bluuebunny/crossref_metadata_2025 huggingface dataset:
CUMULATIVE DIS/ADVANTAGE, COHORTS, AND ECONOMIC SHOCKS BEFORE AND AFTER: LIFE COURSE INEQUALITY AND THE RECESSION
Authors: Crystal Stephen , Zewde Naomi
Published: November 2019

We examined age/cohort profiles of income inequality in the Survey of Consumer Finances for 2007, 2010, and 2016. Overall, the Gini coefficient decreased somewhat following the 2008 onset of the Recession, but rebounded by 2016 to a higher level than the 2007 baseline. Within-cohort inequality trends from 2007-2016 differed considerably across cohorts. For late baby boomers and millennials, inequality increased sharply – from .56 to .67 for the 1963-1972 birth cohort and from .49 to .60 for the 1973-1982 birth cohort. Inequality was higher at baseline for early baby boomers than later cohorts but did not increase as they moved into midlife and early late life. The Great Recession, with its large drops in asset values, initially led to slight reductions in inequality, but this effect was temporary. Late boomers and millennials experienced sharp increases in inequality following the Recession, presaging a very high-inequality late-life experience for these cohorts.
BRAIN FUNCTIONAL CONNECTIVITY IN OLDER ADULTS WITH MCI: DO FALLS MATTER?
Authors: Egbert Anna R , Hsu Chun Liang , Crockett Rachel , Liu-Ambrose Teresa
Published: November 2019

Older adults with mild cognitive impairment (MCI) are at an elevated risk of falls. We conducted a pilot longitudinal observational study to examine the natural course of brain intrinsic functional connectivity (FC) and cognitive function changes in association to falling history in older adults with MCI. 15 MCI participants (mean age 75.9, range 67-86) included 10 non-fallers and 5 fallers (minimum two falls in the previous 12 months with one in the last 6 months) from Metro Vancouver, BC, Canada. At study entry and 1-year follow-up, participants completed brain scanning session of structural MRI and resting state (RS) functional MRI, the Montreal Cognitive Assessment (MoCA), and the Mini Mental State Examination (MMSE). Results indicated an interaction between time (baseline vs. follow-up) and falls history on RS-FC in individuals with MCI (p<0.001). At 1-year follow-up, MCI non-fallers showed increased FC between frontal, parietal and occipital cortex (from baseline R=0.141 to follow-up R=0.321) and lack of decline on cognitive measures. Meanwhile, MCI fallers showed weakening of FC between those brain regions (from baseline R=0.314 to follow-up R=0.201) with simultaneous cognitive deterioration. Significant relationships between FC strength and cognitive status existed only at follow-up (R=0.525, p<0.05), suggesting that the triggered functional compensatory brain mechanisms in MCI non-fallers are not successfully executed in MCI fallers. Together, our pilot data suggest that older adults with MCI who fall show more advanced brain functional degradation with adjacent cognitive decline as compared to MCI individuals who do not fall.
SATISFACTION WITH OUTDOOR ACTIVITIES AMONG LONG-TERM SERVICES AND SUPPORTS RECIPIENTS
Authors: Sefcik Justine S , Hirschman Karen , Petrovsky Darina V , Hodgson Nancy , Naylor Mary
Published: November 2019

Being outdoors in nature has been associated with improved mental and physical health. There are no known studies exploring older adults’ satisfaction with outdoor activities at the start of long-term services and supports (LTSS; in nursing homes, assisted living, or at home). We examined characteristics of older adults receiving LTSS and factors associated with outdoor activities satisfaction. A secondary analysis was conducted of baseline data involving structured interviews with older adults new to LTSS (Health-Related Quality of Life: Elders in Long-Term Care; R01AG025524-05). Primary outcome was a single item on the satisfaction with outdoor activities (not at all satisfied to extremely satisfied). We conducted multivariable linear regression models controlling for the influence of the characteristics important to health-related quality of life (LTSS setting, gender, age, number of comorbidities, and sensory impairment [vision/hearing].) Among 356 people, the majority (59%) were satisfied with their outdoor activities. Of 339 participants with complete data, more depressive symptoms (higher Geriatric Depression Score; p<.001) and higher cognitive functioning (higher MMSE score; p=.038) were associated with lower ratings of satisfaction with outdoor activities. Higher self-rated physical health (p=.038) and more independence with activities of daily living (p=.017) were associated with greater satisfaction with outdoor activities. Due to the cross-sectional nature of this study it is difficult to determine causality; however, outdoor activity is important to people receiving LTSS. Interdisciplinary teams can work with older adults receiving LTSS to assess interest level with outdoor activities and create a person-centered plan to increase outdoor activity and satisfaction levels.
TREATMENT WITH ANTIPSYCHOTICS AND RISK OF DEATH IN 58,000 PATIENTS FROM SWEDISH DEMENTIA REGISTRY
Authors: Religa Dorota , Schwertner Emilia , Garcia-ptacek sara , Johansson Bjorn , Nägga Katarina , Winblad Bengt , Eriksdotter Maria , Secnik Juraj
Published: November 2019

