bluuebunny/crossref_metadata_2025 huggingface dataset:
POLICY SERIES: MOVING FORWARD NURSING HOME COALITION CALL TO ACTION: BUILDING A SYSTEM FOR RESIDENT GOALS, PREFERENCES, PRIORITIES
Authors: McMullen Tara , Shippee Tetyana
Published: January 2025

A 2022 National Academies of Sciences, Engineering, and Medicine (NASEM) report on nursing home quality called for nursing homes to provide care aligned with residents’ goals to ensure autonomy, quality of life, and to manage risks. While there are existing structures to support care planning clinical needs, most nursing homes lack tools and procedures to systematically identify and provide care that aligns with resident goals, priorities, and preferences (GPPs). GPPs are part of the care planning process that translates into actionable interventions supported by measurement to determine if care aligns and is concordant with GPPs, and health information technology to collect GPPs. Many nursing homes are working to improve the way they gather residents’ GPPs, and develop and implement unique care plans. These efforts represent an opportunity to improve outcomes and reduce disparities. Experts representing the Moving Forward Nursing Home Quality Coalition are developing an integrated approach to these challenges. This presentation will describe the Moving Forward Nursing Home Quality Coalition and a) the purpose and structure of the new Guide for Addressing Resident GPPs; b) an evaluation that explores whether a resident’s self-directed GPPs were included in their care; c) a description of the tools that assess GPPs and the feasibility of using those tools; and d) discussion about the development of technology advancements promoting HIT readiness and person-centered care. When completed, proposed work will provide evidence of successful and feasible quality improvement approaches to care planning resident GPPs that can inform future policy changes and guidance to surveyors.
THE DESIGN AND PILOTING OF A NEW GUIDE FOR ADDRESSING RESIDENT GOALS, PREFERENCES, AND PRIORITIES
Authors: Cornelison Laci , Ciolfi Mary Lou
Published: January 2025

Engaging nursing home residents and their designated representatives in meaningful conversation about their needs and preferences for care, services, and environments is essential to high quality long-term care, as confirmed in the 2022 National Academies of Sciences, Engineering, and Medicine (NASEM) report. The Moving Forward Coalition’s Goal One Committee has created a quality improvement Guide for Addressing Resident Goals, Preferences, and Priorities (GPPs) to support nursing home care planning staff in improving and deepening care planning conversations with residents. The Guide includes key suggestions, tools, resources, and training material that will help homes lay a foundation for resident and family inclusion and empowerment in disclosing goals, preferences, and priorities (GPPs) and also in implementing those GPPs at the outset of a resident’s admission to care and as needs and preferences change over time. Goal Committee One leads will present the Guide purpose and design along with a review of included resources; review the feedback and suggestions from myriad nursing home stakeholders, including current nursing home residents, nursing home providers, and nursing home quality improvement organizations; outline the results of the Guide pilot in several nursing homes, and the upcoming planned Guide evaluation and wider dissemination.
MOVING FORWARD TOWARD A NURSING HOME MEASURE FOR GOAL CONCORDANCE AND EVALUATION OF RESIDENT GOALS
Authors: McMullen Tara
Published: January 2025

Longstanding evidence suggests that the goals, preferences, and priorities (GPP) of nursing facility residents may not be adequately addressed during episodes of care. Aligning care with residents’ GPP represents an opportunity to improve outcomes and reduce disparities in the resident population. The 2022 National Academies of Sciences, Engineering, and Medicine (NASEM) report recommended improvement in quality measures under the domain of resident and family experience, along with reporting of these measures on Care Compare to improve shared decision-making and transparency. The subcommittee on quality improvement and measurement is focused primarily on measures of GPP as a useful addition to CMS’ plans to expand the Quality Reporting Program (QRP) measure set. To develop a reliable measure of concordance, this committee explored and assessed the alignment between the individual goals set by residents and the care interventions provided by the staff in routine care delivery. In an evaluation that employed in-depth interviews and reviews of the resident care plan and portions of the medical record, this group of subject matter experts attempted to gain a better understanding of the concordance between resident goals and care provision with the intent to identify areas for improvement in care delivery and enhanced person-centered care practices. In this presentation, committee members will discuss the development and outcomes of this evaluation along with an update on the development of a care concordant measure for nursing home settings.
IDENTIFYING TOOLS TO MEASURE NURSING HOME RESIDENT GOALS, PRIORITIES, AND PREFERENCES FOR PERSON-CENTERED CARE
Authors: Roberts Tonya , Parikh Romil , Li Jingxi , Nizza Megan , Smith Amelia , Levy Sorah , Shippee Tetyana
Published: January 2025

