bluuebunny/crossref_metadata_2025 huggingface dataset:
BRAIN CLEARANCE SYSTEM ALTERATION AND COGNITIVE DECLINE IN AFRICAN AMERICANS WITH POOR SLEEP QUALITY
Authors: Lincoln Karen , Gaines Bryan , Golithadka Kaushik
Published: January 2025

African Americans have 2-3 times the prevalence of Alzheimer’s disease (AD) than Whites, making this a significant health disparity in the US. Healthy sleep plays a critical role in providing protection from cognitive decline and AD. Unfortunately, African Americans have significantly poorer indicators of sleep quality than Whites. Moreover, the mechanism whereby sleep drives AD and related cognitive decline is not well understood, in part because causal links are yet to be established by human studies. One possible mechanism linking sleep to AD is the glymphatic system, a network of perivascular spaces (PVS) that support waste clearance. This study used ultra-high field magnetic resonance imaging technology, novel PVS mapping technology, wrist actigraphy and sleep assessments, cognitive assessments and regression analysis to investigate how alteration of the glia-lymphatic system associated with sleep contributes to cognitive decline in 61 community-dwelling African Americans (age 45+). African American who slept more and spent more time in bed had a higher risk for cognitive impairment as indicated by lower MMSE scores. We also found that African Americans with larger PVS volume (more metabolic waste in the brain) had lower cognitive scores. The effect of sleep quality on cognitive status was mediated by PVS, such that African Americans who spent more time in bed had larger PVS (more waste and fluid) and lower cognitive scores. Findings from this study advance our understanding of the role of sleep and brain clearance in cognitive decline in African Americans, and identify PVS as a novel marker for cognitive decline.
RESILIENCE THROUGH ELDERSHIP
Authors: Thompson Lena , Kim Steffi , Lewis Jordan
Published: January 2025

Alaska Native (AN) Elders face significant challenges aging in place, yet Elders find joy and connection from living in their villages and often choose to remain in their villages as they age. As keepers of wisdom and knowledge bearers, AN Elders serve as guides and collaborators in overcoming challenges on individual, community, and at policy-levels. This study collects stories and strategies of AN Elder resiliency fostered through leadership, community engagement, and cultural practices in Southeast and Interior Alaska. This study comes from a parent study exploring meanings of and strategies for “aging in a good way” among Alaska Native Elders. In-person semi-structured interviews were conducted with 72 Elders from 11 communities in Southeast and Interior Alaska. Recordings were transcribed, de-identified, and coded thematically. Elders described navigating life-long challenges, related to experiences of racism, generational trauma, and generational changes. Elders described ways that they address these life challenges, including practices and beliefs rooted in traditional teachings, gathering, hunting, and living their “native way of life.” Notably, Elders felt that it was their duty to pass knowledge on to younger generations to address their own life challenges, incorporate and continue traditional practices, and save them hardships experienced by Elders. The concept of Eldership is vital to individual, family, and community wellbeing promoting bidirectional and mutually beneficial relations within youth, communities, tribes, and organizations. Through Eldership, AN Elders provide important guidance in managing challenges which can support Tribal governments and other service systems as they determine effective strategies to support AN communities.
DAILY EXPERIENCES OF AGING: A COUNTRY-INFORMED PERSPECTIVE FROM THE SUBJECTIVE AGES PROJECT
Authors: Neupert Shevaun , Kornadt Anna
Published: January 2025

The proposed symposium provides a global perspective regarding antecedents, correlates, and consequences of views on aging based on the Subjective AGES (Aging within Global everyday Ecological Studies) consortium. This culture-informed approach highlights the contextual and dynamic influences on views on aging across different temporal perspectives. We enrich the existing body of knowledge by including a broad variety of cultures and investigating how views on aging connect to daily indicators of health and well-being. First, Wu and Fung investigate the moderating role of future self views on the relationship between self continuity and preparation for old age in six cultures. Taking into account the historic context of inflation in Turkiye, Can and Neupert find that daily subjective economic status and daily subjective age are each uniquely related to daily happiness. Wirth and Rothermund show that the daily experience of expectations regarding aging in Germany influences affective experience. Finnigan and Tse show that daily flow experiences in a sample from the UK were related to younger subjective age, which in turn increased positive affect. Finally, Shrira and colleagues compare the daily coupling of ageist attitudes and negative affect in five different countries using an integrated data analysis approach. Our findings shed light on country-specific and global relationships between views on aging and development. We showcase how experiences of aging are shaped by contextual and dynamic influences.
PARTICIPATORY ACTION RESEARCH IN GERONTOLOGY: CONCEPTUALIZATION, CONDUCT, AND DISSEMINATION
Authors: Flatt Jason , Glover Crystal
Published: January 2025

