bluuebunny/crossref_metadata_2025 huggingface dataset:
INSIGHTS ON THE CLINICAL NURSE ROLE IN IMPLEMENTING WHAT MATTERS FOR OLDER ADULTS IN ACUTE CARE
Authors: Taani Murad , Hook Mary
Published: December 2023

The Age-Friendly Health System (AFHS) evidence-based 4Ms framework (What Matters, Medication, Mentation, & Mobility) is designed to be implemented in clinical settings to reliably provide high-quality age-friendly care to older adults and reduce harm and hospital-associated complications. The 4M concept of ‘What Matters to You’ (WMTY) refers to assessing and aligning an individual’s specific health outcome goals and care preferences to ensure patient-centered care with a measurable impact on patient experience. While published toolkits support the implementation of WMTY for all disciplines, there is limited guidance and empirical evidence about the implementation and impact of this concept when used by clinical nurses in acute care. Some researchers have identified issues with implementing WMTY with patients who are not able to articulate their wishes or when the question is posed in a granular way. A large healthcare system in the Midwest supported five hospitals to implement the AFHS 4Ms including the WMTY concept but did not observe an improvement in nurse-sensitive patient experience measures. A qualitative study is in progress aimed at gaining an in-depth understanding of the knowledge, perceptions, and experiences of leaders and clinical nurses who have implemented the WMTY concept for older adults in their hospital to evaluate the implementation and impact on patient care. The results gathered by this study will lay the foundation for designing clinical nurse-targeted interventions to successfully implement WMTY and identifying supportive strategies for partnering with patients and their caregivers to ensure that their goals/preferences are fully integrated into care.
MOVIN PAST OBSTACLES: BUILDING A CULTURE OF MOBILITY
Authors: Glowinski Sarah , Hook Mary , King Barbara
Published: December 2023

Older adults are at risk for losing their ability to ambulate independently during hospitalization. The “MOVIN” (Mobilizing Older adult patients Via a systems-based Intervention) Study is a cluster-randomized control trial aimed to implement a nursing-led mobility model and monitor the change in nurse behaviors and unit culture before, during and after the 14-week intervention period. The model includes psychomotor training, mobility resources (equipment and ambulation aide), communication tools, ambulation pathways, and support for developing a “culture of mobility” led by nurses. It was launched on two inpatient nursing units at large urban Magnet quaternary medical center in Wisconsin in July 2021 (Unit 1) and March 2022 (Unit 2). Electronic reports based on documentation were generated to monitor patient ambulation and distances for feedback and celebration. The researchers and unit teams met often to implement and ensure intervention integrity despite increasing care demands and staffing shortages. Unit leaders navigated pandemic-induced obstacles including turnover, shortages, and high patient volumes by refining staff training, streamlining communication, promoting in-room walking, and finding creative ways to celebrate and build a culture within the COVID-19 restrictions. Unit 1 ambulated 75% of patients (20% increase) with distances averaging 47 miles/month (540% increase). Unit 2, with less ambulatory patients, ambulated 73% of patients (18% increase) with distances averaging 23.4 miles/month (680% increase). MOVIN is a promising system-based intervention that supports culture change and promotes nurse-led patient ambulation. Units were able to increase and sustain the quantity and quality of patient walking despite the obstacles imposed by the pandemic.
THE LONG LIVES OF PRIMATES AND THE ‘INVARIANT RATE OF AGING’ HYPOTHESIS
Authors: Alberts Susan
Published: December 2023

Can we slow the rate of human aging? A decades-long trend toward increasing life expectancy and greater lifespan equality in human populations raises the possibility that we can. But the rate of aging is closely correlated with other traits and may be highly constrained or even relatively fixed within species, according to the ‘invariant rate of aging’ hypothesis. To gain insight into biological constraints on aging, we use an unprecedented collection of datasets from 39 human and nonhuman primate populations, representing 7 genera distributed across the order Primates. We show that the highly regular linear relationship between life expectancy and lifespan equality reported in humans is recapitulated in other primate genera, and that variation in the rate of aging is several orders of magnitude smaller than pre-adult and age-independent mortality, which are highly variable within genera. Thus, within primate genera, longer life expectancies are associated with fewer early deaths, but not with a lower rate of aging. We also demonstrate that changes in the rate of aging, but not other ageing parameters, can produce striking, species-atypical changes in mortality patterns. Our results support the invariant rate of aging hypothesis, suggesting biological constraints on how much we can slow the human rate of aging.
EXAMINING COVID-19 VACCINE–RELATED AGEISM IN TWITTER DATA
Authors: Bacsu Juanita-Dawne , O’Connell Megan , Cammer Allison , Chasteen Alison , Fraser Sarah , Azizi Mehrnoosh , Grewal Karl , Spiteri Raymond
Published: December 2023