Identifying nursing home (NH) residents’ goals, priorities, and preferences is a critical step in the delivery of person-centered care. While numerous instruments and tools exist to measure resident preferences, it remains unclear how psychometrically validated instruments used in research may be feasibly applied in practice. In this review, we aimed to identify instruments for assessing residents’ goals, priorities, and preferences and develop recommendations for application in practice. We searched MEDLINE, CINAHL, and PsycINFO databases to identify instruments that assessed quality of life, satisfaction, person-centered care, psychosocial needs and goals, and preferences and were validated in US NHs. We also surveyed experts in the field to identify assessment tools from grey literature. We identified a total of 28 validated tools from 23 peer-reviewed articles and 12 additional tools from 35 grey literature sources. These tools varied in structure (e.g. open vs closed questions), content (e.g. domains covered), and length (e.g. few to many items). Tools could be grouped into two major types: generative and evaluative. Generative tools assessed specific resident goals, priorities, and preferences that could inform care planning particularly upon admission, but also throughout the resident’s stay. Evaluative tools required residents to evaluate aspects of care and may be most appropriate beyond admission. NH staff may find different benefits to various assessment approaches and may need to make local decisions about which to use and which will integrate into existing workflows effectively.
GENDER AND EDUCATIONAL DIFFERENCES IN TRAJECTORIES OF PHYSIOLOGICAL AGEING
Authors: Bloomberg Mikaela , Steptoe Andrew
Published: January 2025

Though gender and education are key characteristics that contribute to heterogeneity in ageing-related outcomes, how physiological age (PA) differs by gender and education level is not yet clear. Furthermore, previous studies examining PA are cross-sectional; understanding how PA changes with increasing chronological age is a necessary next step. We examined how gender and education interacted to inform longitudinal PA trajectories using three waves of data (2004/05-2012/13) from 8,891 ELSA participants. PA was derived in a healthy subsample then validated in the full analytic sample by confirming associations between PA and incident ageing-related chronic conditions, memory impairment, and functional limitations. We then used joint models adjusted for birth cohort to produce trajectories of PA between chronological ages 50 and 80 in men and women at three levels of education (less than high school, high school, and above high school). Gender differences in PA were minor at age 50, but PA increased faster in women than in men (p < 0.001); by age 70, women had PA 1.6 years (95% confidence interval=1.0-2.1) older than men. Examination of interactions between gender and education revealed that these gender differences occurred among less educated women only (p interaction=0.03); women educated above high school level maintained PA younger than men at age 70. These results suggest that higher education may be important to reduce gender disparities in physiological ageing. Policies to promote gender equity in higher education may contribute to reducing gender inequalities in a wide range of health outcomes in old age.
SPOTLIGHTING THE EXPERIENCES OF THE HOME CARE WORKFORCE CARING FOR OLDER ADULTS LIVING WITH DEMENTIA
Authors: Fabius Chanee , Spetz Joanne
Published: January 2025

Medicaid Home and community-based services (HCBS) and home-based clinical care (i.e., Medicare home health care) aim to support independence and well-being in the community, especially for older adults living with disability and complex health conditions, such as dementia. Many older adults receive both Medicaid HBCS and home-based clinical care, often concurrently, with services coordinated and delivered by paid and unpaid care partners including care managers, home care workers, and family caregivers. Amid concerns related to workforce shortages, shifting payment policies, and the rising complexity of those aging in place, there have been recent calls to better support the workforce providing care in the home. Responding to these calls will require additional knowledge and understanding of the experiences of workforce members as well as the older adults they serve. This symposium presents four unique studies that describe: 1) experiences of care managers (“supports planners” in Maryland) serving older adults with and without dementia in Medicaid HCBS in Maryland; 2) unmet caregiving needs in a national sample of Medicare home health patients living with dementia; 3) Medicare home health clinician perspectives on supporting dementia caregivers through health information technology, and 4) home care worker attitudes about delivering person-centered care for persons living with dementia. The findings presented reveal current areas of challenge and inform the development of innovative strategies to better support the range of paid and unpaid caregivers caring for older adults living with dementia in the community.
HOME CARE WORKER PERSPECTIVES ON PERSON-CENTERED CARE FOR PEOPLE WITH DEMENTIA
Authors: Reckrey Jennifer , Xu Emily , Watman Deborah , Perez Sasha , Franzosa Emily
Published: January 2025

Person-centered care for people living with dementia has been associated with improved functional ability and quality of life, yet little is known about person-centered care in the home setting. This study explored home care worker perspectives on providing person-centered care for people living with dementia. Using secondary qualitative analysis of 22 semi-structured interviews with home care workers, we identified themes related to the Dementia Initiative’s person-centered dementia care framework. We found that home care workers frequently acknowledged their client’s personhood and developed meaningful relationships with their clients, implementing individualized strategies to meet client needs. However, barriers to person-centered care included limitations of home care worker scope of practice and challenging dynamics with other home care workers and family caregivers. In addition, home care agencies’ formal care plans sometimes served as a barrier to person-centered care, but home care workers advocated within and around their task-based duties to ensure client needs were met. This analysis highlights the importance of integrating home care workers in person-centered healthcare teams and sustaining the meaningful relationships between home care workers and their clients, family caregivers, and other home care workers. Standardized training of home care workers in the principles and goals of person-centered dementia care could enhance existing person-centered care practices and promote alternatives to disease-centered practices. Recognizing home care workers’ unique role in providing person-centered care is essential to identify and meet the needs of people living with dementia in the community and their family caregivers.
HOW DO PRIMARY CARE PHYSICIANS NAVIGATE MEDICAL CANNABIS DISCUSSIONS WITH OLDER ADULT PATIENTS
Authors: Nguyen Annie , O’Malley Pearse , Osae-Oppong Edward , Foo Jamie , Abu-Baker Dania , Tibirica Lize , Diaz Joseph , Moore Alison
Published: January 2025

