bluuebunny/crossref_metadata_2025 huggingface dataset:
LONELINESS AMONG OLDER CAREGIVERS IN THE CALIFORNIA HEALTH INTERVIEW SURVEY
Authors: Chen Xiayu , Lydon Elizabeth , Jones Sarah , Mathias Vincent F , Rogers Wendy , Mudar Raksha , Raj Minakshi
Published: January 2025

In the U.S., adults aged 65 and above represent the second largest age group among familial caregivers. Navigating dual challenges in caregiving demands and their own aging process may lead to higher risk of social isolation for older caregivers. However, research regarding loneliness among older caregivers remains limited. This study aimed to (a) compare risk factors for loneliness between older caregivers and non-caregivers; (b) evaluate if sociodemographic, health, and caregiving characteristics are related to loneliness among older caregivers; and (c) compare the association between these characteristics and loneliness among older caregivers of persons with dementia versus without dementia. We conducted a secondary data analysis of the 2020 California Health Interview Survey. One-fifth of the older adults (n=7,638) served as caregivers in the past year, and 15% of older caregivers experienced loneliness. Using a series of weighted multivariable logistic regressions, we found that older caregivers were more likely to experience loneliness compared with older non-caregivers (aOR = 1.15, 95% CI: 0.89 - 1.49). Those caring for other older adults had a lower likelihood of loneliness compared with those caring for younger individuals (aOR = 0.48, 95% CI: 0.27 - 0.85). Caregivers of persons with dementia were more likely to experience loneliness compared to those caring for persons without dementia (aOR = 1.67, 95% CI: 1.05 - 2.66). Our analyses revealed that older caregivers, especially those assisting persons with dementia, face a higher risk of loneliness, underscoring the need for targeted support and inclusive caregiving policies.
FORTITUDE AND THE MORAL GOOD OF AGING
Authors: Wohns Nicolai
Published: January 2025

Fortitude, classically one of the four cardinal virtues, is taken to be necessary for the possession of every other virtue. In this presentation, I analyze the positive aspects of aging from a philosophical perspective and argue that fortitude is also of particular importance for the moral good of aging. Once aging is understood as a dynamic phenomenon with biological, socio-psychological, and existential dimensions, it becomes apparent that it presents myriad physical and mental challenges for which fortitude is required for one to flourish. I focus on the biological dimension in particular, suggesting that, though it is usually defined in terms of loss, biological aging brings with it the possibility for moral virtue. Using this virtue-theoretic framework, I conclude by arguing, contrary to some trans-humanist critics, that there are in fact positive aspects of aging that depend on biological aging.
THEORIZING FORTITUDE, FRIENDSHIP, AND OLD AGE IN LORE SEGAL’S SHORT STORY CYCLE “LADIES LUNCH”
Authors: Trinkaus Eva-Maria
Published: January 2025

This contribution addresses the question of ‘fortitude’ from a literary studies perspective. In my narrative analysis of Lore Segal’s short story cycle “Ladies Lunch” (2023) I look at the representation of fortitude in the context of friendship in old age. Fictional narratives about female friendships in old age, Chivers argues, can be part of “constructive narratives of aging” in an “imaginary world that can reflect and especially affect circulating social thought” (2003). Friendship in old age, in Segal’s fictional text, constitutes a form of care among the women who partake in their regular lunch meetings in which they contest the readers’ views on stereotypes of old age, but at the same time, also express personal vulnerabilities in opposition to a “decline narrative” (Gulette 2001). On the contrary, the kind of reciprocal care they experience comes from a vulnerability that manifests as a “radical openness towards surprising possibilities” (Hirsch 2016). In theorizing fortitude, this narrative analysis addresses the ways fortitude manifests in ways that do not necessarily address danger or pain in the literal sense of the word. Rather, it provides a perspective that juxtaposes fortitude and age in order to address courage in accepting situations and the creative adaptation to those within the story.
POLICY SERIES: WHAT IS “GOOD WORK” IN LONG-TERM SERVICES AND SUPPORTS? SETTING A RESEARCH AND POLICY AGENDA FOR DIRECT CARE WORK
Authors: Morgan Jennifer , Taylor Philip , Behrens LIza
Published: January 2025

This symposium considers the importance of the care-work nexus in long-term care research and policy. Person-centered care delivery is widely accepted as delivering optimal client outcomes, but this is often not practiced. Job quality is considered a crucial determinant of well-being for individuals, society and of organizational performance, yet direct care work is not generally afforded “good work” job quality. Raising standards of appropriate care and care work job quality is essential to improve the life quality of both clients and workers. Drawing from empirical research in the USA and internationally, this session considers the current state of long-term care work across key dimensions of job quality. Critically from a job quality perspective, this session foregrounds the authentic worker voice in identifying a research and policy agenda focused on addressing the care-work nexus. First, we will provide an overview of job quality across long-term care services and supports sectors highlighting the target areas for research and policy advocacy by sector. Second, we will engage workers and union leaders, using a community-engaged co-design framework, in the local SEIU 775 Washington to react to the job quality domains and provide feedback on priority-setting. Third, Washington-based SEIU leaders will collaborate to review the policy, advocacy and negotiation wins made for clients and worker in conversation with employer partners. Finally, scholars, in collaboration with workers/leaders, will summarize the areas targeted for future research and policy agendas aimed at improving job quality and person-centered approaches for both workers and clients.
DIRECT CARE WORKERS IN LTSS: RESEARCH AND POLICY AGENDA SETTING
Authors: Taylor Philip , Scales Kezia
Published: January 2025