Health disparities continue to critically diminish and deleteriously impact health in aging among large diverse populations across the world. One way to create health equity for all older adults remains through the strengths-based sharing of expertise across diverse communities and researchers from various scientific disciplines. As such, the field of Gerontology requires innovative approaches to engage two critical stakeholder groups – community members and researchers – to meaningfully engage and collaborate with each other to conceptualize, conduct, and disseminate related findings stemming from participatory action research (PAR). Resultant research must generate knowledge and actionable solutions that are mutually beneficial, scientifically sound, and culturally compatible across stakeholder groups. In this workshop, we will first teach both researchers and community members about the purpose, process, and intended outcomes of PAR. Second, we will outline the conduct of PAR using a pedagogical framework that includes key topics such as the researcher’s onus of trust, establishing and sustaining relationships, co-learning and co-design, methodological design and data collection, collaborative data analysis and interpretation, dissemination of findings, and planning and implementing evidence- and strengths-based strategic transformations within diverse aging populations. Lastly, we will discuss opportunities and tools for attendees to expand PAR to address health disparities and facilitate health equity in aging among diverse populations. Throughout, we will leverage our extensive PAR experiences to share examples, lived experiences, and best practices with attendees. We hope to host an enriching, relevant, and forward-looking session with attendees.
CO-CREATING EDUCATIONAL MATERIALS WITH OLDER ADULTS AND INFLUENCING HEALTH CARE DECISION-MAKERS
Authors: Hulko Wendy , Mirza Noeman
Published: January 2025

Rural and small city older adults’ views on primary and community care restructuring indicated a strong desire to provide input directly to healthcare decision-makers through oral over written means and collective rather than individual dialogues (Hulko et al., 2020). Thus, through integrated knowledge translation (iKT), we worked with older adults to (a) interpret our research findings on primary and community care restructuring; (b) create KT tools (grassroots infographic, key messages, documentary); and, (c) host a knowledge summit where we released our KT tools and facilitated discussions between service users and administrators (decision-makers, knowledge users, seniors advocates) about ways to move our findings into practice and affect service delivery. 30 people attended the knowledge summit and were invited to provide feedback on the iKT process and KT tools; 23 (8 service users, 15 administrators) filled out the feedback questionnaires. Service users provided positive feedback about the opportunity to partner with service providers, particularly senior administrators. Administrators recognized the need to shift from being “system focused” to “patient focused,” which can be facilitated through engagement of rural older adults in service delivery decisions. They recognized that service users had “good ideas on how to deliver services locally” and appreciated the opportunity to hear service users’ perspectives and needs, communicate face-to-face, and “discuss possible solutions” together. Our work highlights how emancipatory pedagogy - actioning research findings in collaboration with older adults - can enable mutually beneficial exchanges of ideas and solutions between service users and administrators and lead to improved health service delivery.
PAIN, PLACE OF DEATH, AND USE OF PAIN TREATMENT AT THE END OF LIFE: URBAN–RURAL DIFFERENCE AMONG CHINESE OLDER ADULTS
Authors: Pei Yaolin , Lou Yifan , Qi Xiang , Zhu Zheng , Wang Jing , Wu Bei
Published: January 2025

Pain is a common symptom that older adults encounter at the end of life and has a negative impact on quality of life. The purpose of this study was to investigate the prevalence of pain and the association between pain, place of death, and pain treatment in the context of an urban-rural division. The sample derived from the end -of-life module data from the China Longitudinal Aging Social Survey conducted in 2020. The working sample included 958 decedents aged 60 and above. Logistic regression models were used in this study. 26.4% of the decedents did not receive prompt and effective pain treatment. 66.50% of decedents’ families were not able to control the pain for the decedent. 41.96% of the decedents had severe pain symptoms. Older adults who were rural residents, had no severe pain symptoms, and died at home were more likely not to receive timely and effective pain treatment than their counterparts. The urban -rural differences in these associations were identified: Rural older adults who had severe pain symptoms and die at home were more likely not receive timely and effective pain treatment than urban older adults. Severe pain symptoms and death place were significantly associated with whether receive timely and effective pain treatment among urban older adults, but not significant among rural older adults. It is important to strengthen pain management and bridge the gaps in this regard for older adults at the end of life in China.
CHINESE OLDER ADULTS’ PREFERENCES FOR INVOLVEMENT IN END-OF-LIFE CARE DECISIONS: CAUSES AND OUTCOMES
Authors: Lou Yifan , Liu Jinyu , Carr Deborah , Pei Yaolin
Published: January 2025

Understanding the end-of-life decision making styles of Chinese older adults is an important goal, especially against a backdrop of global population aging. Guided by the Shared Decision-making framework, we use data from 571 adults ages 50+ in Shanghai, China to develop statistically and conceptually distinct profiles of shared, delegated, and autonomous end-of-life decision making; and identify the psychosocial and health correlates of these profiles, and the impact of profile type on advance care planning. We use latent class analysis (LCA) to develop decision-making profiles capturing preferences for involvement in information exchange, deliberation, and decisional control in end-of-life decision-making. Four profiles emerged. Delegated decision makers (16%) almost all prefer to have family or doctors make their treatment and care placement plans. Lead decision makers (49%) want to take the lead in information exchange and final decisions, although they value collaborative discussions. Acquiescent decision makers (15%) prefer to follow their family’s wishes, if discrepant preferences exist. Autonomous decision makers (19%) prefer not to engage others in any process. Older age is associated with delegated decision making, whereas higher income and education are associated with autonomous decision-making. Acquiescent decision makers are less likely to have thought about or discussed their end-of-life wishes, despite their preferences for sharing decisions. Our results reveal great diversity in older adults’ approaches to autonomous versus shared end-of-life decision making, and thus health care providers must devise tailored approaches for working with older patients and their families.
RACIAL EQUITY IN NEW DEAL EMPLOYMENT AND LONG-TERM MORTALITY IN US COUNTIES
Authors: Rehkopf David , Guevara Ivan Mejia , Modrek Sepideh
Published: January 2025

