bluuebunny/crossref_metadata_2025 huggingface dataset:
EVERYDAY SOLITUDE, TIME SAVORING, WELL-BEING, AND HEALTH IN OLDER ADULTHOOD
Authors: Pauly Theresa , Wallimann Miriam , Peleg Shira
Published: December 2023

Despite the significance of social relationships, solitude (being alone and without social interaction) forms an essential part of older adults’ lives. The current study aimed to examine the role of time savouring (i.e., the ability to attend to positive experiences and up-regulate positive feelings) for mitigating associations of solitude with indicators of negative well-being and health in old age. For this purpose, a sample of 108 older adults aged 65–92 years took part in a daily diary study. Over 14 days, participants reported daily amount of time spent in solitude, extent of time savouring, levels of depressive mood, and somatic symptoms in an end-of-day diary. Data were analysed using multi-level models controlling for study day, age, gender, education, and living alone. Participants reported higher depressive mood but not more somatic symptoms on days on which they spent more time in solitude than usual. On days on which participants indicated higher time savouring than usual, they reported lower depressive mood and lower levels of somatic symptoms. Importantly, associations of solitude with depressive mood and somatic symptoms were weaker on days with increased time savouring. There were no person-level associations between solitude or time savouring with depressive mood or somatic symptoms. The study’s findings highlight the importance of everyday time savouring in attenuating negative health-related aspects of solitude in older adults. Preserving and promoting time savouring in older adulthood may thus promote health and well-being in this age group.
AGE-RELATED DIFFERENCES IN DAILY EXPERIENCES OF HAPPINESS: THE ROLE OF THINKING ABOUT THE FUTURE
Authors: Choi Yoonseok , Lay Jennifer , Lu Minjie , Jiang Da , Fung Helene , Graf Peter , Hoppmann Christiane
Published: December 2023

We examined the role of future time perspective (thinking about the future) in shaping age-related differences in time-varying experiences of happiness. Older adults’ experience of happiness is more strongly associated with low-arousal than with high-arousal positive affect. Low-arousal positive affective states may be conducive to engaging in meaningful social interactions with close others (e.g., listening, adjusting to others) and therefore serve key socio-emotional goals that are prioritized when future time is perceived as limited. We hypothesized that thinking less about the future would be related to stronger associations between happiness and low-arousal positive states in older than younger adults. We used daily life assessments from 258 participants (M = 48.4 years; 68% female; 77% Asian; 73% post-secondary education), which comprised older (M = 63.4 years) and younger (M = 20.1 years) adult samples collected at two locations (Vancouver, Canada; Hong Kong). Participants reported on their momentary affective states and thinking about the future (0-100 scales) up to 30 times over 10 days. Results replicate previous findings by showing that momentary happiness was more strongly associated with momentary calmness and more weakly associated with momentary excitement among older as compared to younger adults. Younger adults reported thinking more about the future than older adults. Thinking less about the future was related to stronger happiness-calmness and weaker happiness-excitement associations in daily life for older participants, only; for younger participants, it was associated with weaker happiness-calmness associations. Age and future thinking-related contours of happiness are discussed in the context of emotional aging theories.
METHODOLOGICAL CHALLENGES AND OPPORTUNITIES FOR STUDYING RESILIENCE
Authors: Varadhan Ravi , Bandeen-Roche Karen , Kuchel George
Published: December 2023

Many older adults experience a major stressor at some point in their lives. The ability to recover and live well after a major stressor is known as resilience. An important goal of geriatric research is to identify factors which influence resilience to stressors, and ultimately, to devise strategies to enhance the resilience of older adults. In order to accomplish these worthy aims, several methodological challenges need to be addressed. Methodologies for studying resilience in clinical settings are only recently being developed. Investigators at Duke, Johns Hopkins, and Radboud Universities are studying cohorts of older individuals who are undergoing invasive clinical procedures using longitudinal designs. These studies collect a vast array of information on each participant including socio-demographics, health status, physical, cognitive, psychological, and biological functions. Also, large amount of experimental data is collected on the dynamics of select physiological systems as probes of resilience (“deep phenotyping”). Deep phenotyping leads to several challenges in the conduct and analysis of the study including selective participation (selection bias), informatively missing data, characterizing resilient responses based upon trajectories of multidimensional measures before and after stressor, modeling dynamical systems experimental data, and quantification of resilience capacity and its determinants. In this symposium, we will discuss some of the critical methodological challenges of studying resilience and present approaches to address them. At the end of this symposium, the audience members should understand the importance of designs and analytic challenges in studying resilience, and become knowledgeable on the approaches to overcome methodological challenges.
APPROACHES TO QUANTITATIVELY EXAMINE RESILIENCE IN OLD AGE
Authors: Melis Rene , Kok Almar , Huisman Martijn
Published: December 2023