At a time when the provision of long-term care is under more scrutiny than ever, and as demand for care increases, it is timely to consider what this will mean for the future organization of care work. Recent reviews have recommended changing the nature of the modern workplace, creating good work, and reducing poor-quality work. As well as positive worker outcomes, good work benefits organizational performance—and enhances care quality. The task is to develop a “conducive model” of jobs that generates positive outcomes for a care workforce that is disproportionately female and people of color who face multiple structural inequities. Drawing on international literature concerning the relationship between long-term care organization, staffing and care quality, the working environment, and worker and resident/client outcomes, this paper utilizes the multidimensional job quality concept to assess the state of knowledge. Unsurprisingly, the evidence demonstrates that poor-quality jobs result in poorer worker outcomes, and good-quality jobs support good care. However, significant gaps in understanding across dimensions of job quality are identified, particularly how it can be operationalized in day-to-day practice. It is argued that focusing on job quality will help reframe the analysis and interventions needed to improve care and adapt provision to meet future demand. In conversation with our worker and union leader guests and the panel scholars, we will collaboratively set the research and policy agenda for direct care workers in LTSS. Implications for establishing a national taskforce or an international concord on the direct care workforce will be discussed.
CO-DESIGNING SOLUTIONS WITH WORKERS: SETTING RESEARCH AND POLICY PRIORITIES
Authors: Rhodes Annie , Waters Leland
Published: January 2025

An emerging body of literature has linked the quality of care for care recipients with the quality of work experience with the professional caregiver across the spectrum of long-term services and supports. For instance, prior to the COVID-19 vaccine, nursing home workers who worked in multiple locations were significantly more likely to be infected with COVID-19 and, subsequently, more likely to infect care recipients. Despite the natural alignment with worker and recipient interests, LTSS quality improvement efforts often do not focus on aligning recipient and worker perspectives as a reform and quality improvement strategy. For instance, although current evidence supports that staffing ratios improve both recipient care and caregiver safety, there has been a backlash against a proposed staffing mandate in nursing homes by provider stakeholders. To uplift the caregiver’s voice and collaborate with SEIU 775 (Washington State), workers from home care and nursing home organizations with leadership experience will talk with panelists about COVID-19, staffing ratios, advocacy, job quality, job safety, career ladders, and advancement, and intrinsic rewards. These workers will relay their experiences and discuss why they took up these jobs, stay in these jobs, and work to improve these jobs through union strategies. Panelists will ask questions related to agenda setting and co-designing research and policy solutions that simultaneously uplift and align recipient and caregiver voices.
“HOW DOES THAT MAKE YOU FEEL?” USING NETWORK SCIENCE TO ESTIMATE AFFECT DYNAMICS ACROSS ADULTHOOD
Authors: Hamilton Lucas , Allard Eric
Published: January 2025

Research on affect dynamics has dramatically changed in the past two decades. With the proliferation of ecological momentary assessment and online data collection, methodological and analytical approaches have greatly expanded. One approach is the estimation of emotion networks which can be done through a few lines of R code but requires a great deal of planning and interpretation by the researcher. Network estimation models individual emotions as distinct (i.e., sad or angry) and dimensionally dependent (i.e., sad and angry). This technique can test the independent influence of each emotion and unique associations between every pair of emotions. Critically, network structures (i.e., magnitude of co-fluctuation, independence of items) can be compared both within-individuals and between groups. Our previous findings demonstrate the feasibility and utility of estimating emotional reactivity across the lifespan. Using a video clip elicitor and a sample of 531 people (178 younger, 175 middle-aged, and 178 older adults), emotion networks were used to verify mean affective reactivity before and after the clip while also testing distinct co-occurrences (i.e., mixed emotions). To further demonstrate the usefulness of this approach, we have undertaken a database project that evaluates affective blending in response to 48 video clips. Mirroring the methodology from above, a sample of younger, middle-aged, and older adults rated their emotions before and after each video clip they watched. After summarizing overall reactivity findings, we will discuss how emotion networks offer great utility for disentangling unique and co-occurring emotions and their importance in emotional aging research.
PARSIMONIOUS MODELS OF LONG-TERM COGNITIVE DECLINE AND IMPAIRMENT PREDICTION IN MIDDLE-AGED ADULTS
Authors: Merten Natascha , Pinto A Alex , Paulsen Adam , Chappell Richard , Chen Yanjun , Engelmann Corinne , Hancock Laura , Schubert Carla
Published: January 2025

