bluuebunny/crossref_metadata_2025 huggingface dataset:
PREPARING “EXPERIENCED” CAREGIVERS FOR FUTURE CARE: PERSPECTIVES FROM FORMER CAREGIVERS OF PARENTS WITH DEMENTIA
Authors: Mroz Emily , Piechota Amanda , Ali Talha , Matta-Singh Tara , Abboud Anissa , Sharma Shubam , Fried Terri , Monin Joan
Published: December 2023

Providing care for more than one care partner across adulthood is becoming increasingly common, resulting in a growing number of ‘experienced’ caregivers (those who have been caregivers before and are anticipating or engaging in caregiving roles again). Caregivers have opportunities to develop caregiving skills and experience positive and negative psychological consequences that persist after care roles have ended. Little is known about how these factors shape preparedness in the large and growing group of former adult-child caregivers of parents living with dementia (PLWD) who anticipate future caregiving roles. We conducted a qualitative study of 32 interviews with midlife former caregivers of now-deceased PLWD. Consensual Qualitative Research and grounded theory techniques guided study design and analysis. Analyses demonstrated that preparedness for future caregiving roles was shaped by personal narratives from former caregiving roles across two dimensions: insights and confidence. All caregivers described insights (i.e., caregiving self-conduct, care systems and resources, and relating with a care partner) that contributed to their preparedness. Though some former caregivers also described a positive (i.e., boosted or sustained) sense of confidence, others described a diminished (i.e., restricted or impeded) sense of confidence. Findings suggest that for some former caregivers, past experiences offer cumulative advantages; for others, past experiences may contribute to apprehension towards, or rejection of, future caregiving roles. Entering new roles with diminished confidence may have negative consequences for caregivers’ and care partners’ wellbeing. This presentation will conclude with suggestions for resources that address both insight-based and confidence-based preparedness and are tailored to experienced caregivers.
FORMAL SERVICE USE BARRIERS AND ITS IMPLICATIONS ON PREPAREDNESS IN DEMENTIA FAMILY CAREGIVERS
Authors: Falzarano Francesca , McCarthy Megan
Published: December 2023

Dementia family caregivers are critical to sustaining the long-term services and supports system in the US, yet the identification-assessment-referral pipeline to connect caregivers to needed resources remains siloed and complex. The use of formal services can serve as a mechanism to foster preparedness, resiliency, and enhance positive aspects of the caregiving role and ameliorate against adverse care-related outcomes. Despite resounding sentiment among caregivers expressing their need for relevant services, formal service utilization remains strikingly low. A greater understanding is needed regarding the multidimensional factors, stemming from within and beyond the direct care environment, influencing perceived ability to carry out care responsibilities. Thus, the purpose of this study was to examine the individual, psychosocial, and contextual characteristics associated with preparedness and self-efficacy among 46 dementia family caregivers (Mage=55.9, SD=16.3) who participated in a mixed-methods study examining facilitators and impediments influencing service utilization. Overall, 65.9% of participants reported receiving no formal preparation for their care responsibilities. Results showed that age, spousal kinship, longer duration of care, financial stress, more difficulty accessing formal services, and more negative service experiences were associated with lower feelings of perceived preparedness and self-efficacy. Findings underscore the need for more holistic, person-centered assessment to equip caregivers with the needed, relevant resources to enhance their ability to provide effective care.
HOW ARE OLDER PEOPLE FARING POST-PANDEMIC? EVIDENCE FROM THE ENGLISH LONGITUDINAL STUDY OF AGING
Authors: Gessa Giorgio Di , Zaninotto Paola , Zaninotto Paola
Published: December 2023

This session provides insights into the experiences of older people in England post-COVID-19 pandemic. Evidence suggests that stay-at-home and lockdown measures during the pandemic impacted several aspects of people’s lives with detrimental consequences for their wellbeing and mental health, particularly among older people. Little is known, however, on whether and to what extent there has been a return to ‘normal life’ since COVID-19 restrictions were lifted. Using data from the English Longitudinal Study of Ageing (ELSA) this symposium aims to provide new evidence on the experiences of older English people since the successful and rapid COVID-19 vaccination rollout and the easing of restrictions in England through the second half of 2021. ELSA is an ongoing longitudinal biennial survey representative of individuals aged 50 and over in private households that has collected data before the pandemic (with the most recent pre-COVID-19 data collected in 2018/19), during the pandemic (on two separate occasions in June/July and November/December 2020), and post-COVID-19 pandemic (with interviews taking place between October 2021 and March 2023). Exploiting the richness of this dataset, this symposium will present the most up-to-date picture of how older people are faring post-pandemic. Results will focus on mental health and wellbeing, social isolation and loneliness, employment and financial status, as well as social participation (including volunteering, caring, and grandparental childcare).
SOCIAL ENGAGEMENT AMONG OLDER PEOPLE IN ENGLAND SINCE THE COVID-19 PANDEMIC
Authors: Gessa Giorgio Di
Published: December 2023