We interviewed 20 physicians who provide primary care in California and have patients ages 65+ in their practice. Interviews lasted 30 minutes and followed a semi-structured guide. The majority of physicians said that older patients were most likely to use cannabis for pain and sleep issues while younger patients used it for mental health-related conditions. Older patients often seek physicians’ advice about doses, forms, and efficacy, but most physicians were unsure on how to advise patients, with many defaulting to the strategy of starting with low doses and titrating up if needed; inhalation was universally discouraged. Many physicians were unsure about the strength of evidence, because while the evidence for sleep and pain appear to be supportive, there are not enough studies and large-scale clinical trials to develop a strong opinion. All agreed that physicians would benefit from training to increase confidence and be informed when discussing cannabis with patients.
ACUTE EFFECTS OF EDIBLE CANNABIS FOR OLDER ADULTS: THE GOOD, THE BAD, AND THE NEUTRAL
Authors: Bryan Angela , Skrzynski Carillon , Stanger Madeline , Giordano Gregory , Lervick Dana , Broyhill Tatum , Tracy Brian
Published: January 2025

Many older adults use cannabis to alleviate pain, increase sleep quality, and mitigate symptoms of anxiety and/or depression. Yet few studies assess co-occurring effects of cannabis use that may be more salient to older adults. We recruited 234 participants (average age 70.46 (sd=5.83) who either did (n=175) or did not (n=59) want to use edible cannabis for pain, sleep disturbance or negative affect. We compared acute effects on balance, mood, and memory before and after consumption of edible cannabis products differing in cannabinoid ratio (CBD dominant, THC dominant, CBD+THC). Among older adults who used cannabis, we observed balance impairment from pre to 60-minutes post use (p<.01). Those who used cannabis experienced improvement in pain from pre to 60-minutes post use (p=.001) and higher concentrations of THC in blood (measured at time of use) were associated with greater decreases in pain (p<.05). Older adults who used cannabis also experienced increases in subjective intoxication (p<.001); higher THC in blood was associated with greater intoxication (p<.001) while higher CBD in blood was associated with lower intoxication (p<.05). There were few significant differences between those who did versus did not use cannabis on memory and cognitive tasks. We add to the growing literature examining cannabis use among older persons and identify significant outcomes experienced by those who use edible cannabis products. Disseminating this work among clinicians may facilitate more informed conversations with older persons who may consider cannabis as a therapeutic alternative.
CANNABIS USE AMONG INFORMAL CAREGIVERS OVER 50: FINDINGS FROM THE CALIFORNIA HEALTH INTERVIEW SURVEY
Authors: Martinos Fadi , Bhagianadh Divya
Published: January 2025

Despite the availability of evidence-based therapeutics and supports, informal primary care partners of older adults are using cannabis as an unproven, potentially harmful, alternative for reducing physical burden and psychological distress. Using the 2019 California Health Interview Survey, we identified 2,278 respondents over 50 years old who indicated providing care to someone also over 50 in the past year. We determined 23.0% of these survey respondents between 50 to 64 years and 18.0% of those over 65 years older used cannabis in the past year, and older caregivers were more likely to use cannabis than non-caregivers. Cannabis use among older caregivers was associated with smoking and self-reported feelings of depression (AOR 1.76) and/or nervousness (AOR 2.06). Cannabis use among older caregivers was not associated with the burden of caregiving or the condition of the care recipient. Caregivers who use cannabis were more likely to experience a delay in accessing health care services relative to caregivers who do not use (AOR1.54).However, they were no more or less likely to use emergency department or outpatient medical care. These findings illuminate how cannabis is being used as a understudied form of self-care among informal care partners.
WE GOT THE MOVES LIKE JAGGER: REFLECTIONS ON AGING RESEARCH, EDUCATION, AND COMMUNITY
Authors: Montepare Joann
Published: January 2025

Over the last 50 years, tremendous advances have been made in our understanding of aging and its many components through lifespan developmental research. As well, educators in the field of aging have designed creative and impactful strategies for teaching about aging and dismantling ageist thinking. Together, scholars and educators have made age matter in meaningful ways in our contemporary world. This presentation uses examples from my professional experiences to reflect on several key aspects of aging research and education – and how community connections are necessary to sustain this work, with special attention to the need to advance age inclusivity in higher education.
HIGH-FIVE! – DISCOVERING THE POWER OF MENTORSHIP
Authors: Bradley Dana
Published: January 2025