During the pandemic, many high-income countries prioritized older adults for COVID-19 vaccination in an attempt to reduce mortality. This prioritization may have exacerbated ageism and intergenerational conflict, especially with the limited quantity of COVID-19 vaccines. This presentation examines vaccine-related ageism during COVID-19 on social media to inform future vaccination campaigns and policies. Using Twitter, we gathered 1,369 relevant tweets using the Twint application in Python from December 8, 2020 to December 31, 2021. Tweets were assessed using inductive thematic analysis and steps were taken to ensure rigor and trustworthiness. Based on our analysis, four main themes were identified including: i) Blame and aggression; ii) Misinformation and mocking content; iii) Ageist political insults; and iv) Challenging ageism. Our study identified issues of false information, hate speech, and ageist political insults that are contributing to intergenerational conflict. Although some tweets challenged this derogatory messaging and demonstrated intergenerational unity, our findings suggest ageism contributed to COVID-19 vaccine hesitancy among older adults. Accordingly, urgent action is required to challenge vaccine misinformation, counter aggressive ageist content, and support intergenerational unity during the pandemic.
ASSISTED LIVING ADMINISTRATORS’ UNDERSTANDING OF REGULATORY REQUIREMENTS IN SEVEN STATES
Authors: Carder Paula , Thomas Kali , Smith Lindsey , Reed David , Sloane Philip , Zimmerman Sheryl
Published: December 2023

Each state requires assisted living (AL) residences to employ an administrator whose job responsibilities include oversight of resident care, managing staff, and regulatory compliance. This study surveyed administrators of 151 AL residences in 7 states. These AL residences reflect 28 license types (e.g., based on level of care, dementia care services). Administrators were asked whether there were any regulations, policies or procedures that required their AL to do any of 11 health-related activities (e.g., staff able to check vital signs, advance directive on file, reporting change in condition to resident’s healthcare provider). Using health services regulatory analysis, we documented the applicable regulations for each of the 151 AL residences, then assessed whether administrator responses were congruent with the licensed requirements. Almost all (95%) administrators of AL residences governed by a licensure requirement regarding change in condition reported this policy in their residence. In contrast, less than half (48%) of administrators who work in an AL in our sample that state law requires to keep an advance directive on file for residents reported that they did not have a policy to do so. Over one-third (37%) of administrators who work in an AL required to have a policy of non-pharmaceutical treatment for residents with dementia said that they did not have this policy in place. Some administrators reported the presence of policies in the absence of state requirements, suggesting that these AL residences exceed minimum requirements. These results vary by AL license type both within and across states.
THE AGING BRAIN: A NEUROVISCERAL INTEGRATION PERSPECTIVE
Authors: Thayer Julian
Published: December 2023

Healthy aging is associated with significant changes in both the brain and the heart. The changes between these, the two most important organs of the body, are linked via the vagus nerve. Using a model of Neurovisceral Integration I will describe how autonomic imbalance and decreased parasympathetic tone in particular may be the final common pathway linking negative affective states and conditions to ill health. The central nervous system network that regulates autonomic balance is closely related and partially overlaps with networks serving executive, social, affective, cognitive, and motivated behavior. This inhibitory cortico-subcortical circuit may structurally as well as functionally, link psychological processes with health-related physiology. When the prefrontal cortex is taken “offline” for whatever reason, parasympathetic inhibitory action is withdrawn and a relative sympathetic dominance associated with disinhibited defensive circuits is released, which can be pathogenic when sustained for long periods. This state is indicated by low heart rate variability (HRV), which is a marker for low parasympathetic activation and prefrontal hypoactivity. In this presentation, I examine the normative changes with aging and the effect that stress may have on how the brain–heart connection changes with age. I will present data linking peripheral physiology to brain structure and function. I conclude by noting that significant sex and ethnic differences exist but that future studies are needed to more fully explicate how they may influence the aging brain and its association with the cardiovascular system.
TOWARD A BETTER UNDERSTANDING OF SOCIAL EXCLUSION IN LATER LIFE
Authors: Aartsen Marja , Myck Michal
Published: December 2023

Social exclusion (SE) – or the separation of individuals and groups from mainstream society - is a serious problem with adverse health and well-being outcomes and increased societal costs. Older adults form a vulnerable group as they tend to be excluded for longer periods than younger people. A growing body of knowledge suggests that SE is multidimensional, including social, cultural, economic, material, and geographical aspects. There are however noticeable knowledge gaps, of which some are addressed in this symposium. Three presentations are based on large cross-national data sets, the final is a qualitative study on a rarely investigated but relevant social group, i.e., older Roma people. The first presenter shows how childless older adults in Europe feel more excluded than older adults with children and discusses how normative pressures can exclude people from society (data from the European Social Survey, wave 1 and 10). The second presenter explains how depopulation of geographical areas can act as driver of SE through material hardship, low social integration and lacking public infrastructure in the depopulated areas (data derived from SHARE, wave 4 and 6). Based on unique data from Poland and Germany, the third presenter shows how associations between markers of SE and well-being are modified by the macro-social context and characteristics of the individual. By using an intersectional life course perspective, the last presentation indicates how pathways in- and out SE are linked to social and societal processes and the political history of a country in a socially deprived group.
THE SOCIAL DETERMINANTS OF BRAIN HEALTH: FROM THE SEARCH FOR MECHANISMS TO RECOMMENDATIONS TO INCREASE EQUITY
Authors: Leist Anja , Muniz-Terrera Graciela
Published: December 2023

