaluated the feasibility of delivering a virtual (online), nature-based, group activity to older adults with physical and cognitive limitations in assisted living. Days at Dunrovin (D@D) is a “virtual care farm” featuring live web-cameras, recorded content, and online discussion boards that focus on life on a rural Montana ranch. Qualitative data from 18 interviews with participants, staff, and interventionists and 40 days of field notes were analyzed for themes related to feasibility. Themes were organized using an established framework of feasibility domains and outcomes. Results indicated that D@D was well-received by participants (Demand/Acceptability). Results also illuminated the process by which the researchers delivered and subsequently modified the activity (Implementation/Adaptation) in response to challenges presented by the assisted living environment, including the cognitive functioning of participants, the physical structure of the facility, and staffing issues (Practicality/Integration). A range of benefits (Effectiveness) were associated with D@D, such as gains in emotional well-being, increased socialization, enhanced engagement with nature, and stimulation of reminiscence. These findings suggest that it is feasible to deliver virtual, nature-based group activities to older adults with cognitive and physical limitations in long-term care. In doing so, we may be able to provide expanded access to the wonders of nature to this all too often excluded population.
DEVELOPING A STRATEGY TO SCREEN FOR CAREGIVER NEGLECT: EXAMINING EXISTING PUBLISHED TOOLS
Authors: Chang E-Shien , Elman Alyssa , Baek Daniel , Rosen Tony
Published: January 2025

Screening for elder mistreatment among older adults with dementia may be helpful, but the value of existing tools is not supported by evidence. Shifting the focus to individual sub-types of mistreatment may provide improved approaches to screening and ultimately to intervention. We have chosen to focus on caregiver neglect, the subtype associated with highest mortality and particularly common in dementia. As a preliminary step to develop a novel strategy to screen for caregiver neglect, we identified all existing published elder mistreatment screening tools to find items assessing for the presence of or risk for caregiver neglect. We identified 31 screening tools, which were all reviewed by 3 team members with complementary expertise (gerontology, social work, emergency medicine). Overall, none of the tools screened only for caregiver neglect. Among them, 22 (71%) included neglect-related items consisting of patient questions, caregiver questions, and provider observations. The total percent of items within each tool assessing for neglect ranged from 18-96%. After removing identical or very similar items, a final of list 202 was created, the majority of which (67.8%) were provider observations. These items were further grouped into 42 discrete categories: 11 categories of patient questions, 10 of caregiver questions, and 21 of provider observations. These serve as a clear starting point for development of caregiver neglect screening.
NOVEL METHODS, MODELS, AND METRICS FOR MEDICARE DATA TO UNDERSTAND RECOVERY AFTER HOSPITALIZATION FOR INJURY
Authors: Shardell Michelle , Ensrud Kristine
Published: January 2025

Medicare is the U.S. federal health insurance program for adults aged ≥65 years and some younger persons with specific conditions. The Medicare Minimum Data Set (MDS) is a standardized clinical assessment tool administered by the Centers for Medicare and Medicaid Services to facilitate care management for residents in Medicare and Medicaid certified nursing homes. Medicare administrative claims and MDS databases provide opportunity to generate novel and impactful real-world evidence, but deriving accurate conclusions can be difficult due to measurement and research design challenges. In this symposium, we illustrate four methods to overcome these challenges in the context of understanding mechanisms of post-hospitalization recovery among older adults, consistent with meeting theme “The Fortitude Factor”. First, we describe a new data science method to overcome unmeasured confounding when identifying factors associated with post-hospitalization monthly days at home (DAH), a person-centered metric that reflects aging in place, among older adults with Alzheimer’s Disease and Related Dementia (ADRD) who experience a hip fracture. We next examine the role of contextual socioeconomic disadvantage in recovery from hip fracture using weighting estimation to mitigate survival bias. To overcome bias from informative observation times in the MDS, we apply a flexible joint model to examine time-varying factors associated with post-fracture physical function among older adults with ADRD. Lastly, we innovatively apply latent variable analysis to identify post-hospitalization DAH trajectories among older adults with traumatic brain injury. We discuss how the gerontology community can use these bias-reducing approaches for policy-relevant health research with Medicare data.
TRAJECTORIES OF DAYS AT HOME FOLLOWING TRAUMATIC BRAIN INJURY AMONG OLDER ADULTS
Authors: Albrecht Jennifer , Chen Chixiang , Falvey Jason
Published: January 2025

