bluuebunny/crossref_metadata_2025 huggingface dataset:
LIFE-COURSE AND CONTEXTUAL FACTORS OF ADVANCE CARE PLANNING AMONG OLDER ADULTS WITH LIMITED INCOME
Authors: Kimpel Christine , Lauderdale Jana , Schlundt David , Dietrich Mary , Ratcliff Amy , Maxwell Cathy
Published: December 2023

Background

Cumulative disadvantage across the lifespan can lead to income, health, and advance care planning (ACP) disparities, resulting in increased caregiver decisional distress and reduced healthcare equity during times of cognitive incapacity. ACP is the process of patient and familial learning, communication, and documentation of life-sustaining care and quality of life preferences after personal reflection, but ACP rates remain lower among older adults with limited income. To better understand how life-course factors influence these low ACP rates, we aimed to explore participant perceptions of healthcare and ACP barriers and facilitators through different life stages.

Methods

We sampled older adults (aged 50+) with limited income from six community-based sites (N=20). Qualitative descriptive design was utilized to perform semi-structured, in-person interviews.

Results

Themes emerged from the inductive inclusion of in-vivo codes and the deductive application of the Cumulative Disadvantage Theory. Mean age: 64.8 years old (SD: 6.8); 11 participants identified as female (55.0%); 16 identified as Black/African American (80.0%). Four themes emerged: 1) structural, life-stage, 2) social stressors and resources, 3) individual stress responses and 4) ACP readiness. Participants’ perceptions denoted that proactive planning inequities among older adults with limited income result from the dynamic interplay of multi-dimensional stressors, protective factors, and personal stress responses. Implications: Identified themes serve as a conceptual basis for future intervention development that is responsive to traumatic life-course experiences and supportive of building ACP resilience (i.e., adapting to ACP stress and actively planning for times of cognitive incapacity), as well as policy and practice implications.
LONELINESS, ANXIETY AND DEPRESSION AMONG CAREGIVERS OF PERSONS WITH DEMENTIA: MEDIATING EFFECT OF SELF-EFFICACY
Authors: Thompson Alisha , Lemieux Catherine , Kim Youn Kyoung (Lily) , Ainsworth Laura , Bardales Rhonda , Trahan Julia , Wilks Scott
Published: December 2023

A geriatrics enhancement program in southern United States piloted an interdisciplinary telehealth program to improve the health of caregivers of persons with dementia (PWD). Literature indicates that social isolation, loneliness, anxiety, and depression are common among PWD caregivers. When caregivers struggle to manage their own health, they may lose confidence in their health care abilities, i.e., caregiver self-efficacy. Using loneliness as the primary factor, the current study tested the mediating effect of caregiver self-efficacy on distinct outcomes of anxiety and depression. In a hospital setting in southern United States, the team in medicine, nursing, and social work collected data from 95 PWD caregivers on measures of loneliness, anxiety, depression, and caregiver self-efficacy. SEM with bootstrapping tested the two hypothesized mediation models, controlling for age, gender, and relationship to care recipient. The typical respondent was a 62-year-old Caucasian female providing care to a parent. Mediation model 1 direct effects were significant for loneliness on self-efficacy (β=-.4.24, p<.01); for self-efficacy on depression (β=-.02, p<.05); and for loneliness on depression (β=.67, p<.001). Indirect mediation effect of loneliness on depression through self-efficacy was significant (β=.09, bootstrapping 95% CI[.01, 21]). Model 2 direct effects were significant for loneliness on self-efficacy (β=-.4.19, p<.01), and for self-efficacy on anxiety (β=-.02, p<.05); direct effect of loneliness on anxiety was not significant (β=.04, p=.706). Indirect mediation effect of loneliness on anxiety was significant (β=.09, bootstrapping 95% CI[.02, 23]). Results underscore the importance of emphasizing social engagement, and including self-efficacy as a mediating factor, when treating caregivers’ anxiety and depression.
LOVOT ROBOT AS COMPANIONS FOR OLDER ADULTS IN LONG-TERM CARE
Authors: Hung Lillian , Ito Hiro , Wong Joey
Published: December 2023

This exploratory, mixed-methods study explores how older adults living in Canadian Long-Term Care (LTC) homes experience and perceive LOVOT, an AI-driven social robot from Japan. It is an extended arm of a mixed-methods, three-country study conducted in Singapore, Hong Kong, and Canada. Our Canadian sample consists of 20 older adults and 40 interdisciplinary staff, and 10 leadership team members. The participants join four weekly sessions of interaction with LOVOT. In the quantitative portion of the study, questionnaires are administered before and after interaction with LOVOT to assess participants’ experiences of the LOVOT robot. The qualitative portion consists of individual conversational interviews with older adults and focus groups with the LTC staff and leadership. We use thematic analysis to guide our initial conceptual framework, and later use both Chi-square tests and content analysis for our quantitative and qualitative data. This study demonstrates (1) the experiences and perceptions of older adults and their family members regarding their interactions with the LOVOT robot, and (2) the LTC staff and leadership perceptions on having the LOVOT robot in LTC. The study offers insights into the potential role of social robots in LTC homes across eastern and western countries.
MALE AND FEMALE PERSPECTIVES: EXPLORING THE USE OF PASSIVE BRAIN HEALTH TECHNOLOGY TO MEASURE GLYMPHATIC FUNCTION
Authors: Carey Cyriah , Sappington Erica , Roberts Mitchell , Dagum Paul , Iliff Jeffrey , Levendovszky Swati Rane , Jaffee Michael , VandeWeerd Carla
Published: December 2023