There is an art and a science to mentorship that transforms lives – for the mentor and the mentee. Often, this mystique of mentoring can be intimidating, creating a misperception of one’s abilities to serve as a mentor. While every mentoring opportunity is unique, generally accepted principles have been delineated in the rich mentorship literature that undergirds a productive and positive mentorship experience. In this view, mentoring is a hidden superpower that lies within each person, waiting to be discovered, shared – and celebrated. Reflecting on my career, I will share five observations from the mentor-mentee relationships that have shaped my life – and, in gratitude, give a virtual “high-five” across the room – and miles – to colleagues who have joined me on this journey.
LONG-TERM EXPOSURE TO OUTDOOR LIGHT AT NIGHT, AIR POLLUTION, AND DEPRESSIVE SYMPTOMS AMONG OLDER PEOPLE IN ENGLAND
Authors: So Rina , Gessa Giorgio Di , Scholes Shaun , Kim Su-Hwan , Park Yujin , Lee Jinkook , Adar Sara , Zaninotto Paola
Published: January 2025

Air pollution and light at night (LAN) are environmental stressors that may lead to depression, but the epidemiological evidence is inconsistent and scarce, especially for LAN. We used data from 8,583 participants (25,151 observations), aged ≥ 50 years, of the English Longitudinal Study of Ageing from waves 6-9 (2012-2019). Annual levels of fine particulate matter (PM2.5), nitrogen dioxide (NO2), and LAN were assessed at participants’ residential addresses for each interview year. Having depressive symptoms was defined as reporting ≥3 items of the 8-item Center for Epidemiologic Studies Depression Scale. We used mixed effects generalized linear models (binomial distribution) to examine associations of air pollutants and LAN (in quartiles) with depressive symptoms, adjusting first for age and sex and then adding control for individual lifestyle and socio-demographic factors, and area-level deprivation index. In models minimally-adjusted, increased odds of having depressive symptoms were observed for PM2.5, NO2, and LAN with odds ratio (OR) (95% confidence interval) of 1.15 (1.05, 1.25) and 1.20 (1.10, 1.32) per interquartile range of PM2.5 (2.2 µg/m3) and NO2 (4.2 ppb), respectively, and 2.47 (1.96, 3.12) in the highest quantile of LAN compared to the lowest. These associations were attenuated in fully-adjusted models to 0.97 (0.90, 1.05) for NO2 and 0.91 (0.84, 0.99) for LAN, while the association with PM2.5 remained positive [OR: 1.05 (0.97, 1.14)]. Higher residential PM2.5 levels might be associated with an increased risk of having depressive symptoms, but associations with NO2 and LAN were explained by confounding by individual- and area-level characteristics.
THE UTILITY AND POTENTIALS OF CLAIMS-BASED FRAILTY INDEX IN CLINICAL CARE AND RESEARCH: NEW DEVELOPMENTS IN 2024
Authors: Kim Dae Hyun
Published: January 2025

The development of a claims-based frailty index (CFI) for Medicare claims (Kim et al., Journals of Gerontology: Medical Sciences, 2018) has empowered researchers to integrate frailty into pharmacoepidemiology and health services research. This symposium aims to overview the CFI’s development and validation process and spotlight its recent applications in studies utilizing Medicare claims and electronic health records (EHR). The CFI, estimating a deficit accumulation frailty index (range: 0 to 1, with higher values indicating greater frailty) based on the previous year’s claims, demonstrates 60% sensitivity and 86% specificity for a deficit accumulation frailty index ≥0.25, and 62% sensitivity and 78% specificity for the Fried Frailty Phenotype. Additionally, a crosswalk between CFI and clinical frailty measures is available, aiding the translation of research findings into clinical practice. Featured presentations will explore the CFI’s application to EHR data, its role in assessing dementia severity, its contribution to the CMS Hierarchical Condition Category model in predicting healthcare costs, its predictive value for outcomes following post-acute care in skilled nursing facilities, and its association with opioid discontinuation rates in older adults hospitalized with fractures. These examples will highlight the benefits and challenges of using CFI in research.
CLAIMS-BASED FRAILTY INDEX AS A PREDICTOR OF POSTACUTE SKILLED NURSING FACILITY CARE OUTCOMES
Authors: Shi Sandra , Oh Gahee , Park Chan Mi , McCarthy Ellen , Kim Dae Hyun
Published: January 2025

How claims-based frailty index (CFI) predicts post-acute skilled nursing facility (SNF) care outcomes is unknown. We used the National Health and Aging Trends Study 2011-2017 survey data linked to Medicare claims. CFI and comprehensive geriatric assessment-based frailty index (CGA-FI) were calculated at each survey and categorized into non-frail (<0.25), mild frailty (0.25-0.34), moderate frailty (0.35-0.44), and severe frailty (≥0.45). We examined the first post-acute SNF admission within 6 months after survey assessment. The primary outcome was home time in the 6 months following SNF admission defined as days not in hospital or nursing home. We estimated the effects of frailty on home time using linear regression for each frailty measure. The secondary outcome was total healthcare costs in the 6 months following SNF admission estimated using a generalized linear model with a gamma distribution and identity link. Analyses adjusted for age, sex, and income. In our sample of 643 Medicare beneficiaries (representing 2.7 Million beneficiaries nationally), increasing frailty was associated with greater home time loss and healthcare costs by both measures. The mean difference (95% CI) of home time loss for severe frailty compared with non-frailty was -39.2 [-66.8, -11.5] days by CFI and -43.2 [-60.0, -26.4] days by CGA-FI. The mean healthcare cost increase (95% CI) for severe frailty compared with non-frailty was $21,583 [$13,132, $30,033] by CFI and $11,110 [$6,236, $15,983] by CGA-FI, respectively. Pearson correlation between CFI and costs was higher than CGA-FI (0.1885 vs 0.0804). CFI up to 6 months before SNF admission predicts healthcare utilization.
OPIOID DISCONTINUATION RATES: RISK STRATIFICATION USING A CLAIMS-BASED FRAILTY INDEX (2013–2018 MEDICARE)
Authors: Pritchard Kevin , Yang Chun-Ting , Chen Qiaoxi , Zhang Yichi , Wilkins James , Kim Dae Hyun , Lin Kueiyu Joshua
Published: January 2025