Traumatic brain injury (TBI) is a common fall-related injury among older adults that results in over 123,000 hospitalizations and 485,000 emergency department visits annually. While older adults have poorer recovery following TBI relative to younger adults, most older adults recover well from TBI. Identifying those at increased risk of poor recovery could inform appropriate management pathways, facilitate discussions about palliative care or unmet needs and permit targeted intervention to optimize quality of life or recovery. Time spent at home and not in a hospital or other health care facility each month is a patient-centered measure associated with improved outcomes. We identified unique trajectories of monthly home time following hospitalization for TBI among Medicare beneficiaries aged ≥65 using group-based trajectory modelling and identified characteristics associated with poor recovery. Among 20,350 Medicare beneficiaries who sustained TBI between 2010-2018, four unique trajectories of home time were identified: poor recovery (9.5%), improving recovery (13.7%), good recovery (66.4%), and declining recovery (10.4%). Recovery of monthly home time was complete for most by three months post injury. The strongest predictors of membership in the poor relative to the good recovery trajectory group were diagnosis of ADRD (odd ratio (OR) 2.42; 95% confidence interval (CI) 2.16, 2.72) and dual eligibility for Medicaid, a proxy for socioeconomic vulnerability (OR 5.13; 95% CI 4.59, 5.74). Future studies should seek to further characterize and investigate identified recovery groups to inform management and development of interventions to improve recovery.
PRESIDENTIAL SYMPOSIUM: PRESIDENTIAL POLITICS AND THE FORTITUDE FACTOR: EMPOWERING OLDER ADULTS IN TODAY’S POLITICAL LANDSCAPE
Authors: Shippee Tetyana , Kaskie Brian
Published: January 2025

In the backdrop of a presidential election, the United States faces a critical issue: a diminishing unity within the advocacy community dedicated to addressing the needs of an aging population. While acknowledging past successes in securing significant public investments for older adults, there is a noticeable decline in advocacy cohesion as the older adults demographic continue to grow. Presenters highlight the need for renewed advocacy efforts, emphasizing intergenerational collaboration, to compel presidential candidates to address aging policy agendas. Presenters also challenge the reliance on individual fortitude in aging policies, arguing that systemic supports are essential to equitable outcomes. They advocate for rethinking aging policies, emphasizing collective action and alternative organizing principles, especially in light of the complex challenges faced by older adults.
WHERE HAVE ALL THE ADVOCATES GONE?
Authors: Stone Robyn
Published: January 2025

We face a serious challenge as we enter this presidential election season: the lack of a unified advocacy community to support a coherent national political platform that needs to be addressed around the aging of the U.S. population over the next 15 years and into the future. This presentation briefly summarizes the history of the modern advocacy movement to improve the lives of older adults who were more likely than any other age group to be living in poverty in the 1960s and 1970s. The advocacy organizations were strong and united, helping to secure huge public investments including Medicare and Medicaid, affordable senior housing and the establishment of an aging network. Strong champions on Capitol Hill and in the executive branch supported these policies and investments. Ironically, as the older adult population is living longer, and the baby boomer population has grown larger than those under age 18, the advocacy voice has either disappeared or has become diffuse and less powerful. We need new advocacy efforts that bring younger and older generations together to advocate for an aging policy agenda that both presidential candidates are forced to acknowledge and address. The climate change advocacy approach that calls for short and long-term solutions to benefit current and future generations may provide a good framework for an intergenerational aging movement. When generations across age, racial/ethnic identity and other diverse groups (including class) see they are all in this together, a collective fortitude can emerge.
THE LIMITS OF FORTITUDE: PRINCIPLES FOR ADVANCING EQUITABLE AGING POLICY
Authors: Lowers Jane
Published: January 2025

