bluuebunny/crossref_metadata_2025 huggingface dataset:
WILLINGNESS TO LIVE UNDER IMPAIRMENT: FACTORS ASSOCIATED WITH DESIRED LONGEVITY
Authors: de Couto Clara Paula , Rupprecht Fiona , Nikitin Jana , Rothermund Klaus
Published: January 2025

This study delves into the complexities of individuals’ desires for longevity and their willingness to live with impairment. When deciding about their longevity desires, some individuals may focus on present-oriented, concrete aspects of their lives, like their current state of health, whereas others may weigh up more future-oriented, abstract aspects, such as how important it is to be healthy. We investigated what factors are associated with individuals’ willingness to live with impairment. Factors associated with willingness to live with impairment were examined in a sample of N = 790 German participants aged 39–90 years (Mage = 63.38, SD = 14.30, 51% female). To examine age-specific factors related to desired longevity under impairment conditions, chronological age was added as a moderator in the analyses. Findings indicated that for middle-aged adults, fear of becoming a burden and higher importance of health were associated with lower willingness to live with impairment. For older adults, lower willingness to live with impairment was associated with higher levels of instrumental preparation for the end of life. The obtained age differences can be understood as reflecting a shift in time perspective and personal experiences. Among middle-aged adults, willingness to live with impairment is more strongly influenced by distant events that pertain to the future (e.g., fear of becoming a burden). Older adults, however, place more importance on their current life situation (e.g., instrumental preparation), and their willingness to live with impairment seems to be more conditional on practical aspects in the present.
PREMATURE DEATH ATTRIBUTABLE TO SOCIAL DETERMINANTS OF HEALTH AMONG ASIAN AMERICANS: A POPULATION-BASED COHORT
Authors: Qi Xiang , Wang Katherine , Wu Bei
Published: January 2025

Asian adults are one of the fastest growing ethnic minority groups in the US and have higher levels of unfavorable social determinants of health (SDoH), including limited English fluency, unemployment, and reduced healthcare access, yet the impact of these SDoH on mortality remains understudied in this population. This study aims to examine the prospective associations of multiple SDoH with premature all-cause mortality, and to investigate their respective contribution among a nationally-representative cohort of Asian Americans, using data from 3,888 Asian adults aged 20-74 who participated in the National Health and Nutrition Examination Survey 2011-2018. Cox proportional hazards regression models were employed to examine the relationships of SDoH factors with mortality; and population attributable fractions (PAFs) were calculated to assess the contributions of each individual SDoH on premature death. We found that unemployment, limited English proficiency, social isolation, no health insurance, in poverty, housing instability, less education, and food insecurity were significantly associated with mortality (HRs range from 1.20 to 2.35). SDoH explain up to 38.6% of mortality in the Asian Americans, among them, unemployment (18.5%), limited English fluency (9.0%), and social isolation (8.3%) showed the highest relative contributions to mortality. These results challenge the “Model Minority” stereotype, often perpetuated by English-only national survey data, and highlight the unique SDoH challenges faced by Asian Americans. Future research disentangling SDOHs on health outcomes by Asian subgroup is necessary to dispel the “model minority” stereotype that remains prevalent and provide better informed preventive practices and interventions for this population.
LONGEVITY IN THE PACIFIC: FINDINGS FROM THE KUAKINI HAWAII CENTENARIAN STUDY
Authors: Willcox Bradley , Masaki Kamal , Martin Peter , Lee Gina , Obhi Hardeep , Poon Leonard
Published: January 2025

The immigration of Japanese citizens to Hawaii more than one hundred years ago profoundly changed the culture of these islands. Their diet, exercise, and spirituality may have influenced the longevity of Hawaii residents. This presentation highlights longevity predictors among Hawaiian men of Japanese descent. A sample of 3,734 participants (Mage = 77.82 years at baseline) from the Kuakini Hawaii Centenarian Study was included in this research. With follow-up longitudinal data, we compared participants who survived into their 70s, their 80s, their 90s, or to 100 years of age. Results indicated that cognitive function, F(3,3,733) = 52.59, p <.001, and self-reported health, F(3,3,733) = 18.72, p <.001, at baseline distinguished those who survived to centenarian status compared to those who died in their 70s, 80s, or 90s. Centenarians were more likely to carry the protective FOXO3 allele, χ2 (N=3,352) = 8.94, p <.05, and less likely to be diagnosed with diabetes, χ2 (N=3,560) = 12.43, p <.01. Regression analyses suggested that father’s age death (β =.04, p <.05), fluid intelligence (β =.12, p <.001), ADL impairment (β = -.23 p <.001), health behaviors, (i.e., BMI, smoking and drinking, β =.55, p <.01, β = -.10, p <.001, and β = -.08, p <.01, respectively), and diabetes (β = -.06, p <.01), were significantly associated with age at death. The results support policymakers and practitioners in promoting healthy longevity among a culturally distinct group.
WHY CULTURAL CONTEXT IS VITAL TO STUDY LONGEVITY IN JAPAN
Authors: Gondo Yasuyuki
Published: January 2025

