bluuebunny/crossref_metadata_2025 huggingface dataset:
NIGHTTIME AMBIENT TEMPERATURE AND SLEEP IN OLDER ADULTS
Authors: Baniassadi Amir , Yu Wanting , Travison Thomas , Lipsitz Lewis , Manor Brad
Published: January 2025

Background

Sleep quality is a key contributor to overall health and wellbeing in older adults. While lab-based studies demonstrate that changes in ambient temperature influence sleep quality and duration, our understanding of these associations in older adults’ own home, where they have some degree of control over the temperature, is limited.

Aim

To examine the relationships between bedroom ambient temperature and outcomes related to sleep in community dwelling older adults.

Methods

In this longitudinal observational study, we monitored 50 older adults (average age=79 ±7.2y, 41 females) living in Boston, for 18 months. We used wearable sleep monitors and environmental sensors to measure sleep duration, and efficiency (ratio of time spent asleep to time spent in bed) along with bedroom temperature and humidity.

Results

Sleep was most efficient when the nighttime ambient temperature was between 20-24˚C, with a clinically relevant 5-10% drop in sleep efficiency when the temperature increased beyond this range by 5 ˚C. The associations were primarily nonlinear, with significant between-subject variations.

Discussion

Sleep disturbances and difficulties falling asleep are common in older adults, often without undiagnosed underlying conditions. Our study identifies bedroom temperature as a crucial regulator of sleep even within home where the individual can control the temperature. This highlights the potential impact of climate change on sleep in older adults, especially those of lower socioeconomic status. Furthermore, our findings suggest that optimizing bedroom temperature can enhance sleep quality in older adults and emphasize the importance of personalized temperature adjustments based on individual needs and circumstances.
TRAJECTORIES OF SOCIAL SUPPORT AMONG FAMILY CAREGIVERS: THE ROLE OF PSYCHOLOGICAL RESILIENCE
Authors: Lim-Soh Jeremy , Ping Yongjing , Quach Ha-Linh , Ang Shannon , Malhotra Rahul
Published: January 2025

Social support has been widely acknowledged as an important factor impacting family caregivers’ outcomes including burden and depression. However, research focused on social support as an independent factor, and how it changes over time, is limited. This study is the first to describe heterogeneous trajectories (patterns of change over time) in perceived social support among family caregivers of older adults. It also investigates if caregiver psychological resilience influences these trajectories. This study draws on a longitudinal survey of 278 Singaporean family caregivers of community-dwelling older adults aged 75 years and above with activities of daily living limitations. Caregivers were interviewed up to four times across two years. Perceived social support and psychological resilience were measured by Pearlin’s and Connor-Davidson’s scales respectively. We applied Group-Based Trajectory Modeling, an approach that is sensitive to within-population heterogeneity, to describe change over time in perceived social support. We modeled psychological resilience as a time-varying covariate in the model. Five distinct trajectories of perceived social support were identified, with three stable trajectories (91% of caregivers) and two declining trajectories (9%). Psychological resilience was positively associated with perceived social support only in the stable trajectories. While most family caregivers of older adults may experience stable perceived social support over time, a minority do report declining perceived social support. Further investigation is needed to understand the reasons for this decline and design effective interventions targeting this vulnerable group.
JOINT TRAJECTORIES OF CAREGIVING BURDEN AND BENEFITS AMONG FAMILY CAREGIVERS OF OLDER ADULTS
Authors: Ping Yongjing , Lim-Soh Jeremy , Østbye Truls , Malhotra Rahul
Published: January 2025

Caregiving is often associated with burden, but it can also benefit family caregivers. While the two phenomena can co-exist, existing studies have largely considered the two separately. Studies considering the two together are mostly cross-sectional, even though caregiving is dynamic over time, requiring longitudinal study. It is also important to understand the heterogeneity in the joint (co-existing) trajectories (patterns over time) of caregiving burden and benefits as it can help identify family caregivers who are continuously vulnerable and determine modifiable factors linked with detrimental trajectories. We conducted group-based multi-trajectory modelling on longitudinal data – collected at four time-points, at six-to-twelve-month intervals – on burden (negative domains of modified Caregiver Reaction Assessment) and benefits (short Positive Aspects of Caregiving scale) from 274 family caregivers in Singapore. We identified four trajectory groups, each with distinct joint trajectories of burden and benefits – “balanced” (44.5%, least burden and relatively high benefits), “satisfied” (23.0%, second lowest burden and highest benefits), “dissatisfied” (19.0%, second highest burden and least benefits), and “intensive” (13.5%, highest burden and relatively high benefits). Relative to caregivers in the “balanced” group, those supported by trained migrant domestic workers were less likely to be in the other three groups and those more prepared for caregiving were more likely to be in the “satisfied” group. The findings highlight the heterogeneity in the caregiving experience over time and suggest that promoting migrant domestic worker training and family caregiver preparedness for caregiving may contribute to advantageous patterns of burden and benefits of caregiving over time.
HEALTH PRIORITIES IDENTIFICATION FOR INDIVIDUALS LIVING WITH DEMENTIA AND THEIR CAREGIVERS
Authors: Banks Jack , Blaum Caroline
Published: January 2025