Fortitude – an individual’s ability to endure difficulty or adversity – is an implicit premise in U.S. aging policies, which require individuals and families to shoulder the financial, physical, and emotional costs of aging. Emphasizing fortitude in any discussion of aging obscures the assumption that it works best when accompanied by a lifetime accumulation of wealth and other tangible and intangible supports. When systemic supports for aging are fractured and inadequate, no amount of individual fortitude can adequately bolster older adults challenged by fixed incomes, decreased availability of family caregivers, and lengthening years with chronic and progressive illness. Using examples of adults aging solo with dementia, this presentation will propose alternatives to fortitude as organizing principles for rethinking U.S. aging policy.
PRESIDENTIAL POLITICS AND THE FORTITUDE FACTOR
Authors: Lindberg Brian
Published: January 2025

Education, engagement, advocacy, and coalition building are key elements of GSA’s ongoing work in the nation’s capital. Election years provide both opportunities and challenges for working in the legislative and regulatory processes, and GSA staff and our members across the country have become effective in sharing the research, policy development, and practice experiences with policymakers in DC. Although the field may face challenges in “advocacy cohesion,” this presentation will include examples of the continued strength of aging advocates in the face of ageism and generational competition for resources. GSA’s intergenerational approach to engagement and our recent policy initiatives will be discussed. The presentation will include examples of the strength of aging advocacy organizations and their ability to successfully protect federal programs facing proposed cuts or elimination and securing billions of dollars in additional resources during the COVID-19 pandemic. While the timing is not good for large new entitlement programs, coalitions have been successful in improving benefits such as home delivered meals, tackling the social isolation crisis, providing resources for caregivers, and reducing the cost of Medicare prescription drugs and more. GSA is often providing the evidence to support these positive steps.
ENRICHING EARLY-LIFE ACTIVITIES AND LATER-LIFE COGNITION: THE MODERATING ROLE OF MULTIPLE SOCIAL POSITIONS
Authors: Reynolds Addam
Published: January 2025

Mounting evidence suggests that associations between early life factors and later life cognition are not universal across racialized populations. While evidence suggests that enriching early life activities (EELA) are protective for cognitive aging, no study has evaluated if this association is equally salient for older Black adults across the socioeconomic gradient. Using data from the Life History Mail Survey in the Health and Retirement study, we employ a growth curve analysis to estimate the association between EELA and later life cognition among non-Hispanic White and Black older adults. We also test for moderating effects to assess the relative importance of race and childhood socioeconomic status (cSES) in this association. I found evidence of a three-way interaction between, EELA, cSES and race (b = 0.26, p <.05). Among non-Hispanic White older adults, we observed a stronger relationship between EELA and baseline cognition among those with lower levels of cSES. Among Black participants, we observed the opposite effect. Among Black participants with one standard deviation below the mean of cSES, there was no effect of EELA on baseline cognition. This study suggests that associations between EELA and later life cognition are conditional on multiple social positions, rather than being universal across populations. While White individuals with lower cSES have the most to gain from EELA, Black individuals from similar backgrounds do not benefit from EELA. The implication of this finding suggests that EELA may buffer against the negative effects of lower cSES among White, but not Black participants.
TECHNOLOGY-BASED PHYSIO-FEEDBACK EXERCISE PROGRAM (PEER) TO PREVENT FALLS AND ENHANCE HEALTH EQUITY
Authors: Thiamwong Ladda , Xie Rui , Lighthall Nichole , Loerzel Victoria , Park Joon-Hyuk , Stout Jeffrey
Published: January 2025

