bluuebunny/crossref_metadata_2025 huggingface dataset:
The 52,000 gifts of the Gratitude Train: objects, emotions and Franco–American relations after the Second World War
Authors: Broch Ludivine
Published: December 2023

The Gratitude Train was sent from France to America in 1949. Conceived as a ‘thank you’ for American help during and after the world wars, it contained 52,000 personal objects chosen and donated by French people who wanted to express their gratitude to Americans. The objects were divided between forty-nine boxcars, and each state received one of these boxcars containing approximately 1000 objects. What where these objects? Who sent them? Why have they been forgotten? Why do they matter? This article is interested not only in the story of the Gratitude Train, but in the stories within the objects themselves. By closely analysing a porcelain dog, a silver spoon and a painting, it traces the longer life biographies and trajectories of these objects and uncovers a range of both intended and unintended emotions as well as meanings, be they collective or individual. The unique and almost completely unknown Gratitude Train collection offers valuable inroads into our understanding of the relationship between objects, emotions and international relations, as well as into the materiality of gratitude at the heart of the age of extremes.
EDUCATIONAL DISPARITIES IN COGNITIVE DECLINE AND DEMENTIA IN LATER LIFE
Authors: Herd Pamela
Published: December 2023

According to the most recent (2020) Lancet commission report, one of the most important determinants of Alzheimer’s Disease and related dementias (ADRD) is educational attainment. For those aged 80 and older, the risk for dementia is three times lower for those with a college degree compared to those without a high school degree, with even larger educational disparities by ethnicity. Despite these large and persistent gaps, there is much we do not understand about the relationship between education and dementia. Moreover, we have yet to develop effective clinical treatments that substantially slow or reverse the course of dementia. In this context, unpacking the education—ADRD relationship may be key to understanding how to delay ADRD onset. This panel explores how genetic risk, early life conditions, ranging from cognition and the quality of schooling to mid life factors, may mediate and moderate the relationship between education and cognitive decline and dementia in later life. The papers also pay close attention to variance by gender and ethnicity.
INTERSECTIONAL AND BIOSOCIAL PATHWAYS TO COGNITIVE FUNCTION AMONG OLDER HISPANICS AND LATINOS
Authors: Garcia Catherine , Brown Lauren
Published: December 2023

Hispanics/Latinos are the fastest-growing segment of older adults in the United States (U.S.). They are at high risk for cognitive impairment (CI) and Alzheimer’s disease and related dementias (ADRD). While increased research attention has been given to the socioeconomic and cultural factors that influence the prevention, diagnosis, and care provided to Hispanics/Latinos with CI and ADRD, there are still theoretical and methodological gaps in clarifying the mechanisms and pathways that produce ADRD inequities, including life course and multilevel mechanisms. Given the diverse origins of Hispanics/Latinos in the U.S. – in ethnic origin, birthplace, and current residence – it is crucial to understand how these social conditions get “under the skin” that influence cognitive function in older adulthood. Namely, it is important to unpack how different intersectional positions show different relationships with deprivation that influence cognitive and healthy aging. Thus, this study had two main objectives: (1) to examine the mediating role of physiological (dys)regulation between education and cognition, and (2) to understand for which Hispanic/Latino subgroups the interrelated relationships are stronger/weaker for. Correspondingly, we employed multigroup structural equation modeling to address our study objectives. We used data from the Health and Retirement Study (HRS) to discern and assess the effects between education, physiological factors, and cognitive function at baseline and follow-up by Hispanic/Latino subgroups (e.g., foreign-born Mexicans, U.S.-born Mexicans, island-born Puerto Ricans, foreign-born Cubans, etc.). The results from this study underscore the role of structural interventions and community engagement in reducing and eliminating cognitive health disparities among Hispanics/Latinos.
SELF-IDENTIFIED STRENGTHS AMONG ADULTS AGING SOLO WITH EARLY DEMENTIA
Authors: Lowers Jane , Datcher Ivree , Kavalieratos Dio , Hepburn Kenneth , Perkins Molly
Published: December 2023

People with Alzheimer’s and related dementias require increasing assistance with basic life activities, yet one in three lives alone (i.e., is aging solo). Drawing on a strengths-based perspective, this study seeks to identify barriers and facilitators to successful aging among adults who are aging solo with cognitive impairment or early dementia. We conducted semi-structured interviews with 15 adults aging solo with a diagnosis of cognitive impairment or early dementia (age 48-81, mean 69; 80% female; 86% white; 13% black; 7% Hispanic) and used a hybrid inductive/deductive thematic analysis approach to analyze the data. Participants identified self-advocacy, friendship networks, financial resources, and institutions (e.g., assisted living) as potential assets that could address future care needs. Participants described an identity as self-sufficient, fear of being a burden, and worries about exploitation as barriers to help-seeking. Facilitators to care-seeking from friends, neighbors, and others included a belief that helping is rewarding for others, being able to provide reciprocal favors, and framing care-seeking as self-advocacy. Conclusion: Adults aging solo with early dementia face a number of challenges but also exhibit numerous strengths and can use a diversity of skills, attitudes, relationships, and tangible resources to address increasing care needs.
INSIGHTS FROM A HAPF ALUMNUS ON AGING POLICY ADVOCACY IN SOCIAL WORK
Authors: Kusmaul Nancy
Published: December 2023