Older adults’ (OA) research participation is essential to gain insights into the causes, progression, and potential treatments of Alzheimer’s Disease (AD). Brain health technology, such as the Glymphatic Function (GF) Monitor, has the potential to measure the progression of AD. The GF Monitor is a multimodal in-ear dynamic impedance spectroscopy and electroencephalogram (EEG) system worn during sleep and records physiological signals: photoplethysmogram (PPG), bioimpedance (BioZ), and acceleration. This study aims to understand OA perceptions and perceived benefits of passive brain health technology such as the GF Monitor. Six focus groups (3 female, 3 male) were conducted with OA (N=48) between June-August 2022 in The Villages, Florida. Domains assessed included concerns for developing AD, health technology perceptions, and preferences for data/outcomes visualization. Focus groups were transcribed verbatim, and content analysis identified salient themes. Across genders, motivation to participate in brain health technology research was influenced by concerns of family history of AD. Females expressed that using the GF monitor “is a small sacrifice to pay” for data-driven interventions and “preventative measures.” Males value “receiving easily digestible results” that allow them to monitor their cognitive health. Overall participants desire passive brain health monitoring to “stay active” and “remain independent” while aging in place. Passive technology has the potential to engage OA in research. Participants value prevention, maintaining independence, and receiving comprehensive results. The GF monitor has the potential to harness these wishes to monitor and receive translational brain health findings.
MAPPING SEDENTARY BEHAVIOUR USING WEARABLE DEVICES AND DIARIES IN OLDER ADULTS WITH FRAILTY: A FEASIBILITY STUDY
Authors: Rodrigues Isabel , Adachi Jonathan , Bray Steven , Fang Qiyin , Kobsar Dylan , Rabinovich Alexander , Zheng Rong , Papaioannou Alexandra
Published: December 2023

Older adults with frailty are sedentary. Prior interventions to reduce sedentary time in older adults have not been successful as there is little research about context (posture, location, purpose, social environment). There is limited evidence on feasible measures to assess context of sedentary behaviour in older adults. Our aim was to determine feasibility of measuring context of sedentary behaviour in older adults with frailty using objective and self-report measures. We defined “feasibility process” using recruitment (20 participants within two-months), retention (85%), and refusal (20%) rates and “feasibility resource” if the measures capture context and can be linked (e.g., sitting-kitchen-eating-alone), and are all participants willing to use the measures. Context was assessed using a wearable sensor for posture, indoor positioning system [IPS] for location, and electronic or hard-copy diary for purpose and social-context over three days in winter and spring. We approached 80 individuals, and 58 expressed interest; of the 58, 37 did not enroll due to lack of interest or medical mistrust (64% refusal). We recruited 21 older adults (72±7.3 years, 13 females, 13 frail) within two months and experienced two dropouts (90% retention). The measures captured one domain of context, but the hard copy was not completed with detail making it challenging to link with the other devices. Not all participants were willing to use the wearable devices or electronic diary; but we linked the measures of those who did. Future studies will need to determine the most feasible and valid method to assess the context of sedentary behaviour.
MCI AND CAREGIVING: DYADIC STRESS AND DEPRESSION CONTAGION EFFECTS
Authors: Giannotto Emily
Published: December 2023

Individuals diagnosed with Mild Cognitive Impairment (MCI) remain functionally independent and able to complete instrumental activities of daily living while simultaneously experiencing subjective and objective decline in one or more areas of cognition. Loved ones of individuals with MCI are also impacted and spouses often serve as formal or informal caregivers. Relationships impacted by cognitive impairment experience widespread impacts among cognitive, behavioral, and affective factors within and between individuals. The present study took a novel approach to understanding longitudinal daily parallel patterns of depressive affect, relationship mutuality, sleep, stress, and behavioral problems associated with cognitive impairment. 27 dyads comprised of one spouse with diagnosed Mild Cognitive Impairment (M= 74.6 years, SD= 8.26, 10 female), and the other as a cognitively healthy caregiving spouse (M= 71.4 years, SD= 8.35, 18 female) completed individual nightly reports for two consecutive weeks. Exploratory multilevel modeling revealed significant and complex interactions among spouses’ depressive affect, stress, relationship mutuality, and behavioral problems. Results indicate co-occurring daily effects for depressive affect and stress as contagion effects, with mutuality serving as an important moderator. The impact of mutuality was also significant over and above its role in the interactions. Mutuality seems to act as a buffer for negative affect and stress contagion from one partner to the other across days and from one day to the next. These findings highlight the importance of healthy daily relationship dynamics in mitigating stress and depressive affect contagion among older adults impacted by MCI.
MENTAL HEALTH AND CAREGIVING SELF-EFFICACY AS PREDICTORS OF PERCEIVED OVERALL HEALTH AMONG ADRD CARE PARTNERS
Authors: Wilks Scott , Ainsworth Laura , Lemieux Catherine , Kim Youn Kyoung (Lily) , Thompson Alisha , Bardales Rhonda , Trahan Julia
Published: December 2023