Only a few studies have focused on low-income older adults with a mismatch between perceived fall risk and physiological fall risk. We developed a Physio-fEedback Exercise pRogram (PEER) which includes a) physio-feedback using a real-time portable innovative technology—the BTrackS Balance System: BBS; b) cognitive reframing based on a novel fall risk appraisal matrix; and c) peer-led exercise by focusing on balance and strength training. This NIH-funded clustered randomized control trial is led by an interdisciplinary team representing nursing, kinesiology, cognitive psychology, engineering, and data science. We aim to prevent falls and reduce health disparities by facilitating shifts from maladaptive to adaptive fall risk appraisal (i.e., moving from irrational, incongruent, or congruent to the rational quadrant) The 8-week PEER intervention is offered at low-income independent living communities/units in Central Florida through our partnership with community-based and public health organizations. We collected data at baseline and measured outcomes after program completion and found that 17.78 % of the participants in the PEER group (n=45) had adaptive shifting compared to 13.46 % in the control group (n=52). Up to 24.99% of the control group had maladaptive shifting compared to only 12.73% of the PEER group. The PEER intervention results in a shift from maladaptive to adaptive as a way of preventing falls, which is novel, and PEER may slow down the maladaptive shifting process. Integrating technology into fall risk assessments could increase engagement in fall interventions in low-income settings due to barriers faced by older adults regarding accessibility, knowledge, and healthcare costs.
CLUSTERING OF MULTIDIMENSIONAL NEIGHBORHOOD CHARACTERISTICS IN SHAPING HEALTHY AGING
Authors: Yu Jiao , Qin Weidi , Wang Jiuzhou , Kahana Eva
Published: January 2025

Neighborhoods are pivotal in shaping later life health and well-being. While previous research has primarily examined a single dimension of neighborhood risk factors (e.g., socioeconomic disadvantages), this study proposes a timely shift toward a multi-dimensional perspective of neighborhood characteristics. We aim to explore how multiple neighborhood characteristics synergistically shape various later life health outcomes, including comorbidity, disabilities (ADL), mental health, functional limitations, cognitive health, and epigenetic aging (GrimAge). Using data from the 2014 and 2016 waves of the Health and Retirement Study linked to the National Neighborhood Data Archive (n = 8,474), we first applied a machine learning algorithm -- the Partitioning Around Medoids (PAM) method to identify a neighborhood typology based on neighborhood-level socioeconomic status, facilities, services, and hazards. This analysis identified four clusters: affluent neighborhoods, mid-SES with high hazards neighborhoods, high amenity neighborhoods, and disadvantaged neighborhoods. Subsequently, we conducted multilevel regression analyses to examine the association between the identified neighborhood clusters and later life health outcomes. Regression results revealed significant health disparities across different neighborhood clusters. Compared to their counterparts living in affluent neighborhoods, older adults residing in disadvantaged neighborhoods and those in mid-SES with high hazards neighborhoods experienced greater chronic conditions, worse mental health, and more functional limitations. These findings underscore the urgent need for tailored interventions aimed at enhancing service facilities and mitigating environmental hazards in disadvantaged and high-risk communities. Addressing these neighborhood factors is essential for promoting communities that are conducive to healthy aging and supportive of successful aging in place.
TOXIC HOMES AND COMMUNITIES? EXPOSURE TO URBAN FIRES AND INCREASED LIFE COURSE DEMENTIA RISK
Authors: Finlay Jessica , Bowman Grace , Miller Matthew , Reid Colleen
Published: January 2025

Little is known about the health impacts of wildland urban interface (WUI) fires, which are increasingly common and mostly burn human-made materials. The Marshall Fire Community Health Research Study investigated a destructive WUI fire that affected communities of Superior and Louisville (CO) on December 30, 2021. Semi-structured seated and mobile interviews conducted July through November 2023 probed for perceived impacts on physical, mental, social, and cognitive health. Participants (n=44) were on average 52 years old (±16 years), 86% identified as Non-Hispanic White, 67% female, 86% homeowners, and 46.5% of participant homes were fully destroyed (53.5% smoke damaged). Reflexive thematic analysis identified behavioral and social pathways that may pose longer-term risk for Alzheimer’s Disease and Related Dementias across the life course. This includes early-life educational disruptions (e.g., displacement and stress/anxiety) and mid-life increased risk for hypertension, obesity, and alcohol consumption through heightened stress, lack of time and motivation for diet and exercise, maladaptive coping mechanisms, poor sleep quality, and reduced access to health-promoting services. Later life factors include increased risk for depression, social isolation, physical inactivity, diabetes, and exposure to poorer air quality. These risks varied by individual factors such as education, employment, insurance coverage, type of fire damage, and household composition. Individuals whose homes were smoke damaged may be particularly vulnerable. The study identifies novel behavioral and social pathways through which WUI fires may pose multifaceted and long-term cognitive health risks beyond the acute recovery phase.
SLEEP QUALITY IMPROVES IN DEMENTIA CAREGIVERS USING ONLINE SELF-GUIDED ACCEPTANCE AND COMMITMENT THERAPY
Authors: Fauth Elizabeth , Gossner Jacob , Juhasz Audrey , Aller Ty , Levin Michael
Published: January 2025