“Once a fellow, always a fellow” and “Networks get things done”. The Health and Aging Policy Fellows Program has brought together experts in aging for more than ten years for policy education and fellowships, assembling an alumni network of more than one hundred and fifty fellows. Fellow alumni are social work scholars, physicians, nurses, gerontologists, sociologists, and many more. Each of these alumni completed one or more placements in policy making in congress, federal agencies, and advocacy organizations. Some have remained in those spaces while others are academics, state and local officials, and corporate leaders. They continue to advocate for and shape policy in aging in those positions. Told from the perspective of a non-residential program alumnus who is a mid-career faculty member in social work, this presentation will discuss the lessons learned during the fellowship, how the fellowship shaped future policy work, and present insights on how social workers can engage in policy advocacy in aging through the fellowship.
IMPROVING THE VALUE OF SERIOUS ILLNESS CARE
Authors: Kaufman Brystana
Published: December 2023

My Health and Aging Policy Fellowship placement with CMMI provides an opportunity to learn about the current policies impacting palliative care payment and process for developing new models. Palliative and hospice care has been one of the fasting growing health services in the U.S. and the VA over the past decade. Although Medicare’s hospice benefit requires a 6-months life expectancy, palliative care may be appropriate for seriously ill individuals depending on their clinical and psychosocial needs. Palliative care is an interdisciplinary, team-based approach that focuses on improving quality of life, aligning care with patient preferences, and relieving distressing symptoms for people with serious, life-limiting illness and their families. In practice, palliative consultations, teams and services are highly tailored to each patient and family’s needs. The heterogeneity of patient needs, care settings and services creates challenges designing value-based payment strategies. I am working on a team that will assess the feasibility of a value-based strategy for supporting seriously ill beneficiaries’ palliative care needs. Current learnings include 1) understanding the CMMI priorities as identified in their strategy refresh in 2021; 2) mapping the design elements that are relevant for palliative care across Medicare Advantage and Traditional Medicare Alternative Payment Models; 3) synthesizing evidence and leveraging my research experience evaluating value-based payment models and outcomes for high cost, high need populations in Medicare and the VA. In addition to key learnings specific to my placement, I will share how the HAP fellowship experience has impacted my research career and opportunities for the future.
ADDRESSING THE NEEDS OF AFRICAN AMERICAN BEREAVED DEMENTIA CAREGIVERS
Authors: Baker Zachary , Supiano Katherine
Published: December 2023

Within the next 10 years there will be at least 9 million NEWLY Bereaved Dementia Caregivers, disproportionately affecting African American families due, in part, to dementia prevalence that is twice that of White counterparts. Up to 26% of Bereaved Dementia Caregivers experience pathologically prolonged or exacerbated grief, often referred to as complicated grief or prolonged grief disorder: 2.5x the rate of other chronic disease care contexts, like cancer. The present project used an asset-based approach to assess the needs and resources of African American Bereaved Dementia Caregivers. This project was conducted with community members and university members serving as Co-Principal Investigators. Community PIs lead a grassroots organization that has served Bereaved Dementia Caregivers since 2016. The University PI leads a research team devoted to understanding and improving the experience of Bereaved Dementia Caregivers. The present symposium will discuss the challenges and opportunities offered by this unique collaboration and insights gleaned by a project designed to serve doubly underrepresented groups: African American Bereaved Dementia Caregivers (who sometimes call themselves the “ultra-invisible”). Because this was a project funded through grant dollars, we will also discuss actionable insights that we hope may help others develop fruitful academic-community partnerships. Finally, we will share recruitment strategies for speaking with minoritized populations and insights from engaging gleaned through conversations with African American Bereaved Dementia Caregivers.
CANNABIS USE IN OLDER ADULTS: EVIDENCE FROM THE HEALTH AND RETIREMENT STUDY
Authors: Bhagianadh Divya
Published: December 2023

Cannabis use among persons over 50 years old has tripled since 2000. Some studies have found negative outcomes associated with increasing use of cannabis use among older adults such as higher rates of injury and emergency department use. Other studies have shown improvements in pain, sleep and other outcomes such as self-reported health and labor force participation. In this study, we identify individual determinants and outcomes related to cannabis use among adults aged 50+ sourcing data from the 2018 cannabis module of the Health Retirement Survey and constructing a longitudinal panel by linking this data with the respondents’ 2016 and 2020 data. Among the 1,372 respondents, 10% reported past year use. Among these past year users, 35% were persistent, lifelong users and nearly 25% used solely for medical purposes. Multivariate logistic regression controlling for demographics, health and functional status and individual fixed effects showed that those who reported pain in the last wave had higher odds of reporting cannabis use (OR 1.70, p-value-0.03). Troubled sleep was associated with higher odds of cannabis use (significant at 10%). We did not see any effect of cannabis use on pain in later years or subsequent healthcare utilization (hospital or doctor visits). Our results reflect a nationally representative survey of cannabis use among aging Americans and affirms how motives and outcomes of cannabis use are age sensitive.
CATALYZING NOVEL METHODS OF MEASURING COGNITION BY HARNESSING TECHNOLOGY
Authors: Andersen Stacy , Boot Walter
Published: December 2023