Established risk scores for dementia prediction (e.g., the CAIDE and Framingham Risk Score) often focused on cardiovascular factors and have not been updated in more recent generations. We aimed to construct a parsimonious risk prediction model of 10-year cognitive decline and impairment using factors measured in midlife in a current cohort. This longitudinal study is based on N=1529(54% women, mean age 49years) Beaver Dam Offspring Study participants with data from baseline, 5-year and 10-year follow-up. We assessed hearing, vision, olfactory, motor, lifestyle, cardiovascular and general health factors, and blood-based neurodegenerative markers, and amyloid. We determined 10-year cognitive decline (trail-making test B time;10% most decline) and cognitive impairment (neurocognitive case review). We constructed least absolute shrinkage and selection operator logistic regression models with 10-fold cross-validation and evaluated predictive ability via receiver operating characteristic curves (AUCs). There were N=121 cognitive decline and N=217 cognitive impairment cases. The six top predictors for cognitive decline (age, income, motor function, olfactory function, peripheral artery disease, neurofilament light chain protein (NfL)) and for cognitive impairment (sex, motor function, olfactory function, self-rated vision, alcohol consumption, NfL) yielded AUCs of 0.80(95% confidence interval:[0.76-0.83]) and 0.73[0.69-0.77], respectively. In midlife, sensory and motor measures and NfL were among the best predictors of 10-year onset of cognitive decline and impairment. Only 6 factors were needed for acceptable to excellent AUCs. Other cohort studies should cross-validate these predictors. Risk scores for asymptomatic middle-aged people based on practical test batteries will be useful for population screenings to target early prevention and intervention strategies.
INSIGHTS ON OLDER ADULTS WITH COGNITIVE IMPAIRMENT AND HEARING LOSS: END-USER AND CARE PARTNER PERSPECTIVES
Authors: Hope Peter , Nieman Carrie , Blinka Marcela , Lee Paul , Tu Xueting , Wang Natalie , Yasar Sevil , Oh Esther
Published: January 2025

Hearing loss is prevalent among persons aging with cognitive impairment and can have significant repercussions for individuals and their care partners. However, hearing aid usage is low among older adults, particularly among individuals with cognitive impairment. To understand the barriers and facilitators to hearing care among persons living with cognitive impairment and their care partner and to inform the development of a hearing care intervention, we conducted 20 semi-structured interviews with 10 participants with cognitive impairment and their care partners. Participants were recruited from the Johns Hopkins Memory and Alzheimer’s Treatment Center. We used heterogeneous purposive sampling to recruit participants from diverse race, ethnicities, education, and income levels. Qualitative content analysis was used to identify themes. Among end-users and care partners, 30% self-identified as African American, 45% as male, and 40% reported less than a college degree. Participants with cognitive impairment had a mean score of 16.8 (SD8.2) on the Montreal Cognitive Assessment and mean speech frequency pure tone average of 44.9 dB HL (SD12.7). End-users and care partners identified barriers to accessing care, including stigma, cost of hearing aids, lack of availability of hearing care, and participants’ denial of hearing difficulties. Suggested facilitators for improving access to hearing care include affordable hearing aids and incorporating hearing screenings into routine care. The participants’ desire to improve communication and care partner support motivate accessing hearing care. Our findings suggest that addressing barriers, promoting affordability, and enhancing accessibility to hearing care are critical in extending care to individuals aging with cognitive impairment.
NEW TOOL ENHANCES DETECTION OF LIFE-EXTENDING INTERVENTIONS BY DELINEATING THEIR TEMPORAL EFFICACY
Authors: Jiang Nisi , Liu Qianqian , Cheng Catherine , Strong Randy , Gelfond Jonathan , Nelson James
Published: January 2025

Drug discovery of anti-aging interventions relies on survival data, which is time-consuming and costly to generate, yet the analysis of such data often fails to capitalize on its full potential. The predominant method for assessing intervention effects on lifespan, the log-rank test, lacks the power to identify when and for how long an intervention is effective. Moreover, it has decreased sensitivity for interventions that are only effective during part of the life course. Statistical tools are needed to address these limitations. They should be capable of identifying when, for how long, and to what extent an intervention reduces (or increases) mortality risk. Here we introduce a Temporal Efficacy Profiler (TEP), which meets these needs, and apply it to survival data from 42 compounds tested in the NIA Interventions Testing Program (ITP) using UM-HET3 mice. Compared to the log-rank test, this tool identified over twice as many compounds that increased (or decreased) survival, largely because of its sensitivity to variable efficacy of the interventions across the life course. Sex differences were prevalent. The TEP revealed agents that either reduced (22 compounds) or increased (15 compounds) mortality hazards, with some (2 compounds) showing dual effects depending on sex. Notably, the efficacy of these interventions varied significantly in both duration and magnitude. Moreover, the TEP uncovered adverse effects that were missed by the log-rank test. Of note, only 8 compounds significantly reduced mortality hazards beyond the 90th percentile of mortality, a period when the burden of senescence is highest.
PREDICTING TIME TO COGNITIVE IMPAIRMENT USING BRAIN AGE
Authors: Imms Phoebe , Chen Siyu , Wang Haoqing , Li Ruixi , Irimia Andrei
Published: January 2025