A geriatrics workforce enhancement program piloted interdisciplinary telehealth services to Alzheimer’s disease and related dementias (ADRD) care partners. The team in medicine, nursing, and social work noted that consistently mentioned mental health issues and social isolation. The purpose of this study was to evaluate the extent to which the care partner’s sense of caregiving self-efficacy, juxtaposed with the aforesaid mental health issues, predict the care partner’s sense of their overall health. In a hospital setting in southern United States, the team collected data from 95 ADRD care partners on demographic characteristics and on measures of loneliness, anxiety, depression, caregiving self-efficacy, and perceived overall health. Data were analyzed using OLS multiple regression. Sample characteristics served as covariates. Adjusted R-squared estimated the corrected goodness-of-fit. The sample’s average age was approximately 62 years. Most identified as female (74%) and Caucasian/white (66%); about one-third identified as African American/Black. The plurality reported as adult child of the care recipient (47%). An overwhelming majority (94%) scored as clinically anxious; 29% scored as clinically depressed; 33% reported loneliness; 12% reported low caregiving self-efficacy; and 20% reported poor overall health. Depression and loneliness negatively predicted caregivers’ overall health (B=-.17, p<.001; B=-.15, p<.05, respectively). Surprisingly, anxiety positively predicted caregivers’ overall health (B=.54, p<.001). Self-efficacy was not a significant predictor. Adjusted R-squared value was .63. Results underscore the importance of including mental health and social networks when evaluating and treating ADRD care partners’ overall health. Future studies should consider broader, diverse samples to determine the reliability of these findings.
MIGRATION, STRESS AND SUCCESSFUL AGING AMONG GRANDPARENTS: A MIXED METHODS STUDY
Authors: Hu Yue , Fung Helene
Published: December 2023

Objectives

the present work aims to explore the stress and coping related to successful aging among migrant and non-migrant grandparents.

Methods

both qualitative and quantitative methodologies were employed. Twenty-one grandparents (12 migrants, median age = 59 years old, 14 females) in mainland China were interviewed about the definition of successful aging, as well as stress and coping related to successful aging based on ecological systems theory. Another 303 grandparents (92 migrants, mean age 61.2 ± 4.8, 158 females) were recruited to complete some questionnaires about the intensity of grandparenting, proactive coping, successful aging, as well as some demographic information (e.g., migration, socioeconomic status).

Results

the interview data revealed that all grandparents valued harmonious family relationships most. Migrant grandparents uniquely faced stressors in different ecological systems, i.e., hardships in their close relationships, inadequate social welfare, and uncertainty in aging preparation. Regarding coping strategies, migrant grandparents uniquely employed avoidance coping strategies when facing intergenerational conflicts and preparing for their later life, as compared with non-migrant grandparents, in the process of perceiving successful aging. The quantitative study found that intensive grandparenting activated more proactive coping thus establishing a successful late life, which only existed among non-migrant grandparents.

Discussion

Migration has a detrimental effect on older adults’ successful aging via imposing extra pressure on grandparents’ life, and/or damaging their ability to proactively cope with potential challenges.
MIRROR-TCM TRIAL: THE INFLUENCE OF PATIENT-LEVEL FACTORS ON ACUTE CARE RESOURCE USE OF OLDER ADULTS
Authors: Osokpo Onome , Hirschman Karen , Ahrens Monica , Ji Wenyan , Hanlon Alexandra , Naylor Mary
Published: December 2023

Adverse Social Determinants of Health (SDoH) impact post-hospitalization outcomes (e.g., frequent acute care resource use: emergency department [ED] visits, rehospitalizations). The Transitional Care Model Intervention (TCM), an advanced practice registered nurse–led team-based care-management strategy, has demonstrated improved outcomes among older adults throughout transitions from hospital to home. Yet, little is known about the relationship between specific patient-level factors (i.e., demographic, clinical, SDoH) and acute care resource use (i.e., counts of rehospitalizations and ED visits) among hospitalized older adults with multiple chronic conditions who receive the TCM intervention. A total of 480 patients were randomized to receive the TCM in the MIRROR-TCM trial conducted from September 2020 to March 2023 at three diverse health systems in four states. Using multivariable generalized linear mixed effects regression with backward elimination, we examined the relationship between demographic (e.g., biological sex), clinical (e.g., counts of chronic conditions, etc.), SDoH characteristics (e.g., transportation, etc.), and acute care resource use during the intervention. Compared to those without housing concerns, older adults with housing concerns had 2.4 times higher rates of ED visits (p=0.049) and 2.2 times higher rates of rehospitalizations (p=0.005). Those who lacked transportation for medical appointments had 2.5 times higher ED visit rates (p=0.021) and 1.5 times higher rehospitalization rates (p=0.041). For each additional comorbidity, the rate of rehospitalization increased by a multiple of 1.08 (p=0.008). Understanding the adverse SDoH factors and increasing clinical complexity impacting resource use and tailoring evidence-based transitional care interventions to mitigate these factors to improve posthospitalization outcomes is critical.
MITIGATION OF MAJOR HIP INJURY FROM FALLS: EARLY RESEARCH RESULTS WITH SMART BELT STUDY
Authors: Tarbert Rebecca
Published: December 2023