Early detection of cognitive impairment is essential for enabling access to clinical assessments and treatments and facilitating participation in clinical trials for Alzheimer’s disease. By employing smartphones and digital technologies to capture cognitive behaviors with high precision we may be able to detect novel, subtle biomarkers of cognitive impairment during clinic-based assessments, in-home self-administered tasks, and daily activities. In this Collaborative Symposium from the Alzheimer’s Disease and Related Dementias and Technology and Aging Interest Groups, we will explore the development of technologies to detect cognitive impairment and discuss the feasibility of obtaining these data in non-traditional settings. The first presentation reports on the use of eye-tracking technology to detect cognitive impairment with high accuracy. The second presentation discusses acoustic features from digital voice recordings of a cognitive screener that are associated with cognitive impairment and increase the screener’s specificity. The next presentation describes linguistic features from voice recordings of a memory test that are associated with depression and distinct from those associated with cognitive impairment. The fourth presentation introduces a smartphone application that measures hand grip strength, a known correlate of dementia risk. The symposium concludes with a summary of older adults’ attitudes toward wearable technologies to detect cognitive decline and the development of a smart reminder system to promote adherence to home-based assessment. Overall, these presentations highlight ways we can harness technology to capture unique features of cognitive function that increase the accuracy of traditional testing or detect cognitive impairment in novel settings. This is a collaborative symposium between the Alzheimer’s Disease and Related Dementias and Technology and Aging Interest Groups.
COMPARISON OF LONELINESS AND SOCIAL NETWORK BETWEEN OLDER ADULT CAREGIVERS AND NONCAREGIVERS
Authors: Yong Ting , Visaria Abhijit , Malhotra Rahul
Published: December 2023

In ageing societies, more older adults are taking up informal caregiving roles. Caregivers, compared to non-caregivers, are found to have poorer psychosocial outcomes such as loneliness and social isolation in various studies. However, most of this research is not specific to older adult caregivers and does not account for selection bias into caregiving. We compare loneliness and social network between older adult caregivers and older adult non-caregivers in Singapore, applying inverse probability weighted regression adjustment (IPWRA), to address selection bias into caregiving, on data from a nationally representative longitudinal study of older adults. Those providing unpaid assistance to any person because of their health condition were considered as caregivers. Loneliness (score: 0-12; higher score=lonelier) and social network (0-60; higher score=greater network) were measured using validated scales. The relationship of caregiving status with loneliness and social network was estimated using IPWRA, controlling for multiple demographic and health characteristics. Of the 2639 respondents, 7.2% were caregivers. Older adult caregivers, versus non-caregivers, were more likely to experience loneliness (average treatment effect [ATE] β-coefficient for loneliness score: 0.328 (95% confidence interval: 0.011-0.645; p-value: 0.042); and odds ratio for being lonely: 1.080 (1.001-1.165); p-value: 0.047). However, they did not differ in terms of their social network (ATE β-coefficient for social network score: 1.456 (-0.405-3.316); p-value: 0.125). Our findings suggest that even with a similar extent of social network, older adult caregivers are at a higher risk of loneliness, i.e., perceived social isolation or relational deficits, compared to non-caregivers.
SERUM CONCENTRATIONS OF LOSARTAN METABOLITES CORRELATE WITH IMPROVED PHYSICAL FUNCTION IN A PILOT STUDY OF PREFRAIL OLDER ADULTS
Authors: Abadir Peter M
Published: December 2023

DOI: 10.1093/gerona/glac102
THE ADULT DAY CENTER: UNTAPPED TERRITORY FOR AGING RESEARCH
Authors: Sadarangani Tina , Sun Fei
Published: December 2023