Resilience is a complex system’s ability to maintain or recover in function following a perturbation. The concept is generic and can be applied to any complex system going from a cell, a person, to their support networks. By applying a resilience approach, we can better understand why people respond differently to a similar exposure. While most people have an intuitive understanding of what resilience is, it’s definition and application is not straightforward. Therefore, it is important to carefully define the stressor, system and (functional) outcome(s) and how it is studied using e.g., the TransNIH resilience framework. Quantitative examination of resilience can focus on predictors, mechanisms, trajectories and/or outcomes and each aspect requires a different analytical approach. This talk will review different quantitative approaches to examine resilience in the context of aging. These approaches can be categorized based on the statistical methods that are used to operationalize resilience: the effect modification approach to study how hypothesized resilience factors modify the outcome following perturbation, scale construction in the psychometric approach, comparison of characteristics between groups based on predefined prospective resilience responses in the a priori approach, data-driven subgroup identification based on resilience outcome (trajectories) in the clustering approach, analyzing predictors of adversity-outcome residual values in the residual approach, and analyzing stressor-response patterns in intensive longitudinal data to better understand resilience mechanisms. The approaches are not mutually exclusive. Researchers may choose to combine multiple approaches and may analyze the same data using multiple approaches to compare the findings between them.
STATISTICAL MODELS FOR ESTIMATING RESILIENCE
Authors: Pieper Carl , Colon-Emeric Cathleen , Sloane Richard , Peskoe Sarah , Whitson Heather
Published: December 2023

One important component of the Resilience paradigm is the degree of initial change and rapidity of recovery after a stressor. Resilience is determined by both the degree of response, if any, to an insult and, subsequently, the process of return to the initial state. Modeling the recovery process requires use of longitudinal analysis which can incorporate the underlying non-linear trajectory of change, and the multiple systems impacted by the stressor. We will show the models we have employed for one common stressor, surgery. First, we will define and show findings on the Expected Predicted Differential (ERD), the difference between predicted and observed recovery. Second, we will show multivariate trajectories of recovery to demonstrate methods to (1) define typologies of recovery, using PCA, and (2) typologies of individuals in type of recovery, using latent class analysis of trajectories. Second, given the state of the emerging art in resilience research, we will provide a statistician’s view on enhancing the resilience research through design (increasing number and timing of measurements, the number of subjects, and expanding use of the EHR), data structures (incorporating measurements from a greater number of diverse sources, using timing of measures to allow for assessment of dynamic mediation and moderation effects in defining the process), and analysis - extending the ERD to modeling non-linear recovery, incorporating causal analysis, including dynamic mediating and moderating effects into the analytic structure, use Area Under the Curve as a metric for recovery, latent class analysis, and use of multivariate trajectory analysis.
MECHANISMS UNDERLYING SLEEP AND DEVELOPMENT OF CHRONIC CONDITIONS IN OLDER ADULTS
Authors: Kaufmann Christopher , Lee Soomi , McCrae Christina
Published: December 2023

Mounting evidence suggests poor sleep is associated with the development of chronic conditions. Numerous mechanisms for these links have been proposed, including inflammation, metabolic function, and brain structure. In this symposium, we will present five studies focused on links between poor sleep and subsequent development of chronic disease across adulthood. Specifically, we will examine this relationship at multiple levels from the cellular to the clinical level with the ultimate goal of identifying potential mechanisms and consequences of links between poor sleep and chronic conditions. Paper 1 will identify within-person patterns of various sleep experiences and link them to incident chronic conditions over a 10-year period. Paper 2 will examine associations between sleep parameters, measured via wrist actigraphy, and levels of adipokines, which are adipose-derived cytokines associated with development of metabolic disease. In Paper 3, we will shift our focus to examine the association between poor sleep and inflammatory biomarkers, specifically C-reactive protein, circulating and lipopolysaccharide-stimulated cytokines. Paper 4 will assess the impact of poor sleep health on fear of falling and actual falls. Paper 5 will focus on the effects of poor sleep and arousal with cognition and brain structure, specifically within a population of patients with chronic pain. As Discussant, Dr. Christina McCrae will integrate these findings and suggest directions for future research. In summary, our symposium will elucidate biological and psychological mechanisms linking poor sleep to manifestation of chronic disease. Better understanding of these mechanisms will inform the development of interventions to promote successful aging.
SLEEP TIGHT, STAY HEALTHY? MULTIDIMENSIONAL SLEEP HEALTH AND CHRONIC CONDITION DEVELOPMENT OVER ONE DECADE
Authors: Smith Claire , Lee Soomi
Published: December 2023