Due to the worldwide expansion of the aging population, the number of centenarians has been increasing over the last decade. However, the centenarian population ratio is highly diverse among countries. The cause of diversity tends to be attributed to differences in the country’s economic situation. However, cultural differences in attitudes toward aging and deference to older people are potentially influential factors. In the case of Japan, regardless of its higher centenarian ratio in the world, there is a larger bed-bound population of centenarians. This unique situation is caused by combining a universal insurance system supported by a strong economy, a traditional healthy diet, and motivation to maintain good health. However, rather than those, a conventional attitude of deference to older people would be an essential cause of longevity in Japan. In Japan, Respect for the Aged Day is a national holiday. It was enacted in 1963 based on the Act on Social Welfare for the Elderly. With this timing, many local governments start presenting cash to older people. Currently, these cultural-based policies seem to have reached a turning point. A multi-country survey reported that only 25% of Japanese people wish to live to 100, the lowest among countries. At the same time, the main reason not to wish for a long life was “dislike to be a burden to people around” by observing a more significant number of bed-bound older people daily. This negative motivation might accelerate healthy behavior and cause further longer life, ironically.
THE IMPACT OF AN INTENSIVE LIFESTYLE INTERVENTION IN TYPE 2 DIABETES ON LONG-TERM MULTIMORBIDITY
Authors: Davis Ian , Huckfeldt Peter , Woodhouse Mark , Espeland Mark , Wagenknecht Lynne , Goldman Dana , Salive Marcel , Harada Ann
Published: January 2025

Multimorbidity, or the accumulation of multiple chronic diseases, is an important clinical issue in aging and is associated with geriatric syndromes, physical and cognitive function declines, increased health care costs, and poorer health-related quality of life. This study aims to better understand multimorbidity occurrence and accumulation over the postintervention period (2013-2019) of Look AHEAD, which randomized 5145 individuals aged 45-76 in 2001-2004 with type 2 diabetes and overweight/obesity to an intensive lifestyle intervention (ILI) or a control arm receiving diabetes support and education (DSE). The ILI was previously found to reduce weight, improve diabetes control, and reduce diabetes complications. The ILI was also associated with relative improvements in self-reported multimorbidity during the intervention period. We included 2940 participants consenting to linkage of their trial data with Medicare data, focusing on participant years with Medicare fee-for-service coverage during the postintervention period. We identified conditions from the list developed by the “Department of Health and Human Services Initiative on 21 Multiple Chronic Conditions (MCC)”. We estimated ILI versus control differences in numbers of conditions using linear models that control for baseline demographic and clinical characteristics and study site. We found similar levels of multimorbidity for the ILI and DSE groups (4.21 versus 4.31, p=0.41). This result suggests that the positive impacts of the ILI on diabetes control did not translate to long-term reductions in multimorbidity.
DIRECT CARE WORKER RETENTION DURING THE COVID-19 PANDEMIC AND THE IMPACT OF STATE POLICIES
Authors: Miller Katherine , Yang Yang , Shen Karen
Published: January 2025

Due to persistently low wages and poor working conditions, direct care worker shortages and high turnover existed in long-term care (LTC) industries prior to COVID-19, but became more visible during the pandemic. Some states responded to the threat of a large exodus of workers through wage-support policies (e.g., hazard pay). However, little research has examined whether these state policies were effective in mitigating the effects of the pandemic on direct care worker exits. We use the Annual Social and Economic Supplement of the Current Population Survey 2016-2022 to decompose direct care worker exits based on where they exited to: (1) unemployment or exiting the labor force, (2) a different healthcare job or industry, and (3) non-healthcare job (e.g., retail). We compare the rates of these components for direct care workers pre-pandemic (2016-2019) and during the pandemic (examining 2020 and 2021-2022 separately), and the association of these rates with state wage-support policies. Direct care worker exits were highest in 2020, with workers primarily becoming unemployed or leaving the labor force. Yet, in 2021-2022, exits decreased relative to pre-pandemic periods, primarily because fewer people switched jobs. Among those who did switch jobs, we find that workers are more likely to stay in a healthcare industry in 2021 relative to 2016-2019. We find no evidence wage support policies were associated with direct care worker retention/exits during or post-pandemic. Together, our findings suggest that broader economic trends of a shrinking workforce may be the primary driver of direct care worker exits during the pandemic.
NAVIGATING PAID CAREGIVING IN HOSPICE DURING COVID-19: AN INTEGRATED MULTIPLE METHODS ANALYSIS
Authors: Kim Patricia , Franzosa Emily , Boafo Jonelle , McDonald Margaret , Moreines Laura , David Daniel , Aldridge Melissa
Published: January 2025