Public Emergency Work was a critical policy action during the New Deal used to address the unemployment of the Great Depression (1929-1941). Due to local control of hiring, there were substantial geographic differences in Public Emergency employment by race, relative to need for work. We examined the associations of Black-White differences in the relative equity of county level Public Emergency Work relief in 1940 with county level age 65 to 84 mortality from 2000 to 2019. We find that counties that strongly favored Black workers in Public Emergency Work programs in 1940 had lower mortality rates for both Black and White individuals from 2000 to 2019, as compared to counties that strongly favored hiring White workers. These findings suggest that there are meaningful connections between the structures that influenced the local level implementation of social policies at least as far back as 1940, with recent county mortality differences.
IPUMS MULTIGENERATIONAL LONGITUDINAL PANEL
Authors: Fitch Catherine , Ruggles Steven
Published: January 2025

Over the past five years, the IPUMS Multigenerational Longitudinal Panel (MLP) has constructed a massive longitudinal population panel by linking together American censuses, surveys, administrative sources, and vital records spanning the period from 1850 to the present. MLP is designed as a general-purpose resource for studying longitudinal processes and long-run social and economic change. By linking individuals across generations from birth through death using data from multiple sources, MLP enables reproducible research on shifting patterns of life course patterns and intergenerational processes. The large scale of the MLP database allows researchers both to study particular communities and small dispersed populations and to conduct big studies spanning many places and periods. Mounting evidence shows that early life social, economic, policy, and environmental exposures are important drivers of later life cognitive, health, and economic outcomes. MLP creates unprecedented opportunities for prospective analyses of the impact of early-life exposures on a wide range of later-life outcomes.
A HISTORY OF ENVIRONMENTAL INJUSTICE: SEGREGATION AND AIR POLLUTION IN 1940 AND 2010 IN THE UNITED STATES
Authors: Shearston Jenni , Shan Xiaorong , Henneman Lucas , Mobley Taylor , Mayeda Elizabeth Rose , Morello-Frosch Rachel , Casey Joan
Published: January 2025

Air pollution is inequitably distributed across the United States, whereby minoritized racial/ethnic groups have greater exposure and consequent health effects. To understand present-day disparities, it is important to understand changes over time. We compared relationships between county-level air pollution and segregation in 1940 and present-day (2010). We calculated segregation as the Dissimilarity Index (Black vs non-Hispanic white population) using Census data. We evaluated three air pollution emission sources: oil/gas well locations (Enverus), fossil fuel powerplant locations (Energy Information Administration, Environmental Protection Agency), and gasoline consumption (proxy for traffic-related air pollution; Federal Highway Administration). We estimated rurality-stratified associations between each segregation/pollution pair by year with non-linear generalized additive models, adjusted for population density and within-state clustering. Mean county-level segregation decreased from 1940 to 2010 for rural (-33%) and urban (-42%) counties. In 1940, we found more oil/gas wells and lower gasoline consumption in rural counties with higher segregation (>median). For example, if segregation increased from the median to the 75th percentile, we observed a 0.15 kg/year decrease (95% confidence interval: -0.23, -0.07) in gasoline consumption. We saw no association between segregation and powerplants in rural 1940 counties, but observed fewer powerplants and lower gasoline consumption in counties with less segregation (< median) in 2010. In 1940, we found fewer oil/gas wells in urban counties with higher segregation. We found suggestive evidence of a relationship between segregation and air pollution in 1940 and 2010, with substantial differences by rurality. Policy to reduce air pollution should consider historical exposure inequities in emission sources.
QUALITY OF LIFE OF OLDER INFORMAL CAREGIVERS IN SWEDEN: CAREGIVER PROFILES AND RELATED FACTORS
Authors: Kirvalidze Mariam , Mateo-Abad Maider , Ayala Alba , Bernal-Alonso Amaya , Forjaz Maria João , Rodríguez-Blázquez Carmen , Calderón-Larrañaga Amaia
Published: January 2025