Adult day service centers (ADCs) in the United States are a vital, but overlooked source of community-based long-term care for diverse older adults with multiple chronic conditions, including dementia. The National Institute on Aging has called for more research on ADCs. In this interdisciplinary symposium, we present challenges and opportunities in conducting research in these congregate settings. First, we look at the operating status of ADCs nationally in the aftermath of the COVID-19 pandemic and disparities in access to care using longitudinal data from the National Post-acute and Long-term Care Study. Then we examine the lack of electronic health record utilization and clinical data capture in 4,035 ADCs nationally and discuss strategies to modernize technology in these settings to facilitate data collection. We subsequently present a new database, developed vis a vis an academic/community partnership between the National Adult Day Services Association and researchers, that centralizes and makes data collection feasible in ADCs with limited resources. We will also explore factors supporting intervention research that are unique to ADCs. Finally, we present a protocol adapted for the ADC setting, to test a mobile application that facilitates data collection and enables communication between ADCs, caregivers, and healthcare providers. Our findings show that, while research in ADCs has been limited historically, academic, government, and community partners are working together to spur pragmatic innovations that modernize these settings and better resource them to elevate standards of care.
UNDERSTANDING EVERYDAY NEEDS OF OLDER ADULTS WITH MACULAR DEGENERATION OR GLAUCOMA
Authors: Mumma Kara , Remillard Elena , Umar Tooba , Bhookya Divya , Rogers Wendy
Published: December 2023

Older adults with long-term vision loss may experience challenges in their everyday activities. Different types of vision loss may cause different problems. For example, macular degeneration leads to a loss of foveal vision whereas glaucoma leads to peripheral vision loss. As part of the Aging Concerns, Challenges, and Everyday Solution Strategies (ACCESS) study, we are using a mixed-methods approach to explore the unmet needs of older adults with these two conditions to provide guidance for interventions. We will present insights from 51 older adults (mean age = 69, SD = 5.5) who have had serious difficulty seeing for an average of 42 years (SD = 24.3) due to either glaucoma (n = 28), macular degeneration (n= 19), or both conditions (n = 4). We will present participants’ difficulty ratings for a wide range of everyday activities as well as initial themes and illustrative quotes from interview data on challenges and response strategies for their most difficult activities (e.g., shopping, traveling for leisure, dressing). For example, it can be difficult to navigate through a crowded store and read details on labels when shopping. Additionally, flying was described as frustrating and stressful because airports can be unfamiliar and require arrangements (e.g., transportation to/from, guidance to the gate). Moreover, when getting dressed, participants said that they rely on touch to differentiate between clothes; however, color coordination and matching can be very difficult. Data provide insights on unmet needs among people aging with vision loss and illuminate opportunities for technology innovation.
LIFETIME REVICTIMIZATION: EVIDENCE FROM THE WISCONSIN LONGITUDINAL STUDY
Authors: Kong Jooyoung , Easton Scott , Fletcher Jason
Published: December 2023

Research has documented the increasing prevalence of elder abuse victimization and its devastating impact on the health and well-being of older adults. However, a life-course view of the victimization experiences of older adults has rarely been adopted in the elder abuse literature. The current study examined lifetime links between victimization experiences that span childhood, adulthood, and older adulthood. Specifically, we examined: a) the mediating effect of adverse childhood experiences (ACE) on elder abuse victimization via intimate partner violence (IPV) victimization in middle adulthood, and b) whether this indirect association differs by gender. Data were obtained from the Wisconsin Longitudinal Study (WLS). We analyzed the previous and current victimization experiences of a total of 5,391 older adults in their early 70s and estimated the mediational and moderated mediation models. The key results indicated that a higher ACE score was associated with exposure to IPV victimization in middle adulthood, which was in turn associated with exposure to elder abuse victimization. This indirect association was stronger for women than for men. Regarding specific types of childhood victimization, parental physical abuse, sexual abuse, and witnessing domestic violence significantly predicted elder abuse victimization via IPV. Our results support the phenomenon of lifetime victimization, whereby an individual experiences reoccurring forms of victimization across the life span from childhood to late adulthood. Findings highlight the compelling need for the assessment of cumulative victimization experiences and their impact on elder abuse victims. A life course-based, trauma-informed approach would greatly enhance prevention and intervention services for elder abuse.
AN INTERGENERATIONAL TRAINING PROGRAM TO SUPPORT LATINE ELDERS: LESSONS LEARNED
Authors: Cotton Quinton , Kissell Paul , Johnson Elma , Chambers Yolima , Nkimbeng Manka , Gaugler Joseph
Published: December 2023

Cultural adaptation and tailoring of caregiving interventions has garnered greater attention in part due to high levels of unmet need and poor intervention outcomes among dementia caregivers from racial and cultural groups. Additionally, there is a growing interest in understanding intervention mechanisms. We conducted a formative analysis of the process employed in the design of an intergenerational training program to support elders within the Latine community. A content analysis of memos and stakeholder listening sessions and document review guided this analysis. Framed within a discussion on the continuum of cultural adaptation, we report on lessons learned. Lessons include: 1) embracing community-led design, 2) demonstration of partnership commitment to facilitate trust-building, 3) consistent appreciative inquiry, and 4) demonstration of cultural centeredness within the partnership.
TRAJECTORIES OF FORMAL SOCIAL PARTICIPATION, GENDER, AND END-OF-LIFE CARE QUALITY AMONG OLDER AMERICANS
Authors: Mahmoud Kafayat , Onge Jarron Saint , Ekerdt David
Published: December 2023