Background: Behavioral and Psychological symptoms of Dementia (BPSD) are a heterogeneous group of clinical phenomena that is subjectively experienced by the patient and/or observable by an examiner (e.g., caregiver, physician) consisting in disturbed emotions, perception, thought, motor activity, and altered personality. There are recommendations to limit antipsychotic use in patients with dementia, and the big educational effort is made to follow them. In Sweden antipsychotics use changed from 10.1% in 2007-2008 to 5.2% in 2014-2015. Aims: The aim of the study is to analyze the actors associated with treatment and mortality of dementia patients, particularly those suffering from BPSD. Particularly we focus on assessing all-cause mortality patients with dementia treated with antipsychotic drugs (APDs). Methods: We have analyzed 58,412 patients newly diagnosed with dementia. We have found that 2526 of the patients were prescribed APDs (602 typical APDs and 1833 atypical APDs)- Results In the adjusted models, use of APDs at the time of dementia diagnosis was associated with increased mortality risk in the total cohort (hazard ratio = 1.4; 95% confidence interval 1.3-1.5). We have also stratified the results. Conclusions: The risk of death in patients with dementia was increased in group that used atypical and typical APDs. Our study gives more evidence to advice caution in APD prescription for patients with dementia.
INVESTIGATING MODERATORS OF THE RELATIONSHIP BETWEEN SUBJECTIVE AND OBJECTIVE MEMORY
Authors: Falzarano Francesca , Minahan Jillian , Siedlecki Karen L , Salthouse Timothy
Published: November 2019

Subjective memory complaints (SMC) among older adults have been explored as an indicator of decline in objective memory functioning. While some research has found that SMC may be predictive of future cognitive impairment and dementia (Glodzik-Sobanska et al., 2007; Wang et al., 2004), others have suggested that SMC are common among healthy older adults (Cooper et al., 2011) and are not strongly related to objective memory performance. Researchers suggest that SMC may be more strongly related to affective factors (e.g., depression and anxiety; Rowell, Green, Teachman, & Salthouse, 2015). The current study examined the relationship between SMC, objective episodic memory performance (OEMP), along with depression and anxiety in a sample of 18-99 year olds (N = 5,430) from the Virginia Cognitive Aging Project (VCAP). Structural equation modeling with full information maximum likelihood estimation was used to investigate whether clinically-relevant depression and anxiety levels moderated the relationship between SMC and OEMP, controlling for age, education, gender, and health. OEMP was represented as a latent construct while the remaining variables were observed. Although depression and anxiety are significantly related to SMC (r’s = .29, .17, respectively), they are not correlated with OEMP. Furthermore, depression, but not anxiety, moderated the relationship between SMC and OEMP, such that those at risk for depression had a stronger relationship between SMC and OEMP (-.07, p<.05) compared to those not at risk (-.02, p=.31). This suggests that SMC may not be a valid indicator of OEMP as it may reflect variance from other sources, such as depression.
EPIGENETIC PROFILES OF BIOLOGICAL AGING HALLMARKS
Authors: Leung Diana L , Liu Zuyun , Levine Morgan E
Published: November 2019

Investigation into the hallmarks of aging point to the existence of shared mechanisms that underlie the biological aging process. While there is a general consensus that hallmarks of aging rarely occur in isolation, little is known in regards to their overlapping networks or how interactions contribute to manifestations at the clinical level. Here, we examine whether shared epigenetic alterations—one of the proposed hallmark of aging—underlies diverse conditions characterized by other hallmarks, including cellular senescence, loss of proteostasis, genomic instability, mitochondrial dysfunction, and inflammation. Using weighted network analysis, we identified consistent overlaps in the methylation profiles across the different traits. For instance, epigenetic modules that were distinct in senescence were also affected in progeroid syndromes (Hutchinson-Gilford Progeria Syndrome and Werner’s Syndrome) and smokers. These CpGs tended to be located in CpG islands, which are notable for their strong association with transcriptional regulation. Overall, our results suggest that epigenetic alterations intersect with various hallmarks of aging. In moving forward, incorporation of this understanding may lead to the development of biomarkers that better capture the biological (rather than chronological) aging process.
THE EFFECTS OF AGE AND SIZE ON THE COMPANION DOG METABOLOME: ROLES OF TRYPTOPHAN AND FATTY ACID METABOLISM
Authors: Hoffman Jessica M , Austad Steven
Published: November 2019

Recently, the companion dog has been promoted as an ideal animal model for human aging. Dogs show an interesting phenomenon where smaller individuals are longer lived than their larger counterparts. However, many of the underlying molecular mechanisms that influence aging and longevity in the dog are unknown. To begin to uncover these physiological changes, we completed the largest metabolomics study to date in the companion dog. Here, we collected blood plasma samples from companion dogs in three in the United States for metabolomics analysis. We then looked at the effects of age and size on the metabolome to develop new hypotheses about healthy canine aging. Our most striking differences were found with regards to geographic location in the canine metabolome, in which metabolic profiles were more similar between dogs in the same city than across cities. After controlling for this location effect, we found a strong signal of amino acid metabolism, specifically tryptophan metabolism, associated with weight in the dog where metabolites in the tryptophan metabolism pathway were always higher in small, long-lived dogs. Future studies will directly investigate the role of tryptophan metabolism in model organisms.
FUTURE CARE PLANNING AND END-OF-LIFE CARE DECISION MAKING: INDIVIDUAL AND SOCIAL INFLUENCES
Authors: Lee Jeong Eun , Sörensen Silvia
Published: November 2019