The neurological changes that occur during the asymptomatic pre-clinical phase of cognitive impairment (CI) can be quantified using brain age (BA) measures and leveraged to identify those at risk of clinical manifestation. We employ a machine learning survival model to predict future CI among healthy older adults using cognitive, demographic, genetic, and neuroimaging data including regional brain volume and anatomically specific measures of BA. Participants were 2,718 adults from NACC (1,795 females, mean age=69.14±10.91). Converters (N=343) were diagnosed with CI during the study, and non-converters (N=2,375) were CN across all visits. We predicted time to conversion (days) from baseline MRIs (185 brain volumes and regional BA measures) and 69 clinical variables. The model was trained on 1,846 converters and 252 non-converters, validated on 32 converters and 238 non-converters, and tested on 150 converters and 200 non-converters with 5-fold cross-validation. The model’s predictive accuracy (c-index) was 0.82 for training, 0.83 for validation, and 0.78 in the test set. Important features for prediction included age, neurocognitive test scores, education, history of hypertension and stroke, BA, and volumes of the right hippocampus, right precentral gyrus, bilateral white matter, and left inferior temporal gyrus. Products of this model allow us to compare a) the risk, and b) the BA biomarkers across population subgroups with heightened CI risk such as racial minorities and people with fewer years of education. The ability to accurately predict future cognitive impairment (CI) benefits those most in need of therapeutic interventions and reduces the burden of CI on healthcare systems.
MARKERS OF PHYSICAL HEALTH AND HEALTH BEHAVIORS CONTRIBUTE TO LATER COGNITIVE FUNCTIONING AMONG ADULTS AGED 55–65
Authors: Katz Ben , Sands Laura , Khan Maham
Published: January 2025

Life’s Essential 8 (LE8) represents a summary score consisting of a set of physical health (BMI, blood pressure, cholesterol, A1C) and health behaviors (sleep, diet, smoking status, physical exercise) that are closely associated with risk of cardiovascular disease. LE8 is designed to be simple for physicians to calculate, using regularly collected self-report and biomarkers, and easily interpretable for patients. While no equivalent score exists for Alzheimer’s disease and related dementias (ADRD), given close links between cardiovascular risk factors and cognitive outcomes, recent studies have identified links between LE8 and cognition and dementia. However, longitudinal work in this space is limited; additionally, many prior studies do not examine links from midlife to changes in later life cognitive functioning. The present study draws from 761 midlife adults aged 55-65 without cognitive impairment at baseline who were recruited to participate in the Health and Retirement Study. Data informing LE8-style indicators (including health behaviors and bloodspot biomarker data) were recorded in 2006. Performance on the Telephone Interview for Cognitive Status (TICS) assessment was measured 14 years later. Utilizing linear regression techniques that incorporated the HRS sample weights and age, gender, education, and baseline cognitive functioning, we found that both the aggregated health behaviors (p <.01) and aggregated physical health biomarker indicators (p <.001) accounted for unique variance in the TICS scores 14 years later. These findings have implications both for basic research to investigate the mechanisms connecting lifestyle and physical biomarkers to later cognition, but also for clinical practice and patient communication.
ASSOCIATION BETWEEN SERUM BIOMARKERS OF ALZHEIMER’S DISEASE AND “DUAL DECLINE” IN COGNITIVE AND MOTOR FUNCTIONS
Authors: Pinardi Elena , Ornago Alice , Grande Giulia , Valletta Martina , Rizzuto Debora , Laukka Erika Jonsson , Bellelli Giuseppe , Vetrano Davide Liborio
Published: January 2025

Individuals experiencing simultaneous decline in cognitive and motor performances (i.e., dual decliners) face an increased risk of dementia and other adverse health outcomes. While the underlying pathophysiology remains largely unknown, this study aims to explore the association between serum biomarkers of Alzheimer’s disease (AD) and various patterns of cognitive/motor decline. Data are drawn from the Swedish National Study on Aging and Care in Kungsholmen. The rates of cognitive and motor decline were assessed over a 15-year period using linear mixed models, with Mini-Mental State Examination and gait speed as the respective measures. Participants were categorized into slow/non-decliners (reference group, n=1115), fast motor decliners (n=162), fast cognitive decliners (n=162), and dual decliners (n=264). The association between serum AD markers levels and the four decline patterns was analyzed using multinomial logistic regressions. Phosphorylated tau181 (OR = 1.77, 95% CI: 1.60;1.97), neurofilament light chain (OR = 1.44, 95% CI: 1.31;1.57) and phosphorylated tau181/amyloid-β42 ratio (OR = 1.18, 95% CI: 1.12;1.25) were associated with the highest risk of a dual decline pattern among study participants. In isolated cognitive decliners, robust associations were observed for amyloid-β42, amyloid-β42/40 ratio and glial fibrillary acidic protein, whereas no significant association emerged for those exhibiting only motor decline. Dual decliners present distinct profiles of serum AD biomarkers. The extensive involvement of tau pathology and neurodegeneration suggests an intrinsic biological complexity that necessitates further research, encompassing vascular and neuroinflammatory pathways.
DESIGNING FUTURE HEALTH CARE ENVIRONMENTS FOR AN AGING SOCIETY: TRANSDISCIPLINARY PERSPECTIVES
Authors: Kabo Felix , Contreras Cameron
Published: January 2025