Chronic conditions affect half of adults and are the leading cause of death in the United States. Healthy sleep is a modifiable risk factor, but greater information is needed about specific sleep experiences linked to chronic condition development. The present study aims to (1) identify within-person patterns of various sleep experiences (i.e., sleep health phenotypes describing sleep duration, regularity, sleep onset latency, insomnia symptoms, daytime tiredness, and nap frequency) and (2) understand the connection between transitions in sleep health phenotypes and chronic condition development. We use self-report data from a national sample of adults (N=5,026) taken from the Midlife in the United States (MIDUS) study across two waves (II and III) separated by about ten years. Latent transition analysis revealed four sleep phenotypes: good sleepers (optimal sleep across dimensions), insomnia sleepers (short duration, long sleep onset latency, high daytime tiredness, frequent insomnia symptoms), weekend catch-up sleepers (long sleep duration on weekends compared to weekdays), and nappers (frequent naps). For cardiovascular conditions, consistent insomnia sleepers (i.e., insomnia sleeper -> insomnia sleeper) were at 72% higher risk (CI:[1.04, 2.82]) than consistently good sleepers. For diabetes, consistent insomnia sleepers again were at higher risk (188%; CI:[1.72,4.79]) as were consistent nappers (128%; CI:[1.26,4.09]) and weekend catch-up sleepers -> nappers (137%; CI:[1.21,4.60]). For cancers, only nappers -> insomnia sleepers exhibited higher risk (45%; CI:[1.16,1.83]). We newly identify two sleep health phenotypes (napper and, especially, insomnia sleeper) as risks for developing life-threatening chronic conditions.
ASSOCIATIONS OF ACTIGRAPHIC SLEEP WITH ADIPOKINES IN OLDER ADULTS
Authors: Yue Yiwei , Wei Zhikui , Rabinowitz Jill , Chia Chee , Tanaka Toshiko , Simonsick Eleanor , Ferrucci Luigi , Spira Adam
Published: December 2023

Adipokines are adipose-derived cytokines that play important roles in metabolism and obesity. Accumulating evidence suggests that sleep disturbance could alter adipokine levels and contribute to systemic metabolic dysfunction in younger and middle-aged populations. Less is known about links between sleep disturbance and adipokines in older adults. We examined cross-sectional associations of actigraphic sleep parameters with adipokine levels in 353 community-dwelling older adults aged 74.8±8.3 years (51.3% male, 26.6% non-white) enrolled in the Baltimore Longitudinal Study of Aging. Participants completed 6.56±1.06 nights of wrist actigraphy and had morning fasting adipokine levels measured in plasma. Predictors included actigraphic total sleep time, sleep onset latency, wake after sleep onset, sleep efficiency, and average wake bout length (WBL), and outcomes were levels of the adipokines, specifically adiponectin and leptin. Adjusting for sex, age, race, years of education, BMI, hypertension, and diabetes, longer WBL was associated with lower adiponectin (B=-1.73, 95%CI: -3.07,-0.38) and leptin (B=-2.93, 95%CI: -4.61,-1.24). WBL interacted with sex (p-value for interaction = 0.018); higher WBL was associated with lower adiponectin in men (B=-4.12, 95%CI: -6.46, -1.79), but not in women (B=-0.34, 95%CI: -2.48,1.80). Findings link sleep fragmentation to lower leptin and adiponectin in older adults, particularly lower adiponectin in older men. Findings provide a potential mechanism by which disturbed sleep may promote metabolic derangements in later life. Prospective studies and sleep intervention trials are needed to evaluate whether these associations are causal, and to elucidate factors contributing to sex differences in these associations.
GENDER DIFFERENCES IN THE ASSOCIATION BETWEEN SLEEP AND INFLAMMATORY MARKERS: RESULTS FROM THE EINSTEIN AGING STUDY
Authors: Ji Linying , Shen Yuqi , Graham-Engeland Jennifer , Derby Carol , Engeland Christopher , Buxton Orfeu
Published: December 2023

Prior research links poor sleep and higher systemic inflammation. Gender differences in both sleep and in inflammatory responses have been observed. We investigated gender differences in the association between levels as well as variability of objective sleep health and inflammatory markers (including stimulated inflammatory markers) among a diverse sample of older adults. Participants free of dementia (N=215, Mage=77.5 years, 64% women; 46% White, 39% Black, 15% Hispanic/other) were from The Einstein Aging Study. Actigraphy (2 weeks) yielded wake after sleep onset (WASO), total night sleep time (TST), and midpoint night sleep. Inflammatory markers included circulating C-reactive protein (CRP) and circulating and lipopolysaccharide (LPS)-stimulated levels of interleukin (IL)-1β, IL-4, IL-6, IL-8, IL-10, and tumor necrosis factor (TNF)-𝛼. Bayesian variability models evaluated associations of inflammatory markers with mean and variability of sleep measures, adjusted for BMI, gender, age, education, race/ethnicity. Circulating inflammatory markers were not associated with sleep measures, except higher TST variability with higher circulating IL-6 among women. For stimulated cytokines, among men, higher mean WASO, TST, and later midpoint were associated with higher stimulated IL-8 and TNF-𝛼. All stimulated cytokines except IL-1β were associated with greater variability in WASO, TST, and sleep timing among men. Among women, the only significant association with stimulated cytokines was between higher mean TST and higher stimulated IL-8. We found gender differences in the associations between sleep and inflammation in older adults, primarily in men and for stimulated (not circulating) cytokines. Interestingly, associations were also more frequently observed for sleep variability than mean levels.
PHYSIOLOGICAL LINKAGE WITH CAREGIVERS IS ASSOCIATED WITH EMOTION RECOGNITION IN CARE RECIPIENTS
Authors: Chen Kuan-Hua , Casey James , Brown Casey , Merrilees Jennifer , Levenson Robert
Published: December 2023