Volunteering, providing grandparental childcare, and provision of family care were quite common activities pre-pandemic among older people. However, during the pandemic, older people in particular were strongly advised to stay indoors, to work from home, and to avoid or at least limit interactions with people outside of their immediate household, including grandchildren and friends. As a result, evidence from the English Longitudinal Study of Ageing (ELSA) showed dramatic changes in the level of engagement in these socially productive activities. About 10% of grandparents stopped looking after grandchildren altogether during the first 9 months of the pandemic, with 22% reporting an overall decrease in the amount of grandchild care provided. Similarly, among those who were volunteering or caring for someone outside their household pre-COVID-19, almost two thirds decreased or stopped altogether engaging in these activities, with overall negative consequences for their mental health and wellbeing. To date, though, little is known on whether, in emerging from the current pandemic and as restrictions are lifted, social engagement among older people has resumed pre-COVID-19 pandemic levels and whether this is related to a rebound also in emotional wellbeing. Using data from ELSA collected in 2021/23 allows for an exploration of changes in grandparental childcare provision, caring, and volunteering since the COVID-19 pandemic, with a focus on levels of engagement among those older people who had stopped altogether these activities during the first months of the COVID-19 pandemic
SOCIAL WELL-BEING OF OLDER PEOPLE IN ENGLAND SINCE THE PANDEMIC: DID ALREADY-ISOLATED OLDER ADULTS FARE WORSE?
Authors: Kung Claryn
Published: December 2023

The COVID-19 pandemic and actions to reduce transmission (including stay-at-home orders and workplace closures) have had an impact on actual and perceived social isolation and support across all age groups. There was a clear increase in social isolation during the pandemic, especially among older adults, potentially due to the heightened risks of complications and mortality if infected with the novel coronavirus. In England, employing data from the nationally representative English Longitudinal Study of Ageing and using pre- (2018/19) and during pandemic data (June/July 2020 and November/December 2020), we found that overall, older adults who were already experiencing social isolation prior to the pandemic (isolated group) experienced a larger rise in loneliness and drop in social contact during the pandemic than older adults who were previously socially connected (non-isolated group). Results are robust even when we account for the fact that respondents socially isolated (including those not married and with infrequent contact with relatives and friends) felt lonelier and less supported even before the pandemic, and when we adjust for demographic and socioeconomic characteristics. Expanding on this work with post-pandemic data collected between October 2021 and March 2023, this paper describes loneliness, social contact, and social support pre-, during, and post-COVID-19 pandemic and investigates whether and to what extent trends in social well-being continued to diverge between the isolated and non-isolated groups.
LONELINESS AND OLDER ADULTS: RESULTS FROM A COMMUNITY-BASED INTERVENTION
Authors: Macomber Catherine , Freddolino Paul
Published: December 2023

The number of older adults identifying themselves as lonely has increased during the last two years as they have struggled with the impact of the pandemic on their perceptions of relationships with others. Recent research has shown that the negative health implications of loneliness are similar to those found with smoking or obesity. Most current interventions continue with past practice by adding people to engage with the older adult, although research suggests that while this intervention addresses social isolation, it does not address loneliness directly. Information regarding the development and implementation of a loneliness intervention with older adults based on the Health Beliefs Model in one rural mid-west county will be presented. Participants were recipients of home-delivered meals and had volunteered for a project that provided peer-to-peer instruction to improve digital literacy. In addition to technology training sessions, participants received a weekly contact from a separate volunteer as a friendly ‘check-in.’ Beginning in the fourth week, brief 5-10 minute coaching sessions about loneliness were included in these weekly contacts. The presentation will include details of the loneliness content, and describe training and support provided to the volunteers. Interviews were conducted with participants at baseline, approximately three months, and at the end of contact with each participant. Results showed no statistically significant change in loneliness, but participants reported they saw potential usefulness for the content with family and friends and potentially themselves in the future. They also provided helpful suggestions for revision. Plans for revision will be presented.
SOCIAL PARTICIPATION AND DEPRESSION AMONG HONG KONG OLDER ADULTS: THE MODERATING ROLE OF DIGITAL ENGAGEMENT
Authors: Liu Chang , Bai Xue , Lee Chi-Ko
Published: December 2023