“What matters” is the foundation for the Age-Friendly Health System Initiative and yet many clinicians have a difficult time addressing it with their patients. Patient Priorities Care (PPC) is an evidence-based approach that identifies health priorities by first eliciting health values of older adults with multiple chronic conditions, integrating values into health outcome goals, and describing the one-thing to focus on. Clinicians’ then consider patients’ conditions and current treatments to identify care options that align with the identified health priorities. Furthermore, care of persons living with dementia (PlwD) involves care partners, thus identifying what matters most to PlwD is dyadic in nature. Recent studies have examined dyadic decision-making using the PPC approach with PlwD and their care partners. This symposium will present results from three studies that use PPC across diverse cultural and clinical contexts and discuss the role of PPC to achieve better dementia care. The first presentation will describe how clinicians consider health priorities with dyads facing dementia and discuss how health priorities identification can help care partners become better decision makers for their family members with dementia and multimorbidity. The second presentation will describe the cultural adaptation process of the PPC approach for older Hispanics with multimorbidity and dementia. The third presentation will describe how PPC facilitates deprescribing among older adults with multimorbidity and dementia. The panel will provide suggestions on how to better identify health priorities with PlwD and their care partners and share resources to facilitate the adoption and implementation of PPC with these dyads.
PRIORITIES ALIGNED DEPRESCRIBING FOR PERSONS LIVING WITH DEMENTIA AND THEIR CARE PARTNERS
Authors: Naik Aanand
Published: January 2025

PlwD average 8 daily medications compared to 3 for persons without dementia. PlwD have high polypharmacy burden from anticholinergic and psychotropic medications. PlwD, their care partners and clinicians endure the workload of managing multiple medications, and want to decrease this burden. Thus, a shift that reduces polypharmacy, and focuses medication use on what matters most is needed. Deprescribing is an approach to reduce polypharmacy for PlwD. However, deprescribing studies for PlwD have a narrow scope. Few studies place deprescribing within ambulatory care contexts for patients with mild to moderate dementia. Appropriate deprescribing in dementia requires identifying health priorities. Deprescribing is most appropriate when guided by priorities of patients and care partners. Patient Priorities Care (PPC) is an evidence-based approach to health priorities aligned decision making. We found evidence that PPC facilitates deprescribing by identifying health priorities that are misaligned with current medications. When used in the care of PlwD and their care partners, PPC could facilitate deprescribing. Less is known about how PPC works in the triadic context of clinician, care partner, and PlwD. Care partners may have concerns about stopping medications considered inappropriate such meds help manage symptoms. Clinicians may focus on cognitive and functional harms of medications without considering tradeoffs of stopping medications. Without eliciting priorities, families and care partners of PlwD may make decisions to stop medication without communication with their clinicians. We recently completed a study using PPC to deprescribe unnecessary medications among PlwD. We will discuss our findings and the implications for future work.
ADVANCING GLOBAL HEALTHY AGING: MY JOURNEY IN GERONTOLOGICAL RESEARCH
Authors: Wu Bei
Published: January 2025

In this presentation, Dr. Bei Wu will reflect on her over three-decade-long career as a gerontologist, exploring how her personal history, educational background, and professional experiences have informed and developed her program of research, focusing on her efforts to advance global healthy aging. Dr. Wu intends to highlight key findings from her research. She will discuss the pivotal role of secondary data analyses as a means to investigate the complex relationships between oral health, cognitive decline, and systemic health. Moreover, she will elaborate on the development of behavioral interventions aimed at improving oral health for individuals with cognitive impairment. She will also address her contributions to the establishment of NIH-funded centers aimed at mitigating health disparities and enhancing equity among older Asian Americans. Lastly, Dr. Wu will explore the policy and clinical ramifications derived from these findings, highlighting their potential to shape future approaches to gerontological care.
MITIGATING SOCIAL ISOLATION AND LONELINESS AMONG OLDER ADULTS
Authors: Yow W Quin
Published: January 2025

Approximately 24% of older adults in the US experience social isolation, a condition linked to numerous physical and mental health issues, including stroke and cognitive decline. However, there is a lack of research in the assessment and intervention of social isolation and loneliness within older populations at the community level. This symposium seeks to address this gap by examining current research progress in assessment and intervention strategies for combating social isolation and loneliness among older adults. Paper 1 explores factors influencing healthcare providers’ comfort levels in screening for social isolation. The author found that important factors include effective communication, interaction, and minority status. Paper 2 evaluates the community-based project “Waigaya project” in suburban Japan aimed at fostering connections among older residents. The project shows effectiveness in addressing social isolation and loneliness among suburban residents. Paper 3 presents survey findings on the impact of online connections in alleviating loneliness among older adults, emphasizing the importance of fostering quality interactions within digital communities. Finally, Paper 4 explores the use of AI-driven conversation agents to encourage social engagement among older adults to combat social isolation and loneliness. They will also present findings from a preliminary study on conversation topics among older adult friends, guiding the chatbot development. The symposium aims to enhance participants’ understanding of two key areas: factors to consider and strategies for implementing community-level screening and interventions targeting social isolation and loneliness among older adults, and the feasibility of leveraging technology to address social isolation and loneliness in older adults.
NAVIGATING SOCIAL ISOLATION SCREENING: EXPLORING HEALTH CARE PROVIDER COMFORT FACTORS
Authors: Hou Su-I
Published: January 2025

Purpose

This study investigates factors influencing healthcare providers’ comfort levels in screening older patients for social isolation (SI), a significant risk factor for negative health outcomes in this demographic.