Dementia risk has been established to be partly attributable to modifiable social and behavioral risk factors. However, the biological pathways behind these associations and the effects of intervening on present risk factors to reduce dementia risk have not been fully elucidated. The symposium will present latest research on the social determinants of brain health and dementia. We will explore proposed mechanisms between modifiable risk factors and risk of dementia, and present findings on the modifiability of dementia risk through addressing risk factors. Specifically, the first presentation reports analyses testing possible pathways from socioeconomic status, notably childhood and adulthood indicators such as (parental) education and occupation, to cognitive functioning in later mid-adulthood via indicators of brain damage and white matter connectivity with the Maastricht Study. The second presentation reports empirical analyses testing the possible mediating role of the gut microbiome in the relationships between social and modifiable risk factors and Mild Cognitive Impairment with data of the controls of the Luxembourg Parkinson’s Study. The third presentation reports on the associations between hearing loss as a modifiable risk factor and incident dementia in the UK Biobank and investigates the potential to modify hearing loss-associated dementia risk through the use of hearing aids. Lastly, the fourth presentation moves to recommendations for policy and government action. It gives an overview of various fields in which policy and legislation could implement cognitive impact assessments to protect individuals’ cognition, with the aim of improving population brain health and health equity. This is a Brain Interest Group Sponsored Symposium.
EDUCATION AS A RISK FACTOR OF MILD COGNITIVE IMPAIRMENT—THE ROLE OF THE GUT MICROBIOME
Authors: Klee Matthias , Aho Velma , May Patrick , Krueger Rejko , Wilmes Paul , Leist Anja
Published: December 2023

Background

Social determinants of health relate to an individual’s risk of MCI and dementia. However, pathways from identified modifiable risk factors such as education are not well understood, yet. While previous findings suggest distinct taxonomic signatures of the gut microbiome in dementia and MCI patients, and further education linked to its composition, we sought to test the possibly mediating role of the gut microbiome in the relationship between education and MCI. Method: Gut microbiome composition was ascertained with 16S rRNA gene amplicon sequencing. MCI classification was based on the Montreal Cognitive Assessment. Education in years was grouped (0-10, 10-16, 16+). Mediation analysis was conducted decomposing direct and indirect effects of education on MCI mediated by gut microbiome diversity (Chao1, Inverse Simpson, Shannon) or individual species at Genus level (ldm-med, permanova-med). Differential abundance analysis across education groups was conducted (ANCOM-BC, DESeq2). Result: After exclusion of participants with PD, below age 50, or with missing data, n=256 participants (n=58 with MCI) of the Luxembourg Parkinson’s Study were eligible for analysis (M[SD] Age=64.7[8.3] years). Education (16+ compared to 0-10 years of education) had a natural direct effect of NDE=0.36 (P<.01) on MCI, Chao1 included as mediator. We did not find significant mediation by gut microbiome composition or individual species.

Conclusion

Our findings indicate direct effects of education not mediated by the gut microbiome. Taxonomic analysis suggests a signature linked to lower risk of dementia in higher educated individuals. Longitudinal research is needed to investigate associations over time.
LESS HOSPICE UTILIZATION AMONG CONNECTICUT MEDICAID DECEDENTS WITH NURSING HOME STAYS BEFORE DEATH
Authors: Dillon Ellis , Migneault Deborah , Shugrue Noreen , Wakefield Dorothy , Lee Chae Man , Charles Doreek , Richards Bradley , Robison Julie
Published: December 2023

Hospice use, and length of enrollment of over 7 days are both considered indicators of quality care at the end of life, but the potential impact of nursing home (NH) stays on these outcomes is not well understood. This study analyzes hospice use and short hospice enrollment (0-7 days) for decedents in Connecticut’s Medicaid program who died between 2017 and 2020 and had a hospice-appropriate diagnosis. We compare individuals who had a NH stay within 60 days of their death to those who did not. Among 26,264 decedents meeting inclusion criteria, 14,227 (54.2%) had a NH stay within 60 days of death. Overall, 12,368 (47.1%) of all decedents received hospice care prior to death. Patients with a NH stay within 60 days of death were less likely than those without one to use hospice (44.3% vs 50.4%, p<0.01) (OR=0.78, (95% CI: 0.74, 0.82), p<0.01). Among those receiving hospice care, 4911 (39.7%) had short hospice enrollment. Patients with a NH stay within 60 days of death were 2.4 times more likely to have short hospice enrollment (OR=2.41 (95% CI: 2.24, 2.60), p<0.01) compared to those without. These findings suggest a need for further research into why individuals with NH stays are less likely to use hospice care and more likely to have shorter hospice enrollment. Comparing Medicaid decedents with NH stays prior to death to those living in the community may reveal disparities and areas that would benefit from interventions or policy change.
OVERCOMING TENSIONS IN CULTURALLY RESPONSIVE RESEARCH WITH LGBTQ+ OLDER ADULTS OF COLOR
Authors: Oswald Austin , Cooper Lujira , Guess Aundaray
Published: December 2023