Paid caregivers are integral members of the end-of-life care team, but navigating paid care services is complex. Families must often work across multiple providers including hospice, home health, private pay, and government to coordinate the care they need to help patients die at home. We examined experiences with end-of-life paid caregiving among 61 patients in a large, New York City health system during the first year of the COVID-19 pandemic. We analyzed care trajectories of patients who enrolled in hospice and died between March 1, 2020-March 31, 2021, integrating data from real-time linked medical and hospice electronic health records with reflective interviews with 30 interdisciplinary team members at 3 organizations providing end-of-life care during the pandemic. We found: 1) Paid caregivers were the “eyes and ears” of the hospice team and paid caregivers’ work helped families keep patients at home; 2) Patients’ increasing end-of-life needs required additional paid caregivers, heightening patients’ infection risk; 3) Conflicting organizational policies across providers and payers, such as screening, vaccination, and visitation restrictions, disrupted aide care; and 4) Scope of practice restrictions for some types of paid caregivers reduced their ability to help. Our findings highlight both the essential support role of paid caregiving in end-of-life care, and regulatory/policy burdens that may reduce the benefit of paid caregiving at this critical juncture. Supporting stability and continuity in caregiving teams and building more flexibility into paid caregivers’ scope of practice and patients’ care plans may assist aides and families in managing end-of-life care.
A LATENT CLASS APPROACH TO UNDERSTANDING HOMELESSNESS AMONG OLDER ADULTS
Authors: Souza Anita , Tsai Jenny , Pike Kenneth
Published: January 2025

The complex characteristics that differentiate adults over 50 experiencing homelessness are understudied. Latent class analysis (LCA) is a novel approach to identifying unobservable subgroups within populations. Housing providers have little information to adopt tailored service approaches. Capitalizing on the strength of LCA, this paper identifies the heterogeneity within older adults utilizing housing. Using a retrospective cohort study design, we extracted data from the Homeless Management Information System to describe the health conditions of adults utilizing services of a leading housing provider in Washington. These data captured developmental disability, physical health, disabling conditions, chronic conditions, mental health problems, and substance use. Among 1,971 homeless individuals, 76% were male, 49% white, and 70% homeless 6 months or more. Forty percent were 50 years or older; 17% were veterans. Probability calculated by LCA found that a 4-class solution best represented the data (fit indices: AIC=11,688, BIC=11839, entropy=0.85). Class 1 (n=519) reported higher than average proportions of mental health problems and substance abuse along with average proportions of members with a chronic health condition and slightly higher than average proportion of members with a disabling condition. Class 2 (n=254) was dominated by individuals with a disabling condition and physical disability. Class 3 (n=827) reported the lowest proportion of members with all conditions. Class 4 (n=371) was higher than average on all conditions. This knowledge builds a foundation for further research and policy endeavors to support older adults experiencing homelessness.
EXAMINING AND ADDRESSING BARRIERS TO MENTAL HEALTH CARE FOR OLDER ADULTS IN PERMANENT SUPPORTIVE HOUSING
Authors: Robinson Randee
Published: January 2025

Permanent supportive housing is an evidence-based intervention to support individuals exiting from chronic homelessness. Increasingly, the demographic of adults prioritized for PSH are over the age of 50. Despite the higher prevalence of mental health concerns amongst older PSH residents their engagement with mental health services remains limited. The purpose of this investigation was to examine barriers to mental health care for older adults living in PSH and provide suggestions to address the identified barriers. A one-hour semi-structured focus group protocol was developed. Question sets focused on individual and system level barriers to mental health services. The focus group was digitally recorded, and responses were transcribed. Eight PSH residents from one housing provider participated in the focus group session. Thematic analysis utilizing inductive and deductive approaches was completed by two individuals. Themes of case manager role and limitations, stigma, service navigation, and trustworthiness emerged from the data. The mean age of participants was 63.8 years (SD 9.78). The mean length of tenancy was 6.6 years (SD 3.29). Addressing mental health access is critically important for older adults in PSH. Interventions to improve mental health care access at both the individual and systems level should target building trust, reinforcing available services, clarifying the care manager’s role, and supporting staff consistency. Future research should target effective interventions to address these barriers.
HEALTH CARE UTILIZATION OF AGING INDIVIDUALS EXPERIENCING CHRONIC HOMELESSNESS: A CASE STUDY APPROACH
Authors: Berg Russell
Published: January 2025

The population of individuals experiencing homelessness in the United States is both growing and aging. Late baby boomers are overrepresented amongst those experiencing chronic homelessness and this cohort is now of geriatric age. Many challenges interfere with providing medical care to this group including mental health, substance use disorders, carceral history, lack of surrogate decision makers and dementia. In some cities, the COVID 19 pandemic led to transition of congregate emergency homeless shelters to hotels, providing an opportunity to co-localize enhanced services such as embedded medical services. This session will present three medical cases from a low barrier, harm reduction focused hotel shelter for chronically homeless individuals. The cases focus on selected individuals with high hospital utilization and demonstrate how the hotel shelter model with embedded medical clinic can function as a “medical home” reducing unnecessary service utilization while pursuing placement for those requiring a higher level of care. While residing at the shelter, important medical conditions such as dementia and Parkinson’s disease can be diagnosed that qualify residents for additional benefits. For some patients with severely limited life expectancy, the hotel shelter space can provide a setting for patient centered palliative care and even home hospice services. The challenges to providing care for an aging population experiencing homelessness require novel models for the provision of health care and hotel shelters with embedded medical care can fill the role of “medical home”.
THE STUDY OF MUSCLE, MOBILITY AND AGING (SOMMA): LESSONS LEARNED RECRUITING OLDER ADULTS
Authors: Kennedy Kimberly , Kritchevsky Stephen , Nicklas Barbara , Newman Anne , Glynn Nancy , Strotmeyer Elsa , Danielson Michelle
Published: January 2025