Hip fractures sustained from falling are a devastating outcome for over 300,000 older adults every year in the US. The recovery from this major injury is extremally costly to the healthcare system and results in reduced mobility, increased dependency and up to 30% higher morbidity within 12 months of fracture. Avoidance of falls and injuries from falls is embedded into the standard of care for older adult providers though these standardized measures have not reduced the rate of death from falls as shown in recent studies. The study, Mitigation of Major Hip Injury due to fall in an At-Risk, Older Adult Population with a Wearable Smart Belt, seeks to compare the safety and efficacy of a wearable smartbelt to be worn around the waist of high risk older adults in order to mitigate major hip injuries related to falls through built-in sensors and the deployment of anatomically situated airbags around the hips during the hip impacting fall. The design of the study includes multiple older adult settings where subjects who are identified as being at high risk of fragility fracture and falls wear the study device for 6 months. Comparison of falls with major hip injury, emergency room visits and hospitalizations from falls and hip fractures from falls will be compared to a retrospective control group matched with the same inclusion/exclusion criteria. The poster will share the subject criteria and data gathered into November 2023. This study is listed on clinicaltrials.gov NCT#05245097
MODERATING EFFECT OF ANXIETY ON PROACTIVE CONTROL OF EMOTION ACROSS AGE
Authors: Chen Ziyuan , Martins-Klein Bruna , Varu Ava
Published: December 2023

Anxiety and aging predict difficulties engaging cognitive control and emotion regulation strategies like reappraisal. Dual mechanisms of control (DMC) theory suggests that cognitive control is engaged in anticipation of a task (proactive control) or in-the-moment (reactive control). Both aging and anxiety predict limited benefit from proactive control and greater reliance on reactive control during cognitive tasks. However, this remains unexamined in the emotion regulation context. In this eyetracking study, 41 younger (18-29) and 40 older adults (60-85) were cued to reappraise or view 80 negative images after a proactive (4s) or reactive delay (500 ms) prior to image onset, as regulatory arousal and effort were tracked by pupil responsivity. Multilevel models revealed that anxiety was associated with greater benefit of proactive over reactive control (reduced pupil response) for older adults during reappraisal and viewing (p < .001). For younger adults, anxiety was associated with reduced benefits of proactive compared to reactive reappraisal use. Image viewing in younger adults revealed an interaction, where low anxiety predicted greater benefit from reactive control, and moderate to highly anxiety predicted greater benefit from proactive control. Thus, while older age was associated with greater proactive benefits in both emotional reactivity and reappraisal, younger adults only showed proactive control benefits during image viewing when anxiety was elevated. Future work should explore the clinical benefit of proactive training in late-life anxiety, and how emotional reactivity and reappraisal outcomes differ with cognitive control temporal dynamics in individuals with diagnosed anxiety disorders across the lifespan.
MODULATION OF MITOCHONDRIAL THIOREDOXIN IN AGE-RELATE MUSCLE ATROPHY AND INJURY
Authors: Barkley Morgan
Published: December 2023

Maintenance of skeletal muscle is vital to health and wellbeing. Over the course of age there is a progressive decline in muscle mass and function. This decline results in frailty, reduced independence, reduced quality of life and elevated risk of mortality. Lean muscle mass contributes approximately 50% of body mass in a young adult while only 25% in an individual in their 80s. Critically, this decline in muscle mass is not continuous but composed of periods of stability punctuated by rapid declines. The chief driver of such events is loss due to injury related inactivity. Bed rest, is an essential part of recovering from injuries, however, long periods of inactivity can lead to skeletal muscle atrophy. A study of just 10 days bed rest in older adults produced a 6% decline in lower extremity lean muscle mass and a 15% decline in muscle function. Importantly much of the muscle mass lost even from short bed rest events are thought to never be recovered and to accelerate age related muscle declines. For this reason, development of interventions which reduce bed rest induced muscular atrophy would have considerable benefits in maintenance of independence for older adults. In my research project I am investigating a novel genetic target to ameliorate muscle atrophy as a consequence of immobility. We have found the protein TXNIP, a critical driver of apoptosis, to be induced under limb. Using TXNIP knockdown and TXNIP inhibitors I’m testing the hypothesis that prevention of TXNIP induction can reduce muscle atrophy.
MUTUAL INFORMATION OF NEUROIMAGES AND GENETIC VARIANTS TO STUDY THE DETERMINANTS OF BRAIN AGING
Authors: Kim Nicholas , Amgalan Anar , Imms Phoebe , Chowdhury Nahian , Chaudhari Nikhil , Irimia Andrei
Published: December 2023