Persons with neurodegenerative diseases (PWDs) often develop profound declines in the ability to recognize emotions in others that lead to diminished social connectedness with their loved ones. Physiological linkage, which refers to the degree that people’s physiological responses change in coordinated ways, can serve as a proxy measure for social connectedness. Physiological linkage has been found to be diminished during interactions between PWDs (i.e., care recipients) and their family caregivers. However, the association between diminished physiological linkage and PWDs’ lower emotion recognition has not been determined. In a sample of 28 PWD-family caregiver dyads, we quantified physiological linkage as the positive (“in-phase”) correlations between PWD’s and caregiver’s somatic activity. Somatic activity was measured remotely via actigraphy using wristwatches worn by both partners in their homes during waking hours for 7 days. PWDs’ emotion recognition was quantified as the ability to recognize positive and negative emotions of their caregivers accurately during a 10-minute conflict conversation in our laboratory prior to the 7-day home assessment. Lower emotion recognition by PWDs of their caregivers’ negative emotions (β = .49, p = .01), but not positive emotions (β = .12, p = .52) in the laboratory assessment was associated with lower physiological linkage between PWDs and caregivers in their home. Establishing a relationship between PWDs’ deficits in emotion recognition and diminished physiological linkage during conversations with their caregivers provides a basis for understanding problems in establishing social connections that are often observed in PWDs.
GENDER-BASED VIOLENCE IN HOMICIDE–SUICIDE EVENTS: A CALL FOR ADHERENCE TO THE CDC DEFINITION FOR “MERCY KILLING”
Authors: Salari Sonia , Sillito Carrie , Videla Emma
Published: December 2023

Intimate partner homicide suicide (IPHS) events are overwhelmingly male perpetrated (90%). Gender-based violence (GBV) prevention requires ‘best practices’ for media reporting. Consider the following: In a patient room of a busy hospital, an overwhelmed man (71) suicided after firing shots at his wife (70) who had survived a stroke. The gunfire caused trauma among witnesses. Media reports used the term ‘mercy killing,’ but critical ingredients were missing. The CDC’s NVDRS (2022) defines ‘mercy killing’ as “…Killed, at the victim’s request…to end…pain or distress…Do not assume…murder/suicide by a sick, elderly couple is mercy killing.” Evidence of a clear wish to die, is needed “due to a hopeless or terminal condition.” Our IPHS, news surveillance study was updated 1999-2022 and used content analysis to identify GBV rationalizations, based upon 2219 events and over 5000 fatalities across young (n=987), middle aged (n=699), and older 60+ (n=533) categories. Only the 60+ group had claims of ‘mercy killing,’ mostly without adherence to the CDC definition. Older men who are suicidal may also harm an unsuspecting partner. For women, end of life decision-making is lost in ‘safe spaces,’ like homes or care facilities, which is made worse by rationalized excuses. Women are rarely suicidal and use passive methods (i.e., drugs). When women care for an ailing partner, they don’t commit IPHS. Older men are more suicidal and utilize more lethal firearm methods (similar to the IPHS patterns). Media best practices involve valuing persons with disabilities, publicizing services and recognizing violence is a public health problem.
MIGRATION AS A PATHWAY TO KINLESSNESS AMONG OLDER ADULTS LEFT BEHIND
Authors: Matos-Moreno Amilcar , Santos-Lozada Alexis , Sheftel Mara , Verdery Ashton
Published: December 2023

Recent research examines the topic of kinless adults, people over the age of 50 who have neither a living spouse nor living children. Crossnational examinations find that the prevalence of kinlessness in these age groups ranges between 2% and 10% in most countries around the world and that kinless individuals tend to be disadvantaged on health and well-being dimensions. Prior work has not, however, examined migration in the context of kinlessness. Given high rates of migration in numerous sending contexts around the world, this study examines the prevalence of kinlessness in Puerto Rico, Mexico, Costa Rica, and the United States incorporating migration as a pathway to kinlessness and examining its association with well-being. Using surveys from the Health and Retirement family of studies from Puerto Rico, Mexico, Costa Rica, and the United States, we estimate the prevalence of kinlessness focusing on how these estimates change when treating adult family migrants as not available for the provision of social support. We also estimate the association between kinless typologies and health status. Puerto Rico exhibits the highest older adult kinlessness prevalence (Puerto Rico: 8.4%, Costa Rica:6.0%, Mexico:6.5%, United States:7.2%). The incorporation of migration as a pathway to kinlessness increases the prevalence in Puerto Rico (+3.8%) and Mexico (+5.2%) more so than for Costa Rica or United States. Kinlessness is associated with higher levels of depression among Puerto Rican older adults. This study reveals the importance of considering migration as a pathway to kinlessness in high outmigration countries and its impact on health.
THE CO-EVOLUTION OF PERSONAL NETWORKS AND LONELINESS FOLLOWING WIDOWHOOD FOR MEN AND WOMEN
Authors: Lee Jina , Schafer Markus
Published: December 2023