As a growing number of older adults reach very old age, future care planning and end-of-life care decision making becomes increasingly important. Previous studies have shown that concrete future care planning steps are related to improved ability to manage illness and to better mental and physical health outcomes among older adults. Yet, relatively few older adults sufficiently plan for their future care. The purpose of this symposium is to highlight a collection of studies that each brings a unique perspective to the issue, reporting on individual and social factors that influence future care planning, end-of-life care decision making, and strategies to enhance future care planning among older adults. First, Chen and Siconolfi address common barriers and facilitators across diverse domains of age-related planning using content analysis. Second, Boerner and colleagues focus on the completion of formal planning without discussing the contents and factors associated with formal planning completion. Third, Strum investigates the complexities of navigating “fair” later life decisions involving family resources. Fourth, Moorman examines the racial differences in decisions of euthanasia and physician assisted suicide. Finally, Lee and colleagues report the findings from a future care planning intervention with older adults in rural area. The discussion by Sörensen will integrate the five papers with the goal of connecting the current evidence for meaningful steps in research and practice related to future care planning in older populations.
COMMON BARRIERS AND FACILITATORS ACROSS DIVERSE DOMAINS OF AGE-RELATED PLANNING
Authors: Chen Emily K , Chen Emily K , Siconolfi Daniel
Published: November 2019

Advance care planning (ACP) – plans that express wishes for healthcare for when a person is unable to communicate – is often studied independently of other age-related planning activities. This study explored a broad set of age-related planning activities, such as retirement, finances, aging in place, and healthcare, including ACP. We used directed content analysis to identify barriers and facilitators to age-related planning from semi-structured interviews with 38 respondents (ages 55-74). Surprisingly, a common set of structural, interpersonal, and individual barriers and facilitators emerged across domains. Barriers included competing demands, resistance from family members, and aversion to planning in general. Facilitators included exposure to planning behaviors through professional and social networks, having witnessed negative outcomes from others’ failure to plan, and a belief that planning would spare others future distress. These results reinforce the idea that ACP exists within of a set of age-related planning behaviors that share common characteristics.
LEVERAGING ANALYTIC METHODS TO EXPAND OPPORTUNITIES IN AGING-RELATED HEALTH DISPARITIES RESEARCH
Authors: Akushevich Igor , Hill Carl V , Whitson Heather E
Published: November 2019

The objective of the Symposium is to improve the understanding of how existing analytic methods and data can be leveraged to make progress in understanding the causes and mechanisms of health-related disparities in Alzheimer’s disease, related dementias and other prominent age-related diseases. Topics will cover a range of academic and administrative topics including: i) advanced analytic methods and modeling of health disparities with application to racial and geographic disparities in AD/ADRD; ii) the role of repeated anesthetic and surgical exposure in generation of disparities in AD/ADRD risk; iii) the nature of health disparities in cognitive aging as parallel to or distinct from health disparities in patterns of aging in other systems in the body; iv) recent advances in machine learning applied to large claims databases involving medical disparities; and v) geographic-related disparities in life expectancy across the U.S. A focus will be made on demonstrating how studies using established administrative data resources such as Medicare claims databases combined with innovative analytic approaches such as partitioning analyses, time-series based methods of projection and forecasting, and stochastic process models can be used to uncover previously overlooked or understudied aspects in this area of research. Analyses of such increasingly available large health datasets provides an opportunity to obtain nationally representative multiethnic results based on individual-level measures that reflect the real care-related and epidemiological processes ongoing in the U.S. healthcare system and allows the targetting of relatively rare diseases in relatively small population subgroups.
DISPARITIES IN ALZHEIMER’S DISEASE: THE ROLE OF REPEATED ANESTHETIC AND SURGICAL EXPOSURE
Authors: Kertai Miklos D
Published: November 2019

Annually, there are 7 million patients > 65 years who undergo noncardiac surgery in the US. This number is expected to increase by 30% over the next 3 decades, and given the prevalence of surgically correctable comorbidities, the elderly will continue to undergo multiple surgical procedures. Currently, it is unclear what factors initiate or promote the development of Alzheimer’s disease (AD). Preclinical studies suggest that exposure to anesthesia and/or surgery could be one of the environmental exposures that increase AD risk through neuroinflammation and neuroapoptosis. However, previous studies indicated substantial disparities in AD risk by gender, ethnicity, and race, but failed to explore the role of anesthesia and/or surgery exposure in the risk for AD. This presentation will review the role of disparities and anesthesia and/or surgery exposure in the risk for AD in elderly surgical patients.
M. POWELL LAWTON AWARD LECTURE
Authors: Inouye Sharon
Published: November 2019

The M. Powell Lawton Award is presented annually to an individual who has made outstanding contributions from applied research that has benefited older people and their care. The lecture will be given by the 2018 recipient, Carol Whitlatch, PhD, Benjamin Rose Institute on Aging. The session will also include the presentation of the 2019 Lawton Award. The 2019 Lawton Award recipient is Barbara Resnick, PhD, CRNP, FGSA, of the University of Maryland. Supported by the Polisher Research Institute of the Madlyn and Leonard Abramson Center for Jewish Life.
FOLLOWING IN THE FOOTSTEPS OF A GREAT APPLIED GERONTOLOGIST (WHILE SIMULTANEOUSLY FORGING YOUR OWN PATH)
Authors: Whitlatch Carol
Published: November 2019

