bluuebunny/crossref_metadata_2025 huggingface dataset:
A META-COGNITIVE GROUP INTERVENTION FOR OLDER ADULTS WITH SCD OR MCI: RCT AND QUALITATIVE EVALUATION
Authors: Rotenberg Shlomit , Anderson Nicole , Dawson Deirdre
Published: January 2025

We explored ASPIRE, a meta-cognitive group intervention aimed to improve engagement in daily activities of older adults with subjective cognitive decline (SCD) or mild cognitive impairment (MCI). We performed a double-blind randomized controlled trail, and complementary qualitative study. Participants were randomly assigned to ASPIRE (n=131) or a Brain Education control group (n=133). The primary quantitative outcome was improvement in performance of daily activities not trained in either intervention, using the Canadian Occupational Performance Measure (COPM). A linear mixed effects regression model found clinically significant improvement (change ≥ 2 points on the COPM) post intervention in 32.5% of untrained activities in ASPIRE; and 30.6% in Brain Education, with no significant group effects (exp(ß)=0.96, z=-0.15, p=.879). Improvements from pre- to post-intervention were found in both arms on secondary measures of subjective cognition and self-efficacy, with no significant group effects. Qualitative data were written responses about the experience of ASPIRE or Brain-Education collected post intervention, analysed using inductive thematic content analysis. ASPIRE participants were pleased with the Group Context, that included learning from, and helping others with shared experiences of cognitive concerns. They described ASPIRE as applicable to Everyday Life, providing practical strategies and motivating action through accountability to the group. Brain-Education participants were pleased with the Content, specifically the topic areas, described as interesting and stimulating. Both groups were pleased with the facilitation approach. We conclude that ASPIRE and Brain-Education have similar potential to improve subjective cognition, self-efficacy, and engagement in daily activities, but the mechanisms by which they work are different.
LIFE AT AGE 100 IN SWITZERLAND: FINDINGS FROM THE SWISS100 CENTENARIAN STUDY
Authors: Jopp Daniela
Published: January 2025

Switzerland is among the countries with the highest life expectancy and has seen a strong increase of very old individuals over the past century. Yet very little is known about its oldest-old population, including those aged 100 and older. This symposium presents findings from the first national centenarian study conducted in Switzerland, SWISS100. The presentations offer findings from the SWISS100 Main Study, allowing due to its interdisciplinary nature a comprehensive perspective on life at age 100 in Switzerland. Jopp and colleagues will present findings on key characteristics in centenarians (e.g., health, cognition, social resources, psychological strengths) and their associations with quality of life. Stahlmann and colleagues will share findings on the use of ambulatory assessment in centenarians, more specifically sound recordings which allow to investigate everyday life activities, showing that such innovative tools are applicable in this population and that these methods lead to important insights, complementing self-report. Masotti and colleagues will present results on the caregiving setting in centenarians, illustrating that Swiss centenarians show a notable variation in needs and support. Hoffman and colleagues will present results on centenarians’ goals, coded by content and orientation, and associations to well-being outcomes, illustrating that goals remain important adaptation features in very old age. Overall, SWISS100 findings help to better understand the specific life phase centenarians are experiencing, including its challenges, but also show notable psychological resilience and well-being.
EXPLORING GOAL CONTENT AND ORIENTATION OF SWISS CENTENARIANS
Authors: Hoffman Adar , Jopp Daniela , Cavalli Stefano , von Gunten Armin , Roecke Christina , Martin Mike , Herrmann Francois
Published: January 2025

In very old age, goal orientation is expected to shift towards maintenance-oriented goals, as adaptive mechanism (e.g., Ebner, Freund, & Baltes, 2006). For centenarians, opportunities can be especially limited due to physical and contextual constraints, calling for adjustment in goal content and orientation. This study investigated the number, content, and orientation of goals among a subsample of 135 centenarians (Mage = 101.6 years) in the SWISS100 study. Within this sample, 78 (58%) centenarians mentioned at least one goal, and 57 (42%) centenarians did not mention any. Specifically, 27 (35%) specified one goal, 24 (30%) two, and 27 (35%) three distinct goals. Goals were coded for content and orientation. Leisure and family contents were most prevalent domains for goal setting, covering half of the goals mentioned. Subsequently came contents of health and home-related, while domains of social, well-being, independence and religion were also mentioned but to a lesser extent. Moreover, approach and maintenance orientations were the most widespread, representing 75 percent of all goal orientations. Some improvement goals were mentioned, but avoidance goals were rare, particularly for second and third goals. A higher number of goals was associated with more meaning in life and higher subjective well-being. Overall, results show that centenarians still have goals, the most prevalent contents reflect their life stage, and the many approach goals suggest a positive orientation. As goals seem to remain important mechanism of adaptation among centenarians, more research is needed to better understand the role of goals as a potential means of successful aging.
WHY MEASUREMENT MATTERS IN UNDERSTANDING SOCIAL CONNECTIONS: REFLECTIONS ON MEASURING SOCIAL ISOLATION
Authors: Pomeroy Mary Louise , Mehrabi Fereshteh , Jenkins Emerald , O’Sullivan Roger , Lubben Jim , Cudjoe Thomas
Published: January 2025