Late-life transitions such as widowhood often re-calibrate people’s close personal networks. Some network change—particularly growth in network size and closer geographic access to network members—is assumed to protect against loneliness, but scholars have yet to systematically examine these processes post widowhood. This study uses data from four waves of the German Aging Survey (DEAS), conducting gender-specific hybrid panel modeling to estimate both within- and between-individual effects of (1) network conditions up to seven years past widowhood, and (2) the effects of network change on loneliness. Results reveal that network size takes on a reversed U-shape: Germans becoming widowed tend to see an influx of new core ties from beyond their family, but this trend slows and reverses with time. There was also some evidence of non-linear change related to distance: geographic distance to core network members tended to shrink following widowhood before expanding back outward. Furthermore, moderation analyses an important role for these network characteristics on loneliness. Larger non-kin networks in the aftermath of widowhood partially alleviated the loneliness associated with that transition. The role of geographic proximity was gender-specific, as widowed men with nearby non-kin ties were most protected against loneliness, whereas widowed women fared best if their kin ties were farther away. Altogether, this study presents novel insight into how personal networks evolve after widowhood, revealing the nuanced, gendered ways that networks adapt. Efforts to reduce loneliness after widowhood may consider how gender roles and expectations shape the transmission and meaning of companionship and support.
PILOT RCT TO EXAMINE A MOBILE HEALTHY EATING INTERVENTION FOR PERSONS WITH FRAILTY
Authors: Zaslavsky Oleg , Wu Kuan-Ching , Naik Aishwarya , Su Yan
Published: December 2023

New scalable approaches are needed to promote healthy eating and improve health in persons with frailty. We evaluated a new mobile intervention consisting of a patient-facing app and clinician interface to support Mediterranean-style eating in a pilot RCT. Fourteen females and one male, averaging 71 years of age, were randomized to intervention (n=8) or control (n=7) for three months. In the intervention, participants were encouraged to interact with the app at least once a week, whereas, in control, participants received handouts with information and online resources concerning the Mediterranean Diet. Mann-Whitney and Cohen’s d estimates were used to compare groups and evaluate effects. All participants completed and consistently adhered to the study protocol throughout the study. At the end of the study, there was a significant improvement in the intervention compared to the control in the following outcomes: SPPB (W=45, p=0.049; d=1.14); Mediterranean Diet Knowledge (W=49.5,p=0.013; d=1.26); consumption of vegetables (W=47, p=0.03; d =1.42); consumption of legumes (W=54, P=0.001; d=1.32), and negative outcome expectations (W=9,p=0.03; d=0.56). Albeit insignificant, intervention group participants improved their inflammatory, lipids, and glycemic blood measures. At the exit interviews, most participants expressed satisfaction with the app and acknowledged that the app was useful and easy to operate. They also provided points for improvement concerning control over the frequency of interactions with the app, more personalized choices for meals, and better visualization of their progress. The study demonstrated the preliminary efficacy of the digital intervention and suggested several mechanistic measures involved in behavioral change.
A SYSTEMATIC REVIEW OF MEASURES OF SOCIAL CONNECTION FOR PEOPLE LIVING IN LONG-TERM CARE HOMES: THE SONNET STUDY
Authors: Bethell Jennifer , Sommerlad Andrew , Chapman Hannah , Dewan Neha , Liougas Madalena , Livingston Gill , McGilton Katherine
Published: December 2023

Social connection is important for quality of life and care in long-term care (LTC) homes. However, measuring social connection in LTC residents is challenging and research is limited by a lack of consensus on best approaches to measurement. Our study objective is to systematically review measures of social connection developed for LTC residents. We are following COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) systematic review methods. We searched multiple bibliographic databases to April 2022 for studies conducted in LTC residents that quantified any aspect(s) of social connection and reported at least one psychometric property for the measure(s) of social connection. We are using COSMIN guidelines to evaluate the properties reported for each measure. We identified 60 studies reporting on 38 measures that assess social connection in LTC homes. Twenty-eight were measures of quality of life, wellbeing or life satisfaction and included a social connection subdomain. Only 10 measures specifically targeted social connection. From our evaluation of 32 measures to date, we found that 16% (n=5) have sufficient structural validity, 9% (n=3) have sufficient internal consistency, 22% (n=7) have sufficient reliability, and 19% (n=6) have sufficient construct validity. Many measures have assessed social connection in LTC homes, but few are designed for this purpose and many have insufficient psychometric properties. This review will provide detailed evidence of the quality of these measures to enable researchers to prioritise valid and reliable tools. Our results will inform our development of a new person-centred measure of social connection for LTC residents.
PATTERNS OF ANTIHYPERTENSIVES CHANGE AND MORTALITY IN VA NURSING HOME RESIDENTS
Authors: Liu Xiaojuan , Odden Michelle
Published: December 2023