Lesbian, gay, bisexual, transgender, and queer plus (LGBTQ+) older adults of color are underrepresented in gerontological scholarship due to structural factors that limit their research participation. This presentation applies critical reflexivity to weave together the narratives of a gerontological researcher, service provider, and older adult who co-constructed a research project committed to improving the visibility of LGBTQ+ older adults of color in gerontology scholarship. Through the lens of queer failure, we analyze personal narratives documenting our process designing and implementing a participatory action research project to uncover pivotal moments that shifted the course of the research in unexpected, yet critically important ways. Three themes emerged that illuminate key epistemic tensions associated with culturally responsive research with LGBTQ+ older adults of color, specifically navigating cross cultural tensions, intergenerational tensions, and pandemic related tensions. These findings highlight the limitations of traditional research methods which fail to account for historic and contemporary experiences that may shape perceptions of researchers and individuals’ willingness to participate in research. Working through these tensions in solidarity contributed to the revision and improvement of traditional methods by developing culturally responsive approaches to research with LGBTQ+ older adults of color. Embodying a participatory, reflexive, and collaborative approach to inquiry has the potential to challenge and transform hegemonic scientific discourse that marginalizes certain communities. This presentation ends by offering implications for research that may support the development of culturally responsive methods for underrepresented communities in which future studies can expand upon, so long as the community is in the lead.
LONELINESS, SOCIAL ISOLATION, AND HEALTH WITHIN THE CONTEXT OF A GLOBAL PANDEMIC
Authors: Graham Eileen , Neupert Shevaun , Antonucci Toni
Published: December 2023

Social connectivity is a crucial human experience. The objective experience of being disconnected (i.e., social isolation) and the subjective feeling of being disconnected (i.e., loneliness) are related but distinct experiences that have unique impacts on physical, mental, and cognitive health. The COVID-19 pandemic forced much of the global population into a prolonged state of isolation, and many older adults found themselves abruptly cut-off from important sources of social interaction. The lasting impacts of the pandemic are still unknown. This symposium brings together several projects addressing key questions about longitudinal processes of loneliness and social isolation among middle aged and older adults, both prior to and during the COVID-19 pandemic. Jackson will present results from a coordinated data analysis (CDA) showing the extent to which loneliness, social isolation, and social asymmetry are related to MCI, dementia, mortality, and life expectancy. Rule will discuss the impact of stroke on trajectories of loneliness in a CDA. Zhang and Fingerman will present findings that show how loneliness and social isolation vary among individuals with functional limitations. Zavala will present results from a CDA that explored daily patterns of loneliness during the early months of the COVID-19 pandemic. Lastly, Beck will discuss a CDA that examined trajectories of social asymmetry prior to and during the COVID-19 pandemic. Antonucci will synthesize and discuss each project within the context of broader implications for empowering older adults. In sum, this symposium presents novel evidence showing that loneliness and social isolation in older adulthood are impactful predictors of health.
A COORDINATED ANALYSIS OF THE ASSOCIATIONS BETWEEN LONELINESS, SOCIAL ISOLATION, AND THE COGNITIVE HEALTHSPAN
Authors: Jackson Kathryn , Yoneda Tomiko , Luo Jing , Mroczek Daniel , Ong Anthony , Steptoe Andrew , Graham Eileen
Published: December 2023

Insufficient social connection in older adulthood is a growing public health concern. Current research suggests that loneliness and social isolation are related to consequential health outcomes in later life. There is a large and growing literature suggesting that loneliness and social isolation are associated with increased risk of dementia and mortality, but these outcomes typically have been considered separately and without controlling for competing risk factors. Using multi-state survival models which permit simultaneous estimation of transitions between several states within one model, the current study examined the extent to which loneliness, social isolation, and social asymmetry (defined as the discordance between loneliness and isolation) are associated with transitions between cognitive status categories (non-impaired, mildly impaired, severely impaired) and death. We estimated near-identical models individually across 11 independent long-term longitudinal studies (i.e., ELSA, HILDA, HRS, LISS, OCTO-TWIN, SATSA, SHARE, SHP, SOEP, MAP, MARS) using the coordinated data analysis methodological framework, representing a total sample size of over 140,000, and meta-analysis to provide precise estimates of the effects of loneliness, isolation, and social asymmetry on cognitive healthspan transitions. Preliminary findings suggest that loneliness is associated with increased risk of transitioning from non-impaired to mildly impaired cognitive functioning. Higher loneliness is associated with shorter survival time and fewer years in a healthy cognitive state. Lastly, we found that lower social asymmetry (i.e., social resilience) is associated with longer cognitive health span (more years in NCI). These results provide promising evidence suggesting that poor social relationships are robustly associated with a diminished cognitive healthspan.
SOCIAL DETERMINANTS OF HEALTH AND DEMENTIA: PUBLIC HEALTH PERSPECTIVES
Authors: Gaugler Joseph , McGuire Lisa , Epps Fayron
Published: December 2023