Social isolation has a negative impact on society and increases the risk of morbidity and mortality. Despite recent strides in this literature, methodological issues remain in how social isolation is measured and subsequently described. Fundamentally, most measures are not validated, do not measure objective social isolation, or interchange assessments of social isolation with loneliness. Many studies continue to rely on a single item to measure social isolation, most likely resulting in biased estimates. Researchers are faced with a variety of unvalidated metrics that differ in their theoretical framing and composition. We believe that this heterogeneity stems in part from the lack of psychometric testing, impeding the advancement of work in this area. The lack of consistency perpetuates misunderstandings in population-based estimates or other rigorous characterizations of social isolation, precludes the comparison of findings across studies, and undercuts our understanding of intervention effectiveness. We call for the research community to employ psychometric testing of social isolation measures and to solicit input from a wide array of stakeholders to substantiate a proposed measure. This information could then be used to generate broad support for use of evidence-based measures of social isolation, promoting consistency and uptake in clinical, research, and community settings. Establishing acceptability and validity of social isolation measures is critical to developing screening and prevention strategies, designing effective interventions, and adopting practice and policies that are relevant to stakeholders.
USE OF A NOVEL STAFFING PROGRAM IN NURSING HOMES: A MIXED METHODS STUDY
Authors: Peterson Lindsay , Smith Kelly
Published: January 2025

Staffing in nursing homes (NHs) has long been a critical policy issue. Faced with NH staffing challenges, Florida legislators approved a 2021 measure allowing lesser trained staff (personal care attendants [PCAs]) to work as certified aides for four months, with the expectation the PCA would become certified in that time. We used mixed methods, aiming to assess Florida NH administrators’ views on this novel staffing program. We distributed a Qualtrics survey of closed- and open-ended questions to 695 administrators via email between July 2022 and September 2022, receiving 55 unduplicated, complete responses. Logistic regression was used to estimate relationships between independent variables (e.g. facility characteristics, federal five-star rating, survey responses) and the outcome, whether respondents found the PCA program beneficial (yes/no). To build on quantitative results, we used thematic analysis to assess four open-ended survey questions. Results found the average bed size of respondents’ NHs was 135, 75% were nonprofit and 62% were part of a chain. Regression results found a significant relationship between rating the program as beneficial and hiring more PCAs (p=.003) and having a higher quality rating (p=.02). We identified three qualitative themes, 1) benefits of the program, 2) barriers to success, 3) how to make the program work, with an overarching theme of administrative proactivity. Analysis of quantitative and qualitative results together found administrators who rated the PCA program as beneficial were more likely to describe proactive efforts (e.g. establishing PCA mentorship programs). Results provide guidance on practices required to make a novel staffing program succeed.
CHURN: TRANSITIONS OUT OF HEALTH SECTOR EMPLOYMENT FOR LOW-PREPARATION WORKERS, 2017–2022
Authors: Bishop Christine , Donelan Karen
Published: January 2025

Shortages and turnover for front-line paid caregivers and support staff in long-term services and supports for older adults undermine quality of care. These workers are part of the health sector workforce, and also participate in a larger labor market of jobs requiring minimal formal education and brief training. The Brandeis Front-line Health Worker Survey queried a random sample of U.S. residents screened for holding patient-facing jobs in the health sector between the survey date (Summer 2022) and five years prior (2017), generating information on a retrospective longitudinal cross section of US health sector workers. Respondents reporting occupations in Bureau of Labor Statistics Job Zones 1 and 2 were identified as participating in low-preparation labor markets. About half of low-preparation health sector workers reported work in nursing homes, residential settings, or home care. We estimated annual rates of transition into and out of heath sector employment for all low-preparation health workers for years prior to and during the pandemic. Descriptive logistic regressions showed the relationship of job churn to gender, caregiver status, and previous employment pattern. Despite concerns about health workforce stability as the pandemic wound down, low-preparation workers exhibited about the same year-to-year transition rates out of (and back into) the health sector throughout the period. This suggests that the Great Resignation in healthcare is a continuing pattern rather than a pandemic phenomenon. Employers and public policy makers setting wages and working conditions should recognize that front-line workers have, and have always had, alternatives beyond the health sector.
NURSING HOME STAFFING DISPARITIES IN DISTRESSED COMMUNITIES DURING PANDEMIC
Authors: Kang Yu Jin , Nielsen Karen , Jordan Jacqueline , McGee Blake
Published: January 2025

This repeated measures study aims to examine the extent of US nursing home staffing disparities in distressed communities during the COVID-19 pandemic. The study used 2020-2022 Nursing Home Compare, 2021 LTCFocus, and the Distressed Community Index from the Economic Innovation Group. Mixed-effects models were used for data analysis. Outcomes were quarterly case-mix adjusted hours per resident day (HPRD) of all nursing staff in the last three quarters of 2020 and all of 2021: registered nurses (RN), licensed practical and vocational nurses (LP/VN), and certified nursing aides (CNA). Predictors included 2020 first quarter nurse staffing levels and distressed community index quintile. Covariates were nursing home size (greater or less than 100 beds), 5-star overall rating, Medicaid payer percentage, and non-profit status. Of the 13,845 nursing homes, 70% were for-profit and 50% had over 100 beds. On average, 5-star overall rating of nursing homes was 3.19 (sd=1.41) and Medicaid payer percentage was 60% (sd=23.5%). Compared to pre-pandemic nurse HPRD, average HPRD of the subsequent 7 quarters declined (differences: Total=-0.67, 17%; RN=-0.30, 43%; LP/VN=-0.13, 15%; CNA=-0.26, 11%). Pandemic HPRD were negatively associated with pre-pandemic HPRD (slopes: Total= -0.078; RN= -0.039; LP/VN= -0.010; CNA= -0.062, all p< 0.001). Modeled interactions suggest that declines in HPRD were greatest in the most distressed communities. Analyses showed declines in nursing home staffing levels during the pandemic, with the lowest HPRD and greatest declines observed in the most distressed communities and RNs. Practical significance of the predictors and resident outcomes requires further examination.
ACTIVITIES OF DAILY LIVING (ADL/IADL) ASSISTANCE AND DEPRESSION AMONG COMMUNITY-DWELLING OLDER ADULTS IN THE US
Authors: Gupta Debasree Das , Kelekar Uma
Published: January 2025