Antihypertensive treatment is common in nursing home residents, yet data on the frequency and pattens of treatment changes in this group are lacking. We described the patterns of antihypertensive treatment changes and examined the mortality rate in 24870 Veterans Affairs (VA) nursing home residents ≥65 years with long-term stays (≥180 days) from 2006-2019. The number and dose of antihypertensive use was averaged weekly, and two change events were defined: deprescribing (reduced number of antihypertensives or dose of ≥30% compared to previous week) and intensification (opposite to deprescribing). More than 91% of residents were prescribed antihypertensive and 75% experienced at least one event during their stay. Death occurred in 7881 (32%) residents. We categorized residents into 10 distinct pattern groups: no change (27%), 1 deprescribing event (11%), 1 intensification event (10%), multiple deprescribing events (5%), multiple intensification events (7%), 1 deprescribing followed by 1 intensification (3%), 1 intensification followed by 1 deprescribing (4%), 3 changes with mixed deprescribing/intensification (7%), >3 changes with mixed deprescribing/intensification (10%), and no antihypertensive use (15%). We found treatment changes were more frequent in residents with better mobility and cognitive function. Residents who experienced deprescribing events had higher mortality than those experienced intensification events. The highest mortality was for those without medication (incidence = 344/1000 person-year) and this group also had the worst cognitive function. These findings indicate that complex patterns of medication changes exist in VA nursing home residents. A better understanding of the consequence of antihypertensive treatment changes could inform clinical practice in this population.
DIGITAL LITERACY, INTERGENERATIONAL RELATIONSHIPS, AND CARE PREPARATION AMONG CHINESE AGING ADULTS IN HONG KONG
Authors: Bai Xue , Yu Wing-Lam , Liu Chang
Published: December 2023

The rapid ageing trend spotlights the need for more eldercare. Care preparation as a form of proactive coping can mitigate the negative effects of potential eldercare needs. Acquisition and preservation of resources are essential for effective proactive coping. The roles of digital literacy and intergenerational relationships as two significant resources in older people’s care preparation are still understudied. Integrating social convoy theory, intergenerational solidarity theory, and proactive coping theory, this study compared the levels of digital literacy, intergenerational relationships, and care preparation in son-dominant, daughter-dominant, and daughter & son-balance families; and examined the mediating effects of intergenerational relationships on the relationship between digital literacy and care preparation. Data from 3,626 participants with at least one adult child were drawn from the Panel Study of Active Ageing and Society, a biennial study conducted with a representative sample of people older than 50 years in Hong Kong. ANOVA was used to compare scores of key variables in three types of families. PROCESS was used to examine the mediation effects. Results showed that participants in a son-dominant family had the highest level of digital literacy; those in a daughter-dominant family reported the highest levels of intergenerational relationship quality and care preparation. Intergenerational relationship quality mediated the relationship between digital literacy and care preparation in three types of families while the effect sizes differed. These findings implicate the need to enhance older people’s digital literacy and foster their intergenerational relationships, thereby assisting them to be well-prepared for care needs in later life.
ADVANCED-COMFORT: TESTING A CARE PLANNING INTERVENTION FOR NURSING HOME RESIDENTS WITH ADVANCED DEMENTIA
Authors: Lopez Ruth Palan , Wei Andrea , Locke Jenna , Plys Evan
Published: December 2023

Many nursing home (NH) residents with advanced dementia receive burdensome interventions rather than interventions that promote comfort or quality of life. The purpose of this study was to test the usability of a novel intervention called ADVANCED-Comfort that aims to enhance the provision of personalized, comfort focused care for residents with advanced dementia. The intervention consisted of structured care plan meetings between the NH team and proxies of residents with dementia (e.g., family members). Using the ADVANCED-Comfort workbook, proxies and staff created individualized care plans addressing 6 domains adapted from the Age Friendly Health System Framework (what Matters; Meaningful activities; Mealtime; Mobility; Medications and treatments; and Make comfortable). We evaluated the intervention using surveys, observation, and exit interviews. We found the intervention to be highly usable (acceptable, appropriate, and feasible) and exit interviews identified several promising outcomes. Both families and staff reported that the intervention improved communication and trust. Families reported that they had a newfound trust in staff to provide consistent quality care. Staff reported that the intervention helped them build better relationships with families and allowed families to articulate what they prefer rather than waiting until “something goes wrong.” Staff also reported that the intervention improved their excitement to go to work and enhanced their sense of teamwork. Finally, both staff and proxies reported exciting implications for residents such as a reduction in antipsychotic medication, decrease in distressed behaviors, weight stabilization, and initiation of hospice. Based on these preliminary findings, additional testing of the ADVANCED-Comfort intervention is warranted.
ANTI-ASIAN RACISM AMONG OLDER KOREAN AMERICANS DURING THE COVID-19 PANDEMIC
Authors: Kwon Soonhyung
Published: December 2023

Background

Hate crimes in the U.S. targeting adults of Asian descent have sharply increased during the COVID-19 pandemic. Korean Americans experience the highest level of everyday racism (37.5%), followed by Chinese (15.2%) and Vietnamese during the pandemic (Jung et al., 2021). Moreover, perceived discrimination in older Korean Americans is significantly related to a greater risk for poor mental health (Chau et al., 2018). However, older Korean Americans were likely to experience barriers to mental healthcare services. With this concern in mind, this study explored how older Korean Americans perceived discrimination related to ethnicity/race and coped with adverse mental health during the pandemic.

Methods

Our study used the thematic analysis of textual data to reconstruct and categorize, engaging in six steps: 1) familiarizing the qualitative data, 2) generating initial codes, 3) searching for themes, 4) reviewing themes, 5) defining and naming themes, and 6) producing a final report.

Results

This study identified that older Korean Americans (N=18) experienced direct and vicarious racism during the pandemic but felt barriers (limited English proficiency and a lack of accessible resources) to mental healthcare services. Active religious activities ameliorated discrimination-related stress. Some participants tried to solve the stress through wrong behaviors that criticized Chinese Americans. As a result, barriers to mental healthcare were likely to cause secondary discrimination and prejudice against Chinese Americans.