The U.S. Department of Health and Human Services and its Office of Disease Prevention and Health Promotion define social determinants of health (SDOHs) as “the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.” Featuring presenters from the three national Building our Largest Dementia Infrastructure (BOLD) Public Health Centers of Excellence as well as other Centers of Disease Control and Prevention Healthy Brain Initiative programs, this symposium will examine how dementia influences, and is influenced by, SDOHs. Specifically, issues that require critical public health action, including prevention, early detection, and family caregiving will be examined within a SDOH framework. Transcending these concerns, this symposium will also feature a presentation that considers the complex associations between health equity, SDOHs, and dementia. We anticipate that this symposium and its presentations will facilitate and advance gerontology’s understanding of dementia as a public health imperative, and as importantly, begin to identify how public health at the local, tribal, state, and federal levels can mobilize to address the challenges and opportunities of dementia.
FEASIBILITY AND EFFICACY OF LIFE REVIEW DEPRESSION INTERVENTION BY VIDEO-TRAINED FAMILY CAREGIVERS
Authors: Miyawaki Christina , McClellan Angela , Bouldin Erin , Brohard Cheryl , Kunik Mark
Published: December 2023

Due to the high prevalence of depressive symptoms and dementia in older Americans, we developed a six-week virtual depression intervention, Caregiver-Provided Life Review (C-PLR) for care recipients (CRs) with early-stage dementia and mild depression and their family caregivers (CGs). We changed the length of CG training iteratively, trained CGs in interviewing and probing skills via video, and CGs delivered life reviews (LR) with CRs at home (N=25 dyads). The objective of the study was to examine the feasibility and efficacy of C-PLR on CRs who were community-dwellers and long-term care facility residents. We collected pre- and post-measures of CRs’ depression (primary outcome) and life satisfaction, CGs’ burden, positive aspects of caregiving, and CG-CR relationship quality (secondary outcomes) and compared them using paired t-tests. We evaluated if the effect differed by race/ethnicity, residential setting, or living arrangements. CGs were 52 years old (mean), working (64%), college-educated (72%), female (88%), and in good-excellent health (72%). CRs were 81 years old (mean), female (84%), and in poor-fair health (56%). CRs’ depression significantly improved following C-PLR (p< 0.001), and this effect was found in CRs who were Asian (p=0.017), White (p=0.040), community-dwelling (p< 0.001), lived alone (p=0.045), and lived with others (p=0.002). Secondary outcomes did not change. This study demonstrated that C-PLR can be successfully taught to CGs via video and effectively reduces CRs’ depressive symptoms without increasing CG burden. C-PLR could be implemented broadly to improve symptoms among CRs in community and residential settings, as well as among a diverse population of CRs.
FOOD INSECURITY AMONG OLDER ADULTS IN THE UNITED STATES DURING THE COVID-19 PANDEMIC
Authors: El-Abbadi Naglaa , Fan Zhongqi , Yang Amy , Ronan Ana , simpson Ryan , Nguyen Kimberly , Naumova Elena
Published: December 2023

The COVID-19 pandemic severely impacted food access and nutritional security across the United States, and exacerbated disparities in household food insecurity rates particularly among older adults due to potential for reduced food access, mental or physical health limitations, or fixed incomes. This study investigated food insecurity among older adults in the US throughout time periods of the pandemic, exploring differences among population groups for food insecurity risk factors. Data was from the US Census Bureau’s Household Pulse Survey, April 2020 through December 2022, weight-adjusted for a nationally representative sample (n=3,884,922). Logistic regression models were constructed to examine the association between older age and self-reported household food insecurity. Reasons given for food insecurity were examined as secondary outcomes. Covariates included demographics, socioeconomic status, household structure, food support programs, and mental health status. Findings showed risk of food insecurity among adults aged 60+ years more than doubled among minority racial groups compared to non-Hispanic White (p<0.001) but was inversely associated with being female compared to male (OR 0.77, p<0.001). Older adults who reported experiencing at least one mental health indicator (anxiety, depression, low interest, or worry) more than half of the week had over five times the odds of being food insecure (OR 5.68, p<0.001). Overall, trends and factors associated with prevalence and reasons for food insecurity were found to vary across age groups, and at different points of the pandemic. Our findings can help elucidate factors to identify older adult groups at greater food insecurity risk.
USING NETWORK ANALYSIS TO EXPLORE DIFFERENCES IN DIETARY INTAKES ACROSS OLDER ADULTHOOD
Authors: Shea Kyla , Rogers Gail , Barger Kathryn
Published: December 2023