Limited research has examined the association between formal social participation trajectories and end-of-life care quality. The end of life could be characterized by experiences of heightened feelings of physical and psychological distress, breathlessness, constant hospitalization, and intrusive interventions. Formal social participation may improve the end-of-life care of older adults because they serve as sources of useful information, receipt of emotional support, and improve self-efficacy. This research examines the associations between formal social participation trajectories and proxy ratings of overall end-of-life care quality, and the moderating role of gender. Growth-based trajectory models were used to identify distinct developmental trajectories of formal social participation among older adults in the United States. Findings revealed four social participation trajectory classes among older adults towards the end of life, all with a general tendency to decline across time. Multinomial logistic regression analyses showed that although older adults with higher levels of formal social participation have more positive overall end-of-life care ratings, there are gender differences in these care ratings. Women are less likely than men to chart, by proxy report, positive care ratings at the end of life even though they have higher levels of formal social participation, and these gender differences in end-of-life care rating are explained more by healthcare factors than formal social participation trajectories. These results suggest that both formal social participation and positive interactions with health care at the end of life are more beneficial for older men than women.
STRESS AND DEATH: GLUCOCORTICOIDS AND SURVIVAL IN A WILD PRIMATE MODEL OF AGING
Authors: Campos Fernando
Published: December 2023

Chronic exposure to stressors has been linked with a wide range of detrimental effects on health in humans, laboratory animals, and a few wild animal populations. Glucocorticoids (GCs) mediate stress responses, and consequently GC levels are regularly measured in humans and other animals as biological markers of stress. However, no tests in humans or in natural populations of animals have yet established clear connections between environmental stressors, chronically elevated GCs, and shortened lifespan. To fill this gap, we used longitudinal data on wild female baboons to investigate the relationship between GC levels and survival—the single greatest determinant of variation in evolutionary fitness among female baboons. Using 14,173 GC measurements from 242 wild adult female baboons over 1634 female years, we document a powerful link between GCs and survival: females with relatively high current GCs or high lifelong cumulative GCs face an elevated risk of death. A hypothetical female who maintained GCs in the top 90% for her age across adulthood would be expected to lose 5.4 years of life relative to a female who maintained GCs in the bottom 10% for her age. Hence, differences among individuals in HPA axis activity provide valuable prognostic information about disparities in lifespan. Together, our results both support the value of GCs as a window into health, fitness, and aging and suggest that they may mechanistically contribute to the established link between sociality and lifespan.
AGEISM EXPERIENCED AND EXPRESSED: MANIFESTATIONS ACROSS CONTEXTS AND TRANSGRESSORS
Authors: Chasteen Alison
Published: December 2023

Ageism was first defined more than fifty years ago, yet its expressions and effects on society continue today. In this symposium, we examine manifestations of ageism across contexts and transgressors in order to determine the effects of ageism in light of a pandemic as well as a post-pandemic world. Important social contexts in which ageism plays a part are examined, such as the workplace and COVID-19 vaccination. As well, efforts to reduce ageism through confrontation are investigated, particularly with respect to reactions to ageist behavior. Providing a window into ageist communication during the pandemic, Bascu and colleagues detail how ageism was expressed in social media regarding policies for COVID-19 vaccination. Delving into the factors that drive older workers’ decisions to remain or to leave an organization, both Lagacé et al and Swift investigate the role that perceived ageism plays. Lagacé and colleagues assess how older workers’ perceptions of being the target of ageism impacts their well-being, their psychological disengagement, and their intentions to leave their organization. Swift considers how experiences of ageism in the workplace predict older workers’ retirement intentions through reduced job satisfaction and lowered intrinsic motivation to work. Chasteen et al. test the impact of confronting ageism on perceptions of transgressors as well as how perceivers use characteristics of an older adult target as a normative cue for determining their reactions to ageist behavior. Taken together, these presentations illustrate the influence of ageism on vital life domains such as healthcare and the labor force.
ADMISSIONS AND DISCHARGE PRACTICES IN ASSISTED LIVING: THE ROLE OF REGULATORY AND ORGANIZATIONAL CHARACTERISTICS
Authors: Hua Cassandra , Smith Lindsey , Zimmerman Sheryl , Gadkari Gauri , Slolane Philip , Carder Paula , Wretman Christopher , Thomas Kali
Published: December 2023