As our society grapples with demographic aging, it is imperative that we design healthcare environments that better support the well-being of older adults in the context of critical staffing shortages in the healthcare sector. Beyond aesthetics and visual appeal, thoughtful healthcare design significantly and directly impacts patient outcomes, staff well-being, and the overall quality of care. This symposium brings together four complementary presentations from the design and research fields that employ transdisciplinary perspectives to examine the issue of designing healthcare environments for an aging society. Kabo, Morrison, and Ritsema discuss how digital twins, virtual representations of real-world objects, can be used to transform the future of healthcare design, thus delivering quality care experiences that sufficiently support the needs of older adults. Calkins provides an overview of evaluative research on healthcare design outcomes by focusing on the post-occupancy evaluation process by the SAGE Federation and links the research to the holistic design of age-friendly healthcare environments. Perreault and Kaminski use two innovative case studies to discuss and illustrate best practices in healthcare design for older adults, and how the built environment can be designed as an active aid for patient recovery. Kim will discuss how smart technologies and machine learning can facilitate successful aging-in-place and the design of home environments that better support healthcare for older adults. Collectively, this symposium brings together speakers from different fields (design and research) and disciplines (e.g., gerontology, architecture, interior design, engineering, etc.) to discuss the convergence of design and healthcare for our aging society.
END-OF-LIFE DECISION-MAKING: INFORMATION PRACTICES OF UCHINANCHU OLDER ADULTS
Authors: Shiroma Kristina
Published: January 2025

End-of-life (EOL) decision making encompasses sensitive, yet pivotal decisions requiring nuanced information. Understanding how diverse populations understand and make EOL decisions is crucial as diverse information practices can inform policies to enhance value-centered care for a broader range of patients at end-of-life. This study aims to better understand diverse approaches to EOL decision-making from older adults’ who come from an underrepresented ethnic minority group in the United States. Reflexive thematic analysis of in-depth, semi-structured interviews with 18 Uchinanchu American older adults. Recruitment through convenience and snowball sampling for in-person and telephone interviews. Three themes were identified in Uchinanchu American older adults’ approaches to EOL decision making: Prioritizing Mitigation of Burden for Adult Children; Keeping Customs of Filial Responsibility; and Maintaining a Shoganai Mindset. Uchinanchu participants were thinking about EOL decision making both down the familial lineage as they prioritized mitigating burden for their adult children, but also up the familial lineage as they kept customs of filial responsibility for their parents. Participants’ cultural approach to shoganai (the Japanese word associated with accepting one’s fate) helped them to balance a cultural acceptance of death as a fated part of life to either make or defer from EOL decision making. This study extends our understanding of diverse approaches to end-of-life decision making for underrepresented ethnic minority older adults in the United States. Future work in EOL decision making should include hard-to-reach, underrepresented populations to provide for inclusive and representative understandings of death and dying.
DEVELOPMENT AND CONTENT OF THE STUDY ABROAD COURSE
Authors: Fauth Elizabeth
Published: January 2025

Pedagogy of faculty-led short study abroad programs posits that these programs offer unique opportunities to build cross-cultural adaptability and global citizenship, expand disciplinary and interdisciplinary content knowledge beyond the traditional classroom, foster experiential learning opportunities, and facilitate personal and professional identity. This presentation on the Aging in a Welfare State covers the how course design, content selection, site visits, assignment, and excursions map onto these objectives. Optimizing three credits (which is ideal for most students’ programs) necessitates reading and assignments before, during and after “in-country” portion of the course. In-country content is delivered by US faculty and Swedish faculty, who purposefully are chosen (or select lecture content) based on their own discipline and expertise. With lecture content in nursing, social work, developmental psychology, gerontology, and more, students from diverse majors often connect closely to at least some of the content within their discipline, but expand learning into new topics. The addition of content on family and child policies is attractive to students outside of gerontology programs. Days are organized around themes, with three lectures in the morning broken up by the Swedish coffee tradition of FIka, a lunch break, and site visits to hospitals, adult day programs, child care programs, senior centers, assisted living facilities, and rehabilitation programs. Site visits offer applied learning experiences, where students can interact with professionals and clients/residents/users. Excursions are used to expose students to Swedish culture, and the historical perspectives that inform their social care policies. Assignments bridge academic application and personal/professional self-reflection.
ESTABLISHING A SHORT-TERM STUDY ABROAD COURSE ON AGING AND HEALTH CARE: FACILITATORS AND BARRIERS
Authors: Hermann Carla
Published: January 2025