Understanding the genetic determinants of brain aging is important because advanced biological age of the brain is a risk factor for Alzheimer’s disease (AD). Single-nucleotide polymorphisms (SNPs) are genetic variations with effects on brain aging; mapping their influence on brain structure can elucidate the genetic correlates of AD. We adopted an information theoretic approach to this by computing the mutual information (MI) between (A) 22 AD-risk SNPs and (B) the MRI intensities of the cortex in 6,000 UK Biobank participants (~50% females) aged 54 to 84 years. These cortex-wide calculations quantified how SNPs impact brain structure. As expected, the APOE-ε4 allele, the strongest genetic risk factor for AD, exhibited significantly (p < 0.025) higher MI with MRI intensity, when compared to the average MI expected for a null distribution model, in the medial parietal lobe, pars orbitalis, and left inferior occipital lobe, three brain structures responsible for memory recall, language processing, and visual perception. These findings reflect the memory loss, decreased speech, and reduced peripheral vision experienced by individuals with AD. The ABCA7 allele, a risk factor for late- onset AD, had significantly (p < 0.025) higher MI in the inferior temporal sulcus and angular gyrus. These structures are responsible for visual recognition and attention, two functions that are severely impaired by AD. Other findings reveal similar relationships between AD-risk SNPs and brain structure. Our findings illustrate how mapping the MI between MRI intensities and SNPs provides insight into genetic influences on brain structures linked to AD symptoms.
NAVIGATING THE CHALLENGES OF RETIREMENT TRANSITIONS FOR COUPLES IN ARAB SOCIETY
Authors: Nashef-Hamuda Reem
Published: December 2023

Retirement marks the beginning of the third age and is considered one of the most significant transitions in the later stages of life In the aging process, individuals and couples must adapt to many changes that affect their lifestyle and marital relationships. This study investigates post-retirement couples’ dynamics in Arab society, focusing on Relational Turbulence Theory (RTT) and its correlation with marital satisfaction and intimacy. Data from 106 retired couples (average male age = 70.3, female age = 65.1) reveal RTT’s relevance in explaining relationship uncertainty and interdependence during transitions. Using Confirmatory Factor Analysis, psychometric properties are validated, and gender equivalence is established. Actor-Partner Interdependence Modeling demonstrates that self-uncertainty, partner uncertainty, relationship uncertainty, interference, and facilitation significantly predict marital quality and intimacy. Partners’ impact is crucial. emphasizing how a partner’s experiences influence marital outcomes. These findings contribute to a deeper understanding of the complexities of post-retirement relationships in Arab society. The main theoretical contribution of the current study will be linking gerontology and couple dynamics in the context of the Arab society in Israel, which is an ethnic minority group and a traditional society in transition (modernization). the Practical implications of this study are helping professionals understand the factors that affect the quality of a couple’s relationship after retirement. This understanding will help professionals to provide adequate interventions for couples pre and postretirement, furthermore, the study’s findings will contribute to developing retirement planning interventions and culturally sensitive intervention programs for couples from the Arab society in Israel postretirement.
NEAR-INFRARED SPECTROSCOPY IN VIVO DISTINGUISHES AMYLOID DEPOSITION IN SUBJECTS WITH ALZHEIMER’S DISEASE
Authors: Schell Brent , Greco Frank
Published: December 2023

Cerebral amyloid angiopathy (CAA), a condition characterized by amyloid beta peptide deposition in cerebral vasculature, is commonly found in patients with Alzheimer’s disease (AD). Previous studies have shown that it is possible to distinguish subjects with Alzheimer’s disease from age-matched controls in vivo using near-infrared (NIR) spectroscopy. However, correlating neuropathological findings with the spectral features that best distinguish disease from control remains a challenge. Tissue optics predict that pathology in the leptomeningeal vasculature should be distinguishable from that of the adjacent brain parenchyma. In this study, NIR spectra were acquired in vivo from subjects with autopsy confirmed AD (n= 26). Postmortem specimens were histologically classified according to the degree of CAA (0 to 3+) noted in the leptomeningeal vasculature for each patient. A feature selection approach was used to discover spectral features that distinguished patients with high versus minimal degrees of CAA found at autopsy (scored as 3+ vs. 0, respectively). Two distinct spectral regions around 768nm and 891nm were identified as discriminants which could properly classify patients according to their CAA score, suggesting that these regions are correlated with amyloid beta peptide deposition. These results suggest that NIR spectroscopy can be used to detect and possibly inform the burden of amyloid deposition. More research is needed to establish if this technique can be used to monitor disease progression and response to therapeutic interventions, especially in light of emerging new immunotherapies.
NEED-BASED INTERVENTION DELIVERY FOR FAMILY CAREGIVERS OF OLDER ADULTS WITH DEMENTIA
Authors: Zauszniewski Jaclene , Burant Christopher , Jeanblanc Alexandra , Juratovac Evanne
Published: December 2023