This study examined how state regulations and AL organizational characteristics relate to admissions and discharge practices. Using data from a representative sample of 250 AL communities in 7 states and a database of AL regulations, we employed bivariate analysis and multilevel linear probability models to examine regulatory and organizational correlates of AL community admissions and discharge practices for three activities of daily living (ADLs [bathing, getting out of bed, and eating]). There was a pattern between admissions regulation and admissions practices in AL; for example, 38% of communities with license types that had the most flexible admissions regulations allowed residents with feeding limitations to be admitted; conversely, 18% with the least flexible regulations allowed them to be admitted. However, the relationships were not statistically significant in bivariate or multivariate analysis. A higher percent of residents with Medicaid as a primary payer source was associated with a decrease in the probability of admitting (𝛽 = -0.01, p<.001, 95% confidence intervals [CI]: -0.01, 0.00) and discharging (𝛽 = 0.01, p=.013, 95% CI: 0.00, 0.01) residents with bathing limitations. Being operated in association with a continuing care retirement community or nursing home was associated with a higher probability of discharging residents who needed assistance with bathing (𝛽 = 0.14, p=.013, 95% CI: 0.03, 0.26) and more so with feeding (𝛽 = 0.26, p <.001, 95% CI: 0.15, 0.36). Findings suggest a need to consider whether models of AL and AL practices could better align with the residents’ needs.
INCOME AND WELL-BEING IN OLD AGE—SYSTEMIC AND REGIONAL FACTORS IN A COMPARISON BETWEEN GERMANY AND POLAND
Authors: Oczkowska Monika , Kulati Ellam , Myck Michal
Published: December 2023

We examine the responsiveness of later-life well-being measures to income using unique data, matching regional and individual level information from Germany and Poland. These two neighboring countries still strongly differ both in their welfare system designs, as seen in contrasting public social support as well as the quality of services, and in outcomes among older individuals. For example, the proportion of individuals aged 50+ who declare significant difficulties in making ends meet is only 3% in Germany, and as high as 16% in Poland. While up to 13% of individuals aged 65+ are classified as materially and socially deprived in Poland, the proportion in Germany is only 6%. Granted the importance of contextual factors in determining individual welfare, income is expected to matter less for the well-being of those enjoying higher quality local environments. Our preliminary findings confirm a much stronger relationship between income and well-being in Poland. The relationship is also found to be highly heterogeneous – for instance, it is substantially greater among those in poor health. Individual resources are thus shown to be more strongly related to well-being in conditions wherein individuals cannot rely on support through public services. Surprisingly, in both countries the effect of income on well-being does not significantly change when we control for the different local conditions expected to mediate the relationship. This suggests that the country-wide systemic context matters more for the examined relationship than specific regional environment.
THE ASSOCIATIONS OF SOCIOECONOMIC POSITION WITH STRUCTURAL BRAIN DAMAGE AND CONNECTIVITY AND COGNITION
Authors: Geraets Anouk , Schram Miranda , Koehler Sebastian , Jansen Jacobus , van Boxtel Martin , Koster Annemarie , Stehouwer Coen , Bosma Hans
Published: December 2023

Socioeconomic inequalities in the risk for cognitive impairment have been reported, which might partly act through structural brain damage and connectivity. This study investigated the extent to which the association of early-life socioeconomic position (SEP) with later-life cognitive performance is mediated by later-life SEP, and whether the association of SEP with later-life cognitive performance can be explained by structural brain damage and connectivity. We used cross-sectional data from the population-based Maastricht study (n=4,839; mean age 59.2±8.7 years, 49.8% women). Early-life SEP was assessed retrospectively by self-reported poverty and parental education. Later-life SEP included education, occupation, and household income. Participants underwent cognitive testing and 3 T magnetic resonance imaging to measure volumes of white matter hyperintensities, gray matter, white matter, cerebrospinal fluid, and structural connectivity. Multiple linear regression analyses tested the associations between SEP, MRI brain markers and cognition. Structural equation modeling tested mediation. Results indicated that higher SEP was associated with higher grey matter volume, lower white matter volume, and higher structural connectivity. Structural brain damage and lower structural connectivity were associated with lower cognition. Both higher early-life and later-life SEP were associated with higher cognition. The association of early-life SEP with later-life cognition was partly mediated by later-life SES (73.8%). However, the extent to which the association of SEP with cognition could be explained by structural brain damage or connectivity was marginal (up to 5.9%). More research is needed to investigate alternative pathways that can explain the associations between SEP with later-life cognition.
ASSOCIATION BETWEEN PATIENT PORTAL ACTIVITIES AND END-OF-LIFE OUTCOMES
Authors: Portz Jennifer , Wan Shaowei , Powers John , Palen Ted
Published: December 2023

Examining end-of-life (EOL) patient outcomes associated with patient portal use will help identify benefits and barriers of portal use during EOL care. The primary objective of this retrospective cohort study was to assess the association between EOL outcomes and patient portal use among a cohort (N=6,517) of deceased patients (18+ years old) in the last 12 months of life within Kaiser Permanente Colorado (KPCO). Outcomes including 1) number of hospitalizations in the last 30 days of life, 2) having documented advance directive before death, and 3) dying in hospice were investigated by levels of patient portal use (no use, non-active use, active use without provider, and active use with a provider) for the first six months of the last year of life. A generalized linear model with Poisson distribution, a log link and an offset to account for person-days of follow-up was used to estimate rates of hospitalizations in the last 30 days. Logistic regression was used to estimate advance directive and death in hospice outcomes. Patient portal use appeared to be associated with beneficial EOL outcomes such as advance care planning (P = 0.0226) and dying in hospice (P = 0.0070). Hospitalizations were greater with higher levels of patient portal use (P = 0.0492), suggesting that patients/caregivers may have used patient portals for disease related information and accessing health services during times of need. More research is needed to leverage patient portal use to intentionally engage, educate and guide patients with serious illness and approaching EOL.
ALONE TOGETHER: SOCIAL ISOLATION AND LONELINESS ACROSS COVID-19
Authors: Beck Emorie , Ong Anthony , Graham Eileen
Published: December 2023