The population of older persons is growing in every country in the world. In the United States (US), the older population is increasing at an unprecedented rate and is becoming significantly more diverse. Population aging is one of the most significant social transformations of the twenty-first century. Every occupation will be impacted by this transformation; therefore, education of individuals across disciplines about aging is imperative. To address the demand for aging-related professionals, Indiana University Southeast developed and implemented an interdisciplinary short-term study abroad course on healthcare and gerontology for students of any major. Although this course was previously offered by other US universities in collaboration with the College of Health and Welfare at Jönköping University in Sweden, the course offered in May 2023 was the first time Indiana University Southeast was involved. There were multiple facilitators and barriers to establishing this short-term study abroad course. Facilitators included: collaboration with an established course and international experts; institutional support from the host university in Sweden; high interest in an international learning experience by the students; the course available to students of any discipline; offered over a short-term (2 week) period. Barriers to offering this course included: lack of institutional infra-structure to support study abroad; post-pandemic traveling concerns; lack of student knowledge regarding basic concepts of aging and healthcare. High impact educational practices such as study abroad can help meet the demand for professionals that are prepared to promote the well-being of the aging and diverse population.
HISTORY OF A SUSTAINED AND SUCCESSFUL MODEL OF INTERNATIONAL GERONTOLOGICAL EDUCATION
Authors: Zarit Steven
Published: January 2025

A successful and sustained study abroad program depends on a foundation built in advance by the faculty of the participating institutions. Three foundational elements contributed to the success of the program, Aging in a Welfare State: What We Can Learn from Sweden, that has been ongoing since 1995. The first and most important foundational element is the relationship between the faculty at participating institutions. In this program faculty of the two initial participating institutions (Jönköping University and Penn State) had worked together for several years prior to developing and offering the program. Another foundational element was long-standing relationships between our Swedish partners and personnel at social and care facilities serving older people in Jönköping. A central goal of the program was that students would learn how care is organized and delivered in Sweden by visiting programs that served older people. Because our Swedish partners had long-established relationships with local care facilities, they were able to arrange visits for students at a range of programs for older persons. Staff at these facilities welcomed us, were open and informative and even invited us to Swedish Fika (coffee and a snack). We were also able to talk with the people using these programs. The visits were the most inspiring part of the class for students because they demonstrated innovative ways of providing care compared to the US. An obvious but important foundational element was having housing, transportation, and other comfort issues in place. These foundational elements were the key to our ongoing success.
WECAREADVISOR: CAREGIVER USE OF A DIGITAL PLATFORM TO MANAGE DEMENTIA-RELATED BEHAVIORAL SYMPTOMS
Authors: Gitlin Laura , Davis Vincent , Bouranis Nicole , McClure Leslie , Kales Helen , Webster Melinda
Published: January 2025

Dementia-related behavioral and psychological symptoms are undertreated and have negative consequences for people with dementia and their caregivers. Families typically do not have access to dementia education and effective management strategies. WeCareAdvisor is an online platform providing caregivers with dementia information, daily tips, and a 4-step systematic approach for describing behaviors, investigating underlying causes, creating a list of tailored strategies (prescriptions), and evaluating their effectiveness (DICE). It is being tested in a randomized trial to evaluate effects on caregiver wellbeing and behavioral symptoms. This paper reports utilization patterns of 240 caregivers under two “prompting” conditions to use the platform: high-intensity (telephone plus email reminders) and low-intensity (email reminders only). A total of 999 DICE sessions were started of which 347 (35%) sessions were evaluated. Caregivers sought strategies for all 13 behaviors included in the platform ranging from 141 DICE sessions for Anxiety (14%) to 31 sessions for Hallucinations (3%). Caregivers in the high-intensity prompt group (n=46) had more DICE sessions (296, mean=6.4, SD=4.5) compared to 163 sessions in the low-intensity prompt group (n=41, mean=4.0, SD=3.5), generated 82% more prescriptions, and requested close to 3 times more additional strategies. Of 171 study completers, an average of 4.5 (SD=3.8) DICE sessions were conducted over 6-months (range 1-19). Caregivers engaged with WeCareAdvisor to obtain strategies for managing common behavioral symptoms; however, only 1/3 evaluated their effectiveness. Caregivers used the online platform more when prompted by telephone/email than by email alone. This utilization pattern has significant implications for cost and scaling of the WeCareAdvisor.
EXPLORING THE ACTIVATING EFFECT OF THE CARE ENVIRONMENT OF GREEN CARE FARMS FOR PEOPLE WITH DEMENTIA
Authors: Rosteius Katharina , Frissen Laura , de Boer Bram , Gabrio Andrea , Verbeek Hilde
Published: January 2025

Engagement and activity is important for people with dementia for their sense of purpose, and for cognitive and physical stimulation. Aiming to increase engagement and activity, innovative long-term care environments like Green Care Farms (GCFs) reorganize care by including nature, animals and a more home-like environment into daily care. Previous studies have shown that GCF-residents are more active than those of regular care facilities. This study explored the role of the GCF-environment in this activation. Ecological Momentary Assessments were conducted with 152 participants from four Dutch GCFs, combined with cognitive and physical assessments. Residents were observed during mornings, afternoons and evenings, with a total of 4,600 valid observations. Each observation combines activity-, engagement-, as well as place scores, which are mapped on a ground plan of the facility. Analyses showed that residents were actively engaged in an activity in 67.9% of the observations. Residents spent most of their time in inside common areas (54.0%), followed by their own room (24.6%), outside (10.6%) and in communal inside areas outside of their ward (e.g. a café) (7.7%). In relation to passive behavior, active engagement was highest outside (87.1%), as well as in communal areas outside of the ward (81.7%) and inside the ward (81.3%). These results show that areas where residents spend time together have most activating potential and call for a more communal organization of care. Further research should explore what in the environment triggered residents’ engagement in order to react to needs arising in a tailored way.
UNDERSTANDING ACTIVITY ENGAGEMENT EXPERIENCE AMONG RESIDENTS WITH DEMENTIA IN LONG-TERM CARE HOMES
Authors: Zhang Ziying , Chaudhury Habib
Published: January 2025