Dr. M. Powell Lawton was an inspirational and productive scholar whose work had application for improving personal care and well-being for older adults and their families. He held strong to the principles of Person- and Family-Centered Care long before this terminology and model of care was commonly practiced. He was a living example of PFCC always wearing comfortable clothes and shoes to ensure his unique creativity was not obstructed by physical discomfort. Dr. Lawton’s work has inspired countless gerontologists who have taken the next steps towards ensuring quality of care by understanding personal preferences, activities, and care values. Dr. Whitlatch will discuss Dr. Lawton’s ongoing influence on care and best practices focusing on her own research that gives voice to the care values, preferences, and activities of families facing early-stage dementia. Dr. Whitlatch encourages attendees to wear their most comfortable shoes to the lecture in honor of Dr. Lawton.
DOES DEMENTIA POLICY ACCOUNT FOR DIVERSITY? AN ANALYSIS OF CANADIAN DEMENTIA POLICIES
Authors: Wilson Kimberley
Published: November 2019

Background: The World Report on Ageing and Health outlines key policy challenges that need to be addressed to have successful public health response to population aging, including ‘dealing with diversity’ and ‘reducing inequity.’ Dementia has been framed as a global health challenge affecting approximately 46 million people worldwide. To reduce inequality, dementia policies must account for and respond to diversity. The purpose of this research was to conduct an analysis of current Canadian federal, provincial, and territorial dementia strategies to examine their inclusion of dimensions of diversity. Method: We conducted an internet-based search and identified 13 unique Canadian federal, provincial, and territorial dementia documents. We completed a deductive content analysis to review each policy for content on: age and sex; racial and ethnic identity; sociocultural identity; religion; socioeconomic status; gender identity and sexual orientation; geographical location; and language fluency and communicative ability. Results: Within Canadian dementia policies there is minimal focus on diversity. When diverse identities were acknowledged in policies, very little guidance was provided to local policy-makers, healthcare administrators, or service providers in how to acknowledge and accommodate different group’ needs with services. Further, none of the policies adopted an intersectional approach; that is, they failed to recognize that older adults have several overlapping and interrelating identities. Conclusion: As Canada and other countries move towards developing and revising dementia policies it is imperative that they account for diversity within aging populations.
RATES OF DISENROLLMENT FROM MEDICARE MANAGED CARE PLANS ARE HIGHER AMONG RACIAL, ETHNIC, AND LINGUISTIC MINORITIES
Authors: Martino Steven , Mathews Megan , Damberg Cheryl , Ng Judy , Agniel Denis , Tamayo Loida , Wilson-Frederick Shondelle , Elliott Marc N
Published: November 2019

Voluntary disenrollment from Medicare managed care (Medicare Advantage; MA) plans is related to beneficiaries’ negative experiences with their plan, disrupts continuity of care, and conflicts with goals to reduce Medicare costs. Information on associated factors may help illuminate the dynamics that drive decisions to disenroll. We used data from 17,517,852 beneficiaries enrolled in 736 MA plans in 2015 to investigate differences in rates of disenrollment by race, ethnicity, and preferred language. Disenrollment data came from Medicare’s enrollment system. Social Security Administration data on race and ethnicity were augmented with surname, address, and other Medicare administrative data to calculate probabilities of membership in seven race/ethnicity/language-preference groups: White, Black, English-preferring Hispanic, Spanish-preferring Hispanic, Asian or Pacific Islander (API), American Indian or Alaska Native, and multiracial. We summarized disparities across groups using regression models with and without plan intercepts, controlling for gender, disability, and Medicaid eligibility. Adjusted rates of disenrollment were significantly higher for Spanish-preferring Hispanics (19.1%), Blacks (10.2%), and APIs (9.4%) than for Whites (7.7%), and significantly lower for English-preferring Hispanics (7.4%, p’s<0.001). Within-plan disparities accounted for only a small fraction of overall disparities, indicating that Spanish-preferring Hispanics, Blacks, and APIs tended to be enrolled in plans with higher disenrollment than plans in which Whites were enrolled, whereas English-preferring Hispanics tended to be enrolled in plans with lower disenrollment. These between-plan differences may indicate that high-minority-enrollment plans less effectively inform beneficiaries about the cost and coverage of care or that racial/ethnic/linguistic minorities more often select plans that raise rates or restrict coverage.
HEALTH-RELATED QOL IS ASSOCIATED WITH COMPLETION OF PULMONARY REHABILITATION IN OLDER VETERANS WITH COPD
Authors: Bamonti Patricia M , Moy Marilyn L , Goodwin Christina , Elsen Kdee , Silberbogen Amy
Published: November 2019