Federal nutrition guidance in the Unites States (US) is based on the premise that healthy diets can help delay the onset or progression of age-related disease and disability. Yet, little is known about if or how dietary intakes differ across the older adulthood age span. We used NHANES 2015-2016 and 2017-March 2020 data to examine the dietary intakes of 60-69 year old (n=2079), 70-79 year old (n=1181) and 80+ year old (n=644) adults in the US. Mutual information was used to infer network relationships among all possible pairs of fourteen What We Eat in America food group categories. Based on edge weights, we observed some similarities and some differences in the manner in which food groups were co-consumed across older adulthood. For example, fruit and dairy were co-consumed similarly in the three age groups. Among the 60-69 and 70-79 year olds, protein and vegetables were co-consumed, while fruits were consumed with grains and mixed dishes. However, in the 80+ year olds, vegetables were mostly consumed with fats and oils, but less so with protein, and grains were consumed with dairy, but less so with fruit. Based on a network science approach, the manner in which food groups are consumed appears to change throughout older adulthood. Future studies are needed to evaluate consumption patterns of specific foods among age-defined and other subgroups of older adults and explore potential associations with age-related health outcomes.
THE EFFECTS OF AGE AND SEX ON THE GUT MICROBIOME AND GUT HOMEOSTASIS IN MICE
Authors: Lee Jennifer , Wellenstein Kerry , Matuszek Gregory
Published: December 2023

Symbiotic interactions between the gut microbiome and intestinal epithelium are key contributors to regulating gut homeostasis and host metabolism in mice. However, the majority of studies measuring these outcomes have been reported in male and not female mice. Here, we find sex-specific differences in gut homeostasis and host metabolism in conventional C57BL6 chow-fed mice. Functional analyses of the gut metagenomes and metabolomes, gut barrier function, and colonic T-cell populations are different between young and old female and male mice. These data highlight the importance of considering sex as a biological variable in aging rodent studies, which may lead to optimized strategies to improve healthy aging for all.
PATIENT AND FAMILY PARTNER OUTCOMES OF THE FAM-FFC TRIAL
Authors: Boltz Marie , Mogle Jacqueline , Kuzmik Ashley
Published: December 2023

The Fam-FFC trial tested the hypotheses that patients who participated in Fam-FFC would have more return to baseline function, more physical activity, and less delirium, depressive symptoms, and behavioral symptoms of distress, and that care partners would demonstrate increased preparedness for caregiving (primary outcome) and less anxiety, strain, and burden, as compared to participants in the control arm. The likelihood of returning to baseline function across time for Fam-FFC participants was twice that of the control group by the end of 6 months (OR = 2.39, p =.011). Fam-FFC was also associated with fewer behavioral symptoms of distress at six-months (changeintervention = -1.973, SE = .396, p < .0001, d = .467; changecontrol = -.859, SE = .389, p = .028, d = .203); moderate physical activity, depressive symptoms, and delirium severity did not differ by treatment arm. Preparedness for caregiving increased significantly more from 2 months to 6-months (changeintervention=2.4, SE=.439, d=.563; changecontrol=.893, SE=.450, d=.212, overall p = .02), and marginally increased from discharge to six months. (changeintervention= 2.783, SE= 0.44, d=.682; changecontrol=1.695, SE=0.44, d=0.415, overall p =0.08), in the intervention group, with no group differences in anxiety, strain, and burden. Fam-FFC may prevent some of the post-acute functional decline and behavioral symptoms in persons with dementia while increasing FCP preparedness. Future research should focus on sustainability of patient improvements and addressing the chronic stressors associated with the care partner role.
DEVELOPMENT OF A SENSOR-ENHANCED CARE COORDINATION APPROACH TO FACILITATE AGING IN PLACE
Authors: Popejoy Lori , Reeder Blaine , Robinson Erin , Proffitt Rachel , Vogelsmeier Amy , Lee Knoo
Published: December 2023

Older adults living in rural areas of the country face unique challenges in accessing health services and community-based supports to facilitate aging in place (AIP). This is especially true for those with health concerns that have required care at a nursing facility. Re-establishing independence after a permanent discharge from a long stay nursing home can be difficult and puts strain on informal care networks. To address this, our team developed a novel approach to help older and disabled adults who were discharged from the Show-Me Home project, which supports clients permanently discharged from the nursing home. The Age-friendly Sustainable Smart and Equitable Technologies for Aging in Place (ASSETs for AIP) is a demonstration project funded by the Department of Health and Human Services. We are an interdisciplinary team of researchers and clinicians who use a strengths-based and client-driven approach to empower older and disabled adults for self-management of their disability, conditions, health, and well-being. Our care coordination team consists of a registered nurse, occupational therapist, and social worker, who assess health-related conditions, set goals, empower change, and monitor progress. For individuals enrolled in ASSETS for AIP, we rely on open-source smart home technologies and consumer-grade wearable devices to monitor activity patterns to identify changes in activity and health. Our care coordination team uses these data as well as client assessments to engage with clients to help them maintain independence. This model shows great promise in addressing the needs of older and disabled adults, thus enabling them to age in place.
RECRUITMENT FOR A COMMUNITY-BASED SENSOR TECHNOLOGY PROGRAM: CHALLENGES AND SUCCESSES
Authors: Vogelsmeier Amy , Roberts Ashley , Bacon Suzette , Curtis Elizabeth , Robinson Erin , Reeder Blaine , Popejoy Lori
Published: December 2023