SOMMA is a two-site (Wake Forest University School of Medicine [Wake] and University of Pittsburgh [Pitt]) ongoing observational study of 879 participants ≥70 years investigating the role of muscle biology in age-related mobility decline. Those eligible were free from any life-threatening disease, able to walk ≥0.6 m/s (4m) and complete a 400m walk, and safely undergo muscle tissue biopsies and magnetic resonance imaging. Recruitment was from April 2018 to December 2021 and, despite partially spanning the COVID-19 pandemic, exceeded its goal of 875 (Total enrollment: Wake=440; Pitt=439). SOMMA phone screened 4225 persons (Wake=1887; Pitt=2338) with 33.1% (n=1398) eligible for further screening. Advertisement strategies for SOMMA were evaluated and direct mail postcards were most successful and cost-effective; 75% of those phone screened were from direct mailings. At Wake, advertising costs totaled $52k or ~$28/phone screen and $118/enrolled participant. At Pitt, advertising costs totaled $41k or ~$17/phone screen and $93/enrolled participant. Participants eligible after phone screening were invited to attend an in-person information session in which the comprehensive multi-day exam and detailed consent form were reviewed and 4m gait speed was assessed. Sessions were held virtually during pandemic, at which point the gait speed screening was discontinued. A total of 210 information sessions took place (Wake=90; Pitt=120), with an average attendance of ~15 individuals/session and ~80% of those who attended the session were eligible and 63% were ultimately enrolled. SOMMA demonstrated the successful recruitment of a large older adult cohort study for an exam-intensive protocol which included tissue sampling and MR measures.
SUCCESSFUL APPROACHES TO ENHANCING OLDER ADULT REPRESENTATION IN MOTRPAC TRIAL
Authors: Espinoza Sara , Coen Paul , Talton Jennifer , Houmard Joseph , Moreau Kerrie , Nicklas Barbara
Published: January 2025

NIH mandates that clinical research include participants of all ages (or specify a reason for excluding based on age); yet, older adults (OAs) are often underrepresented even in studies without an age exclusion. Barriers to their inclusion are multi-factorial and include lack of recruitment strategies targeted to this demographic and eligibility criteria associated with age that reduce representation. Supported by multiple NIH Institutes, including NIA, the purpose of MoTrPAC is to characterize the molecular changes that underlie the benefits of exercise in humans. The goal is to randomize approximately 1980 sedentary, healthy participants (across 10 sites) to a 12-week control group or a supervised, moderate-intensity resistance or aerobic exercise intervention. The target is to balance enrollment across three groups (18-39, 40-59, and 60+ years). Recruitment is ongoing; as of 3/1/24, the number randomized is n=1043 with 20.6% OAs, compared to 40.5% younger and 38.9% middle-aged. Recruitment is monitored regularly, and early in recruitment a large age differential in eligibility yields was discovered, with only 4.5% of screened OAs being randomized, compared to 13.8% of middle-aged and 18.3% of younger individuals. Since the use of lipid-lowering medication was the single largest reason OAs did not qualify (36% of exclusions involved statin use in those >60 yrs), the protocol was altered to drop this exclusion to enhance OA representation. Also, successful recruitment marketing approaches are tracked closely and vary across age groups. This presentation will discuss the strategies which provide the most success for attracting OAs to inquire about the study.
REIMAGINING WORK: TAPPING INTO THE STRENGTHS OF OLDER ADULTS
Authors: Nearing Kathryn , Terveer Katy , Rooks Ronica
Published: January 2025

This session will focus on inspiring and informing the audience about how we can reimagine the way we work in order to benefit from the experience, skills, and wisdom of older workers. We will explore the modern trends that are enabling us to work longer and the history of ageism in the workplace. We will help aging advocates to understand and promote the benefits of working longer from an individual, employer, and societal level. Finally, we will look at some of the strategies that organizations can leverage in order to recruit and retain older workers as well as leverage the full potential of an age-diverse workforce.
OLDER ADULTS PURSUE ENCORE CAREERS IN RESEARCH TO PROMOTE INCLUSION OF OLDER ADULT PEERS IN CLINICAL TRIALS
Authors: Nearing Kathryn , Wright Leslie , Williamson Christin , Sedey-Seitz Cory
Published: January 2025

We created an innovative pathway to encore careers in research for older adults at the University of Colorado Anschutz Medical Campus. Our program trains older adults from the community (average age 68; range: 56-82) for specialized community-facing and participant-centered roles on clinical trial teams to increase the recruitment and retention of older adult peers, as well as other underrepresented populations, in clinical trials. Older Adult Research Specialists’ roles include: 1) developing effective communication and outreach strategies to engage older adults from diverse backgrounds in research; 2) recruiting and consenting participants for trials; 3) supporting retention by identifying barriers to study participation and connecting study participants with needed resources to address social needs; 4) educating research teams regarding key considerations for including older adults in research, anchored by the Geriatric 5Ms, to inform trial design and implementation; and, 5) catalyzing research innovations to increase representation in, and the relevance and translational potential of, research. OARS prepare for their essential roles on clinical trial teams by completing a 14-week, 140-hour, virtual, competency-based training program. Health Navigation training is the foundation. To date, we have trained four cohorts (43 graduates). OARS are making the research workforce and associated teams more age-inclusive in the Division of Geriatric Medicine, Department of Neurology, Department of Physical Medicine and Rehabilitation Sciences, Center for Inclusive Design and Engineering, and at our healthcare affiliate, the Rocky Mountain Regional VA Medical Center. By promoting intergenerational learning, encore careers and research innovation, OARS are advancing our priorities as an Age-Friendly University.
SHAPING, AND BEING SHAPED BY, POLICIES AND PROGRAMS THAT PROMOTE AN AGE-INCLUSIVE WORKFORCE: A PERSONAL JOURNEY
Authors: Westcott James
Published: January 2025