Discussion

To ameliorate adverse mental health and prevent secondary discrimination, it is essential to identify well-accepted, well-timed, sustainable, and cost-effective therapeutic strategies to alleviate the adverse mental health associated with discrimination-related stress.
GOAL ATTAINMENT SCALING IN CAPABLE: A COMPARISON OF CARE PARTNER AND OLDER ADULT PARTICIPATION
Authors: Perepezko Kate , Toto Pamela
Published: December 2023

Aging in place is an optimal outcome for our maturing population as health systems become increasingly overburdened. One program that facilitates aging in place is the Community Aging in Place, Advancing Better Living for Elders (CAPABLE) program. CAPABLE improves older adult performance in everyday activities and reduces inpatient and long-term service use. Although CAPABLE is designed as a person-centered program aiming to help older adults set and achieve goals, research demonstrates that care partners (i.e. family or friends providing unpaid support) are frequently involved in healthcare decisions and can reinforce intervention goals. This presentation will report findings from the trial stage of a Hybrid Type 1 Study of CAPABLE involving care partners for which recruitment is ongoing (N=100). We aim to describe how older adults and their care partners engage in goal setting using Goal Attainment Scaling, share the frequency of their goal attainment, and present the types of goals that they set. For example, older adult participant goals for our current sample focus on reduced fear when showering, improved mobility, and more efficient dressing. For our care partner participants, goals include finding respite and preventing older adult injury. All participants who have completed CAPABLE were able to achieve their goals by the end of the program. Findings from this study support care partner involvement in interventions to promote aging in place, aligning with the RAISE Act’s goal to engage family caregivers as key partners in the delivery of services and support.
EFFECTIVE CLINICIAN BEHAVIORS FOR INCLUDING FAMILY CAREGIVERS IN THE GERIATRIC MENTAL HEALTH SETTING
Authors: Wyman Mary , Raj Hayley , Perzynski Joseph , Gleason Carey , Trivedi Ranak , Byers Amy , Voils Corrine
Published: December 2023

To improve patient and caregiver outcomes, the 2022 National Strategy to Support Family Caregivers recommends training for professionals on caregiver inclusion and provision of person- and family-centered care. Caregiver inclusion is especially important for older adults with dementia, who experience high rates of comorbid mental health (MH) disorders but are disadvantaged by disparities in care access and quality. Current training options are limited. Our VA-funded project seeks to develop caregiver inclusion training for MH clinicians working with older adults with dementia. We present preliminary findings from in-depth, 45-min qualitative interviews with 9 multidisciplinary MH clinicians (psychiatry, social work, psychology, and clinical pharmacy) on their experiences with engaging family caregivers in MH treatment. A multidisciplinary coding team conducted content analysis to identify facilitators and barriers to effective communication and collaboration with caregivers, with a focus on clinician behaviors. Facilitators of effective caregiver involvement include clinician attention to developing rapport with the caregiver, addressing knowledge gaps about dementia and mental health interventions, and helping to address the challenges of caregiving with supportive resources. Barriers included not tailoring clinician approach to caregiver needs, failing to clarify the caregiver role in healthcare, and failing to address one own’s defensiveness or labeling of caregivers in distress. The importance of system factors (e.g., technology, clinic scheduling, and care team dynamics) was noted. Findings will be used to inform the development of strategies to increase clinician skills for caregiver inclusion, supporting improved patient and caregiver outcomes and the goals of the RAISE Act and the National Strategy.
PARTICIPATORY DESIGN OF A WEB-BASED COMMUNITY AND RESOURCE CONNECTION TOOL FOR RURAL DEMENTIA FAMILY CAREGIVERS
Authors: Werner Nicole
Published: December 2023

Rural family caregivers of people living with dementia have higher caregiver burden and experience lower social support than their urban counterparts. Technology has potential to address rural caregiver health disparities, but only if designed to their specific needs. Available technology interventions lack focus on rural caregivers and community influence. This represents a gap in rural caregivers’ ability to leverage technology for community supports to overcome their unique barriers. Thus, we are engaging rural caregivers and community resources in a participatory co-design process to design CareVirtue Family Connection, an online community and personalized resource connection tool specific to rural dementia caregivers. We conducted N=19 interviews with dementia caregivers self-identified as living in a rural area. We analyzed transcripts using team-based affinity diagramming to create meaningful clusters related to how rural caregivers get the help they need. We used consensus discussion to refine clusters and applied resulting categories to transcripts to identify confirming/disconfirming evidence. We identified seven dimensions influencing rural caregivers’ ability to get the help they need including community attributes, caregiving challenges, community connection, experience with community supports, caregiving goals, attitudes on caregiving and community, and information behavior. Results will guide subsequent co-design in which we will engage rural caregivers and related community organizations to co-design the CareVirtue Family Connection tool. Our participatory approach is aligned with the National Strategy to Support Family Caregivers’ goal to advance caregiver engagement, and CareVirtue Family Connection will support the Strategy’s vision to “expand access to programs, services, supports, and products to family caregivers.”
CONCERNED AND LONELY AMIDST COVID-19: FINANCIAL STRAIN AND LATER-LIFE PSYCHOLOGICAL WELL-BEING IN NEVADA
Authors: Bhatta Tirth , Miller Dante , Lekhak Nirmala
Published: December 2023

Objectives

Nevada has some of the nation’s highest suicide rates among older adults, which are linked to social isolation, loneliness, and mental health. The COVID-19 pandemic is likely to have exacerbated the loneliness and financial insecurity that older Nevadans have already been experiencing to a greater extent since the 2008 financial crisis. Prior research based on national data has documented the relationship between financial strain and mental health in later life. However, the social and psychological mechanisms that underlie such relationships have not been investigated, particularly in light of the devastating economic and health effects of the pandemic on older adults in Nevada.