Older adults are increasingly stepping into informal caregiving roles, primarily due to the inadequacy of formal care services to meet their growing demands. We aimed at identifying profiles of older caregivers according to their quality of life (QoL), and describing the factors characterizing them. A cross-sectional analysis of a cohort study was conducted, including informal caregivers from the Swedish National Study on Aging and Care in Kungsholmen. The study included a total of 1382 observations, corresponding to 994 caregivers aged 60 and above, from waves 1 (2001) to 5 (2013). Multiple Correspondence Analysis combined with cluster analysis were used to obtain the caregiver profiles according to the items of SF-12 QoL instrument. Multinomial regression was performed to determine which demographic, clinical and psychosocial factors were related to belonging to each profile. Three caregiver profiles were identified according to the physical and mental health domains of their QoL. People with good QoL (58%) had better mental and physical health status, and reported a lower caregiver burden. People with intermediate QoL (35%) were older than those in the other profiles and, along with the group with poor QoL (7%), had worse health status and often received care themselves. The poor QoL group was also characterized by higher prevalence of depression and perception of burden, and lower levels of social support. Different modifiable factors are associated with the QoL of older informal caregivers, especially in the mental health domain, and could thus be the target of future preventive interventions.
KINSHIP STRUCTURES FOR LEFT BEHIND OLDER ADULTS IN HIGH OUTMIGRATION CONTEXTS
Authors: Matos-Moreno Amilcar , Alburez-Gutierrez Diego , Williams Ivan , Verdery Ashton , Fernandez Mariana , Santos-Lozada Alexis
Published: January 2025

Migration accelerates population aging in high-outmigration contexts; however, the familial structure of older adults left behind has yet to be studied. Evidence suggests that left behind older adults are at higher risk of reduced support networks and increased caregiving burden. This study aims to estimate the kinship structures of older adults, kinlessness, and the presence of migrant kin in Puerto Rico. Data come from the United Nations World Population Prospects from 1950 to 2021. We created a two-sex time-variant model to estimate the kinship structure of older adults in Puerto Rico for 2021. Further, we created a multistate model to estimate the prevalence of transnational family members and their relationship with older adults. Our models suggest that a person born in 1950 will have, in 2021, on average, 5.22 close family members: 1.3 daughters, 1.2 sons, 1.8 sisters, and 1.5 brothers. As they continue to age, the prevalence of female kin supersedes the male presence in the family. Migration is predominant in descendent kins (daughters and nieces). Adults between 20 to 40 are expected to have 0.30 migrant daughters. Older adults between the ages of 60 and 65 have lost 44% of their daughters to migration a lower estimate when compared to adults of the age of 50 or younger (55%). Models suggest that future generations of Puerto Rican older adults will have an increased presence of transnational family members. Thus, public health strategies must adapt to address the need for “new families” in upcoming generations of older adults.
INCREMENTAL HEALTH CARE COSTS OF A SIMPLE MEASURE OF PHENOTYPIC FRAILTY IN OLDER ADULTS
Authors: Ensrud Kristine , Schousboe John , Fink Howard , Kats Allyson , Sheets Kerry , Taylor Brent , Boyd Cynthia , Langsetmo Lisa
Published: January 2025

Frailty defined by the CHS phenotype is associated with higher subsequent total healthcare expenditures in community-dwelling Medicare beneficiaries after accounting for claims-based cost indicators. However, frailty assessment using the 5 component CHS phenotype is often not feasible in clinical practice. Our objective was to determine whether frailty assessed using the simple SOF phenotype (3 components: weight loss, inability to rise from chair 5 times without using arms, poor energy) is associated with subsequent incremental costs after accounting for claims-based measures of multimorbidity and frailty. We utilized a multi-cohort dataset with frailty phenotype measurements linked with Medicare claims composed of 8157 community-dwelling fee-for-service beneficiaries. Healthcare costs were ascertained for 36 months after frailty assessment. Average annualized total healthcare costs (2023 US dollars) were $14945 in women and $15693 in men. After accounting for claims-based indicators of multimorbidity and frailty, average incremental costs of SOF phenotypic frailty (2 or 3 components) vs robust (none) were $7088 in women and $5909 in men, only slightly lower than incremental costs of CHS phenotypic frailty ($9372 in women and $6518 in men). SOF phenotypic frailty in both sexes was associated with higher subsequent expenditures in inpatient, skilled nursing facility and home healthcare sectors. In conclusion, frailty assessed by the parsimonious SOF phenotype is associated with higher subsequent total and sector-specific expenditures after accounting for claims-based indicators. SOF phenotypic frailty can be readily assessed in space-constrained clinic exam rooms and time-limited clinical practice settings to improve identification of older adults at high risk of costly care.
DEVELOPMENT AND VALIDATION OF A MORTALITY PREDICTION MODEL AMONG MIDDLE-AGED AND OLDER FRAIL ADULTS: UK BIOBANK
Authors: Wu Chenkai , Xu Jianhong , Wang Yanxin
Published: January 2025