The literature on family caregivers of persons with Alzheimer’s or other dementias abounds with studies of psychoeducational or cognitive-behavioral interventions to reduce stress and promote mental health. However, the determination of the caregiver’s need for specific interventions is rarely documented or based on clinical judgment. Researchers typically assume an intervention was needed when positive outcomes emerge. In a sample of 87 family caregivers of persons with dementia, our research examined baseline cut scores on validated measures of resourcefulness and dementia knowledge, which exemplify cognitive-behavioral and psychoeducational interventions, respectively, to determine whether the caregivers needed Dementia Education or Resourcefulness Training.© We found that 66% of the caregivers showed a high need for Dementia Education and 61% showed moderate to high need for Resourcefulness Training.© More specifically, subscales comprising the Dementia Knowledge Assessment Scale revealed the highest need for education concerning the cause or course of dementia (72%) communication and behaviors accompanying the illness (79%), and associated risk factors (80%). The need for knowledge on care and symptoms was lowest (28%). Resourcefulness Scale© scores indicated a higher need for social (help-seeking) skills training (82%) than personal (self-help) skills training (36%). Interestingly, we found that 55% of caregivers showed a moderate to high need for both interventions. The findings suggest further research to investigate the delivery of Dementia Education and Resourcefulness Training© interventions based on documented caregiver need and the additive and sequential effects on stress and mental health when both interventions are provided, particularly when a need for both interventions is established.
NEIGHBORHOOD DISADVANTAGE AND PHYSICAL FUNCTIONING: EXPLORING GENDER-SPECIFIC MECHANISMS
Authors: Cheung Pui Yin , Curtis David , Wen Ming
Published: December 2023

The relationship between poverty status and functional limitation among late middle age and older adults is well-established. However, the contextual effect of neighborhood disadvantage on physical functioning is less clear. First, the potential pathways linking the two are largely unexplored. Extant evidence shows that perceived neighborhood safety and order are significant predictors of physical functioning. Moreover, stress eating is a common coping strategy for stressful life events and contexts. These three explanations potentially mediate the relationship between poverty rate and physical functioning. Second, even though existing evidence finds stark gender difference in physical functioning, the explanations for the gender difference remains largely unknown. We propose that gender-specific mechanisms can explain the gender difference in physical functioning. The goal of the study was to test the gender-specific mechanism thesis based on a nationally representative sample of adults 55 to 93 years of age in the MIDUS 2 and 3 data (N = 2099). We employed Multilevel Generalized Structural Equation Modeling to test the gender-specific mediating roles of the three mediators. Results showed that county-level poverty rate is significantly associated with instrumental activities of daily living (IADL) among women and men. In contrast, perceived neighborhood safety and stress eating significantly mediate the relationship between poverty rate and physical functioning among women but not men. Furthermore, the indirect effect among women is significantly larger than among men. The important findings support gender-specific mechanisms linking neighborhood disadvantage and health and highlight the role of subjective neighborhood indicators among older women.
NEIGHBORHOOD ENVIRONMENT AND DEPRESSIVE SYMPTOMS OF OLDER ADULTS IN URBAN AND RURAL CHINA : A MODEL OF SOCIAL CAPITAL
Authors: Li Yuekang
Published: December 2023

Depression is a significant mental health issue among older adults worldwide. This study aimed to examine the mechanisms linking neighborhood environment to depressive symptoms among Chinese older adults and how other levels of social environment influence this relationship. Using data from the China Family Panel Studies, mediation and moderated mediation models were tested among 3,483 urban and 3,812 rural adults aged 60+ years. Results showed that community-level social capital (trust, reciprocity, belonging) partially mediated the association between built neighborhood environment and depressive symptoms in both urban and rural areas. The indirect pathway linking neighborhood environment to fewer depressive symptoms through community social capital was more evident when older adults reported less society social capital, suggesting a compensatory relationship between these two types of social capital. However, this relationship was significant only for urban older adults. The findings highlight the importance of distinguishing different levels of older adults’ social environment. Fostering community social capital through improving neighborhood walkability, safety, and amenities could benefit older adults’ mental health. Community development efforts may play a compensatory role for urban older adults lacking societal-level social resources.
NOVEL GENE VARIANTS ASSOCIATED WITH HBA1C CHANGES OVER TIME AMONG NONDIABETIC SUBJECTS IN THE LONG LIFE FAMILY STUDY
Authors: Wang Siyu , Thyagarajan Bharat , Lee Joseph , Zmuda Joseph , Christensen Kaare , Province Michael , An Ping
Published: December 2023

Longitudinal changes in HbA1c (ΔHbA1c) are associated with insulin resistance, aging, cognition, and mortality. To identify novel gene variants underlying ΔHbA1c, we conducted linkage-guided sequence analysis on 17p12 (LODs=3.59) in the Long Life Family Study, a study with familial clustering of exceptional longevity in the US and Denmark. Subjects with clinical diagnosis of diabetes or diabetes treatment and undiagnosed diabetes cases whose fasting glucose ≥ 126 mg/dl or HbA1c ≥ 6.5% were excluded. ΔHbA1c, collected from two exams 7 years apart, was derived using growth curve modeling, adjusting for age, sex, BMI, smoking, field centers and PCs, and was blom-transformed to approximate normality. We identified a significant variant under the linkage peak (ARHGAP44 rs56340929, p=1.77E-06, MAF=6%, accounting for linkage=26.5%). Taking advantage of our currently available RNAseq data, we found a significant association between quantification of ARHGAP44 RNA transcript and adjusted ΔHbA1c using 16 linkage enriched families (n=176, β = -0.24, SE=0.09, p=0.01). We also assessed currently available lipidomics data (188 metabolites, 13 compound classes) and found phosphatidylcholine (p=0.025) and lysophosphatidylcholine (p=0.02) were marginally associated with adjusted ΔHbA1c. ARHGAP44 is reportedly associated with glycemic traits and is mainly expressed in the brain. Further complete omics-data analyses in the LLFS and a replication study using the Framingham Offspring Study are underway.
OLDER ADULTS’ SAVORING ABILITY IS ASSOCIATED WITH LONGITUDINAL CHANGE IN WELL-BEING
Authors: Stephens Jacquelyn , Mertz Laurel , Smith Jennifer
Published: December 2023