Methods

A diverse sample of 59 providers from healthcare and long-term care settings participated. The mean age of providers was 46, 70% female, and 67% white, possessing an average of 17 years of practice experience. The study utilized research-tested scales measuring provider SI screening comfort level, communication about SI, provider-patient interactions (PPI), provider trust in patients (trust), and cultural sensitivity (CS), showing high internal consistencies.

Results

Providers generally scored high on PPI and CS, and moderately on patient trust and comfort with SI screening. Regression analyses considering all factors revealed that providers with higher scores in communication about social isolation (p=.024), patient-provider interaction (p=.022), and those identifying as minority providers (p=.025) demonstrated greater comfort in screening for social isolation (F(6,32)=3.93, p=.005), explaining a substantial 42.4% of the variance. Gender, patient trust, and cultural sensitivity did not reveal a significant impact on the comfort level associated with screening for social isolation (SI).

Discussion

This study suggests that effective communication and interaction, along with demographic factors like minority status, influence providers’ comfort levels in screening for SI. This pilot study demonstrates the reliability of measures, emphasizing the importance of modifiable communication and interaction factors in addressing social determinants of health, such as social isolation in older adults. Further research with a larger sample is recommended.
OUTCOMES FOR AN INTERGENERATIONAL TECHNOLOGY PROGRAM: A PRE–POST WITH WAITLIST CONTROL STUDY
Authors: Colvin Meaghan , Leedahl Skye , Tsotsoros Cindy , Brasher Melanie , Barbera Gina , Santilli Josie
Published: January 2025

The quickly growing population of older adults in the United States combined with an increasingly digital society post-pandemic has illuminated the digital divide in recent years. The digital divide contributes to social isolation and therefore decreased quality of life in older adults, and intergenerational programming has demonstrated potential to bridge this equity gap and keep older adults involved and productive in their communities and larger society. To expand the literature and enhance the rigor of the research design in intergenerational programming, this study utilized a waitlist control design to strengthen outcomes from the University of Rhode Island Engaging Generations Cyber-Seniors Program on measures of technology use, digital competence, loneliness, social isolation, and quality of life. For this design, data was gathered at time 1 (6 weeks before the program), time 2 (2 weeks before the program), and time 3 (after participation in the program). Repeated measures ANOVA was used to examine changes across time points. Implementing a waitlist control design enabled us to examine natural changes that occurred in the measures compared to after program participation. Results showed that the program likely impacted tablet use, digital competence, and social isolation but that loneliness was impacted due to pre-program activities, such as the interview. These findings strengthen the previous research in understanding the specific aspects of social well-being that the program influences. This methodology was a practical way to utilize an already existing waitlist to enhance the rigor of evaluation research methods used.
FALL RISK FACTOR SCREENING AND MANAGEMENT USING VIRTUAL PLATFORMS, PREVALENCE, AND PERCEPTIONS
Authors: Garbin Alexander
Published: January 2025

Numerous barriers limit comprehensive assessment and management of fall risk factors within primary care including limited time and competing medical priorities. Virtual platforms provide an opportunity outside of primary care to remotely screen fall risk factors and deliver fall prevention interventions. However, researchers and clinicians may be hesitant to assess and intervene on multifactorial fall risk factors through virtual platforms due to perceived safety concerns, difficulty adapting outcome measures to a virtual environment, and potential technological challenges. This presentation will detail strategies and results from a study examining the prevalence of falls, fall risk, and multifactorial fall risk factors in older Veterans seen within Veterans Health Administration (VHA) primary care using a virtual platform (VA Video Connect). Fall risk factor measurements discussed will include the 5 Times Sit to Stand, the Survey of Activities and Fear of Falling in the Elderly, the Home Falls and Accidents Screening Tool, and the Screening Tool of Older Persons Prescriptions in older adults with high fall risk. Results from semi-structured interviews with Veterans and VHA primary care providers will also be discussed with an emphasis on Veterans’ and providers’ experiences with fall risk factor assessment and management within VHA primary care as well as their perceptions of using telehealth for identifying and managing fall risk factors. Together, this presentation will provide insight on the potential for using virtual platforms to assess multifactorial fall risk factors as well as the perceived barriers and facilitators of identifying and managing fall risk factors in a virtual setting.
FORTIFYING SCHOLARSHIP IN THE PUBLIC INTEREST: AN EXAMINATION OF THE MARGINALIZATION OF DRAG ARTISTS
Authors: Holley Lyn , Hites Kenneth
Published: January 2025