Research has identified numerous risk factors for frailty and developed prediction models for the onset of frailty. However, little is known about how multimodal risk factors collectively influence the prognosis of frailty. We developed and validated prediction models for mortality risk among the frail during a 10-year period. Data were from 15,404 frail individuals aged 37-73 years from the UK Biobank. The entire sample was divided into development set (n=14,272 from England and Wales) and validation set (n=1,132 from Scotland). We assessed the associations of 383 survey, 144 physical, and 59 biomarker predictors with all-cause mortality. Variable selection was conducted using LASSO and stepwise regression. We built a series of nested models: survey only (Model 1), survey+physical measurement (Model 2), and survey+physical measurement+biomarker (Model 3). Model performance was measured by discrimination, calibration, and reclassification. A total of 5,654 males and 9,750 females (63.3%) were included. Model 1 retained 122 survey predictors, Model 2 added 42 physical measurements, and Model 3 added 60 biomarkers. The C-statistic was 0.77, 0.80, and 0.79 in three models, respectively. Models 2 and 3 had improvement in reclassification in mortality risk over Model 1 (net reclassification index=0.111 and 0.029). The light gradient-boosting machine found age, cystatin C, FEV1, smoking, and employment status to be most important predictors. We have developed and validated a series of prediction models using multi-modal data to quantify mortality risk among the frail. The findings provide valuable insights into the design of patient-targeted intervention and management strategies.
LONGITUDINAL MEASURES OF FRAILTY AND MORTALITY
Authors: Seligman Benjamin
Published: January 2025

Assessment of frailty has become common in clinical settings to risk-stratify older adults. Understanding how to use repeated measurements answers important questions both for the clinical use of serial assessments and understanding frailty trajectories. Using the Health and Retirement Study, we calculated the most recent value, maximum, minimum, mean, standard deviation (SD), and slope of a deficit accumulation frailty index (FI) and the Fried frailty phenotype (FFP). We assessed the association of scaled values with mortality by Cox proportional hazards regression with adjustment for age, gender, and smoking status. We then used machine learning by LASSO regression to parsimoniously select variables associated with mortality. We found that the strongest association for the FI was its maximum value, with hazard ratio (HR) (95% CI) 1.67 (1.60-1.74). For FFP this was the mean value, HR 1.56 (1.44-1.70). For both FI and FFP, HRs of the most recent, maximum, and mean values were similar in magnitude, with estimates ranging from 1.62-1.67 and 1.50-1.56 respectively. In LASSO regression, the FI measures (HRs) retained were the maximum (1.38), most recent (1.18), and SD (1.01). For FFP, these were the mean (1.37), maximum (1.07), most recent (1.05). These findings show that maximum and most recent values of frailty tend to be most strongly associated with mortality. For clinicians, this means that the most recent assessment may be sufficient for many purposes. The associations of maximum frailty suggest that recovery may not lead to improved outcomes.
THE POWERFUL TOOLS FOR CAREGIVERS TOOLKIT: ENHANCING SELF-CARE AND COMMUNICATION FOR QUALITY CARE
Authors: Lee JeongEun , Svec Joseph , Kim Eunbea , Kim Yulri
Published: January 2025

The Powerful Tools for Caregiver (PTC) program, an evidence-based program, has proven to enhance caregivers’ self-care and communication skills. Prior studies substantiate its efficacy in elevating caregiver competence and promoting self-care practices. This study delves into secondary outcomes, emphasizing perceived relationship quality with care recipients with dementia. We examined responses from 340 caregivers engaged in the Powerful Tools for Caregivers program delivered with both in-person and remote module. Utilizing pre- and post-surveys, we conducted MANCOVA and multiple regression analyses. Findings revealed that caregivers of dementia reported improved self-care, increasing communication competence, and enhancing positive role perceptions. A majority caregivers reported significant increase in allocating time for personal well-being (average 1.24 hours per week) and discovering effective solutions to caregiving challenges using action plans. Moreover, caregivers allocating more time to self-care reported delivering higher-quality care and experiencing improved relationship qualities with care recipients. Notably, these positive changes were attributed to enhanced communication strategies and positive perspectives adopted by caregivers. The findings underscore the pivotal role of self-care and effective communication in augmenting the quality of care provided to recipients. Comparing the module of the delivery, we did not find any significance, confirming parallel effectiveness of the program. In conclusion, this research illuminates the significance of prioritizing self-care and honing communication skills in improving the wellbeing of both caregivers and care recipients with dementia. The paper concludes by outlining implications derived from the findings and proposes avenues for future research to further enrich our understanding of caregiver support programs.
GOING BOLDER: PROMOTING DEMENTIA INFRASTRUCTURE THROUGH INTERACTIVE AND AI WEB-BASED TOOLS
Authors: Ruggiano Nicole , Herzog Monica , Jiang Zhe , Brown Ellen , Hristidis Vagelis , Daquin Jane
Published: January 2025