We aimed to determine if the severity of frailty influences the duration of opioid use following an emergent pain event. This retrospective cohort study included 21,728 fee-for-service Medicare beneficiaries (2013-2018). We included opioid-naïve individuals aged ≥65 years who initiated opioids within 30 days of a hospitalized fracture. Our index date was the opioid prescription fill date. We excluded those with prior opioid use, chronic pain, or contraindications to opioids in the preceding year. Frailty severity was defined using a claims-based index. We estimated opioid discontinuation rates using Nelson-Aalen cumulative hazard functions, stratified by frailty severity. Discontinuation during the follow-up year was defined as a gap in continuous prescription refills exceeding 15 days. We used Cox proportional hazards regression to assess the association between frailty severity and the number of days until discontinuing opioids while controlling for sociodemographic factors, health status, healthcare utilization, and calendar year. Our sample was on average age 80 [SD=9] years old, 77% female, and 91% White. The 30-day discontinuation rate was 85% (95% CI, 83-87%) in the moderate/severe frail group, 84% (83%-84%) in the mildly frail group, 87% (87%-88%) in the pre-frail group, and 90% (89-91%) in the non-frail group. After multivariable adjustment, the likelihood to discontinue opioids depended on frailty status. Compared to adults without frailty, discontinuation was less likely among those who were moderately/severely frail (Hazard Ratio [HR]: 0.88, 95% CI, 0.83-0.94), mildly frail (HR: 0.87, 95% CI, 0.83-0.92), and pre-frail (HR: 0.96, 95% CI, 0.91-1.00). Greater frailty decreased the likelihood of discontinuing opioids.
USING BLACK HISTORY FOR BRAIN HEALTH: APPROACH, OUTCOMES, AND PUBLIC APPLICATIONS IN THE SHARP STUDY
Authors: Croff Raina
Published: January 2025

This symposium focuses on the Sharing History through Active Reminiscence and Photo-imagery (SHARP) study that centers Black history to engage older Black adults in the brain-healthy behaviors of walking, social engagement, and reminiscence within gentrifying areas of Portland and Seattle. Presentations span the study’s theoretical underpinnings to operationalizing results for public awareness of brain health. Dr. Raina Croff introduces the SHARP study, discussing the gap in brain health interventions that it seeks to fill, its culturally celebratory framework, and why such approaches matter for participant engagement. Anthony Cryer and Stephanie Johnson-Toliver discuss the collaborative process in Seattle from the community partner perspective, including recruitment challenges amidst gentrification, creating meaningful walking routes centered on local Black history, and participant feedback. Boeun Kim reports on health outcomes from the SHARP Seattle study and themes from evaluative focus groups, including barriers and motivators to engagement. Charles Fennell discusses the SHARP Caregiver Study in Portland, including adaptations to meet dementia family caregivers’ needs, and health outcomes around sleep and activity levels as captured by wearable digital biomarker technology. Taryn Gordon discusses preparing SHARP’s recorded walking narratives for a public digital oral history archive in a way that preserves participant integrity, and how SHARP concepts are operationalized in the SHARP website by integrating Black oral history from walking narratives with brain health information to educate and empower older Black adults to learn about and practice brain healthy behaviors.
HONORING OUR HEALTH AND HISTORY: FRAMING BRAIN HEALTH THROUGH A CULTURALLY CELEBRATORY LENS
Authors: Croff Raina , Fuller Patrice , Fennell Charles , Gordon Taryn
Published: January 2025

Asset-based, culturally celebratory frameworks center community strengths, history, culture, and community resilience. Applying such frameworks to Black American brain health engenders agency over individual and community health, and empowers older Black adults to engage in aging research. Amidst gentrification, such frameworks become especially salient. The Sharing History through Active Reminiscence and Photo-imagery (SHARP) Study uses Black history to engage older Black adults in walking social reminiscence for brain health within gentrifying neighborhoods in Portland and Seattle. Since 2016, SHARP has engaged 82 healthy and cognitively impaired walkers, including dementia family caregivers. Triads walked 1-mile routes 3x/week for 1, 4, or 6 months using the SHARP walking application on a group tablet. GPS-linked images of local Black history and culture prompted social reminiscence during walking. Walking narratives were recorded for an oral history archive. This presentation explores SHARP’s culturally celebratory framework informed by Black Lives Matter principles applied to health, Asset-Based Community Development, and Africana Worldview. We examine how centering Black history over Black health deficits, community memory over individual memory loss, and group participation over individual research participation produced high retention, re-enrollment rates, and recommendations. We apply theoretical concepts and study design to understand participant experiences, including how impromptu neighborhood encounters during walks mimicked social patterns from younger years, recalling joyful community memories despite gentrification, improved coping with change, and decreased psychological burden of exercise. Finally, we highlight challenges to the SHARP approach, including balancing a culturally celebratory framework with duly addressing the heavy burden of Alzheimer’s and gentrification.
SHARP SEATTLE: A COMMUNITY COLLABORATION TO CREATE BLACK HISTORY WALKING ROUTES AND ENGAGE WALKERS
Authors: Cryer Anthony , Johnson-Toliver Stephanie , Ferguson Dian , Towns Juell
Published: January 2025