Over 14 states have passed or are considering legislation that severely restricts and criminalizes public drag performances. Some bills erroneously label the artistry as “adult cabaret performances” thus, conflating them with nude performances. The Americans Civil Liberties Union, Movement Advancement Project, and other organizations have declared a state of emergency due to this endangerment of constitutionally protected individual human rights. 7.2 to 8 % of the U.S. adult population identifies as sexual and gender minorities (SGM) (HRC, 2021, Gallup,2023). Drag artists are a smaller population within SGM communities and it is believed that the language of anti-drag legislation is designed to also oppress transgender individuals (a separate SGM community). Overall, 2024 has seen 478 anti-LGBTQ bills, 21 of which are drag-specific Several prominent scholars (e.g., Steven Miller of Clemson) have called attention to the similarity between these attacks and the process of “othering” used by Hitler to create public acceptance of annihilation of Jews, the disabled, sexual and gender minorities and ultimately, members of any politically or economically inconvenient group (e.g., older, retired adults). This individual presentation provides a framework to guide scholarly observation and understanding of the current attacks and clarifies the relevant contributions that only scholars can make to produce scientifically valid information and knowledge about Drag Artists and their social and economic impacts on USA society and the economy, thereby strengthening and informing decisions about laws and policy that govern individual freedom of expression.
WE’RE ALL BORN NAKED AND THE REST IS DRAG: EXPLORING DRAMA THERAPY WITH AGING DRAG ARTISTS
Authors: Hafner Camryn , Ortiz Jahmar
Published: January 2025

Due to barriers of mental health stigma, limited accessibility, and ageism, older adults are severely underrepresented among those currently engaging in mental health treatment (Saunders et al., 2021). For older drag artists, additional barriers exist in the lineage of invalidation, pathologization, and discrimination which Western psychology and mental health systems have traditionally afforded gender-expansive individuals (Brewster et al., 2019). Drag artistry itself has been found to offer many salutary functions, including providing a sense of freedom and empowerment, fostering resilience through creative achievement and social support, facilitating catharsis, and/or releasing negative emotions (Knutson et al., 2018; Knutson et al., 2023). However, concerns of depression, substance abuse, stressors, and experiences of discrimination among drag artists represent continued need for inclusive, strengths-based mental health care (Knutson & Koch, 2019; Knutson et al., 2018; Knutson et al., 2023; Tillewein & Kruse-Diehr, 2021). Expressive therapies such as drama therapy and psychodrama may be well-suited to engaging with and enhancing the therapeutic potential of drag art (Nakai & Martinez Di-Carlo, 2024; Soubosky, 2021). This presentation details the findings of an exploratory study examining the coping mechanisms of drag artists (n = 5) through the lens of a drama therapy clinical assessment (Ortiz, 2024). Building upon evidence-based treatment protocols (e.g., Keisari, 2021; Lahad et al., 2013), presenters also consider best practices and implications for the treatment of aging drag artists in drama therapy.
INFLUENCE OF HEALTH CARE PROFESSIONALS ON END-OF-LIFE AND PLACE OF DEATH: A LATENT CLASS ANALYSIS
Authors: Decker Autumn , Weaver Raven , Bolkan Cory , Cooper Brittany
Published: January 2025

People experience end-of-life (EOL) differently due to unique lived experience and sociopolitical position. Most people prefer to die at home, and evidence suggests that healthcare providers have a role to play in fostering a positive EOL experience. This study aimed to understand classes of healthcare provider involvement in the EOL experience and examine the association between class membership and place of death by living alone, race, and/or geographic location. We conducted a latent class analysis with covariates and a distal outcome using Waves 9-12 (n=1290) from the last month of life interview in the National Health and Aging Trends Study. Based on fit statistics, response probabilities, and class separation, a four-class model was selected. These classes were Discordant Death (DD), Controlled Death (CD), Harmonious Death, and Comforted Death. Living alone (p <.001), being White (p =.015) or Black (p =.047), and living in the Northeast (p =.015) or Midwest (p =.039) were significantly associated with latent class membership. Those living alone and in the DD class were most likely to die in a location outside the home, Black individuals in the CD class were most likely to die in a hospital, and those living in the Northwest and in the CD class had the highest probability of dying at home. This work demonstrates that health provider factors have influence over the experiences one has at EOL, and ultimately, their place of death. Future research should explore concordance between EOL wishes and the EOL experience.
TRENDS IN MEDICARE BENEFICIARY PAYMENTS FOR NONHOSPICE SERVICES DURING HOSPICE ELECTIONS
Authors: Christian Thomas , Plotzke Michael
Published: January 2025