Recreational and meaningful activities in long-term care homes are crucial in promoting well-being among residents with dementia. While existing research primarily focuses on planned activities facilitated by staff, little attention has been given to self-directed activities initiated by residents themselves, reflecting their intrinsic motivation, lifestyle, and lifelong interests such as walking, gardening, meal preparation and other household activities. In this study, activity is defined as personally meaningful behavior, including both programmed and self-directed activities, and supported by social and/or physical environmental stimuli. Utilizing critical ethnography in a long-term care home in Canada, our research aims to: 1) gather descriptive data on the types, diversity and process of residents’ activity engagement, and 2) examine the care home setting in its natural context to uncover the social practices, built environmental features and underlying organizational discourses that influence activity engagement. Observations will focus on residents’ engagement in various activities and their interactions with staff and the physical environment. Interviews will be conducted with activity staff and non-activity staff (e.g., care aides, nurses) to explore their perspectives on activity engagement, person-centered approach, and their respective roles in promoting engagement. This study offers insights into residents’ experiences with both structured and self-directed activities, and the influence of the care home’s social and physical environments on engagement. The study addresses the knowledge gap in meaningful engagement through self-directed activities and the role of social and physical environments. Fieldwork will be completed in summer and preliminary findings based on interviews and initial observations will be presented.
TARGETING BIOLOGICAL AGING MECHANISMS OF LOWER URINARY TRACT SYMPTOMS IN OLDER MEN WITH AN EXERCISE INTERVENTION
Authors: Bauer Scott
Published: January 2025

Physical frailty is associated with lower urinary tract symptoms (LUTS) severity and progression among older men with suspected benign prostatic hyperplasia (BPH). Prospective cohort studies have consistently demonstrated that both physically inactive and frail men are more likely to develop BPH or experience LUTS progression. The combination of aerobic plus resistance exercise has been demonstrated in clinical trials to have pleotropic effects that delay, prevent, or treat many frailty-related conditions that often co-occur with LUTS and BPH, including cardiovascular disease, diabetes, and erectile dysfunction. Although it has never been tested in humans, pre-clinical mouse models of BPH demonstrate improved voiding behaviors after exposure to exercise and exercise is known to improve several mechanisms that are implicated in human LUTS/BPH pathophysiology, including insulin resistance, endocrine dysregulation, and mitochondrial dysfunction. The recently launched PROUD study (NCT06225479; MPIs: Bauer, Kenfield) is a 2-arm pilot randomized controlled trial among physically inactive older men with LUTS/BPH testing the effect of a 12-week remote exercise intervention versus health education control. Outcomes include: 1) feasibility, acceptability, fidelity, and safety; 2) changes in LUTS, urologic and physical function, and physical activity; and 3) feasibility of detecting exercise-induced change in novel frailty-related mechanistic measures. This symposium session will review the scientific rationale, key study design and analytic decisions, enrollment progress thus far, and collaborative opportunities using stored biobank specimens.
CLINICAL TRIALS OF GEROTHERAPEUTICS FOR TARGETING LOWER URINARY TRACT SYMPTOMS
Authors: Al-Naggar Iman
Published: January 2025

Aging and the metabolic syndrome, a condition that accelerates biological aging, are both risk factors for lower urinary tract symptoms (LUTS). Storage LUTS, including urinary frequency, urgency, incontinence and nocturia, greatly impact quality of life and contribute to social isolation, depression, increased risk of falls and fractures, and loss of independence in older adults. Dysregulated mechanisms along the brain-to-bladder pathway can lead to LUTS, as the body becomes less resilient and its ability to maintain normal function declines. Although dysfunctional detrusor muscle can be targeted with anticholinergics, these drugs have had little success in alleviating LUTS and are often abandoned due to undesirable side effects. Identifying novel targets would allow the development of more effective drugs to alleviate LUTS. Biological mechanisms of aging that play a role in multiple age-related diseases have recently been implicated in metabolic syndrome-associated LUTS, including inflammation, mitochondrial dysfunction and oxidative stress. Furthermore, studies using mouse models of aging and metabolic syndrome show increased bladder dysfunction in these model organisms. Targeting biological hallmarks of aging to alleviate LUTS in humans represents a promising new direction that our group is exploring. This can be safely done using repurposed drugs or supplements with gerotherapeutic properties, such as MitoQ. This symposium session will describe the rationale and study design for on-going pilot and feasibility studies targeting the biology of aging for LUTS alleviation in older women.
EVIDENCE TO SUPPORT A NOVEL CLINICAL CARE PATHWAY FOR GERIATRIC INCONTINENCE SYNDROME IN OLDER WOMEN
Authors: Parker-Autry Candace
Published: January 2025