Methods

Based on our web-based survey of adults aged 50 years and older (n=313), we examined the roles of loneliness and concerns about the pandemic in explaining the impact of financial strain on depressive symptoms and anxiety.

Results

We documented a statistically significant effect of financial strain on depressive symptoms (b=2.41, p-value< 0.001) and anxiety (b=1.74, p-value< 0.001). The inclusion of loneliness and concerns about the pandemic in our regression models led to substantial reduction in the impact of financial strain on depressive symptoms, whereas such impact on anxiety became statistically not significant. We also found significantly higher levels of depressive symptoms and anxiety among our respondents who reported greater feeling loneliness and concerns about the pandemic.

Discussion

Our findings underscore the need for mental health resources and financial support programs for economically disadvantaged older adults to alleviate their feelings of loneliness and improve mental health in Nevada.
NETWORK ANALYSIS OF OBJECTIVE AND SUBJECTIVE INDICATORS OF SOCIAL ISOLATION AND FUNCTIONAL LIMITATIONS
Authors: Zhong Chuwen , Dang Linh , Ananthasubramaniam Aparna , Mezuk Briana
Published: December 2023

Functional limitations, including decreased physical performance and increased limitations in daily activities, are common among older adults and associated with both objective and subjective social isolation. However, the dynamic interactions between and within different indicators of functional limitations and social isolation are unclear. This study employed network analysis to graphically depict and explore the relationships between various objective and subjective indicators of functional limitations and social isolation. Data came from the 2014/2016 waves of the Health and Retirement Study (n=9,076, mean age =67.25,52.32% female, 80.17% non-Hispanic White). Functional limitations were measured by objective physical performance (grip strength, tandem balance test) and self-reported limitations in daily activities. Objective social isolation was based on marital status, living arrangement, and network composition (children, other family members, and friends); subjective social isolation was indicated by the UCLA loneliness scale. Separate networks were constructed for men and women. Centrality indices, including strength, betweenness centrality, and eigenvector centrality, were computed to quantify the influence of each item. Subjective functioning and isolation items were strongly correlated but had weaker interconnections with one another. Strength and eigenvector centrality indicated that subjective functioning items had high degrees of influential interactions. Subjective social isolation items had high values of betweenness centrality, suggesting important bridging roles of these constructs. Subjective social isolation items had a more influential role in the network of women than men. Findings suggest opportunities for interdisciplinary interventions to address the multifactorial relationship between functional limitations and social isolation among older adults.
EXPLORATORY FACTOR ANALYSIS OF THE COMFORT ASSESSMENT IN DYING WITH DEMENTIA SCALE
Authors: Zhang Peiyuan , Stump Timothy , Tu Wanzhu , Becker Todd , Orth Jessica , Floyd Alexander , Unroe Kathleen , Cagle John
Published: December 2023

The 14-item Comfort Assessment in Dying with Dementia (CAD-EOLD) scale is a widely used instrument measuring end-of-life care for people with dementia (PWD). The instrument has been used to evaluate symptom burden among PWD in nursing homes, but the measurement properties are less studied for symptoms reported by family and staff caregivers. We conducted an exploratory factor analysis to evaluate the psychometric properties of the scale using staff and family (N=476) responses to CAD-EOLD at the baseline of an NIH-funded clinical trial. Subjects were long-stay nursing home residents with moderate-to-severe cognitive impairment in Indiana and Maryland. Staff (n=368) and family members (n=108) completed the CAD-EOLD, describing participating residents. We performed separate exploratory factor analyses on family and staff responses. Family and staff data showed similar clustering patterns. Restlessness, anxiety, fear, crying, and moaning had high factor loadings in the first cluster, interpreted as “Physical and Psychological Distress” (loading range = 0.47–0.91). Choking, gurgling, and difficulty swallowing had high loadings in the second cluster that depicted “Dying Symptoms” (loading range = 0.62–1.15). Serenity, calm, and peace had high loadings in the third factor on “Well-Being” (loading range = 0.72–0.93). Three “Physical Distress” items (i.e., discomfort, pain, and shortness of breath) cross-loaded with “Dying Symptoms.” Accordingly, “Physical and Psychological Distress,” “Dying Symptoms,” and “Well-Being” represented important but separate dimensions for measuring end-of-life experiences of PWD. Findings demonstrated favorable construct validity of CAD-EOLD in PWD with moderate-to-severe cognitive impairment in nursing homes, as reported by staff and family caregivers.