In this session, I will share my personal journey as someone who has both shaped and been shaped by the innovative age-inclusive workforce policies and programming in Colorado. I will describe my state-wide leadership role as part of the Colorado Older Worker Policy Collaborative successfully advocating for the elimination of graduation dates and other age-identifying sections of job applications, which disadvantaged older adults in the job application process. I will also share my experience as an Older Adult Research Specialist who completed a novel pathway to encore careers in research program at the University of Colorado Anschutz Medical Campus. I will share how I apply my dual training as a health navigator and research navigator to recruit and retain older Veterans in clinical trials for the VA Eastern Colorado Geriatric Research Education and Clinical Center – one of 20 centers of excellence focused on aging in the Department of Veterans Affairs. I will describe the meaning of this work to me personally and professionally, as a culmination of many work and life experiences. I will also share the difference I make as an older adult peer for the Veterans with whom I engage in research and on a multi-disciplinary and intergenerational team comprised of an early career investigator and research assistant. My personal and professional journey highlights the importance of a multi-pronged approach, encompassing research, policy and action/application (e.g., education/training and hiring) to promoting the longevity dividend through meaningful work and gainful employment.
BRAIN GLUTATHIONE, MITOCHONDRIA, GLUCOSE METABOLISM, AND COGNITION IN AGED MICE: IMPACT OF GLYNAC SUPPLEMENTATION
Authors: Kumar Premranjan , Sekhar Rajagopal
Published: January 2025

Alzheimer’s disease (AD) remains unsolved, and is associated with brain defects including impaired glucose uptake, mitochondrial dysfunction, inflammation and glutathione deficiency. These defects also occur in age-related cognitive decline (ACD). Because mice do not naturally develop AD, mouse models of AD have been developed and studied. However, such mouse models are highly artificial because defects do not occur naturally and are artificially induced in mice. To understand the mechanistic basis of cognitive decline in aging, it is important to investigate these defects directly in the brain, which is only possible in animal models as performing brain biopsies in humans is not practical. To overcome these challenges, we studied glutathione deficiency, oxidative stress, glucose uptake, mitochondrial function, inflammation, genomic damage and neurotropic factors directly in the brains of old-mice (OM, 90-weeks)) and young-mice (YM, 20-weeks), and also measured cognition (maze-running). Compared to YM, OM had the following defects in the brain: (a) lower glutathione concentrations; (b) elevated oxidative stress (TBARS); (c) lower immunoblot expressions of: GLUT1 and GLUT3 (brain and neuronal glucose uptake); PGC1a; electron-chain complexes and PINK1 (mitochondria), TSPO (inflammation), pH2AX (genomic damage), and BDNF, GDNF and NGF (neurotrophic factors); (d) impaired mitochondrial respiration (high-resolution respirometry); (e) poor cognition (maze-running time). After 8-weeks of supplementation with GlyNAC (combination of glutathione precursors glycine and N-acetylcysteine), all of these defects improved/corrected in the brains of OM and cognitive performance improved significantly. The results of this study have important implications for improving brain health and cognition in human aging and in AD.
MORE THAN JUST A RIDE: TRANSPORTATION PROGRAMS TO MEET THE NEEDS OF OLDER ADULTS IN RURAL COMMUNITIES
Authors: Bayne Alycia , Siegfried Alexa , Chitwood Skyla , Valdivia Nathaly
Published: January 2025

Most older adults (age 65+) living in rural areas rely on personal vehicles for transportation. However, transportation is a significant challenge for older adults who need alternative forms of transportation, including those who do not drive or lack access to a vehicle. Fixed route transportation is limited in rural communities and may not meet the needs of older adults, particularly those who require assistance. Transportation barriers affect older adults’ health, mobility, independence, and quality of life. Recognizing these challenges, the Health Resources and Services Administration Federal Office of Rural Health Policy funded the NORC Walsh Center for Rural Health Analysis and the Rural Health Information Hub to develop the Rural Transportation Toolkit. The toolkit includes 15 promising program models to increase access to transportation, overcome barriers, and improve safety. To develop the toolkit, NORC conducted an environmental scan to identify programs and resources and interviewed representatives from nine rural transportation programs and four experts in rural transportation. The toolkit was first released in 2019, updated in 2024, and has had over 50,000 page views. This session describes toolkit findings, including transportation needs and challenges for rural older adults, and features program models practitioners can adapt. Program models include the Ride Sharing Model, Volunteer Driver Model, Voucher Model, and Coordinated Services Model. This session also describes how technology can improve rural transportation for older adults. This toolkit has the potential to help rural communities meet the transportation needs of older adults.
RURAL–URBAN RESIDENCE, EDUCATION, AND SUBJECTIVE COGNITIVE DECLINE AMONG MIDDLE AGED AND OLDER ADULTS IN THE US
Authors: Wong Roger , Mansour Amer
Published: January 2025