Limitations in daily and instrumental activities of daily living (ADL/IADL) are among the strongest predictors of late-life depression, while ADL/IADL assistance has the potential to reduce depression among older adults. Prior research in this area has predominantly focused on proximate (e.g., going without food when hungry, wetting/soiling bed or clothes) or healthcare (e.g., hospitalizations, nursing home placements) outcomes of unmet ADL/IADL needs. Thus, the risk/protective association of ADL/IADL assistance with late-life depression remains unclear. To address this gap, we evaluated the longitudinal association between ADL/IADL assistance and subsequent depression using data from a nationally representative sample of community-dwelling Americans age 65 and older (n=5,176) who participated in the 2016-2018 Health and Retirement Study. We conducted bivariate and multivariable (logistic regression) analyses to estimate: 1) the proportion of older adults reporting ADL/IADL difficulties but not getting ADL/IADL help, and 2) the odds of subsequent depression among those reporting no versus one or more help with ADL/IADL (reference: those reporting no ADL/IADL difficulties). Results indicated a higher proportion of older adults did not get help with ADL (6.4%) compared to no help with IADL (1.9%). However, the adjusted odds of subsequent depression associated with no IADL assistance (adjusted odds ratio [aOR]: 3.22; 95% confidence interval [CI]: 2.19,4.78) was 1.66 times higher than that associated with no ADL assistance (aOR: 1.94; 95% CI: 1.35,2.78). Given these findings, enhancing long-term care services for older adults would be essential for meeting the current national goal of reducing mental distress among persons living with disabilities.
PATTERNS OF SEDENTARY BEHAVIORS IN OLDER ADULTS IN CHINESE CARE HOMES: A LATENT PROFILE ANALYSIS
Authors: Li Qi , Dong Sihan , Liu Xueying , Xu Mengjiao , Song Yuting
Published: January 2025

Sedentary behaviors remain common among older adults. Previous studies in this area are mostly focused on community settings and used variable-centered approach. In this study, we aimed to identify the pattern of sedentary behaviors among older adults in residential care homes in China. This cross-sectional analysis used data from 283 older adults who lived in 11 residential care homes in China. Eligible participant aged 65 years or older, had lived in the current care home for ≥3 months, and was able to communicate verbally or in writing. Sedentary behaviors were assessed with the Elderly Sedentary Behavior Questionnaire. Participants self-reported the average daily time spent in the past week on each of eight behaviors, such as watching TV, socializing, and doing nothing. Patterns of sedentary behaviors were identified using latent profile analysis and verified by associating with depressive symptoms using a regression model. The average daily sedentary time of older people was 11.6 hours (SD=2.6). Four patterns of sedentary behaviors emerged, which we labeled the high sedentism group (23%), the balanced group (50%), the high mentally-active group (8%), and the high mentally-passive group (19%). Compared to older adults in the balanced group, those in the high sedentism group and high mentally-passive group had higher risks of depressive symptoms and those in the high mentally-active group had lower risks of depressive symptoms. Targeted interventions are warranted for older adults of different patterns of sedentary behaviors, particularly older adults in the high sedentism group and high mentally-passive group.
TWENTY-FOUR-HOUR MOVEMENT AND BLOOD PRESSURE: SIX PART COMPOSITIONAL DATA ANALYSIS STUDY FROM THE PROPASS CONSORTIUM
Authors: Blodgett Joanna , Ahmadi Matthew , Atkin Andrew , Koster Annemarie , Stamatakis Emmanuel , Hamer Mark
Published: January 2025

Physical activity has widely known benefits for cardiovascular health. However, the influence of movement across the entire 24-hour behavioural spectrum (e.g. sleeping, sedentarism, activity type, etc.) on blood pressure remains underexplored. This study investigated associations between free-living activities that comprise a 24-hour day and systolic and diastolic BP (SBP; DBP). Data from six cohorts within the Prospective Physical Activity, Sitting and Sleep consortium (ProPASS) consortium (n=14,761; mean age 54.2±9.6 years) were analysed. Using thigh-worn accelerometers, all activity over a 7-day period and nurse-assessed BP were collected. Individual participant meta-analyses, employing compositional data analysis, were conducted. Reallocation plots were generated to estimate BP reductions by reallocating time from one behaviour to another, highlighting the potential benefits of minimal and optimal behavioural changes.