The COVID-19 pandemic has resulted in a worldwide increase in the number of adults who are socially isolated and experiencing high levels of loneliness. Although research has focused on social isolation (the lack of social contact) and loneliness (the perception of being alone), few longitudinal studies have examined isolation and loneliness together in the context of the COVID-19 pandemic. We introduce a novel index of resilience to loneliness (social asymmetry), which captures the degree of congruence or discordance between subjective feelings of loneliness and objective social contact (social isolation). Using seven longitudinal samples (Total N > 75,000) across three continents, we examined trajectories of social asymmetry across the onset of the pandemic using Bayesian multilevel discontinuous growth models. These allowed us to demonstrate differences in level and change of social asymmetry across the onset of the pandemic. Levels and change tended toward resilience over time but did not show significant changes across the onset of the pandemic. However, these results were not consistent across samples, indicating heterogeneity across countries, age groups, and more. We discuss how examining COVID-related changes in social asymmetry advances our understanding of (1) the extent to which broad societal challenges can induce short- and long-term impacts on trajectories of resilience and (2) what factors account for heterogeneity in adaptive responses to adversity.
SOCIAL DETERMINANTS OF HEALTH AND THE RISK FOR DEMENTIA
Authors: Baumgart Matthew , Hampton Kischa , Kline Chelsea
Published: December 2023

Social determinants of health (SDOH) play a role in the risk for dementia in two ways. First, certain SDOH may be direct risk factors for dementia. Second, SDOH contribute to the prevalence of many modifiable risk factors that in turn may elevate dementia risk – and act as barriers to addressing individually modifiable risk factors for dementia. To better understand how SDOH affect the risk for dementia and the role public health has in addressing dementia-related SDOH, the Public Health Center of Excellence on Dementia Risk Reduction (PHCOE-RR), in partnership with Wake Forest School of Medicine, recently synthesized the current state of the evidence. Following that synthesis, the PHCOE-RR conducted (1) a workshop where researchers and public health officials reviewed the science, and (2) a Public Health Roundtable where the public health community discussed the role of public health agencies in addressing dementia-related SDOH. This presentation will review the results of the evidence synthesis and discuss the work of the PHCOE-RR in helping state, local, and tribal public health agencies take action in their communities.
DELIVERING BRAIN HEALTH EQUITY TO COMMUNITIES CHALLENGED BY SDOH
Authors: Monroe Stephanie , Delgado Daphne , Mudrazija Stipica
Published: December 2023

Growing evidence suggests that dementia risk can be modified by brain healthy behaviors, including effective management of hypertension, diabetes, and obesity. In fact, the Lancet Commission released new research showing that managing a dozen risk factors could prevent or delay approximately 40 percent of worldwide dementia cases. Under-resourced communities are at a disadvantage in managing these risk factors however, due to systemic inequities in health and education, access to exercise opportunities, and to nutritious food. Social determinants of health (SDOH)—and policies that address them—must be part of the solution to ensuring better brain health for all American families. Ensuring that this hope and opportunity reaches all families regardless of zip code, income, race, or ethnicity will take greater commitment, investment, and strategies centered in health equity in public health and community-based initiatives. UsAgainstAlzheimer’s will share what they have done to a) identify, adapt, and disseminate tailored messages to minority-serving communities and b) better equip providers to establish trust and reach those they seek to serve by: 1) better understanding the barriers, opportunities and challenges to reach and build trust in historically underrepresented populations; (2) developing tools, strategies and messages that resonate with these populations; and (3) showing how place matters when it comes to implementing effective public health strategies.
CHALLENGES OF CONDUCTING COMMUNITY-ENGAGED RESEARCH AMONG JUSTICE-INVOLVED MID- AND LATE-LIFE ADULTS
Authors: Sneed Rodlescia
Published: December 2023