Well-being in older adults is an important concern as the aging population grows, as is identifying modifiable factors that contribute to well-being over time. The ability to savor the moment (i.e., to notice and enhance one’s emotional response to positive events) has been shown to be associated with greater well-being, though few studies have examined these relationships longitudinally or in older adults. The current study examined whether savoring ability moderated the trajectory of older adults’ life satisfaction and depressive symptoms over time. A sample of 5777 older adults (Mage = 83.83, SD = 6.61; 66.6% female), recruited from Life Plan Communities, completed four consecutive annual surveys. Multilevel growth curve models revealed main effects of small but significant declines in well-being over time (life satisfaction: B = -.09, SE = .01, p < .001; depressive symptoms: B = .13, SE = .01, p < .001), after accounting for age, gender, education, life stress, and health. Interactions between time and savoring ability indicated that participants with greater savoring ability were better able to maintain their levels of well-being (i.e., smaller decline in life satisfaction [B = .05, SE = .01, p < .01] and smaller increase in depressive symptoms [B = -.10, SE = .01, p < .01]). In contrast, individuals lower in savoring ability experienced less favorable well-being trajectories. Savoring is a malleable emotion regulation ability that is associated with attenuated declines in well-being over time. Implications for savoring interventions in older adults will be discussed.
ON THE FRONTLINES: TRAINING A DEMENTIA CAREGIVING WORKFORCE IN CALIFORNIA
Authors: Pond Brittney , Eldridge Corinne , Neri Mel , Beld Matthew , Ross Leslie , Martinez Suzanna , Hollister Brooke , Yeh Jarmin
Published: December 2023

Direct care workers who provide in-home care – such as caregivers hired by consumers of California’s Medicaid-funded In-Home Supportive Services (IHSS) program – are well positioned to observe changes in their consumer’s cognition, health, or behaviors. This proximity to consumers better allows for reporting to healthcare partners, which may reduce risk of emergency department visits, hospitalizations, and other adverse outcomes that are disproportionately high among people living with Alzheimer’s disease and related dementias (ADRD). Despite their vital role in supporting people living with ADRD, IHSS caregivers receive minimal formal training for their unique position. To address this training gap, the IHSS+ ADRD Training Project is a five-year effort funded by the California Department of Public Health to train 720 IHSS caregivers in Alameda and Los Angeles counties, with classes in English, Spanish, Cantonese, and Mandarin. To date, 582 IHSS caregivers have been trained. Using a pre-posttest design, our preliminary findings indicate statistically significant increases in dementia knowledge and self-efficacy that could bolster caregiver’s skills. These results also reveal that IHSS caregivers value training opportunities to better support their consumers. Correlations between caregiver training outcomes and healthcare utilization patterns of their consumers were further examined by evaluating administrative data before and after the training. The results need to be further understood in the context of COVID-19 and the ADRD illness trajectory. Implications include expanding long-term funding for multi-week training programs, which aligns with the California Master Plan for Aging’s goal to support and create one million high-quality caregiving jobs by 2030.
ORPHANED ELEPHANTS EXHIBIT HIGHER THYROID HORMONE CONCENTRATIONS COMPARED TO CONTROLS
Authors: Chusyd Daniella , Brown Janine , Paris Steve , Dickinson Stephanie , Steiniche Tessa , Austad Steven , Allison David , Wasserman Michael
Published: December 2023

Wild elephant populations provide a natural experiment to study biological effects of early adverse events, such as being orphaned due to poaching. We compared fecal glucocorticoid metabolite (fGCM) and thyroid hormone (T3) concentrations, and body condition between rescued orphaned elephants and similarly age-matched, control wild elephants. In 2021, single fecal samples were collected during the early (n=20 orphans; n=58 controls) and late (n=20 orphans; n=22 controls) dry seasons. Age was known (+/- 3 months) for orphans and estimated by dung diameter (+/- 1 year) for controls. Sex was assigned based on morphology and unknown for some controls. Body condition scores (BCS: 1 to 9) were assigned at time of sample collection. Linear Mixed Models accounting for repeated measures were performed adjusted for age and season. There was no difference in fGCM between orphans (mean 101.48, SD 59.62ng/g) and controls (mean 93.86, SD 49.97ng/g) (p=0.213). Orphans (mean 271.75, SD 123.16ng/g) had higher T3 concentrations compared to controls (mean 98.65, SD 71.89ng/g) (p< 0.001). There was no difference in BCS between groups (p=0.629). In orphans, fGCM was associated with age (beta=-0.499, p=0.011). In controls, T3 was correlated with fGCM (beta=0.287, p=0.011) and season was associated with fGCM (p=0.008) and BCS (p=0.044). Either because of living under human care or because of alterations in T3 secretion, seasonal factors do not seem to impact orphans’ health status to the same extent as in control elephants. The support of an adopted herd may attenuate the physiological stress associated with experiencing trauma in our study population.
PATIENT PORTAL USE IN FAMILY CAREGIVERS OF PATIENTS WITH DEMENTIA OR CANCER: THE NATIONAL STUDY OF CAREGIVING
Authors: Bratches Reed , Wall Jaclyn , Puga Frank , Pilonieta Giovanna , Bakitas Marie , Geldmacher David , Odom J Nicholas
Published: December 2023