Results: On average, participants spent significant proportions of their day of sleeping (7.3hrs;31%), sedentary(10.9hrs;45%), standing(3.1hrs;13%), slow walking(1.5hrs;6%), fast walking(1.1hrs;5%), and exercise-like activity(10.9min;0.01%). Increased time spent in exercise or sleep, relative to other activities, correlated with lower BP. An additional 5 minutes/day of exercise-like activity was associated with estimated reductions of -0.68mmHg (-0.15,-1.21; SBP) and -0.54 mmHg (-0.19,0.89; DBP). Clinically meaningful improvements in SBP and DBP (2 & 1 mmHg) were estimated after reallocating 20-27 minutes and 10-15 minutes, respectively, from other activities to exercise.

Conclusion: This study highlight the significance of exercise in BP management, even in small doses within everyday life. It suggests that minor adjustments to daily routines, favouring exercise, could contribute to significant BP reductions in free-living contexts.
PSYCHOSOCIAL AND NEIGHBORHOOD-RELATED HEALTH FACTORS FOR BLACK AND WHITE ADULTS OF THE HANDLSLEEP PROJECT
Authors: Gamaldo Alyssa , Buxton Orfeu
Published: January 2025

Disparities in cognition and sleep have been observed in middle-aged and older Black and White adults. However, limited research has examined the association between cognition and sleep as well as the underlying psychosocial, contextual, and biomarker factors that explain this association. This symposium will include presentations using data from Healthy Aging in Neighborhood of Diversity Across the Life Span Sleep Study (HANDLSleep), which was conducted to explore psychosocial and contextual factors related to sleep and cognition in a sample of Black and White middle-aged and older adults in Baltimore, MD. The objectives of the proposed symposium are the following: (1) discuss the associations observed between sleep and cognition using cross-sectional and ambulatory data (2) discuss how psychosocial, contextual, and inflammatory markers relate to sleep and cognition. Master and colleagues explored the daily coupling associations between actigraphic sleep and working memory. Allan and colleagues explored the association between different dimensions of health (e.g., sleep and cognition) and objective and subjective measures of neighborhood quality. Linying and colleagues examined the extent that mean and variability of actigraphic sleep relate to global mental status. Lastly, Shen and colleagues explored the association between actigraphic sleep and inflammatory markers and the extent this association varies by race and sex.
ASSOCIATIONS BETWEEN MEASURES OF HEALTH AND OBJECTIVE AND SUBJECTIVE NEIGHBORHOOD QUALITY
Authors: Allan Alexa , Thorpe, Jr. Roland , Buxton Orfeu , Ross Lesley , Beydoun May , Zonderman Alan , Evans Michele , Gamaldo Alyssa
Published: January 2025

The current study examined the cross-sectional associations between self-reported mental/emotional (e.g., patient health questionnaire), sleep (e.g., Pittsburgh Sleep Quality Index), physical (e.g., medical conditions), and cognitive health (e.g., Montreal Cognitive Assessment) and subjective and objective measures of neighborhood quality. This preliminary analysis included 77 community-dwelling socioeconomically diverse Black and White adults (Mage = 62.17, SDage = 9.71; 70% female) from the HANDLSleep study. Neighborhood quality was assessed using self-reported measures of physical built disorder (e.g., graffiti), social cohesion (e.g., close-knit neighborhood), and social control (e.g., neighbors act if children disrespecting an adult). Area Deprivation Index (ADI) National and State values were extracted from the Neighborhood Atlas using participant addresses. Multivariable linear regression analyses were conducted using health measures as the outcome of interest. Models were adjusted for age, sex, race, education, and poverty status. In the adjusted models, participants living in neighborhoods of greater deprivation (i.e., State ADI) reported higher levels of depressive symptomology (p <.05) and worse sleep quality (p <.05). Likewise, higher reports of physical built disorder were associated with poorer cognition (i.e., attention, p <.05). Contrastingly, reports of better social cohesion were associated with lower insomnia severity scores (p <.05) and better performance on a measure of executive function (p <.01). Reports of more social control was also associated with better executive function (p <.05). These findings highlight the importance of examining both objective and subjective neighborhood characteristics as they pertain to different dimensions of health.
PSYCHOLOGICAL RESILIENCE MAY IMPROVE SLEEP QUALITY OF FAMILY CAREGIVERS OF OLDER ADULTS
Authors: Malhotra Rahul , Quach Ha-Linh , Lim-Soh Jeremy
Published: January 2025

Given the increasing focus on the importance of sleep for health and well-being, we assessed the (a) association of caregiving status (family caregiver/non-caregiver) with sleep quality and its moderation by psychological resilience and (b) factors influencing sleep quality among caregivers. Cross-sectional data on subjective sleep quality (Pittsburgh Sleep Quality Index (PSQI); higher global or component scores represent worse sleep quality) and psychological resilience (Connor-Davidson resilience scale) from Singapore on 167 family caregivers of older adults and 135 non-caregivers was analyzed. Multivariable linear regression models assessed the association of caregiving status with global PSQI score and it’s moderation by psychological resilience and identified caregiver and care-recipient characteristics associated with global PSQI score among caregivers. Mean global PSQI score (6.0 versus 4.5), proportion with poor sleep quality (global PSQI score>5; 46.1% versus 28.1%) and mean component scores (for sleep latency, sleep quality, sleep duration, and daytime dysfunction) were higher for caregivers, versus non-caregivers, reflecting their worse sleep quality. In multivariable analysis, caregivers had higher global PSQI score than non-caregivers (beta-coefficient: 1.04, p<0.05). However, this association was moderated by psychological resilience (beta-coefficient: -0.70, p<0.05) – the deficit in sleep quality for caregivers versus non-caregivers reduced with higher psychological resilience. Finally, among caregivers, those with higher education, fewer chronic conditions, fewer functional limitations, and higher psychological resilience had lower global PSQI score, i.e., better sleep quality. Our findings reveal the detrimental effect of being a family caregiver (versus not) on sleep quality and identify psychological resilience as a potential modifiable factor for mitigating it.
HEALTH CONDITIONS AND CONTINUOUS POSITIVE AIRWAY PRESSURE DISCONTINUATION IN US MIDDLE-AGED AND OLDER ADULTS
Authors: Sekhon Vishaldeep , Roth David , Albrecht Jennifer , Wickwire Emerson , Spira Adam , Amjad Halima , Tseng Chien-Yu , Kaufmann Christopher
Published: January 2025