The Sharing History through Active Reminiscence and Photo-Imagery (SHARP) program honors Black health and history through creating culturally celebratory walking routes. Nine community and academic partners implemented SHARP Seattle in the gentrifying Central District. Key to success was partners with established community relationships and expertise aligned with the SHARP approach, including in walking programs, archival images, local Black history, cognitive health, and the needs, concerns, and preferences of older Black adults regarding programming. Study activities were based at and coordinated by a senior center serving primarily African Americans. Student interns led informant focus groups with 10 older Black adults to gather themes and topics for inclusion in twelve 1-mile walking routes. Interns worked with an archivist on selecting local historical images to illustrate community-identified walk themes and solicit stimulating conversational reminiscence among walkers. Themed routes with images were programmed into the SHARP walking application, tested, and revised. After a kick-off celebration, thirty-one older Black adults, grouped into triads, engaged 3 times a week for 4 weeks to walk the 12 routes. In this talk, community partners discuss their experience, including learning the research process, exerting their preference for an adapted, more relaxed study design for less burden and greater inclusion of people with cognitive impairment, creating routes with different generations whose local geo-historical knowledge differed greatly, strategies for curating community buy-in, gentrification and displacement-related recruitment challenges, and learning from participant feedback. Finally, self-reflections explore the meaningfulness of walking and social reminiscence amidst aging and gentrification.
EVALUATION OF A REMINISCENCE AND PHOTO-IMAGERY WALKING PROGRAM FOR BLACK OLDER ADULTS
Authors: Kim Boeun , Kaluna Lia , Otewa Meshack , Belza Basia , Croff Raina
Published: January 2025

The purpose of this study was to pilot the Sharing History through Active Reminiscence and Photo-Imagery (SHARP) program which honors Black history and health through culturally celebratory walking routes in the Puget Sound area. Participants were recruited from a senior center. Thirty-one healthy and mildly cognitively impaired Black Americans completed triadic walking three times a week for 4 weeks. Participants used the SHARP walking application on a group tablet device, and back-up paper routes, to navigate twelve themed, 1-mile looped routes with GPS-triggered local historical images of Black life and culture to prompt conversational reminiscence during walks. Route themes were Childhood Health, Black Advocacy, Community Ties, Building Community, Arts, Entertainment, and Education. Focus groups at the end of the study captured participant experiences, challenges, and preferences. Pre/post measures captured blood pressure, self-rated health, and depressive symptoms. Paired t-tests were performed on pre/post outcomes, and thematic coding was applied to focus group data. Mean age was 71.8 years and the majority (93%) were female. Mean self-rated health improved and depression symptoms decreased, but not statistically significant. Blood pressure had little to no change. End-study focus groups revealed that participants were motivated by and benefited from social engagement with their walking groups. Walks simultaneously motivated people to exercise and facilitated reminisce about lived experiences in the neighborhood, including gentrification. Participants identified confusing prompts, local construction, terrain, and technology as barriers to the current application of the program. Participants made suggestions for future route themes and to improve program accessibility and clarity.
WEALTH LOSS, DEMENTIA, AND COGNITIVE DECLINE: SURFACING NEW CONNECTIONS AND UPSTREAM INTERVENTIONS
Authors: Miller Julie , Yoquinto Lucas
Published: January 2025

Nearly one in ten adults in the United States over age 65 has dementia. Another two in ten have mild cognitive impairment: an early, symptomatic period of memory or cognitive decline experienced by those who do not yet meet the full diagnostic criteria for dementia. It has long been a matter of anecdote that serious personal finance losses can coincide with, and arise in the wake of, a dementia diagnosis. This symposium brings together leading researchers to explore financial losses than can occur both before and after formal dementia diagnosis. The first presentation compares household financial trajectories of individuals who ultimately developed dementia with those who did not. The second presentation explores financial status of older adults prior to and following the onset of dementia. The third and final presentation explores changes in marital and health status (including but not limited to transitions from normal cognition to cognitive impairment or dementia) as risk factors for negative wealth shocks in older age. Combined, the presentations surface new insights and questions about connections between financial health and cognitive health. The presentations will be synthesized and brought together by a discussion of possible cross-sector, cross-industry intervention strategies that can be undertaken to protect individuals and families at risk of financial losses associated with dementia, especially in the pre-diagnosis period.
DEMENTIA AND LONG-RUN CHANGES IN FINANCIAL HEALTH AMONG US HOUSEHOLDS
Authors: Li Jing , Kelley Amy , McGarry Kathleen , Nicholas Lauren , Skinner Jonathan
Published: January 2025