Subjective cognitive decline (SCD) is defined as an individual’s self-reported experience of increased confusion or memory loss, and it is a known risk factor for dementia. There is no existing research on SCD disparities by rural-urban residence, and how education may play a role in this relationship. To address this gap, the 2022 Behavioral Risk Factor Surveillance System data was analyzed to elucidate the interplay between rurality, education, and SCD. The SCD measure was only collected from respondents aged 45 years and older, resulting in a sample size of 63,948 U.S. adults. SCD was significantly more common among rural (12.0%) compared to urban (10.7%) residents [X2(1)=15.5, p<.001]. In a multiple logistic regression model, rural residents had a 16% significantly higher odds of SCD compared to urban residents after adjusting for sociodemographic and health covariates (adjusted odds ratio [aOR]=1.16, 95% CI=1.01-1.33, p<.05). There was a negative relationship between education level and SCD, but insignificant. For example, a college degree was associated with 12.4% lower odds of SCD compared to those with less than high school education (aOR=0.88, 95% CI=0.70-1.09, p=.24). Education did not significantly moderate the association between rurality and SCD. Our results suggest rural residents have higher odds of experiencing SCD, but no level of education may buffer this relationship despite extensive research on the benefits of education on cognitive health. Future research is needed to examine the mechanisms contributing to higher levels of SCD among rural residents, and effective interventions that may be used to mitigate further cognitive decline.
A STATEWIDE PROGRAM FOR EARLY AND ACCURATE DIAGNOSIS OF MEMORY LOSS
Authors: Johnson Theodore
Published: January 2025

Georgia Memory Net (GMN) provides clarity, care, and community connection for Georgians. GMN provides Primary Care Providers the educational resources local infrastructure they need to help Georgians experiencing memory loss or cognitive impairment get timely and accurate diagnoses. Georgia Memory Net also provides initial support and education while linking Georgians dealing with Alzheimer’s and related dementias and their care partners with community resources that can provide ongoing support. Primary Care Providers who have detected memory concerns can refer to one of seven Georgia Memory Net Memory Assessment Clinics or one of the rural telemedicine sites co-located in Department of Public Health clinics. Georgia Memory Net is made possible by a mandate from the Georgia State Legislature as a way to support Georgians all around our state who are dealing with memory issues. GMN is administered by experts at the Goizueta Alzheimer’s Disease Research Center at Emory University.
A REAL-WORLD PHARMACOVIGILANCE STUDY OF SACUBITRIL\VALSARTAN IN OLDER PEOPLE
Authors: Kuai Zheng , Hu Yu
Published: January 2025

Background

Sacubitril\valsartan is the first-in-class angiotensin receptor neprilysin inhibitor which is utilized clinically in the treatment of heart failure with reduced ejection fraction and hypertension patients. However, Systematic studies of sacubitril\valsartan-related adverse events (AEs) signals in older people based on real-world and international databases are still lacking.

Methods

Disproportionality analyses, including the reporting odds ratio (ROR), the proportional reporting ratio (PRR), the Bayesian confidence propagation neural network (BCPNN), and the multi- item gamma Poisson shrinker (MGPS) algorithms, were employed to quantify the signals of Sacubitril\valsartan-associated AEs in older people.

Results

The search retrieved 94,210 sacubitril\valsartan-associated cases within the reporting period; 86 PTs with significant disproportionality were retained in 65+. Angioedema, hypotension, renal impairment, hyperkalemia, cough, dizziness, and seasonal allergies were found at a similar rate to those reported in trials. Reports emerged for several cognitive-related AEs and several fragility acceleration AEs, which were rare. Unexpected safety signals such as ‘Injury, poisoning, and procedural complications’ were only detected in 65+. Most of the cases occurred within the first month after sacubitril\valsartan initiation, and this was consistent across age groups.

Conclusions

Our study found potential new AEs signals and might provide important support for clinical monitoring and risk identification of Sacubitril\valsartan in older people.
AGE-RELATED DEFICITS IN MOBILITY RESILIENCE WITH CLIMATE CHANGE: A CASE STUDY OF HURRICANE IAN
Authors: Manini Todd , gao Shangde , Wang Yan
Published: January 2025