In 2018, the U.S. Congress successfully passed the Building Our Largest Dementia (BOLD) Infrastructure for Alzheimer’s Act to advance public health initiatives that support people living with dementia (PLWD) and their families. Part of the goals of BOLD include advancing community awareness about the latest research on dementia and support the translation of research findings to support PLWD, their families, and providers in addressing needs related to dementia care and caregiving. Infrastructure that supports information seeking is vital, given that caregivers often report challenges in finding the information they need about dementia, caregiving, and existing support. This is especially true for those who turn to the internet for information, where web-based search engines generate an overwhelming number of results to common questions posed by caregivers. To address these information needs, our interdisciplinary team has launched the Alabama Caregiver Connect initiative, which aims to more effectively link caregivers with information they need about dementia and caregiving by harnessing web-based tools that are interactive and driven by artificial intelligence. This presentation will review innovative technologies that the team has developed, implemented, and/or evaluated for their potential to support public health infrastructure for dementia. Findings presented will examine benefits and drawbacks of several approaches identified through the initiative, including ChatGPT, evidence-based chatbots, and crowdsourced asset mapping tools. Implications for policy and practice will be discussed.
WHO MAINTAINS GOOD HEALTH? CONTRIBUTIONS OF BEHAVIORS AND LIFE COURSE CIRCUMSTANCES TO HEALTHY AGING
Authors: Hong Chenlu , Luo Yanan
Published: January 2025

Background

Life course circumstances, encompassing diverse environmental conditions and experiences throughout an individual’s life, are critical determinants of healthy aging. However, limited evidence focuses on their cumulative effects on various aging trajectories and disparities among different subpopulations. Using the healthy ageing scores (HAS), this study aimed to evaluate the relative contributions of life course circumstances in childhood and adulthood to healthy aging among Chinese older adults.

Methods

Utilizing data from the China Health and Retirement Longitudinal Study (CHALRS), we assembled for 7906 middle-aged and older adults in China. HAS, developed by the Ageing Trajectories of Health Longitudinal Opportunities and Synergies (ATHLOS), was calculated to measure overall biopsychosocial aspects of health and functioning, with higher values indicating better health maintenance in later life. Behavioral factors included smoking, drinking and obesity. Life course factors encompassed socioenvironmental circumstances in childhood and adulthood. Linear regression models were employed to analyze the role of life course circumstances domains in healthy aging and estimate the associations of identified subpopulations with healthy aging. The ShapleyValue Decomposition, principal components analysis and hierarchal cluster analysis were performed.

Results

We identified four subpopulations sharing similar life courses characterized by disadvantaged or advantaged childhood and adulthood circumstances. Of these, the most disadvantaged subpopulation, experiencing more adulthood adversity and childhood trauma, along with worse adulthood socioeconomic status, consistently exhibited the lowest levels of healthy aging and coversely the most advantaged subpopulation, characterized by better adulthood SES and childhood SES, demonstrated higher Healthy Aging Scores.
RESEARCHING THE AGING POPULATION IN STATE PRISONS: ETHICAL CONSIDERATIONS AND IRB REQUIREMENTS
Authors: Sneed Rodlescia , Reese Elaina
Published: January 2025

The growing number of older adults within state prisons presents unique challenges and opportunities for gerontological research. To conduct research with this population, however, scholars must navigate a range of ethical issues unique to studying this vulnerable group. The purpose of this presentation is to delve into the ethical considerations and Institutional Review Board (IRB) requirements crucial for conducting research with this vulnerable population. Using examples from our current multisite research study on chronic disease self-management among incarcerated older adults, we will describe how we navigated special considerations related to correctional system research processes, power imbalance, coercion, informed consent, participant selection, participant incentives, and data protection. Understanding how to effectively navigate ethical issues and the IRB process is crucial for conducting research to improve the well-being of incarcerated older adults. This presentation will provide researchers with valuable information useful for navigating the ethical landscape to conduct research that improves the well-being of the aging prison population and informs best practices within correctional healthcare.
UTILITY OF THE CARE TRANSITION MEASURE (CTM-15) AND A MEASURE OF CONTINUITY OF CARE IN LIVE DISCHARGE
Authors: Hinyard Leslie , Wladkowski Stephanie , Hendricks-Ferguson Verna , Juboori Ruaa Al , Coccia Kathryn , Bennett Antonia , Wallace Cara
Published: January 2025

Live discharge from hospice has been referred to as the “forgotten care transition,” as it is understudied compared to other healthcare transitions. Following a hospice discharge, patients and families report feelings of grief and abandonment and 40% of patients die within 6 months of the discharge. However, no measures currently exist to help understand this care transition, an important gap for intervention and improvement. This study aimed to consider the utility of and relationship between the Care Transition Measure (CTM-15) and the Patient-Perceived Continuity of Care from Multiple Clinicians Measure among patients/caregivers following a discharge from hospice care. Though the CTM-15 measures the quality of preparation for post-hospital care, questions were modified to reference hospice instead of the hospital. Relational Continuity questions across 3 sub-scales—comprehensive knowledge of the patient, partnership & confidence, team relational continuity—were included from the Patient-Perceived Continuity of Care Measure, as relationship-based care is an important aspect of positive transitions during serious illness. 67 patients (or their primary caregiver) responded to questions following the experience of a live discharge from hospice. Patients were primarily female (75%) and white (78%), with just over half living at home (54%), and a mean age of 84. Study results found statistically significant, positive correlations between the CTM-15 and each of the subscales, indicating that as relational continuity increases, so does the positive perspective of transition quality. Participants also reported relevancy of the questions related to their live discharge experience, suggesting applicability of these tools among this population.
NATIONAL INSTITUTES OF HEALTH (NIH): SIMPLIFYING THE REVIEW OF RESEARCH PROJECT GRANT APPLICATIONS
Authors: Ortenberg Elia , Fingerman Karen , Birditt Kira
Published: January 2025