Pulmonary rehabilitation [PR] is the standard of care for Veterans with COPD. Psychosocial factors may play a role in PR participation. This study examined psychosocial factors among 253 Veterans with COPD (M age = 70.08, SD = 8.14) who completed (n = 110), did not complete (n = 75; “drop outs”), or never started (n = 68) PR. Measures completed at baseline were health-related quality of life (HRQL; Chronic Respiratory Questionnaire), depression (Beck Depression Inventory II), and exercise self-efficacy (Exercise Self-Regulatory Efficacy). One-way ANOVAs produced no significant differences in self-efficacy or depression. Significant differences were observed for HRQL, F(2,170)=10.58, p<0.001. Post hoc analysis revealed significant differences between never starters (M=69.72, SD=16.65) and completers (M=80.22, SD=19.29), p = 0.007 and differences between drop outs (M=66.69, SD=15.24) compared to completers, p < 0.001, such that better HQRL predicted completion. These findings have important clinical implications for engaging Veterans with COPD in PR.
WEB-BASED PHYSICAL ACTIVITY INTERVENTION IN MIDDLE-AGED AND OLDER ADULT VETERANS WITH COPD
Authors: Robinson Stephanie A , Robinson Stephanie A , Mori Deanna L , Richardson Caroline R , Moy Marilyn L
Published: November 2019

Physical activity (PA) is recommended in all patients with chronic obstructive pulmonary disease (COPD). Technology-based interventions can deliver effective, scalable behavior-change techniques; though feasibility and acceptability among older adults is not established. Veterans with COPD (N=112, aged 49-89 years, median=68) were randomized to a 12-week web-based and pedometer intervention or a pedometer alone (control). Across groups, there was no significant difference between middle-aged (<68 years) and older (≥68 years) adults in percentage of pedometer wear-days over the study period (83.6% vs. 89.9%). In the intervention, there were no significant differences between middle-aged and older adults in total number of website logons (15.04 vs. 16.31), or proportion who reported they recommended the intervention (96.4% vs. 96.7%), found it easy to use (93.1% vs. 90.0%), and would continue to walk (93.1% vs. 89.7%). We conclude that a web-based PA intervention with a pedometer is feasible and acceptable in an older COPD population.
OVERVIEW OF THE ACTIVE STUDY AT 20 YEARS
Authors: Willis Sherry , Rebok George
Published: November 2019

ACTIVE (1998-2019), the largest NIA-funded clinical trial of cognitively normal elderly, was designed to test if cognitive intervention maintains functional independence in older adults (N = 2,802, aged 65-94) by improving basic mental abilities. In this paper we overview major aims of ACTIVE to investigate 1) effectiveness and durability (through 1,2,3,5, and 10 years of follow-up) of three cognitive interventions (memory, reasoning, processing speed) in improving basic measures of cognition; 2) if training in specific cognitive abilities improves or maintains cognitively demanding daily living skills (e.g., medication use, driving); and 3) impact of intervention on everyday mobility, health-related quality of life, and health service utilization. We also review aims of a recent NIA-funded 20-year follow-up of ACTIVE to examine whether improved cognition and daily function results in long-term reduction in dementia risk, years of disability, health care utilization and costs, and increased active years of life in advanced old age.
DEPRESSIVE SYMPTOMS: HAMPERING MAINTENANCE OF COGNITIVE TRAINING GAINS
Authors: Felix Cynthia , Du Simo , Taylor Brad , Rebok George
Published: November 2019

To study the impact of depressive symptoms on the effectiveness of cognitive training interventions, the ACTIVE 10-year follow up data was analyzed for cognition and difficulty in everyday functioning outcomes. Because depression is treatable, this topic is of high public health significance. Analyses showed that females had greater prevalence of depressive symptoms. Reasoning, speed of processing and daily function change scores were significantly worse in the depressive symptom group, while memory change score was non-significantly worse, showing poor proximal and downstream primary (functional) outcomes. Depressive symptoms may lead to lower retention of cognitive training benefits.
MEASURING LOST-WORK OPPORTUNITY AT RETIREMENT AGE
Authors: Voss Maren Wright , Al Snih Soham , Li Wei , Hung Man , Richards lorie
Published: November 2019

There is uncertainty related to whether retirement negatively impacts health--possibly due to the complexity of retirement decisions. The role of lost work opportunity on retirement decisions may help clarify when retirement has a favorable or negative impact on health. Lost work opportunity can be defined as forced retirement or unemployment prompting an earlier than planned retirement. However, 17% of individuals retiring due to the loss of work opportunity (i.e., unemployment, temporary lay-offs, company buy-outs, forced relocations, etc.) do not report either unemployment or involuntary retirement in survey data. We propose a broader conceptualization of late-career unemployment. Using the Health and Retirement Study (HRS), a lost-work opportunity score (LOS) was computed from items indicating unemployment and forced or unplanned retirement. Correlations were computed between this LOS and all continuous variables in the RAND longitudinal compilation of the HRS to determine its convergent and discriminant validity. The LOS demonstrated a Chronbach’s alpha of α=0.82 and had convergent validity with constructs of employment (9 variables), finances (36 variables), and health (14 variables), as predicted by the literature on retirement timing. No other continuous variables in the HRS were identified with a moderate or strong correlation to LOS, demonstrating discriminant validity. Further research should explore whether a combination of variables in the HRS can improve the accuracy of measuring retirement voluntariness. Improved precision in measurement, through an expanded conceptualization of lost-work opportunity, may help explicate the retirement-related factors that impact health, to inform policy and support healthy aging decisions at a societal level.
REDUCING ANTIPSYCHOTIC USE IN LONG-TERM CARE: CONSIDERING THE ROLE OF CULTURE OF CARE AND INFORMAL COMMUNICATION
Authors: Smith Andre , Kurucz Sue , Erb Tara , Kampen Ruth
Published: November 2019