Although continuous positive airway pressure (CPAP) is an efficacious treatment for obstructive sleep apnea (OSA), suboptimal adherence is common, reducing its effectiveness. OSA co-occurs with chronic health conditions that may impact adherence to CPAP. This study evaluated health conditions as predictors of CPAP discontinuation over 2 years. Data came from the 2016 and 2018 Health and Retirement Study, a longitudinal cohort study of a nationally representative sample of 20,000 older adults in the U.S. In both years, participants were asked if “a doctor had ever told them they have a sleep disorder,” and if so, which disorder and any treatments received (including CPAP). In 2016, participants also reported whether a doctor ever told them they had several health conditions (high blood pressure, diabetes, cancer, lung disease, heart disease, stroke, psychiatric problems, and arthritis). We identified CPAP users in 2016 with available data in 2018. Participants not listing CPAP in 2018 were considered to have discontinued CPAP. We used logistic regression to determine which health conditions predicted CPAP discontinuation after controlling for age, sex, race/ethnicity, education, BMI, and marital status. Of N=902 CPAP users in 2016, 38% did not indicate CPAP use in 2018. Participants diagnosed with diabetes in 2016 had 36% increased odds of CPAP discontinuation (AOR=1.36, 95% CI=1.02-1.80) compared to those without diabetes after accounting for other covariates. CPAP discontinuation did not differ across other health conditions. Overall, CPAP users with diabetes were at increased likelihood of CPAP discontinuation, necessitating efforts to encourage CPAP adherence in this vulnerable group.
PUBLIC HEALTH APPROACHES FOR SUSTAINABILITY OF DEMENTIA EVIDENCE-BASED PROGRAMS
Authors: Waugh Kellie , Leavitt Talyah Sands
Published: January 2025

ASTHO, with support from CDC, has gathered strategies, examples, and resources to inform the development of sustainability focused capacity-buildings materials for public health departments, including an actionable resource for integrating sustainability into Healthy Brain Initiative (HBI) implementation. Attendees will be provided with a guided look through this tool, developed to elevate the importance of sustainability and support health departments in sustaining their programmatic dementia work. The public health-driven strategies included provide a unique guide for embedding sustainability into dementia initiatives and evidence-based programs from initial planning to implementation. Subsequently, the guidance is extended to ensure health equity is operationalized throughout the entirety of this process. Attendees will enhance their ability to ensure positive outcomes and provide long-term program benefits by thoughtfully considering complex factors that determine the sustainability of evidence-based programs, such as duration of funding, partnership, and organizational support. To encourage practical application, the presentation will showcase two state public health department examples of evidence-based programs that have effectively prioritized sustainability. The presenter will offer reflective insights on what sustainability means for public health practitioners involved with dementia and older adult health programs and shed light on how these efforts sustain positive outcomes across the life span and advance health equity.
MITOFIT: A FORMATIVE/SUMMATIVE EVALUATION OF A NOVEL INTERVENTION ON MITOCHONDRIAL FITNESS
Authors: Maxwell Cathy , Grubbs Brandon , Boon Jeffrey , Dunavan John , Knickerbocker Kelly , Patel Maulik
Published: January 2025

A key driver that leads to age-associated decline and chronic disease is mitochondrial dysfunction. Our prior work revealed strong community interest in the concept of mitochondrial fitness that led to development of a video-based intervention to prompt behavior change in adults aged 50+.

Aim

To conduct formative and summative evaluations of MitoFit, an instructional, biologically-based communication intervention aimed at improving physical activity (PA) in older adults, aged 50+.

Methods

Phase 1 formative evaluation- Community-dwelling older adults (N=101), rated the acceptability, appropriateness and helpfulness of our MitoFit video series, titled, “How to Slow Down Aging Through Mitochondrial Fitness.” (4 out of five on a Likert-scale survey). Phase II summative evaluation- A subgroup of phase I participants (N=19) participated in a 1-month MitoFit intervention prototype to evaluate intervention and data collection feasibility (70% completion).

Results

Phase I: Participants (mean age: 67.8 [SD 8.9]; 75% female) rated the MitoFit videos as acceptable (agree: 97%-100%), appropriate (agree: 100%) and helpful (agree: 95%-100%) to support adaptation and continued work on our novel approach. Phase II: Participants (mean age: 71.4; 72% female) demonstrated MitoFit competencies (obtaining pulse, calculating maximum and zone 2 heart rate, demonstration of exercises). At one-month post-instruction, 13 participants (68.4%) had completed a self-initiated daily walking/exercise plan and submitted a daily activity log. Feasibility scores ranged from 89.4% to 94.7%. Fifteen participants (78.9%) stated an intention to continue the MitoFit intervention.