Hospice election marks a shift towards palliative objectives, although beneficiaries retain curative coverage for unrelated (non-terminal) conditions. Little is known about beneficiary cost sharing for these services. Using Federal Fiscal Year (FY) 2022 Medicare claims, we cross-referenced beneficiaries’ hospice and non-hospice services claims’ dates. For overlapping claims, we totaled beneficiaries’ liability payments (coinsurance and deductibles) by year, claim type, and ICD-10 code. We used linear regression analysis to assess trends with beneficiary and hospice characteristics. We also compared beneficiary payments to Consumer Assessment of Healthcare Providers & Systems (CAHPS) Hospice score star ratings. In FY2022, Medicare paid $931.1 million for non-hospice services during hospice election, for which beneficiaries were collectively billed $206.8 million (18.2%), with 45.0% of hospice beneficiaries paying some amount. The majority was for services on or after the 60th day from hospice admission. Part B accounted for most (88.9%) of the total beneficiary payments. Pressure ulcers, end stage renal disease, hypertension, and COVID-19 were associated with the greatest payment amounts. Beneficiary payments were largest among beneficiaries black or Hispanic, or younger, or terminal heart disease, or dual-eligible for Medicaid, or in a nursing facility, or from a newer, for-profit, or southern hospice. Daily payment rates were $0.32 at the 10th percentile and $3.31 at the 90th percentile. Daily payment rates were $2.17 at CAHPS one-star hospices vs. $1.00 at five-star hospices. CMS should monitor these trends to ensure that vulnerable beneficiaries are not unfairly impacted and evaluate whether beneficiary payments are a useful hospice quality indicator.
EXPERIENCES WITH AND PREPAREDNESS FOR CLIMATE EMERGENCIES IN OREGON ASSISTED LIVING COMMUNITIES
Authors: Kohon Jacklyn , Himes Dani , Carder Paula , Tunalilar Ozcan
Published: January 2025

Assisted living communities in the U.S. provide housing and care services to a sizable share of older adults and people with disabilities (over 900,000 individuals). The recent increase in climate-related emergencies has underscored the need for these communities to have preparedness measures in place to protect residents and staff. State agencies require preparedness plans, but these plans cannot anticipate all events. Oregon presents an important case study as a pioneer state in community-based care as well as with recent experience in various natural disasters. We interviewed administrators and management company operators (n=14), surveyed 140 direct care workers, and conducted focus groups with direct care workers (n=23) to learn about experiences during recent extreme heat events, wildfires, and ice storms. Thematic analysis revealed several themes related to the existing strengths and challenges in the current systems in place for responding to these emergencies. Strengths included an “all hands on deck” approach demonstrating teamwork among frontline workers, a commitment to show up for the residents in all conditions, and improved relationships with emergency management offices. Challenges included power and internet outage-related interruptions in technology for basic care delivery, insufficient plans for evacuation of residents with complex needs, increased staff injury, and lack of safe transportation. Our findings identify several opportunities and caution against pitfalls for regulators and policymakers in maintaining an acceptable level of emergency preparedness in AL settings.
WE CANNOT WALK THERE ANYMORE: EXPERIENCES OF URBAN STRESS IN AGE-FRIENDLY ENVIRONMENTS
Authors: Maulod Ad , Ravindran Malcolm , Wong Yunjie
Published: January 2025

Urban stress, or tension attributed to city living, is often experienced by individuals in urban areas due to environmental and social stressors. The life-space framework assesses older persons’ mobility based on the extent of movement within their environment while engaging in activities, and whether assistance is required for said movement. Chronic exposure to urban stress affects older persons’ life-space, and is associated with reduced quality of life. Yet, the connection between urban stress and life-space has not been fully explored in the existing literature. Singapore is the third most densely populated city in the world, ranking highly in terms of liveability. However, the country also undergoes frequent redevelopment, which presents a source of urban stress for older Singaporeans who must continually adapt to changing and unfamiliar landscapes. This presentation draws from ‘go-along’ and in-depth interviews with 60 older Singaporeans. Findings highlight challenges in the lived environment and the difficulties individuals experience travelling to places and activities that are important to their well-being. Despite the emphasis on developing age-friendly infrastructure in Singapore, incompatible person-environment fit was evident among participants who struggle with accessibility, wayfinding, social exclusion, heat and poor home ventilation, care options, and lack of choices in living situations. These issues limit older persons’ life-space capacities and hinders aspirations to age well. Policies promoting ageing-in-place must (i) consider multi-level, intersectional factors comprising built environments, individual resources and social contexts that may mitigate frailty and urban stress, and (ii) involve older persons in designing environments which promote autonomy and belonging.
THE LONG-TERM EFFECTS OF AIR POLLUTION ON ELDERLY HEALTH: AN EMPIRICAL STUDY FROM CHINA
Authors: Tang Xiaotong , Mi Hong
Published: January 2025