Family caregivers are often inexperienced and require information from clinic visits to effectively provide care for patients. The patient portal is a common way for health systems to engage family caregivers, especially those of patients with dementia or cancer. The objective of our study was to analyze a large, nationally representative sample of family caregivers from the National Study of Caregiving (NSOC) to determine factors associated with patient portal use among family caregivers of persons with dementia and of persons with cancer. We conducted a secondary data analysis using data from the 2020 NSOC, a large nationally-representative survey of family caregivers. Weighted regression analysis was used to examine associations between family caregiver use of the patient portal and demographic variables including age, race/ethnicity, gender, employment status, caregiver health, education, and religiosity. A total of 462 participants (4,589,844 weighted) were analyzed. In the fully adjusted regression model for caregivers of persons living with dementia, Hispanic ethnicity was associated with a higher odds of patient portal use (OR: 2.81; 95%CI 1.05, 7.57; p=0.04) and having less than a college degree was associated with a lower odds of patient portal use (OR 0.36; 95%CI 0.18, 0.71; p=< 0.001). In the fully adjusted regression model for caregivers of persons living with cancer, no variables were associated with patient portal use. As the patient portal is a common method of connecting caregivers with information from clinic visits, future research should focus on understanding how the portal is used by the groups we have identified, and why.
PEOPLE NEED PEOPLE: A MIXED METHODS STUDY OF COMPANION CAREGIVERS
Authors: McNamara Kelsey , Lang Samantha , Meadows Jill , Hackel Emily , Rudy Ellen
Published: December 2023

Researchers have found positive aspects of caregiving (PAC) for both formal and informal caregivers, including social connection and sense of purpose. However, few have explored the experience of a novel source of helping individuals age in place: companion caregivers (CC), that is someone who is paid for providing companionship and assistance with everyday tasks that are non-medical. We conducted a descriptive mixed methods study to understand the experience of being a CC. Sixteen CCs who completed 10+ caregiving visits participated in semi-structured interviews and related questionnaires in 2023. Quantitative and qualitative data on CC’s perceptions of the impact of caregiving on their own whole health domains (physical, mental, social, purpose) were analyzed. In addition we examined CC’s perceptions of care recipients’ (CR) unmet social needs, risks in the home, and barriers to CRs achieving improved health domains. Among the cohort, the average age was 53, 63% White, and 31% lived alone. Majority of CCs indicated that they always feel a sense of belonging when with their CRs (n=15) and felt better about themselves after interacting with CRs (n=16). Common PAC across whole health domains emerged, including increased physical activity, improved social connection, and helping others improve CCs’ lives. Common barriers to CRs’ improving their whole health included: decreased social connection, physical limitations, and transportation insecurity. These insights highlight potential benefits for those who might engage in companion caregiving arrangements. More research is needed as new models of caregiving are necessary to meet the demands of our aging population.
PERSON-FIRST LANGUAGE FOR OLDER ADULTS INCARCERATED IN PRISON: A RAPID EVIDENCE ASSESSMENT
Authors: Merss Kristin , Block Laura , Kwas Stephen
Published: December 2023

Language can influence a person’s sense of self, relationship with healthcare providers, healthcare utilization, or their own symptoms and behaviors. The person-first language movement began decades ago and has been widely adopted by multiple fields including nursing, medicine, gerontology, and social and health sciences more broadly. For research involving older adults, non-stigmatizing language has become the standard for researchers. Incarceration is widely considered a dehumanizing experience, with recent calls for attention to the language used by researchers when describing their incarcerated participants. Researchers are also identifying that individuals with multiple stigmatizing identities (e.g., incarcerated and disabled, older adult) warrant specific consideration. This study presents a secondary review of terminology from a Rapid Evidence Assessment (REA) investigating what is known about transitions of older adults in the incarceration system. The REA included PubMED, PscyhMED, and CINHAL. Nineteen articles met inclusion criteria (11 qualitative, 11 quantitative, 3 mixed methods). As a sub-analysis, articles were analyzed to consider the language that was used to describe the currently or formerly incarcerated older adults who were the subject of the studies. The majority of articles considered older adults who were no longer incarcerated. While person-first language (i.e., “formerly incarcerated person”, “reintegrating women”, “older adult on parole”) was common, stigmatizing language such as “prisoner”, “offender”, “homicide offender”, and “ex-convict” were used in the majority of the studies included in the review. Appreciation and adoption of person-first, non-stigmatizing language should transcend not only research literature surrounding older adults in the community, but also incarcerated older adults.