Eligibility criteria for the ASSETs for AIP program included older and disabled adults who were one-year post-discharge from the Missouri’s Show-Me Home program and who lived within a designated service area. The service area was comprised primarily of rural Missouri counties within the central I-70 corridor with smaller urban centers retained while larger urban areas were excluded. The goal was to enroll 33 people in year one, with an overall goal to enroll 100 individuals over the three-year project period. A client list was provided to the ASSETs for AIP team based on contact information collected at client discharge from the Show-Me Home Program. Despite diligent efforts, the team encountered several recruitment challenges including: 1) obtaining current contact information for individuals 12 months post-program discharge, 2) working within a limited-service area, and 3) establishing client trust in a new, unknown program upon initial contact. Successful recruitment strategies included 1) partnering with state and local agencies to retrieve up-to-date client contact information, 2) reducing the time from program discharge to facilitate contact and align better with client needs, 3) extending the service area beyond mid-Missouri, and 4) sending out postcard-mailers to potential clients that provided a clear linkage between Show-Me Home program, ASSETs for AIP, and the University of Missouri. A connection to the University was particularly important because the University has a statewide reputation for providing services to our citizens. Within the past 6 months, our enrollment has increased by 225%, with successful recruitment ongoing.
TECHNOLOGY TO SUPPORT AGING ADULTS WITH A COGNITIVE IMPAIRMENT
Authors: Czaja Sara , Ross Lesley
Published: December 2023

Technology applications can play a key role in enhancing independence and quality of life for aging adults with a cognitive impairment (CI) and offer potential benefits in terms of memory support, cognitive remediation, safety/security, and engagement. Drawing from research conducted by the Center for Research and Education on Aging and Technology Enhancement (CREATE) and the Center for Enhancing Neurocognitive Health, Abilities, Networks, & Community Engagement (ENHANCE) this symposium will highlight examples of existing and emerging technology applications that provide support for aging adults with a CI and discuss challenges and benefits with technology-based approaches. S. Czaja will present findings from a pilot trial that evaluated the benefits of a technology system designed to support information and resource access, and social and cognitive engagement (PRISM-CI) for aging adults with a CI. W. Boot will focus on the unique benefits of virtual reality (VR) for aging adults with and without a cognitive impairment and highlight gaps in knowledge regarding the use of VR to provide meaningful social and cognitive engagement. N. Charness will discuss a project (AUGMENT) that is focused on providing support for mobility for aging adults with a CI due to stroke, MCI, or a traumatic brain injury. W. Rogers will highlight how video technology can provide socially and cognitively engaging activities for aging adults with a CI and present a systematic process to help guide the development of a video intervention for this population. Lesley Ross will lead a discussion of the highlighted topics and areas for future research.
VIRTUAL REALITY TO SUPPORT THE NEEDS OF OLDER ADULTS WITH AND WITHOUT COGNITIVE IMPAIRMENTS
Authors: Boot Walter
Published: December 2023

Functional, cognitive, and mobility limitations can interfere with older adults’ ability to engage in socially and cognitively enriching activities, which can lead to further decline. Emerging technology solutions, including virtual reality (VR), have the potential to promote engagement in these activities in a way that can account for these limitations, allowing older adults to engage in productive and meaningful activities within their own home. However, an iterative, user-centered design process is necessary to ensure that these solutions reach their potential. This talk provides an overview of a number of recent studies examining the potential of VR to support older adults’ engagement in VR interventions aimed at improving mood and social connectivity. The following questions will be asked and answered during this talk, based on recently collected empirical data; What are the potential usability challenges associated with VR interventions?; What are older adults’ preferences for different VR experiences?; Can VR provide older adults with meaningful opportunities to engage in social interactions when they are distally located, but co-located in the same virtual space?; To what degree do older adults feel present in the virtual environment?; To what degree are older adults’ attitudes toward VR malleable?; If, and under what conditions, is cybersickness a potential barrier? This talk will conclude with a discussion of what is known and what is unknown regarding the use of VR to provide meaningful socially and cognitively engaging experiences for older adults with and without mild cognitive impairment.
SOCIAL SUPPORT BUFFERS THE EFFECT OF APOE4 GENE ON COGNITION
Authors: Payen Ameante , Bateman James , Bennett Jeanette
Published: December 2023