Healthy elderly individuals are assets to families, communities, and the economic development. Identifying and quantifying long-term effects of environmental factors on elderly health could bring new evidence and policy insights for optimizing pollution response, promoting healthy aging, and unlocking a second demographic dividend. This paper matches city air pollution data from 2003 to 2020 with individual data taken from the China Health and Retirement Longitudinal Study (CHARLS) for the years 2013 to 2020. By utilizing changes in wind direction as instrumental variables, it identifies the long-term health impact of average PM2.5 pollutant concentration on China’s elderly population over 1-10 years. The study finds: (1) Air pollution has a significant long-term negative impact on the health level of China’s elderly population. A 10-year average increase of 1μg/m3 in PM2.5 concentration is associated with a 19% increase in the number of chronic diseases, which exhibits a nonlinear trend. (2) Air pollution has a greater long-term impact on women aged 55-65, population of Northern China, and groups with lower levels of education and consumption. (3) Individuals’ avoidance behavior towards air pollution introduces bias in the basic linear regression results, and the negative health impact of long-term exposure to air pollution on the elderly is greater than that of short-term exposure. This paper provides new empirical evidence on the long-term health impacts of air pollution, while offering policy implications for further optimizing response to air pollution and improving the human capital level of the elderly population from an environmental governance perspective.
INTERCONNECTIONS BETWEEN COGNITION, SKELETAL MUSCLES, AND PHYSICAL FUNCTION IN ETHNICALLY DIVERSE COHORTS
Authors: Rosano Caterina , Kritchevsky Stephen , Coen Paul
Published: January 2025

There is marked variability in mobility function at older ages, yet some maintain high functioning even in the face of adverse locomotor risk factors. The mechanisms underlying this resilience remain elusive, but it is clear that the central nervous system plays an important role. Recent findings have shed light on the interconnected biological processes involving muscle-brain cross-talk, albeit primarily in animal models and specific patient populations with muscle degeneration. The extent and nature of such cross-talk in older adult populations remain debated. This symposium aims to advance our understanding of brain-muscle interactions by delving into this emerging concept. Comprising four talks, the symposium will explore various facets of muscle health across diverse cohorts of older adults in the United States. Topics include the structure of the associations between measures of cognitive and physical functions in 3 studies (SOMMA, B-NET and Dunedin), the role of muscle mitochondrial function in the SOMMA study, and the role of intermuscular adiposity in skeletal muscles in the MESA and CARDIA studies. These observations suggest distinctive modulatory and adaptive capacities of the central nervous and musculoskeletal systems may offer insights into understanding the origins of mobility resilience by facilitating adaptation and compensation. This conceptual framework holds potential for identifying innovative multi-systemic interventions aimed at enhancing mobility resilience in older adults.
INTRINSIC PACE: PATTERNS OF ASSOCIATION BETWEEN PHYSICAL AND COGNITIVE FUNCTION ACROSS THREE COHORTS
Authors: Kritchevsky Stephen , Cawthon Peggy , Johnson Eileen , Moffitt Terrie , Thompson Atalie , Xie Kathy , Miller Michael
Published: January 2025

Physical and cognitive function are fundamental aging concepts. However, our understanding of their connection is limited by past work using few assessments or limited age ranges. We used canonical correlation to study the structure of associations between large sets of physical and cognitive assessments in two studies of adults age ≥70; the B-NET (Brain Networks and Mobility Function) study (N=192; 6 physical measures and 13 cognitive measures), and SOMMA (the Study of Muscle, Mobility and Aging) (N=879; 9 physical and 6 cognitive measures). In B-NET and SOMMA, the first canonical function explained 26% and 25% of the shared variability between the two measure sets. In both studies, ONLY TIMED assessments (e.g. stair climb time, gait speed (4M and 400M), chair stand pace, digit symbol coding, and trail-making test-B) strongly loaded on the first function. We sought to replicate this finding in the Dunedin Study (N=1037), a cohort of residents born in 1972-73 who completed 6 physical and 12 cognitive measures when participants were 45.We observed that the timed measures had the strongest associations across physical and cognitive domains. For example, WAIS Processing Speed was most strongly correlated with chair stand time (r=.25) and gait velocity over 6M (r=.26). In contrast, untimed physical tests were at best weakly correlated with untimed cognitive tests. For example, grip strength was most highly correlated with WAIS Working Memory, r=.15. Together, these three studies confirm the presence of a previously unidentified construct connecting physical and cognitive function, which we have tentatively named ‘intrinsic pace’.
LGBTQIA+ OLDER ADULTS’ NEEDS, CONCERNS, AND EXPERIENCES IN HEALTH CARE: INCLUSIVITY, CAREGIVING, AND VISIBILITY
Authors: Valenti Korijna , Bybee Sara
Published: January 2025