Persons living with dementia-related disorders (PwD) can experience challenging behavioural and psychological symptoms (BPSD) as their illness progresses. There is a continued reliance on antipsychotic drugs (APD) in long-term care to manage this issue despite the well-documented risks of adverse events and increased morbidity and mortality. This study examines the role of culture of care in relation to efforts at reducing inappropriate APD use in managing BPSD within long-term care. Culture of care consists of shared norms, beliefs, and cognitive frames which guide clinical practice and inform the development and implementation of care strategies. Findings were obtained from three Canadian long-term care facilities working on reducing inappropriate use of APD. Data came from interviews with 6 nurses, 18 licenced practical nurses, 14 health care assistants, 4 activity leaders, 4 directors of care, 1 chaplain, and 10 physicians. We found that direct care providers initially varied in their perceived ability to develop and use alternate care strategies with health care assistants being most concerned about safety and exposure to violence. Change involved detective work and innovative thinking in assessing possible causes of BPSD beyond psychosis, including pain and feelings of confusion. Informal reciprocal patterns of communication emerged among health care assistants to identify effective non-pharmaceutical strategies to manage BPSD. Overall, the study shows how shared beliefs in the need for and value of alternate care practices among direct care providers along with the existence of effective informal communication can contribute to successful reduction in APD use when managing BPSD in PwD.
PHYSIOLOGY OF SUCCESSFUL AGING: IMPLICATIONS FOR HEALTH AND WELL-BEING
Authors: Mantantzis Konstantinos , Gerstorf Denis , Hess Thomas M
Published: November 2019

Research into peripheral physiology and its association with cognition, emotionality, and social/physical functioning has received considerable attention over the years. However, many of the underlying mechanisms are not well understood. In this symposium, we have compiled a set of four empirical projects that showcase current and future endeavors to address some of the long-standing questions about when, how, and why physiology shapes and is shaped by key psychosocial resources. Hawkley et al. make use of data from the NSHAP and HRS longitudinal studies to investigate whether social relationships such as number of friends predicts risk of diabetes among older adults. Wilson et al. use dyadic data from young and middle-aged couples to examine cardiometabolic similarity among spouses, and how such concordance is shaped by key relationship factors such as emotional closeness. Pauly et al. use data from two daily-life studies of older couples to investigate how physiological synchrony in cortisol is modulated by partner interactions, empathy, and empathic accuracy. Finally, Mantantzis et al. make use of multi-year longitudinal data from the Berlin Aging Study II to examine the role of glucose regulation capacity for trajectories of subjective well-being among older adults. Thomas Hess will discuss the importance of these papers, discuss strengths and weaknesses of the approaches chosen, and consider implications for future research.
POOR GLUCOSE REGULATION IS ASSOCIATED WITH LOWER WELL-BEING AMONG OLDER MEN, BUT NOT WOMEN
Authors: Mantantzis Konstantinos , Drewelies Johanna , Wagner Gert G , Demuth Ilja , Steinhagen-Thiessen Elizabeth , Lindenberger Ulman , Düzel Sandra , Gerstorf Denis
Published: November 2019

Glucose regulation is a key aspect of healthy aging, but little is known about gluco-regulatory capacity and older adults’ well-being. In this study, we examine whether gluco-regulatory capacity is predictive of within-person age-related trajectories of three major well-being indicators. We applied growth models to multi-year longitudinal data obtained in the Berlin Aging Study II (N = 1437; age 60-89; 53% women) and used insulin resistance as an index of glucose regulation capacity. Poor glucose regulation was associated with lower levels of well-being in men, but not women. These associations among men emerged for two of the three well-being indicators, were maintained across old age, and were independent of the other cognitive and physical factors examined. We discuss how sexual dimorphism may have contributed to our findings, and conclude that our results provide initial evidence for the relevance of glucose regulation for quality of life among older men.
LINKS BETWEEN PARTNER INTERACTIONS, EMPATHY, AND EVERYDAY PHYSIOLOGICAL SYNCHRONY IN OLDER COUPLES
Authors: Pauly Theresa , Michalowski Victoria I , Drewelies Johanna , Gerstorf Denis , Ashe Maureen C , Madden Kenneth M , Hoppmann Christiane A
Published: November 2019

Romantic partners exhibit dyadic covariation (synchrony) in physiological parameters. This study aims to link everyday cortisol synchrony to daily partner interactions and empathy. We conducted coordinated multilevel analysis using data from two independently collected samples of older couples (Study 1: N = 85 couples, aged 60-87 years; Study 2: N = 77 couples, aged 66-85 years) who completed questionnaires and provided salivary cortisol samples 5 to 7 times daily for 7 days. Cortisol levels were significantly correlated among partners in both studies. Cortisol synchrony was higher when partners were present (Study 1), and when partner interactions involved feeling understood and valued (Study 1) and seeking help or closeness (Study 2). Higher cortisol synchrony was further related to greater empathic accuracy (Study 1) and greater empathy (Study 2). Thus, social bonding processes and the ability to consider other’s thoughts and feelings may be intertwined with physiological synchrony in everyday life.
RETIRING AND CAREGIVING IN THE AGE OF STUDENT LOANS: THE IMPACT OF STUDENT DEBT ON RETIREMENT AND LONGEVITY PLANNING
Authors: Brady Samantha , Miller Julie , Balmuth Alexa , D'Ambrosio Lisa , Coughlin Joseph
Published: November 2019