APOE4 allele is one of the most robust genetic risks for Alzheimer’s Disease (AD). It is associated with an earlier onset and conversion from Mild Cognitive Impairment (MCI) to AD dementia. Several studies have shown epigenetic interactions between the social context and the APOE4 allele’s relationship with cognition. Still, explorations of social risk factors for AD in genetically vulnerable populations are limited. This study explored whether the positive effects of social support (SS) on cognition are affected by APOE status in a sample of 115 older adults (n = 72.25, SD = 8.29). SS was measured using the Multidimensional Scale of Perceived Social Support (MSPSS), the preclinical Alzheimer’s Cognitive Composite-5 (PACC5) score to assess concurrent cognition, and the APOE polymorphism was determined via genotyping. As hypothesized, SS buffered the effect of APOE4 gene on PACC5 score, F(1, 107)=5.18, p = .02, Δ R2=.02. Specifically, older individuals who were positive for the allele displayed a significant and positive association between SS and mPACC5 (b=.19, p = .03). This relationship was not found for those who were APOE4 negative (b = -.04, p =.49). These results support the need to consider the epigenetic influence of social factors on later-life cognition, especially for those at risk for developing AD.
AGE-FRIENDLY CAMPUSES: NEED AND OPPORTUNITY FOR SYNERGY IN THE AGE-FRIENDLY ECOSYSTEM
Authors: Montepare Joann
Published: December 2023

Historic shifts in age demographics are reshaping societies and challenging institutions of higher education to respond to older, more age diverse populations through new approaches to teaching, research, and community engagement. Student populations are also becoming more age diverse with adults looking to higher education for lifelong learning opportunities to enhance their personal and professional development as they age. This presentation will describe the guiding framework and set of principles provided by the Age-Friendly University (AFU) initiative to help institutions of higher education shape more age-inclusive practices. Age-friendly campuses can also create opportunities to support other initiatives beyond a campus such as those geared toward age-friendly communities, health care systems, and employers. This presentation will also discuss how synergistic AFU partnerships with other age-friendly initiatives can provide mutual support to strengthen and sustain these efforts. Challenges to this end will also be explored. Examples of existing and promising connections in the ecosystem will be offered to demonstrate the value of this synergy.
PERSPECTIVES OF CAREGIVERS TO BLACK AND HISPANIC PERSONS LIVING WITH DEMENTIA (PLWD) ABOUT END-OF-LIFE COMMUNICATION
Authors: Osakwe Zainab Toteh , Perez Sasha , Odlum Michelle , Stefancic Ana
Published: December 2023

Black and Hispanic Persons Living with Dementia (PLWD) heavily rely on home healthcare to remain comfortably in their own home, even at the end of life. Despite growth in use of hospice in the U.S., research demonstrates persistent racial differences in utilization of hospice - a key indicator of high-quality end of life care. This is particularly relevant among older Black and Hispanic PLWD who experience additional burdensome interventions at the end of life which often run counter to their goals of care. This study examined perceptions of caregivers to Black and Hispanic PLWD regarding discussions with home healthcare nurses about end-of-life communication and transitions to hospice. We conducted semi-structured interviews with 19 Black and Hispanic family caregivers of PLWD. Interviews were recorded, transcribed, translated and analyzed using conventional content analysis. Results showed that Black and Hispanic caregivers of PLWD do not prioritize aggressive and burdensome care at the end of life, had low expectations of the healthcare system to support their needs and preferences at the end-of-life, and were willing to discuss and accept hospice if discussions were transparent about resources and entitlements; acknowledged the strengths of the PLWD/caregivers; involved positive and respectful communication with families during a home visit; acknowledged respect for their social communities and home environment; sat down during a home visit and recognized the role of religion at the end-of-life. Implications to improve care include incorporating family caregiver discussions, identify social determinants of health, and address the role of religion in future interventions.
THE ROLE OF SOCIAL ENTERPRISE ORGANIZATIONS IN SUPPORTING FAMILY CARERS OF OLDER PEOPLE LIVING WITH DEMENTIA
Authors: Cheshire-Allen Maria , Davies Abigail
Published: December 2023

This paper aims to present findings from a primary qualitative study that explored the role of social enterprise organisations (SEOs) in delivering co-produced support for family carers of older people living with dementia (PLWD). Defined in the UK, as businesses with a social or environmental purpose, SEOs are increasingly recognised as occupying a unique space in the landscape of adult social care delivery. In Wales, devolved legislation requires public bodies to collaborate with SEOs - this provision is intended to create a mixed economy of care with co-produced user-led services. To date, however, there is little firm evidence of SEOs delivering co-produced care solutions within the policy framework in Wales, which can be understood to be particularly permissive of SEO involvement, or of how the sector is involved in the delivery of support for family carers of older PLWD. Findings gathered through five focus groups with a purposive sample of family carers, and SEO care providers in South Wales, show how co-produced family carer support programmes are navigated and enacted, as well as how the individual agency of service providers, PLWD, and their carers are involved in these processes. Adopting an ethics of care approach, and utilising reflexive thematic analysis, key themes identified include competition between and within organisations, parochialism, capacity, and organisational barriers. This study highlights implications for policy and practice related to the rhetoric of co-produced support services for family carers, SEOs’ views on delivering that support, and family carers’ experiences of navigating and receiving SEO-delivered services.