We use two decades of the U.S. Health and Retirement Study data to compare long-run trajectories in household finances between individuals who eventually developed dementia and those who did not. In prior work, we find large and steady divergence in household wealth that starts 6-8 years prior to dementia onset. In the current paper, we investigate several possible hypotheses for these changes. By examining detailed categories of household income and spending, we find that long-run divergence in wealth between dementia and non-dementia groups are not explained by higher out-of-pocket healthcare expenses or intentional “spend-down” to qualify for Medicare coverage of nursing home residence. Rather, our findings suggest that they are driven by earlier exit from the labor force and potentially suboptimal investment decisions, which negatively affect long-term income in multiple areas among the dementia cohort relative to their counterparts. We also find that these patterns are more prominent among individuals with higher socioeconomic status.
ADVANCEMENTS IN FRAILTY INTERVENTION RESEARCH: CURRENT TRENDS AND FUTURE DIRECTIONS
Authors: Xue Qian-Li , Xue Qian-Li
Published: January 2025

Frailty, a complex, syndromic condition primarily affecting older adults, faces a lack of evidence-based management strategies due to scarce randomized controlled trials. So far, frailty interventions have employed a spectrum of strategies, including health behavior interventions (e.g., diet and exercise), pharmacological interventions targeting specific biological pathways, and personalized geriatric care models. However, the field faces significant challenges that hinder its progress. A notable issue is that there is a noticeable lack of comprehensive management strategies for frailty patients, supported by robust evidence. Moreover, trials examining the impact of physical activity and dietary interventions have largely focused on the clinical manifestations of frailty (e.g., strength) with little evidence of addressing its biological underpinnings. Further complicating these issues is the inconsistent validation of research findings across various studies and demographic groups, casting doubt on their broader relevance and efficacy. The symposium presents four talks: the first evaluates a values-based digital literacy intervention for prefrail and frail individuals with chronic disease; the next two discuss integrating technologies, including sensors with AI and voice-activated devices, for in-home frailty monitoring and intervention; the fourth considers mind-body practices’ (e.g., yoga and tai chi) potential to influence frailty’s biological underpinnings. Collectively, this symposium aims to: (a) differentiate between interventions tailored specifically to address frailty as a unique clinical entity and interventions aimed at improving care for frail older adults; (b) explore innovative approaches for tailoring frailty interventions to patient-specific goals; (c) tackle the inherent research and implementation challenges in frailty care.
EMPOWERING FRAIL OLDER ADULTS THROUGH DIGITAL LITERACY: A THEORY AND VALUES-BASED INTERVENTION
Authors: Hladek Melissa , Rubio Olivia , Curriero Samantha , Crews Deidra , DeMarco Mara McAdams , Brennan Daniel , Xue Qian-Li , Szanton Sarah
Published: January 2025

Frailty is an age-associated syndrome heightening vulnerability to stressors. Mobility limitations common among individuals with frailty can impede access to physical resources and can lead to social isolation, detrimentally affecting mental and physical health. Digital literacy offers access to health information access, assistive and remote monitoring technologies and social engagement. Each are vital for people with frailty because they can enhance independence, cognition and quality of life. Despite the potential of digital literacy, internet access and digital health resources remain underutilized with older adults, especially among older adults with lower incomes and education levels. We designed a theory and values-based person-directed intervention to address digital literacy for older adults, aiming to recognize and leverage the motivational factors driving their desire to learn new skills. This is a 20 person one-arm feasibility and acceptability pilot trial enrolling participants with varying levels of frailty and digital literacy. The study is comprised of 4-6 in-home biweekly visits over the course of 8-12 weeks that use the older adults’ own values and goals to co-develop action plans that matter to the participant with the primary outcome of improvements in digital literacy. We hypothesize creating a digital literacy intervention that is person-directed will be feasible and acceptable to older adults and will lead to improvements in digital literacy, self-efficacy and quality of life.
AGING IN LONG-TERM CARE FACILITIES IN BRAZIL: NEW CHALLENGES FOR INSTITUTIONAL ENVIRONMENTS
Authors: Tomasini Sergio Luiz
Published: January 2025

This contribution sheds light on the planning of outdoor spaces within Long-Term Care Facilities (LTCFs) for older person as a means to enhance the quality of life for their residents. It presents one of the few empirical studies conducted on this topic in Brazil to date. The study follows an action research approach, focusing on the participatory design of a garden for a LTCF situated in the southern region of the country. The project unfolded in three stages: 1) Initial interviews were conducted with residents to explore their utilization of the institution’s external areas, their past experiences with gardens and their perceptions of the “ideal garden.”. Additionally, systematic observations were made regarding how residents interacted with the open spaces within the LTCF; 2) Subsequent collaborative meetings aimed to actively involve residents in selecting the garden site and defining project requirements; 3) Finally, interviews were held with participating residents to assess the effectiveness of the project methodology. The analysis of these interviews utilized the meaning condensation method, leading to the identification of several themes related to the participatory project approach: a) possibility of creating a territory in the facility; b) opportunity to develop an active role in the facility; c) acquisition of new knowledge; d) promotion of social relations. Overall, the residents’ feedback suggests that employing participatory planning methods can positively impact the adaptive outcomes of older adults in institutional settings.
WHERE DOES EDUCATION COME INTO AGING IN PLACE IN BRAZIL TODAY?
Authors: Kohlrausch Estela , Doll Johannes
Published: January 2025