Saving for retirement and the ability to provide care for a loved one can be dramatically affected by student loan debt. Currently, approximately 44 million people of all ages in the United States carry the weight of over 1.4 trillion dollars of student loan debt. Student loan borrowers of all ages may experience lower financial preparedness for retirement as well as decreased ability to provide care for family members, including aging parents. While older adults hold a relatively small proportion of student loans, they are the fastest growing subset of student loan borrowers and have disproportionately high rates of student loan defaults. As a result of their defaults, the Social Security retirement benefits of Americans ages 65 and older experienced a 500% increase in offsets over the last decade. This presentation will spotlight an MIT AgeLab mixed methods study about how student loan borrowers between the ages of 51 and 75 experience student loans within family systems and perceive and prioritize longevity planning in light of their student loans. Data collected for this study include focus groups and a large national survey. Preliminary findings suggest that for older borrowers, student loans are generally one of several financial constraints that can inform spending and saving decisions. For most, student loan payments are regarded as stunting overall retirement savings while the minority regard the two separately. Older borrowers also tend to have increased financial and familial responsibilities, including caring for aging parents, that compete for borrowers’ limited financial and temporal resources.
RACIAL DISPARITIES IN HOSPICE USE AT THE END OF LIFE: FINDINGS FROM THE REGARDS STUDY
Authors: Ornstein Katherine , Sheehan Orla C , Huang Jin , Rhodes J David , Roth David L
Published: November 2019

Hospice supports patients and families through interdisciplinary care focused on symptom management and maximization of quality of life. Although hospice care confers well-documented benefits, it remains underutilized: many patients do not use it at all or enter care too late to receive any benefit. While racial disparities in hospice use have been documented, hospice utilization among non-white decedents remains understudied, particularly among those with non-cancer diagnoses. Therefore, we used the REasons for Geographic and Racial Differences in Stroke (REGARDS) study, a population-based investigation of stroke incidence with oversampling of Blacks and cause of death adjudication by expert panel review, linked to Medicare claims data to examine racial disparities in end-of-life care. We identified 1221 participants who died between 2013-2015 due to natural causes excluding sudden death. More than half (52.8%) used hospice during the last 6 months of life (median =15 days), with use among cancer decedents over 70%. Overall, Blacks were significantly less likely to use hospice (OR=0.570) compared to Whites in adjusted analyses. Among hospice users, Blacks did not significantly differ from Whites in length of stay. In analyses stratified by cause of death (dementia, cancer, CVD and other), Blacks were significantly less likely than Whites to use hospice for all causes of death other than dementia. Despite tremendous growth of hospice in recent decades, our findings suggest that this effective service remains highly underutilized among Blacks dying from cancer, CVD and other serious illnesses, suggesting a need for targeted intervention to eliminate disparities in quality end-of-life care.
RACIAL VARIATION IN THE RELATIONSHIP BETWEEN LIFE-COURSE TURNING POINTS AND LIFE SATISFACTION
Authors: Carr Dawn C , Kail Ben L , Calvo Rocio
Published: November 2019

According to many social gerontologist and life course scholars, major life course transitions, referred to as “turning points,” have a significant impact on well-being. Although the relationship between major later life turning points and general well-being is fairly well understood, it is unclear whether there is systematic racial/ethnic variation in response to turning points in general. Moreover, much of sparse research on racial/ethnic variation that does exits overlooks how Hispanic Americans may respond differently to turning points than do either white Americans or African Americans. To that end, in this paper, we draw on life course theory to assess whether the relationship between retirement and the death of a spouse (i.e. turning points) and life satisfaction (a measure of well-being) vary by race/ethnicity. We focus on differences between whites, Hispanics, and African Americans. Moreover, we draw on stress process theory to identify mechanisms that may explain any observed racial/ethnic variation in these relationships. Using the Health and Retirement Study, in preliminary results we find: 1) before adjusting for turning points, Hispanics appear to have higher life satisfaction than whites, and African Americans do not differ significantly from whites; 2) however, after adjusting for turning points, only Hispanics who make life course transitions have significantly higher life satisfaction than whites; and 3) this higher life satisfaction observed among Hispanics who experience turning points is largely not accounted for by several factors derived from stress process theory.
POLICY SERIES: RESEARCH, POLICY, AND PRACTICE: IMPACTS OF DISCRIMINATION
Authors: D’Antonio Patricia M
Published: November 2019

Discussant: John Feather Aging crosses all domestic and international borders and affects everyone regardless of religion, race, nationality, ethnicity, sexual orientation, or gender identity. The main purpose of The Gerontological Society of America is “to advance the scientific and scholarly study of aging and to promote human welfare by the encouragement of gerontology in all its areas.” Yet in 2019, policies remain in effect that impact individuals in a discriminatory manner. The program will highlight research in several areas that demonstrate the effects of these discriminatory practices.
DEFINING DIFFERENT FORMS OF DISCRIMINATION IMPACTING SOCIETY
Authors: D’Antonio Patricia M
Published: November 2019