Transdiagnostic interventions treat multiple conditions by addressing common underlying mechanisms. Randomized controlled trials, systematic reviews, and meta-analyses support that Acceptance and Commitment Therapy (ACT) is a transdiagnostic mindfulness-based Cognitive Behavioral Therapy that improves anxiety, depression, pain, etc. in diverse populations. ACT efficacy is supported in dementia caregivers, typically studied via psychological or care-related outcomes. ACT improves sleep in cancer caregivers, and sleep is often disturbed in dementia caregivers. The current study examines if sleep quality improves in (N=80) dementia caregivers engaging with a caregiver-tailored six-session online, self-guided ACT program. Participants completed the Sleep Quality Scale and other assessments at T1 (pre-intervention), T2 (post-intervention) and T3 (6-week followup). A sleep-related item from a depression inventory assessed sleep restlessness. Items from a behavioral symptom inventory assessed the extent to which care receivers woke the caregiver or others in the night, and assessed caregivers’ stress appraisal of this experience. We did not hypothesize that care receivers’ wakefulness would be impacted, but hypothesized improvements in the other caregiver sleep indicators. Repeated measures ANOVA identified that caregivers improved average sleep quality [F(2,158)=7.907, p<.001; partial eta-squared =.091] and reported less sleep restlessness [F(2,156)=10.039, p<.001; partial eta-squared =.114]. Post hoc comparisons identified change occurring between T1-T2 (Intervention phase), sustained over time (T3). Care receivers’ waking behavior did not change over time (p=n.s.), but caregivers experiencing this behavior across all timepoints (N=17), reported being less bothered by it [F(2,32)=5.457, p<.01; partial eta-squared =.254]. ACT interventions offer promise in improving sleep experiences for dementia caregivers.
THE COMBINED IMPACT OF MIDLIFE AND LATE-LIFE VASCULAR RISK FACTORS ON 33-YEAR INCIDENT DEMENTIA: THE ARIC STUDY
Authors: Smith Jason , Pike James , Lutsey Pamela , Sharrett Richey , Gross Alden , Deal Jennifer
Published: January 2025

Midlife vascular risk factors are associated with an increased risk of dementia. However, the overall contribution of modifiable vascular risk factors in midlife and late-life to dementia remains unclear. In this study, we quantified population attributable fractions, which account for risk factor prevalence and strength of relative risks, of incident dementia from vascular risk factors measured in midlife and early late-life. We used 33 years of prospective cohort data in the Atherosclerosis Risk in Communities (ARIC) Study. Incident dementia was ascertained from baseline (1987-1989) through December 31, 2020. We quantified population attributable fractions of incident dementia by age 80 from the combination of hypertension, diabetes, and self-reported current cigarette smoking (at least one risk factor versus none) measured at different ages (45-54 [n=7,731], 55-64 [n=12,273]; 65-74 [n=6,660]). Overall, the prevalence of having one or more of the vascular risk factors was 61.6% at age 45-54, increasing to 68.2% by age 55-64 and 77.5% by age 65-74. The population attributable fraction of dementia from having one or more vascular risk factors increased from 22.7% (95% CI: 15.3-30.1%) for risk factors measured at age 45-54 to 26.4% (95% CI: 19.1-33.6%) at age 55-64 and 45.4% (95% CI: 32.5-58.3%) for risk factors measured at age 65-74. Our data indicate between 23%-45% of incident dementia cases in ARIC were attributed to a combination of hypertension, diabetes, or current smoking up through age 74. Public health strategies targeting modifiable vascular risk factors could delay or prevent new dementia cases.