Environmental Gerontology has involved a wide range of science, but until now, educational aspects are rarely found. In this paper, we argue that educational theory could give important contributions to the understanding and development of the aging person-environment-relation. There are three fundamental contributions: A) In Environmental Gerontology, there is a lot of thinking about adaptation, stimulation, and orientation processes in dealing with changes in the environment or changes in the person during aging process. These processes can be understood as learning processes, and Education Science could contribute by appointing conditions and obstacles for those processes, as for example Peter Jarvis’ existential learning theory for adults. B) Educational theory points out that learning processes happens in social and cultural contexts by social interaction, as Paulo Freire stated: Nobody educates anyone, nobody educates themselves, men (and women) educate each other, mediated by the world. C) Educational processes are intentional, by respecting the other in a dialogical relation. This might be an interesting form for gerontological intervention and is in line with actual discussion about participatory approaches in aging research. Within the major changes in society such as globalization, urbanization, digitalization and climate change, a critical educational perspective, as for example Paulo Freire’s liberation pedagogy can help to understand environment in a broader context, not only to guarantee safety and comfort for older people, but by “reading the world” (Paulo Freire) people can start to get aware of one´s own role within the larger context of community, society and the human world.
CHILDREN’S RESIDENTIAL PROXIMITY, SPOUSAL PRESENCE, AND MODIFIABLE RISK FACTORS FOR DEMENTIA
Authors: Lin Zhuoer , Yin Xuecheng , Levy Becca , Yuan Yue , Chen Xi
Published: January 2025

Objectives

Cognitive impairment poses considerable challenges among older adults, with the role of family support becoming increasingly crucial. This study examines the association of children’s residential proximity and spousal presence with key modifiable risk factors for dementia in cognitively impaired older adults.

Methods

We analyzed 14,731 persons (35,840 person-waves) aged 50 and older with cognitive impairment from the Health and Retirement Study (1995-2018). Family support was categorized by spousal presence and children’s residential proximity. Modifiable risk factors, including smoking, depressive symptoms, and social isolation, were assessed. Associations between family support and the modifiable risk factors were determined using mixed-effects logistic regressions.

Results

A significant proportion of older adults with cognitive impairment lacked access to family support, with either no spouse (47.0%) or all children living over 10 miles away (25.2%). Those with less available family support, characterized by distant-residing children and the absence of a spouse, had a significantly higher prevalence of smoking, depressive symptoms, and social isolation. Moreover, we revealed a consistent gradient in the prevalence of the risk factors by the degree of family support. Relative to older adults with a spouse and co-resident children, those without a spouse and with all children residing further than 10 miles displayed the highest prevalence of the risk factors. These findings were robust to various sensitivity analyses. Conclusions: Family support from spouses and nearby children serves as a protective factor against modifiable dementia risk factors in cognitively impaired older adults. Strengthening family and social support is paramount for this vulnerable population.
COMMUNITY ENGAGEMENT IN DIFFERENT NATIONAL CONTEXTS: BUILDING BRIDGES AND AGE-FRIENDLY ENVIRONMENTS
Authors: Jonsson Oskar , Chi Peggy , Johnson Ian
Published: January 2025

To bridge the gap between research and practice, initiatives to facilitate knowledge mobilization in tandem with community engagement have become increasingly important. This symposium will advance the understanding about knowledge mobilization processes and community engagement efforts by offering insight from scholars from established research centers with long-standing community engagement as well as new initiatives connecting disparate disciplines and sectors. Representing different national contexts, the speakers will share their experiences regarding the complexities of partnership and engagement approaches, processes, and activities. Benefits (research quality, relevance, utilization, transgressing boundaries, addressing complex problems) as well as barriers (diverse conditions/cultures, lack of time/resources, multiple levels of terminology, hard-to-reach groups, projectification, boundaries of traditional science systems) will be addressed. The first speaker will describe the development and establishment of a pool of interested parties in Sweden to systematize and facilitate communication, entryways to research studies, and user involvement in aging research. The second speaker will describe the work of a center serving older African Americans from Detroit, Michigan, including innovative leadership opportunities created for its members. The third speaker will describe new initiatives in the Canadian context that purposefully choreograph knowledge mobilization activities to disrupt disciplinary and industry silos in the practice and research of salutogenic/healthy long-term care environments. The last speaker will describe an engagement effort towards age-friendly infrastructures in rural municipalities in Canada. Finally, discussant Ian Johnson from the University of Texas San Antonio will identify, compare, and discuss underlying themes, commonalities, differences, and lessons learned generated from the presentations.