Conclusion

MitoFit was enthusiastically embraced, and is a cost-effective, scalable, and efficacious intervention to advance with community-dwelling adults.
DEVELOPING AND TESTING A PROTOCOL FOR TELEPHONE REASSURANCE CALLS: A RANDOMIZED PILOT STUDY
Authors: Minyo Morgan , Bass David , Judge Katherine , McCarthy Kate , Terry Christine , Willis Crysta , Beach Douglas , Perkins Fatima
Published: January 2025

Telephone reassurance call programs that provide conversation and check-ins to isolated older adults have increased since the COVID-19 pandemic. The goals of these programs are to give older adults opportunities to express unmet needs, receive service referrals, and increase their use of home-and community-based services. Few empirical studies have examined the efficacy of these programs, including whether different approaches to telephone reassurance calls lead to different outcomes. This 24-month randomized controlled pilot study recruited older adults from an Area Agency on Aging to compared two approaches to telephone reassurance calls: 1) usual care, unstructured friendly check-in calls from a social worker (n=20) and 2) a newly developed protocol of semi-structured calls from a social worker (n=23), which was adapted from an evidence-based program. Multivariate results found significant differences in multiple outcomes. Compared to usual care (M=0.7, SD=1.0), participants who received the new semi-structured calls (M=2.1, SD=2.8) identified 1.75 more unmet service needs (t=2.69, p=.01). Participants who received the new semi-structured calls (M=1.1, SD=1.3) also received 1.23 more service referrals (t=4.07, p<.01) than usual care participants (M=0.3, SD=0.6). Additionally, participants who received the new semi-structured calls (M=3.7, SD=2.6) started or continued using 1.39 more services (t=2.02, p=.05) than usual care participants (M=2.4, SD=1.7). Findings suggest that the semi-structured protocol led to more beneficial outcomes while requiring only a seven-minute increase in the length of each telephone reassurance call. Discussion will focus on next steps for expanding the semi-structured protocol and sample in a multisite randomized trial.
BRIDGING LONG-TERM CARE AND ELDER ABUSE RESEARCH IN A MENTOR–MENTEE COMMUNITY OF PRACTICE
Authors: Roberts Amy , Chang E-Shien , Kilaberia Tina , Rosen Anthony , Epstein-Lubow Gary , Lachs Mark
Published: January 2025

The National Collaboratory to Address Elder Mistreatment (NCAEM) Mentorship Program serves as an emerging hub to learn from thought leaders, build partnerships, and forge collaborations in elder mistreatment research, policy, and advocacy efforts. This one-year program brings together clinicians, service providers, researchers, policymakers, and advocates from many disciplines who share a common goal of eradicating elder mistreatment. Our session will focus on the critical role of the NCAEM in catalyzing interdisciplinary elder abuse research in long-term care settings, including nursing homes and assisted living. We will first identify approaches, mechanisms, and lessons learned in building successful and sustainable mentoring experiences through the support of the NCAEM. Perspectives from both mentees and mentors will be highlighted to reflect the range of experiences, such as mentor-mentee meetings, peer-to-peer mentoring within and across mentee cohorts, and national convenings. To demonstrate the rich collaborative experience of the NCAEM community of practice, we will then present three completed and ongoing impact-driven research projects on resident-to-resident mistreatment in long-term care settings, including: (1) characterizing racial/ethnic conflicts among residents in long-term care, (2) recognizing resident-to-resident mistreatment as a key barrier to an age-friendly environment, and (3) identifying the training and program needs for directors of social services in nursing homes regarding resident-to-resident mistreatment. Lastly, we will discuss learning using the ongoing experience of the NCAEM as a model research network model to advance ongoing work, generate new areas of inquiry, and grow interest in a focused gerontology topic.
COLLABORATIVE MENTORING OPPORTUNITIES VIA THE NATIONAL COLLABORATORY TO ADDRESS ELDER MISTREATMENT
Authors: Troutman-Jordan Meredith
Published: January 2025

Elder abuse is a silent public health issue; with nearly 5 million cases of abuse annually, its prevention is a high priority. Nurses and social workers are the largest groups of healthcare professionals to witness, report and advocate for elder abuse. They have both ethical and legal obligations as mandated reporters. However, a majority of elder abuse is not reported. Home health nurses and social workers are in key positions to identify and intervene when elder abuse is suspected. This presentation shares how collaborative mentoring has worked to address elder abuse. In collaborative mentoring, mentees have the opportunity to engage with a mentor and peers, present ideas, exchange knowledge and experience, and be actively engaged. As a NCAEM mentee the author was guided by a mentor in the development and implementation of a focus groups with home health nurses. Pilot data was used to secure funding for an ongoing mixed-methods study. Qualitative findings from phase one include uncertainty, advocacy, and fear, with some overlap in themes from social work and nursing. This data will inform intervention and resource development for home health nurses and social workers. Positive outcomes of this experience were inspiration to serve as a mentor for a subsequent NCAEM mentee, whose project deals with identification and intervention for elder abuse identified within VA homecare services. This presentation will share outcomes from the presenter’s NCAEM project, the process of then serving as a mentor, and highlight opportunities through collaborative mentoring in addressing the issue of elder abuse.
RACIAL/ETHNIC GROUP DIFFERENCES IN OLDER ADULTS’ INVOLVEMENT WITH ADULT PROTECTIVE SERVICES
Authors: Steinman Kenneth
Published: January 2025