Aging crosses all domestic and international borders. It’s an issue that affects everyone regardless of religion, race, nationality, ethnicity, sexual orientation, or gender identity. The main purpose of The Gerontological Society of America (GSA) is “to advance the scientific and scholarly study of aging and to promote human welfare by the encouragement of gerontology in all its areas.” Yet in 2019, policies remain in effect that impact individuals in a discriminatory manner. The program will highlight research in several areas that demonstrate the effects of these discriminatory practices.
THE IMPACT OF DISCRIMINATORY POLICIES AND PRACTICES ACROSS THE AGING CONTINUUM
Authors: Lindberg Brian W
Published: November 2019

Aging crosses all domestic and international borders. It’s an issue that affects everyone regardless of religion, race, nationality, ethnicity, sexual orientation, or gender identity. The main purpose of The Gerontological Society of America (GSA) is “to advance the scientific and scholarly study of aging and to promote human welfare by the encouragement of gerontology in all its areas.” Yet in 2019, policies remain in effect that impact individuals in a discriminatory manner. The program will highlight research in several areas that demonstrate the effects of these discriminatory practices.
VIEWPOINT FROM THE DIVISION OF AGING BIOLOGY
Authors: Sierra Felipe
Published: November 2019

Dr. Sierra will review accomplishments of the Division of Aging Biology and make projections of future growth in the field.
SPOUSAL INFLUENCE ON EARLY RETIREMENT DECISIONS: ORIGINS AND MECHANISMS
Authors: Eismann Maria , Henkens Kène , Kalmijn Matthijs
Published: November 2019

The interdependence between partners raises considerable interest in the sociology of life course, work and families. Partner influences play a particularly important role in the work domain, because each partner’s work decisions have profound effects on the couple as a whole. In contrast to previous research, this study pays detailed attention to the role partners play in workers’ labor market decisions by using the case of early retirement decisions. We hypothesize that partners’ preferences for older workers’ retirement originate from altruism and self-interest. For example, partners might prefer workers to retire early because the worker’s job is highly stressful or partners might prefer workers to retire early to increase possibilities for joint leisure. Moreover, we expected that partners influence older workers’ early retirement behavior via persuasion and pressure. So, partners might either convince workers to change their preferences, or they might pressure workers to act according to the partners’ preferences, irrespective of workers’ own preferences. To adequately estimate partners’ and workers’ preferences for workers’ early retirement, we used an instrumental variable approach. This was possible due to the multi-actor longitudinal data available from a large representative sample of older workers and their partners in the Netherlands. The results support that partners’ preferences originate in altruism and self-interest and that partners influence workers through persuasion and pressure. Gender differences were marginal, with stronger signs for altruistic origins among female than male partners.
VIEWPOINT FROM THE DIVISION OF GERIATRICS AND CLINICAL GERONTOLOGY
Authors: Hadley Evan
Published: November 2019

Dr. Hadley will review accomplishments of the Division of Geriatrics and Clinical Gerontology and make projections for the future.
FAMILY CAREGIVER SOCIAL ISOLATION AND HEALTH: FINDINGS IN THE NATIONAL SURVEY OF CAREGIVING
Authors: Pohl Janet S , Bell Janice F , Woods Nancy , Tancredi Daniel J
Published: November 2019

Social relationships are important for family/informal caregiver health. Due to caregiving commitments caregivers are at risk for social isolation. Social isolation is associated with adverse health outcomes in the general population, but few studies have examined this association among caregivers. Employing the Convoy Model of social relations, we examined associations between caregiver self-reported health and social isolation—operationalized as a measure that included multiple domains and as specific domains modeled independently. Social isolation prevalence was 24.74% (n=2,175); mean health was 3.46 (SE=0.02) on a scale of 1 (poor) to 5 (excellent). In adjusted models, domain-inclusive social isolation was inversely associated with health (β=-.07; CI=-0.14,-0.02, p=0.01). In independent domain adjusted models, only participation in club activities was associated with health (β=-.22; CI=-0.35,-0.10, p<0.01). Social isolation predicted caregiver health, with club participation explaining much of the variance. Domain inclusive social isolation measures can identify targets for intervention studies to improve caregiver health.
FAMILY CAREGIVING IN THE CONTEXT OF INTENSE AND COMPLEX CARE
Authors: Bell Janice , Whitney Robin L , Young Heather M
Published: November 2019

Approximately four in ten family caregivers experience high intensity care, based on the number of caregiving hours, activities of daily living (ADLs) and instrumental ADLs supported for the care recipient. Using the 2015 Caregiving in the U.S. Survey, we examined outcomes associated with high (compared to low or medium) intensity of care. High intensity was positively associated with emotional stress (OR=2.10; 95%CI: 1.52-2.91); financial strain (OR=1.69; 95% CI: 1.210-2.36); physical strain (OR=3.09; 95% CI: 2.21-4.34); and declines in caregiver health (OR=2.14; 95% CI: 1.56-2.93). High intensity was also associated with greater difficulty coordinating recipient care (OR=1.96; 95%CI: 1.42-2.71), higher odds of performing complex medical/nursing tasks (OR=6.85; 95% CI: 5.27-8.90) and, among task performers, greater difficulty performing tasks (OR=2.10; 95% CI: 1.43-3.08). High intensity of care impacts caregiver health and the caregiving role in multiple domains; new clinical and policy approaches are needed to mitigate risks and ensure adequate support.