LGBTQIA+ aging research requires in-depth examination of experiences around discrimination, inclusivity, and communication in healthcare to better understand the distinct needs of diverse subgroups, including people living in long-term care (LTC) facilities, living with neurodegenerative illnesses, and caregivers. LGBTQIA+ older adults not only have diverse life experiences but also specific needs regarding advocacy, policy, and healthcare support and resources. This symposium includes findings from four distinct areas of study. Valenti and colleagues examined perspectives of 20 palliative-cared trained clinicians to better understand their experiences with LGBTQI+ patients living with serious illness and their chosen care partners, exploring issues around communication, collection of SOGI data, and inclusivity. In a study with LTC administrators in Minnesota, Wright and colleagues examined issues around identifying LGBTQIA+ LTC residents, discrimination of residents (including residents living with cognitive impairment), and barriers around LGBTQIA+ inclusion in research. Stein and colleagues examined issues around discrimination in healthcare for LGBTQIA+ patients through Project Respect, a cross-sectional mixed methods study of 290 patients and partners which found high levels of disrespect and inadequate care. Flatt and colleagues provide insights from an analysis of two qualitative studies of AD/PD caregivers with a specific focus on identifying barriers to support, inclusion in research, and issues around personal and social needs. Presentations in this symposium illustrate how discrimination, inclusivity, and personal and social support inform the needs of LGBTQIA+ older adults living with serious illness, in LTC, and as caregivers as well as providing implications for future aging research and interventions in practice.
DYNAMICS OF SOCIAL ISOLATION IN A NATIONAL SAMPLE OF COMMUNITY-DWELLING OLDER ADULTS
Authors: Umoh Mfon , Pomeroy Mary Louise , Mueller Alexandra , Craig Taylor , Ornstein Katherine , Prichett Laura , Cudjoe Thomas
Published: January 2025

Social isolation is linked to adverse health outcomes; 25% of older adults in the United States are socially isolated. However, episodic social isolation may carry different implications for health outcomes compared to chronic social isolation. Many studies examine social isolation at a single point rather than considering it as a circumstance that is intermittent or persistent. This study examined social isolation dynamics in older adults using nationally representative cohort data from 11 rounds of the National Health and Aging Trends Study (N=6,913) to describe differences between older adults with chronic, intermittent, and no social isolation. Social isolation status was derived from points given for questions about living arrangement, core discussion network size on important matters, religious attendance, and social participation. Persistent social isolation was defined as social isolation during more than 50% of available rounds and intermittent social isolation as isolation in at least one round but less than 50% of rounds. The analytic sample had social isolation scores available for a median of four rounds (IQR 3,10; M = 5.28); 20% experienced persistent isolation, 27% experienced intermittent isolation. Demographic characteristics were compared using Chi-square tests and an alpha threshold of 0.05 with the never isolated group as reference. Age, education, income, difficulty with activities of daily living, dual eligibility (Medicare and Medicaid insurance), and dementia status at baseline were correlated with social isolation persistence. Identifying factors associated with the persistence of social isolation may guide the design of interventions targeted to prevent social isolation and its detrimental consequences.
THE EPIDEMIOLOGY OF SOCIAL ISOLATION AND LONELINESS OF FAMILY AND UNPAID CAREGIVERS OF OLDER ADULTS
Authors: Qian Yiqing , Pomeroy Mary Louise , Saylor Martha , Ornstein Katherine
Published: January 2025

The experience of caring for older relatives and friends can be socially isolating. Family and unpaid caregivers (“caregivers”) may encounter barriers to social participation (e.g., caregiving duties) and unmet needs in support. Given limited epidemiological evidence of social isolation (SI) and loneliness in this population in the U.S., we reported the prevalence and correlates of SI and loneliness in the National Study of Caregiving Round 12 (n=2,119). Most were females (62%), non-Hispanic white (69%), and had a high school education (91%). Most cared for a parent/parent-in-law (46%). Caregivers provided an average of 70 hours of care/month. On a 4-item SI scale ranging from 0 (high SI) to 4 (low SI), the mean score was 2.6. About 13% of caregivers were categorized as socially isolated. About 33% reported feeling lonely “some days,” “most days,” or “every day.” Logistic regression showed female caregivers (OR: 0.56[0.37,0.86]) and those with lower education levels (OR[college vs below high school]: 0.14[0.06,0.33]) were less likely to be socially isolated vs not isolated, controlling for other socio-demographic (e.g., age) and caregiving characteristics (e.g., hours). Adjusted ordinal logistic regression further showed SI levels among care recipients were associated with SI levels among caregivers (OR: 1.66[1.38,2.00]). Null associations were found in parallel analyses on loneliness. This study highlights the heterogeneity of SI among caregivers of older adults and the necessity of examining the shared experiences with care recipients. More comprehensive loneliness instruments in public health surveillance may advance the understanding of experiences and impacts of SI and loneliness in caregiving.
BIRTH COHORT DIFFERENCES IN BURDEN OF MULTIMORBIDITY OVER TIME AMONG CHINESE OLDEST-OLD ADULTS
Authors: Zhu Junmin , Wu Yafei , Duan Siyu , Fang Ya
Published: January 2025

Objective

Multimorbidity has significantly burdened healthcare systems worldwide. Understanding the longitudinal changes of multimorbidity over time among the oldest-old adults is necessary but limited. This study aimed to investigate the birth cohort effects on multimorbidity burden among Chinese oldest-old adults and compare the differences across two decades of longitudinal surveys.

Methods

Data from the Chinese Longitudinal Healthy Longevity and Happy Family Study were utilized. Due to the high mortality and attrition rates in the oldest-old adults, we included 2603 and 2404 participants aged 80 and older in 1998 and 2008 surveys, respectively, with each survey followed up for a decade of repeated assessment. The burden of multimorbidity, defined as the presence of 12 chronic health conditions, was analyzed. The generalized linear mixed models were employed to evaluate the birth cohort effects. Additionally, we analyzed the impact of demographic, lifestyle, and socioeconomic factors on the burden of multimorbidity.