Child protective services has long wrestled with concerns about Black and Hispanic families being disproportionately more likely to be investigated. In contrast, only one, small, recent study has quantified racial/ethnic group differences in adult protective services (APS). A paucity of research and inconsistent findings in this area have limited the generalizability of studies and complicated efforts to develop culturally sensitive practices for specific groups. The proposed project would represent the first national study of racial/ethnic group differences in older adults’ involvement in APS. It would provide the several key findings, including: a conceptual framework that explains why racial/ethnic group differences in APS may exist; benchmarks for the “typical” magnitude of racial/ethnic group differences in key APS metrics across most US states; identification of mistreatment types, genders, and age groups where racial/ethnic group differences in APS metrics are especially large; identification of the types of racial/ethnic group differences in APS metrics that vary markedly from state to state or county to county; and descriptions of the community (e.g., poverty rate) and organizational (e.g., APS agency) characteristics that help explain this variation. The project will also engage researchers, practitioners, and community leaders in three advisory teams. Their regular involvement will help ensure that the project employs the best available theories and methods, provides useful guidance for APS professionals, and reflects the priorities and lived experiences of the communities being studied.
THE STEP-HI STUDY: RECRUITMENT, ADHERENCE, AND RESULTS FOR PRIMARY STUDY OUTCOME
Authors: Binder Ellen , Berry Sarah , Bartley Jenna , Marcus Robin , McDonough Christine , Reeds Dominic , Magaziner Jay , Schechtman Kenneth
Published: January 2025

For STEP-HI women aged ≥65 years with a recent hip fracture were recruited from the community at large and Assisted Living facilities. Women who qualified for the study were assigned to one of three groups for 6 months: exercise plus testosterone (EX+T), exercise plus placebo (EX+P), or Enhanced Usual Care (EUC). EX+T were prescribed a dose of 1% testosterone topical gel intended to maintain serum total testosterone levels between 110-160 ng/dL. Both EX groups performed a supervised exercise program; EUC participants performed home exercise. To identify eligible patients 4695 chart reviews were completed, 207 women consented for screening, 153 were eligible, 129 were randomized to study groups, 122 included in the intention-to-treat (ITT) analyses. Mean age of the sample was 79.3 ± 8.4. Women assigned to the EX+T group achieved a mean serum total testosterone level of 170.1 ± 82.7 ng/dL, compared with 17.8 ± 13.3 ng/dL in the EX+P group (p< 0.001). Adherence to the supervised exercise program (number completed/number of expected sessions) was 82.5% in the EX+T group and 81.1% in the EX+P group (p = 0.68). The pre-specified primary outcome measure was Six Minute Walk Distance (SMWD). In the ITT analysis, SMWD increased over the 6-month intervention period in all three groups, but the changes in EX+T (n=53) vs. EX+P (n=51) vs. EUC (n=18) did not differ significantly by group (p> 0.39 for all comparisons). We conclude that in older women with a recent hip fracture, testosterone replacement therapy does not independently improve SMWD greater than exercise.
CAUSAL EFFECTS OF SCHOOLING ON MEMORY AT OLDER AGES IN FIVE LOW- AND-MIDDLE-INCOME COUNTRIES
Authors: Stites Shana , Amin Vikesh , Behrman Jere , Fletcher Jason , Flores Carlos , Flores-Lagunes Alfonso , Kohler Iliana , Kohler Hans-Peter
Published: January 2025

We investigate the relationships between early life schooling and performances on memory tests at older ages in China, Ghana, India, Mexico, and South Africa using harmonized data from the World Health Organization Study on Global Ageing and Adult Health. We apply a nonparametric partial-identification approach that bounds causal effects of increasing schooling at different parts of the schooling distributions under relatively weak assumptions. We find that an extra grade of schooling is associated with memory scores that are higher by at most 0.12 standard deviations (SDs) in China, 0.06 SDs in Ghana, 0.10 SDs in India, 0.09 SDs in Mexico, and 0.07 SDs in South Africa, between never-attending school and completing primary schooling. The bounds statistically rule out null effects for all countries except South Africa. At higher parts of the schooling distributions (e.g., high-school or university completion) the bounds cannot statistically rule out null effects.
MEDIATING ROLE OF DEPRESSION IN THE ASSOCIATION BETWEEN CUMULATIVE LONELINESS AND MEMORY FUNCTION, 2006–2020
Authors: Yu Xuexin , Zahodne Laura , Gross Alden , Needham Belinda , Langa Kenneth , Kobayashi Lindsay
Published: January 2025

Objective

To investigate the mediating effect of depressive symptoms in the association between cumulative loneliness and memory function.

Methods

Data were from 4,764 adults aged 50+ in the Health and Retirement Study in two random sub-cohorts from 2006-2018 (Cohort A) and 2008-2020 (Cohort B). Participants were categorized as experiencing loneliness at 0, 1, 2, or 3 time points according to the UCLA Loneliness Scale, administered every four years from 2006-2014 (Cohort A) or 2008-2016 (Cohort B), creating an 8-year exposure period in each cohort. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale in 2016 (Cohort A) or 2018 (Cohort B). Episodic memory function was assessed in 2018 (Cohort A) or 2020 (Cohort B). Causal mediation analysis was performed to investigate the mediating role of depressive symptoms in the cumulative loneliness-memory association, in the pooled cohorts.