The National Institutes of Health (NIH) administers >$45B (FY22) of federal funding for extramural medical research, which supports over 300,000 scientists and 2,500 institutions across the United States. These funds are competitively awarded through a two-stage review process. The first level of review solely evaluates the scientific merit of an application by convening peer reviewers who are experts in the field to adjudicate the potential impact of the proposed research. The second level of review takes into consideration for funding both the scientific impact of a proposal as well as its responsiveness to NIH programmatic objectives. NIH is committed to ensuring that all applications for funding receive fair, independent, expert, and timely scientific reviews so the agency can fund the most promising research. NIH upholds its mission of maintaining high standards in peer review by implementing standardized processes and methodologies across all review panels. NIH also continually focuses on efforts to improve peer review. This session is targeted to both experienced and first-time PIs and reviewers. The goals are to provide a general overview of how applications are reviewed by the Center for Scientific Review (CSR) and discuss important changes that impact grant applications, including NIH’s current initiative to simplify the peer review framework for research project grant applications and CSR’s process for ensuring that study sections change with the science. NIH’s ultimate goal through this effort is to identify the best, most innovative science with the potential to improve human health or advance our scientific understanding.
NAVIGATING THE PANDEMIC: THE ROLE OF RESILIENCE AND NEIGHBORHOOD SUPPORT IN STRESS, ANXIETY, AND ADAPTATION
Authors: Balubaid Afnan , Berghoff Ashley , Litzelman Kristin
Published: January 2025

The early stages of the COVID-19 pandemic were associated with increased distress and anxiety symptoms in the general population. We sought to assess how resilience and neighborhood support were associated with stress, anxiety, and positive adaptation during the first 15 months of the pandemic. We used three waves of data from the Survey of the Health of Wisconsin’s COVID-19 Community Impact Survey (Wave 1: May-June 2020; Wave 2: January-February 2021; Wave 3: June 2021; n= 3,534 observations of 1,374 unique adults). Resilience (Brief Resilience Scale), neighborhood support (Brief Sense of Community Scale), and demographics were measured at Wave 1 and outcome variables (stress, anxiety, and positive adaptation) were measured at each wave. Linear mixed models tested independent and interactive associations of resilience and neighborhood support with the outcome variables, accounting for repeated measures. Average levels of anxiety were highest at the start of the pandemic (spring 2020), while stress was highest in winter 2021 and positive adaptation was highest in summer 2021. Across waves, there was a significant interaction between resilience and neighborhood support, such that neighborhood support was more strongly associated with lower stress and anxiety in those with low resilience than high resilience (slope for stress = -0.28 vs 0.03, respectively, p[interaction]< 0.05). Resilience and neighborhood support showed small associations with positive adaptation (beta = 0.11, p<.01 and beta = 0.04, p<.01, respectively). The findings suggest both psychological and social resources buffered adverse effects of the pandemic on well-being, with implications for preparing communities for future crises.
LEISURE ACTIVITY ENGAGEMENT, SOCIAL CAPITAL, AND URBAN–RURAL INFLUENCES ON IQ: IMPLICATIONS FOR COGNITIVE AGING
Authors: Reynolds Chandra , Trubenstein Paige , Pahlen Shandell , Corley Robin , Rey Sergio , Wadsworth Sally
Published: January 2025

Cognitive health interventions often highlight individual or environmental factors, with research perspectives often siloed between psychological and demography disciplines. With key interest in understanding the rural-urban health divide, we examined how behavioral engagement and geospatial features influence cognitive functioning in individuals approaching midlife. The Colorado Adoption/Twin Study of Lifespan behavioral development and cognitive aging (CATSLife) (N=1201, Mage=33.17 years, range=28.05 to 49.33) offers a unique opportunity to evaluate whether cognitive performance, as indexed by IQ, is associated with engagement in cognitively demanding activities and county-level indices of social capital (SCI; i.e., the availability of social networks and resources) and rurality. To understand the rural-urban health divide, we tested whether activity-IQ or SCI-IQ associations were moderated by rurality. We replicated the known influence of cognitive engagement on IQ, irrespective of locale. A major finding, however, was the cognitive differences observed between rural and urban residents after considering activity engagement. We found rural individuals’ IQ performance was less sensitive to the fluctuations of social capital. Moreover, higher IQ scores among urban residents were only revealed when SCI was high; when SCI was low, urban residents performed worse relative to their rural counterparts. While cognitive engagement had a main effect on IQ, the interaction between SCI and rurality revealed contextually meaningful differences in cognitive functioning. Factors contributing to cognitive health are critical to understand, and our study reveals the interplay of lifestyle and environmental factors on cognitive functioning decades before onset of neurocognitive dysfunction, with implications for cognitive maintenance at midlife and beyond.
A TRANSITIONS OF CARE INTERVENTION (FOR OLDER ADULTS) TO REDUCE 30-DAY READMISSIONS FROM SUBACUTE REHABILITATION
Authors: Slossberg Rebecca , Renzetti Lucrezia , Burns Edith , Patel Raj , Ilyas Nazish , Trost Alexander , Rimar Alexander
Published: January 2025