Results

In the 1998 longitudinal survey, the earlier birth cohorts had a higher multimorbidity burden over time than those born later (β = 1.217-1.335). Conversely, in the 2008 longitudinal survey, the older birth cohorts showed a lower multimorbidity burden over time (β = 0.631-0.777). The burden of multimorbidity was influenced by gender (female), residence (urban), region (eastern of China), and smoking history.

Conclusion

Our findings revealed that the higher burden of multimorbidity among the Chinese oldest-old individuals has shifted from the older birth cohorts to the more recent ones, highlighting the urgent need for comprehensive policies promoting healthy ageing and early intervention measures.
SOCIAL ISOLATION, LONELINESS, AND THE LIVING ARRANGEMENTS AND CONTEXTS OF OLDER ADULTS
Authors: Mauldin Rebecca , Li Lydia
Published: January 2025

Many older adults and their caregivers are at risk for social isolation and loneliness, which carry substantial adverse effects for health and well-being. Researchers and practitioners recognize the need for tailored interventions to address the unique circumstances of individuals and groups experiencing social isolation and loneliness. One factor that should be considered is living arrangements (e.g., living alone or in residential care settings) or living contexts such as neighborhood environment. The papers presented in this symposium seek to advance research related to the role of living arrangements or contexts on the social isolation and loneliness of older adults. The first paper examines older adults living alone and without care partners with a scoping review related to their risks and vulnerabilities, the adverse consequences of this living situation; and related interventions. The second paper focuses on the social networks of older adults in an assisted living community and presents quasi-experimental findings of network changes associated with online nature-based group activity programming in assisted living. The third paper examines the role of perceived neighborhood disorder and social support in caregivers’ loneliness using data from the Health and Retirement Study to identify the association between neighborhood stressors, social support, and loneliness. The final paper presents findings from a mixed methods study examining the relationship between loneliness, living arrangements, and social support among caregivers of persons living with dementia. Overall, the symposium demonstrates ways in which living arrangements and contexts can be considered in research and practices with older adults and their caregivers.
MIDDLE-AGED AND OLDER CAREGIVERS’ LONELINESS AND NEIGHBORHOOD DISORDER: THE BUFFERING ROLE OF SOCIAL SUPPORT
Authors: Cho Seungjong
Published: January 2025

This presentation aims to explore the relationship between perceived neighborhood disorder and loneliness among middle-aged and older (age 50+) caregivers using the 2018 Health and Retirement Study (N = 578). It also identifies the role of social support as a buffer. The association between perceived neighborhood disorder, social support, and loneliness is an emerging area of research, especially for middle-aged and older caregivers. For statistical analysis, loneliness was measured as summed scores of 11 items asking how respondents felt about different aspects of their lives. Perceived neighborhood disorder was measured as summed scores of eight items of physical disorder and social disorder. Social support was measured as summed scores of 12 items asking about positive interactions with spouse/partner, children, relatives, and friends. A multiple regression model (Adjusted R-square =.296) showed that higher levels of perceived neighborhood disorder were associated with higher levels of loneliness (Beta =.222, p <.001). Social support had no significant buffering effect on this association (Beta = -.024, p =.495). However, social support itself was significantly associated with loneliness in an anticipated direction (Beta = -.400, p <.001). Among the covariates (gender, age, education, and self-rated health), only self-rated health was significantly related to loneliness (Beta = -.146, p <.001). This study highlights the importance of identifying and managing loneliness and neighborhood stressors among this unique population with the power of social support from their spouse/partner, children, relatives, and friends.
DESIGNING FOR LATER LIFE: SOCIO-GERONTOLOGICAL INSIGHTS IN CONVERSATIONS WITH AGE-TECH EXPERTS
Authors: Katz Stephen
Published: January 2025

This presentation summarizes original research data based on interview conversations with 11 international experts, consisting of designers, innovators and leaders in the gerontechnological field. Their experiences reveal important insights about the creation, production and distribution of care technologies for older adults, and how priorities are imagined for the future. Four main themes emerged from the research that point to a need for wider gerontological and sociological engagement. First, while the experts are aware of the increasing demand for technologies delivering monitoring, robotic, assistive, connective and mobility services, their socio-gerontological research about older adults on issues such as personal privacy is often limited. Second, the experts are challenged to recognize where ageist stereotypes of frailty and decline become scripted into their products. However, a clear protocol for avoiding negative imagery is not always available across age-tech enterprises, even as such imagery affects the appeal and promotion of their products. Third, the benefits of co-design and collaborate participation between designers and older users are not well understood, thus opportunities are lost to create age-friendly, affordable and livable products from the perspective of the users. Fourth, the conditions under which technologies become successful require the labor of care-givers, family members, residential staff and technical repair and maintenance technicians. Thus, understanding their roles should be an essential part of the design process. Conclusions advocate greater ties and co-learning amongst gerontologists, sociologists and age-tech experts, and attention to critical and grounded research on the material realities and challenges of technological adaptation for older adults.