Results

Mean age (SD) at baseline was 65 (7.6), and 62% were female (2,934/4,764). Greater cumulative loneliness over the 8-year exposure period was associated with lower memory function at the follow-up in a dose-response relationship. This association was mediated by depressive symptoms, with natural indirect effects ranging from -0.009 (95% CI: -0.016 to -0.002, loneliness at one time point), -0.016 (95% CI: -0.028 to -0.003, loneliness at two time points), to -0.020 (95% CI: -0.037 to -0.004, loneliness at three time points, 20% mediated).

Discussion

Depression could be a psychological mechanism through which cumulative loneliness affects memory function among middle-aged and older adults in the United States.
ADVANCING AGING IN THE RIGHT PLACE THROUGH MULTIPLE ECOLOGICAL DOMAINS
Authors: Traver Anthony , Lehning Amanda
Published: January 2025

Individuals experiencing housing insecurity encounter service gaps and environmental inadequacies that compromise their health, social inclusion, and resilience in later life. The Aging in the Right Place (AIRP) framework provides a model for recognizing and addressing these gaps and inadequacies across multiple ecological domains. This symposium brings together five papers to examine the interplay of housing, community context, and AIRP. The first paper uses photovoice and qualitative geospatial methods to investigate the social challenges of aging faced by older people experiencing homelessness (PEH). The second paper analyzes interviews to examine how the usage and perceptions of transportation resources differ between younger and older PEH. The third paper uses data from the National Health and Aging Trends Study to examine the influence of various housing typologies on participation in social and physical activities among older adults with functional limitations. The fourth paper profiles the implementation of emergency preparedness strategies by a senior housing advocacy group to enhance the resilience of affordable housing communities. Finally, the fifth paper presents results from a randomized controlled trial to demonstrate the effect of guaranteed basic income on housing access among older PEH. The symposium will conclude with a discussion of innovative community-level strategies to enhance health, inclusion, and resilience among adults who are attempting to age in their right place while economically and socially marginalized.
COMPARISON OF TRANSPORTATION USE AMONG OLDER AND YOUNGER PERSONS EXPERIENCING HOMELESSNESS
Authors: Canham Sarah , Rose Jeff , Jones Shannon , Garcia Ivis
Published: January 2025

Regardless of age, transportation determines access to necessary services and supports, including food, healthcare, shelter, and social connection for persons experiencing homelessness (PEH). This study compared experiences and perceptions of transportation among PEH aged <49 years old to PEH aged 50+ years. We conducted a secondary qualitative data analysis of semi-structured interviews with 18 PEH staying in emergency shelters in Salt Lake County (Utah). Using thematic analysis, we identified three points of comparison between older and younger PEH: 1) Modes of transportation used; 2) Reasons for using public transit; and 3) Perceptions of public transit. While there are some similarities across transportation modes used (e.g., public transit, dedicated homeless-services shuttle, walking), older PEH also reported using taxi services when it could be afforded or shared with others. In addition, older PEH more often discussed using public transit to get to healthcare appointments, while younger PEH reported needing transit to get to places of employment. Though both participant groups described the prohibitive costs of transit, OPEH recommended that to use transit most successfully, there need to be places to sit and rest when walking, as well as more publicly available bathrooms and crosswalks for safety. This age-based comparison offers insight into ways to increase transportation equity and support PEH of all ages who similarly have unmet mobility needs.
ADVANCING HEALTHY AND SOCIAL LIVES BEYOND LATE-LIFE FUNCTIONAL LIMITATIONS: THE ROLE OF CONGREGATE SENIOR HOUSING
Authors: Ryu Byeongju , Kim BoRin , Park Sojung , Baek Jihye
Published: January 2025

Older adults with functional limitations often move into congregate senior housing (e.g., retirement communities and independent living) to maintain social and healthy lifestyles. Research showed mixed findings: some indicated improved social and physical activity from proximity to neighbors and organized activities in housing, while others highlighted negative outcomes such as disruption of existing social networks by relocation and social exclusion of frailer individuals within senior housing. Drawing on the National Health and Aging Trends Study Disability Conceptual Framework, this study examined the association between living in congregate senior housing and social/physical activity participation and whether perceived social cohesion moderates the association. We employed weighted logistic regression models to analyze NHATS Round 9 participants (n=2918) who reported at least one limitation with self-care (e.g., eating), mobility (e.g., getting around inside), or household activity (e.g., preparing meals), excluding those with dementia or in long-term care settings. Our findings indicated that residing in congregate senior housing was positively associated with participation in clubs/organized events [OR=1.43, p<.05], volunteering [OR=1.59, p<.05], and walking for exercise [OR=1.72, p<.01]. Housing types showed no differential influence on the residents’ activities, including visiting friends/family, attending religious services, and going out for enjoyment. We also found that senior housing residents were more likely to participate in organized events when they had stronger perceived social cohesion [OR=1.27, p<.05]. These findings suggest that congregate senior housing potentially enhances access to certain activities for those with functional limitations and that fostering perceived social cohesion is vital for organized activities in senior housing.