Formerly incarcerated mid and late-life adults exhibit high rates of chronic disease and disability; however, there is little attention to chronic physical health within programs designed to provide community reentry support. Healthy eating and physical activity are known to reduce chronic disease risk; yet existing physical activity and nutrition programs fail to address the needs of formerly incarcerated mid and late-life adults, who often experience housing insecurity, unemployment, low literacy, and limited access to healthy food. Through a partnership with a community-based reentry program, we designed a health and wellness program tailored to the needs of formerly incarcerated mid and late-adults that included group fitness instructor training, weekly nutrition/fitness classes, and peer coaching. Our team experienced numerous challenges in implementing this program, including low willingness of local community agencies to engage with justice-involved mid and late-life adults, competition with other reentry program activities, individual-level social factors that inhibited participation, and parole/probation restrictions that negatively impacted program attendance. In our session, we will describe how we engaged with a diverse range of partners to address these challenges to ensure program success. There are a number of barriers associated with conducting community-engaged research among formerly incarcerated mid and late-life adults. Our work to date will inform future engagement with this population.
SENSOR-ENHANCED CARE COORDINATION TO ADDRESS OLDER ADULT HEALTH: LESSONS FROM AN INTERDISCIPLINARY RESEARCH TEAM
Authors: Robinson Erin , Washington Karla
Published: December 2023

Researchers at the University of Missouri have a history of developing and testing aging in place (AIP) care coordination models for clinical translation. Vital to this work are in-home, residentially installed sensors to detect early illness and functional decline over time. While much smart home research is focused on older adults living in continuing care retirement communities, our team developed a novel sensor-enhanced care coordination approach for community-dwelling and disabled older adults as part of two ongoing, federally funded projects. For this symposium, we will highlight the Age-friendly Sustainable Smart and Equitable Technologies for Aging in Place (ASSETs for AIP) demonstration program, funded by the Department of Health and Human Services. Our first presentation will overview our interdisciplinary approach to creating this novel care coordination model, with specifics about research team composition, population focus, and methods. Our second presentation will highlight recruitment strategies and share lessons learned from reaching and enrolling this population that often experience residential transitions. Our third presentation will overview the open-source smart home and consumer-grade technologies deployed in this work, and practical considerations for technology installation, support, and sustainability and clinical team training. Our symposium will close with a presentation of selected client case studies that illustrate how clinical care coordinators use sensor data to remotely monitor and empower older adults for behavior change via telehealth consultations. This symposium will help inform other care coordination research, particularly that which uses sensor technologies and telehealth to facilitate aging in place.
ADVANCING ADOPTION AND SUSTAINABILITY OF AGE-FRIENDLY INITIATIVES THROUGH SYNERGIES AND IMPLEMENTATION SCIENCE
Authors: Kennedy Teri
Published: December 2023

For communities interested in adopting age-friendly principles, the plethora of age-friendly initiatives (i.e., age-, disability-, and dementia-friendly cities and communities; age-friendly universities, health systems, and public health systems) can be overwhelming. For rural, frontier, underserved, and under-resourced communities, it can be challenging to consider tackling even one such initiative. A major barrier to implementation is the know-do gap between what is known and what gets accomplished in practice. This gap is widened as a result of overly complex models and practices that are difficult to disseminate and scale, difficult to reproduce, or do not apply across settings. The know-do gap can be effectively bridged by focusing on core features common across age-friendly ecosystem initiatives. To successfully advance this work, it is important to consider strategies to maximize the collective impact of age-friendly initiatives and explore opportunities to tailor these initiatives so they can be successfully adapted for and adopted by various settings, contexts, and populations. Using an implementation science approach, three models will be introduced (Strengths-Based Interprofessional Practice and Education (SB-IPE); Micro-, Meso-, Macro- M3: Aligning Your Nexus Through a Systems Lens; and Kennedy Model of Sustainability) to facilitate the adoption and sustainability of evidence-based age-friendly principles, programs, and policies.
DETERMINANTS OF ALZHEIMER’S DISEASE AND RELATED DEMENTIA RISK IN OLDER BLACK MEN
Authors: Esiaka Darlingtina
Published: December 2023

Beyond biological determinants of Alzheimer’s disease and related dementias (ADRD), extensive literature also suggests a role for sociocultural determinants—including race, ethnicity, education, neighborhood, and economic environment—in modulating cognitive outcomes. In recent years, research examining sociodemographic disparities in ADRD incidence points to modifiable mechanisms. Important for more personalized dementia prevention is the focus on how social determinants of health interact with lifestyle factors to put people at risk of developing ADRD. However, a historical challenge to research on dementia disparities and prevention relates to stark underrepresentation of Black individuals, particularly Black men. Therefore, this within-group study utilizes data from older Black men to examine social determinants (e.g., neighborhood, home environment, social cohesion), lifestyle factors (e.g., sleep, diet, drinking), and their impact on neurocognitive domains linked to ADRD. Results from 178 Black men, age 70+, from the 2021 National Health and Aging Trends Study show lower presence of neighborhood physical disorders such as vandalism (B=.064, p=0.035) and better sleep quality (B=.022, p=0.036) were associated with better performance on executive functioning tasks. Additionally, ongoing primary data collection (N=100 Black men, age 60+) supports these findings and provides additional insights toward identifying and validating risk/protective factors that predict cognitive outcomes very early in the cognitive aging process among Black men. This work represents a necessary step toward a better understanding of heightened ADRD risk in this understudied group. Results can be used to guide tailored interventions likely to be most effective for mitigating risk and slowing progression in Black men.