Geriatric syndromes define complex health conditions that result from the concomitant presence of multiple geriatric impairments in an older adult. Urinary incontinence (UI), an established geriatric syndrome, is unique in that it is present among younger women due to pelvic floor dysfunction, most commonly due to birth trauma or obesity, as well as older women with aging-related changes in skeletal muscle and cognitive health. The latter is a distinct phenotype of UI called female geriatric incontinence syndrome (GIS). Like other geriatric syndromes, GIS is bidirectionally associated with frailty and commonly occurs with concurrent multimorbidity. The combined impact of pelvic floor dysfunction, aging-related impairments in skeletal muscle and/or cognition, and multimorbidity make defining, diagnosing, and treating GIS a complex task. There is a significant body of work describing non-procedure-based treatments for UI with focus on physical therapy/exercise and medications. However, with unhealthy aging skeletal muscles become smaller and weaker, thus pelvic floor muscle function diminishes. This limits the clinical success of physical exercise to treat geriatric UI. Further, multimorbidity and cognitive impairment may limit the efficacy and safety of pharmacologic UI treatments. Based on our teams qualitative studies, women with GIS desire significant improvement in their symptoms; this may be only possible through multi-modal therapy. During this session, we will review the evidence above in more detail and describe the rationale and proposed approach to a multi-modal clinical care pathway, including both conservative and procedure-based treatments, that we are currently implementing for women with GIS at our tertiary care referral center.
IMPROVING ELDER MISTREATMENT SCREENING AND INTERVENTION IN DEMENTIA: EARLY NIA RESEARCH FINDINGS
Authors: Haggerty Kristin Lees , Fulmer Terry
Published: January 2025

Elder mistreatment (EM) poses a significant public health concern for older adults, particularly those with mild cognitive impairment and Alzheimer’s Disease and Related Dementias (MCI/ADRD). This symposium presents innovative NIA-funded research aimed at assessing risk factors for EM and developing interventions to address these risks, focusing on caregivers and older adults with MCI/ADRD. The first presentation describes the development of a Screening, Brief Intervention, and Referral to Treatment model based on Medicare outpatient data and interviews with stakeholders. Preliminary findings highlight social determinants of health, caregiver stress, and education gaps as key contributors to EM risk. The second presentation introduces a caregiver risk assessment tool linked to an abuse prevention intervention for persons living with dementia (PLWD). The study demonstrates strong predictive capabilities in identifying modifiable caregiver risk factors associated with abuse. The third presentation describes adapting an evidence-based EM screening tool for home-based primary care providers. Qualitative data from seven sites inform the adaptation of the DETECT tool, addressing policy implications, barriers to recognition, and necessary adaptations for effective implementation. The fourth presentation highlights the development of a strategy to screen for caregiver neglect in PLWD. By evaluating existing tools and creating an item bank, this study aims to enhance measurement precision in elder mistreatment interventions. The final presentation reviews interventions targeting elder neglect by informal caregivers. Findings emphasize the need for feasible programs with rigorous evaluation strategies to address caregiver neglect effectively. This symposium presents projects aimed at improving EM risk assessment, identification, and interventions.
BARRIERS TO HOSPICE CARE TRANSITIONS AMONG PEOPLE WITH DEMENTIA IN HOME HEALTH CARE: VIEWS OF DIVERSE CARE PARTNERS
Authors: Murali Komal , Wang Gwenneth , Vergez Sasha , McDonald Margaret , Schulman-Green Dena , Brody Abraham , Bullock Karen
Published: January 2025

Racially and ethnically minoritized persons living with dementia (PLWD) use hospice at disparately low rates and home healthcare (HHC), a preferred setting of end-of-life care, is a key intervention point for increasing hospice transitions. We conducted qualitative interviews with diverse care partners of PLWD to explore views about barriers to hospice care and experiences with dementia care and end-of-life decision-making in HHC. Conceptually rooted in the NIMHD Health Disparities and Equity-Focus Implementation Research Frameworks, we conducted directed content analysis. Participants (n=20) were mostly female adult children of PLWD identifying as Black, Hispanic/Latino, Asian, or White. Six main concepts emerged: 1) Despite general openness to hospice, there was variable knowledge including misconceptions that it could not be received in the home; 2) Limited knowledge of dementia illness trajectories and end-of-life care options including hospice; 3) Communication challenges and conflicts associated with family-decision making; 4) Difficulty with care coordination and limitations of health insurance coverage and access to dementia caregiving support and resources; 5) Unmet cultural aspects of care and language barriers (language discordance between aides and PLWD) led to conflict between care partners and HHC staff); 6) Desire to honor and balance prior stated wishes of PLWD (e.g., prioritizing care at home, avoiding hospitalizations and nursing home) with end-of-life dementia care and decision-making. Findings shed light on views related to hospice care barriers and decision-making experiences of diverse care partners of PLWD that are key for the development of equity-focused culturally sensitive end-of-life care in HHC.