Hospital readmissions for older adults from subacute rehabilitation facilities (SAR) are a common challenge for healthcare systems. Patient medical complexity, lack of communication during transitions of care, and other factors contribute to otherwise avoidable readmissions. We describe a pilot intervention of Geriatrics and Palliative (GAP) consultation after hospital discharge with the goal of reducing avoidable readmissions from SAR. 136 patients seen by the GAP team in 2023 during a first hospitalization were included. The GAP Nurse Practitioner conducted SAR consultations on a convenience sample of 85 patients (Intervention group, IG), with the remaining 51 acting as non-intervention control (CG). Overall patients in the IG group were not significantly different from the CG based on age, sex, race, LOS, or LACE score. Mean age was 86.8 (SD=7.44 years), majority female (62.5%) and white (67.2%). Readmission rate was 18.8% for IG vs. 27.4% for CG, a 38.7% lower odds of readmission for IG. Readmitted patients from IG were similar to CG readmits (age, sex, LACE) but had longer index LOS (8.76 + 10.2 vs. 6.16 + 4.2 days, t=2.06, p=0.041). Cost analysis showed a 25% cost savings for Star IG vs CG. Mean total cost was highest for CG Star and lowest for CG non-star. Results suggest that following patients in transition to SAR post hospital discharge may help reduce avoidable readmissions in older adults by ensuring continuity of communication. Further research to understand what elements of follow-up care impacted readmission (e.g., hospice eligibility, pain levels, code status, etc.,) is needed.
RELATIONSHIP BETWEEN WORKING ENVIRONMENT AND CARE AIDES’ COMPASSION FATIGUE, BURNOUT AND COMPASSION SATISFACTION
Authors: Rahman Ashikur , Duan Yinfei , Estabrooks Carole
Published: January 2025

Severe staff shortages, sustained stress, low compassion satisfaction, high compassion fatigue, and serious levels of burnout among health care workers are frequently reported in the literatures. Limited research has examined compassion-related work life among long-term care (LTC) aides facing high-stress situations due to the deaths of residents and colleagues during COVID-19. In a cross-sectional study with 760 care aides working in 28 LTC homes in Alberta, Canada, we used a two-level multilevel regression analysis to examine how working environments were related to compassion fatigue, burnout, and compassion satisfaction using the Professional Quality of Life (ProQOL-9) scale. Care aides in smaller facilities reported higher levels of compassion fatigue (B = 0.764, p = 0.008) compared to those in larger facilities. Higher compassion satisfaction (B = 1.009, p = < 0.001) and lower burnout (B = -0.909, p = < 0.001) were observed when care aides perceived more supportive working cultures. Care aides reported higher compassion fatigue when there was a lack of structural (B= -0.149, p =0.019) or staffing resources (B= -0.253, p = 0.007). We also found that not having enough staff (B = -0.469, p = < 0.001) or enough time (B = -0.337, p= 0.019) to complete tasks was significantly associated with higher levels of burnout. In conclusion, compassion fatigue and burnout among care aides were associated with some modifiable factors in the working environment. These findings offer direction on which elements of the working environment may be promising for improvement efforts.
HOME HEALTH AGENCY STAFF SAFETY: EXPERIENCES FROM THE FRONTLINES
Authors: Leland Natalie , Shore Amanda , Lam Julia , Prusynski Rachel , Saliba Debra , Mroz Tracy
Published: January 2025

Prior evidence has documented workplace violence among home healthcare agency (HHA) staff. Building on prior evidence, we examined organizational strategies for fostering HHA staff safety and frontline staff experiences before and after the emergence of the COVID-19 pandemic. We engaged a purposive national sample of 102 HHA leaders in virtual one-on-one semi structured interviews completed between November 2020 and December 2022. We then interviewed a subsample of HHA frontline staff (n=12) between April 2023-March 2024. Using a multiple case study design, we conducted a thematic analysis. Five emergent themes captured organizational efforts as well as staff experiences navigating workplace violence. Leadership (a) contrasted HHA safety environment with institutional healthcare, which impacts organizational policies (e.g., gun safety, compliance with COVID-19 infection control policies) and (b) described financial investment in staff safety (e.g., employ escorts to travel with HHA staff). Frontline staff themes included navigating (c) physical and verbally volatile situations during the HHA care encounter (e.g., requesting compliance with HHA’s PPE policy when HHA staff were in the home), (d) community safety, and (e) HHA safety policies and processes. Results highlight the complexity of HHA service delivery, which existed before COVID-19 and was exacerbated as the pandemic evolved. These experiences emphasize the importance of a multi-modal approach to a HHA culture of staff safety (e.g., policies, financial resources). Further, these findings suggest a need for policies that address the operational investments needed to foster an environment of safety.