Resilience is the capacity of a system to respond and recover from extreme events. We aimed to test the feasibility of a new metric of mobility resilience in the context of an extreme hurricane event. We used the concept of the resilience triangle — an engineering framework to conceptualize the resilience of physical infrastructure systems in the public domain. Mobility measures originate from point of interest (POI) visit data using geolocations of 47 million smartphone devices across the U.S.— about 10% of the population in the nation. These data were linked to 4,749 exposed neighborhoods (i.e. census tracts) within Florida who were impacted by Hurricane Ian in 2022. POI data were tracked 1 month prior, and 12 months following hurricane Ian to quantify the impact (ratio of pre-event mobility to maximal loss of mobility), recovery (ratio of post-event to pre-event mobility equilibrium), and duration of recovery (length of time from nadir of mobility lost to a new mobility equilibrium). In multiple regression models, older neighborhood median age was associated with worse recovery and longer duration of recovery. Additionally, neighborhoods with a higher percentage of adults 65+ years had a higher impact, worse recovery, and longer duration of recovery. Adjustments for wind speed, socioeconomic status (poverty, group housing, house cost/structure, uninsured rates), physical/mental limitations, mobile home dwellings, and racial/ethnic minorities had little effect on associations. This study underscores the potential of resilience triangle framework for measuring mobility resilience, although more research across diverse climate events and locations is necessary.
TEMPORAL DYNAMICS OF UNMET LONG-TERM CARE NEEDS IN CHINA: AN AGE PERIOD COHORT ANALYSIS
Authors: Zhang Jingwen
Published: January 2025

The rapid demographic changes, combined with heavy reliance on informal care, pose significant challenges to meeting long-term care (LTC) needs in China. However, research has yet to comprehensively appraise how and to what extent the unmet need has changed during the past two decades. Drawing on data from 6,030 urban and 5,070 rural residents in the Chinese Longitudinal Health Longevity Survey (CLHLS), 2005-2017/18, this study investigates the temporal changes in unmet LTC needs among Chinese older adults. We applied the newly developed age-period-cohort interaction (APC-I) model to disentangle the three temporal processes and their place-based rural-urban variation. The study found that, overall, rural older adults experienced a higher risk of unmet needs for LTC, yet the age, period and cohort effects on unmet needs among rural older people differed from their urban counterparts. Although ‘younger’ older adults had fewer care needs than older adults, they had a higher risk of experiencing unmet needs. The variation in the age effects was larger among rural older adults. The risk of having unmet needs did not change significantly over the 12 years. The unmet needs for LTC were more pronounced among more recent cohorts than previous generations, especially in urban areas. The findings provide crucial policy insights, underscoring the necessity for targeted interventions to address the care needs of ‘younger’ older adults, whose demands may not be perceived as severe enough for immediate attention. The escalating care gap among recent cohorts emphasises the need for increased investment in the formal LTC system.
INSIGHTS ON THE AGING EXPERIENCE WITHIN REMOTE CARIBBEAN ENVIRONMENTS THROUGH THE LENS OF GUANAJA, HONDURAS
Authors: Ferguson Lee Ann
Published: January 2025

This qualitative study examined the aging experience of older adults residing on Bonacca Cay, a 100-acre island that serves as the central municipality of Guanaja, Honduras. Utilizing focused ethnographic methods and drawing upon the Old-Age Exclusion and Age-Space Exclusion Frameworks, the research explored socio-environmental considerations thought to influence the aging experience. The analysis of data collected through direct fieldwork, interviews, observations, and photographic journaling while on Bonacca Cay identifies eight themes elucidating the intricate interplay between sociocultural dynamics and environmental factors impacting the island’s aging population. These influential themes include (1) personal habitus of older adults, (2) vital family support and changing family structures, (3) community and social bonding, (4) cultural heritage and history, (5) built environment and service infrastructure, (6) geographic/environmental influences, (7) government, economy, and policy, and (8) access to instrumental personal care services and safety. This research also results in the recognition of both the strengths and limitations when attempting to apply either the Old-Age Exclusion or Age-Space Exclusion Frameworks to populations of older adults living on island municipalities governed by distant mainland countries. By presenting the lived realities of older adults within this remote island context, the results of this study may contribute to a more comprehensive understanding of the aging experience within low-resource Caribbean environments. It also offers valuable insights for future research and the development of tailored frameworks for studying aging in similar unique settings.
EXAMINING THE ASSOCIATION BETWEEN MULTIMORBIDITY PATTERNS AND MORTALITY RISK AMONG PEOPLE WITH DEMENTIA
Authors: Luo Hao , Zhou Jiayi
Published: January 2025

People living with dementia often live with other diseases. Understanding how other diseases co-occur (‘multimorbidity’, concurrence of two or more diseases) in a person with dementia is important as it can inform a tailored approach to care. This study aimed to identify multimorbidity patterns among patients with and without dementia and examine how these patterns were associated with mortality. We identified dementia patients diagnosed at 65+ between 2007 and 2017 from electronic medical records from all public hospitals in Hong Kong. Each patient was 1:1 matched with patients without dementia by age, sex and index date and followed until death or 31 Dec 2018, whichever was earlier. A total of 156,710 individuals (mean age [SD]: 83.26 [7.28]; 59.6% females) were included. Seven multimorbidity patterns were identified from latent class analysis in the total sample, and similar patterns were identified separately for patients with and without dementia. The pattern characterized by “dyslipidemia and neurological diseases” was most likely to coexist with dementia. Among patients with dementia, compared to the “unspecific” pattern (characterized by the lack of defining diseases), all other patterns were associated with an increased risk of mortality. The highest risk was observed in the “clinically complex” pattern [HR 1.65 (95% CI: 1.60, 1.70)], followed by the “respiratory disease” [HR 1.51 (95% CI: 1.45, 1.57)] and “heart disease” patterns [HR 1.40 (95% CI: 1.36, 1.45)]. The results highlight the importance of taking specific combinations of chronic conditions into account when tailoring the clinical and care approach to people with dementia.
METFORMIN AS A POTENTIAL PHARMACOLOGIC INTERVENTION TO IMPROVE HEALTHSPAN
Authors: Espinoza Sara
Published: January 2025

Metformin is the most widely used oral antidiabetic drug, generally recommended as first-line treatment for type 2 diabetes as well as for diabetes prevention. Metformin extends lifespan in preclinical models, and several observational studies in humans suggest that metformin reduces cancer, cardiovascular disease, dementia, frailty, and all-cause mortality. Therefore, given that it is well-tolerated, safe, and widely used, there is high interest in testing its role as a potential agent to reduce age-related diseases and geriatric syndromes. The exact mechanisms by which metformin exerts these benefits are still being elucidated, but in addition to activating AMPK emerging evidence demonstrates metformin modulates several hallmarks of aging, such as epigenetic modifications, mitochondrial function, cellular senescence and the gut microbiome. Thus, metformin has pleiotropic effects which may contribute, perhaps collectively, to its aging-modulating properties. To date there are few clinical trials of metformin to directly examine metformin’s effects on human healthspan. We are currently conducting a randomized placebo-controlled clinical trial of metformin to prevent frailty in older adults with glucose intolerance, which will also examine the effects of metformin on several hallmarks of aging. Metformin is also being examined in a separate ongoing randomized placebo-controlled trial as a potential therapy to prevent Alzheimer’s disease in older adults without diabetes (including those who have prediabetes). Given its tolerability and safety profile, metformin could be quickly translated to clinical use if ongoing and future clinical trials demonstrate its efficacy in promoting healthspan.
REPURPOSING SODIUM-GLUCOSE CO-TRANSPORTER-2 INHIBITORS FOR GEROTHERAPY
Authors: Solis-Herrera Carolina , Venna Venugopal , Lee Juneyoung
Published: January 2025

Sodium-glucose co-transporter-2 inhibitors (SGLT2i) are drugs used to treat T2DM, offering benefits such as reduced HbA1c, weight loss, and improved insulin sensitivity/β-cell function. Additionally, they provide significant cardio-renal benefits, although the exact mechanisms are not fully understood. The ketone hypothesis suggests that SGLT2i may shift metabolism towards utilizing ketone bodies instead of fatty acids, contributing to their therapeutic effects. Previous research has shown that SGLT2i can increase plasma ketones 2-4-fold. One intriguing area of research is the potential use of SGLT2i as agents for late-aging and longevity. T2DM exacerbates aging-related biomarkers such as senescence, chronic inflammation, oxidative stress, DNA damage, and mitochondrial dysfunction. Preclinical studies have demonstrated that SGLT2i possess anti-inflammatory, anti-oxidative, and anti-senolytic properties, suggesting they may improve health span and lifespan, particularly in patients with chronic inflammatory diseases like T2DM and obesity. However, clinical research in this area is still limited. Preliminary data from our group suggests that in older, obese subjects with prediabetes, treatment with an SGLT2 inhibitor for 12 weeks led to a significant decrease in global and adipose senescent and inflammatory profiles. This effect, correlated with increased plasma ketones, indicates a potential mechanism by which SGLT2i may modulate aging processes and improve symptoms of age-related diseases. Here, we will discuss this and other current studies that support the notion that SGLT2i may contribute to the increase of both healthspan and lifespan.
DASH DIET WITH CULTURALLY TAILORED RECIPES: A PSYCHOEDUCATIONAL SESSION FOR BLACK WOMEN WITH HYPERTENSION
Authors: Groves Angela , Hamann Kate , Roche-Dean Maria
Published: January 2025

The prevalence of hypertension among non-Hispanic Black women in the United States is alarming because they develop hypertension at an earlier age and have higher blood pressures when compared to White women. Approximately 55.3% of Black women have hypertension, which puts them at significant risk of developing heart disease, kidney disease, and cerebral vascular accidents. The Dietary Approaches to Stop Hypertension (DASH) diet, when combined with lower sodium intake, has been associated with a reduction in systolic blood pressure by 10 mm Hg in a four-week intervention study that included 50% African American women with pre-hypertension or stage 1 hypertension. Although, the DASH diet does not consider cultural food preferences. Studies among Black adults have shown that when the DASH diet incorporated culturally traditional foods, adherence to the DASH diet improved, which lowered blood pressure. A key factor in understanding the health behavior of Black women is their general knowledge of hypertension and low-sodium diets. This psychoeducation session was part of an 8-week peer (dyadic) support mixed methods study that included the DASH diet and culturally tailored recipes to improve diet adherence and reduce systolic blood pressure. Purposive sampling was used to secure a sample of 34 older Black women from local churches and one senior center to participate in a one-hour DASH diet education session. Psychoeducation was reinforced with weekly newsletters and opportunities for one-on-one discussions via email or phone. Study results indicated that participants were able to successfully reduce systolic pressure. We discuss the implications for hypertension management.