Depression is a significant public health issue among older adults. Active social participation is crucial for older people to promote mental well-being. Previous studies mainly focused on the impacts of offline social activities on older people’s mental health, despite that digital participation has substantially changed their patterns of social participation in the context of Covid-19 pandemic. Extending the use of Activity Theory to digital context, this study investigated how social participation in three types of activities (i.e., formal, informal and solitary activities) and digital engagement independently and jointly influenced mental health among Hong Kong older adults. Data from 5,007 participants were drawn from the baseline survey of the Panel Study of Active Ageing and Society, a biannual longitudinal survey conducted with a representative sample of ageing Chinese adults aged 50 years and above in Hong Kong. Exploratory factor analysis, ordinary least squares regression analysis and mediation analysis were conducted. The results showed that participation in informal and solitary activities was related to less depressive symptoms, while participation in formal activities was related to more depressive symptoms but higher life satisfaction. Although the main effect of digital engagement on depressive symptoms was not significant, more digital engagement reduced the negative effect of formal activities and decreased the effect of informal activities in reducing depressive symptoms. The findings have implications for policy-making and intervention development to encourage and balance social and digital participation among ageing populations.
EVALUATING AND ADDRESSING ASPECTS OF SOCIAL HEALTH AMONG AGING POPULATIONS
Authors: Marziliano Allison , Cudjoe Thomas
Published: December 2023

The physical and psychological aspects of human functioning have traditionally been at the heart of gerontological research. In recent years, however, social health, including such concepts as social isolation, social support and loneliness, have received increasing attention. This symposium describes research in this developing area, starting with a description of the evaluation of disparities in social health and culminating with an overview of the development process for interventions to improve poor social health. First, Victor and Taylor, in their respective presentations, focus on identifying disparities (racial, ethnic, gender, marital status, household composition) in social health across older adults in two geographic regions (United Kingdom, United States). Next, Marziliano describes the iterative process of developing 6 brief (~5 minute) videos to administer an adaptation of Meaning-Centered Psychotherapy for the purpose of increasing meaning and reducing loneliness in caregivers of persons with Alzheimer’s Disease (AD) or AD-related dementias (ADRD). Development of this intervention consisted of three phases: preparatory work among the study team, interviews to collect stakeholder feedback with 15 AD caregivers, and construction of the web-based tool. Lastly, guided by Intervention Mapping, the Health Belief Model and Social Cognitive Theory, Thomas describes the process of developing an educational video and website to address social isolation among homebound older adults. This process incorporated multiple steps: a needs assessment during two focus groups; literature review; pilot of educational materials; and finally, implementation and evaluation of the intervention.
RACIAL DIFFERENCES IN LONGITUDINAL TRAJECTORIES OF SOCIAL ISOLATION AND LONELINESS
Authors: Taylor Harry
Published: December 2023

The purpose of this study was to determine if there are racial differences in the longitudinal trajectories of social isolation and loneliness among older adults. Data come from the Health and Retirement Study Leave Behind Questionnaire, waves 2006-2016. Social isolation was operationalized as a social network index and loneliness was operationalized by the UCLA-3 item loneliness scale. Race was operationalized by White, Black, and Hispanic. I also adjusted for age, gender, education, household income, and employment status. Racial differences in longitudinal trajectories were determined by multilevel models with survey weights included by the HRS. In unadjusted models, I found Hispanic older adults were less likely to be socially isolated compared to White and Black older adults; furthermore, White older adults were less likely to be lonely compared to Black and Hispanic older adults. In fully adjusted models, White older adults had greater social isolation in comparison to Black and Hispanic older adults, and Black older adults had greater isolation compared to Hispanic older adults. For loneliness, Black older adults were found to be lonelier compared to Hispanic older adults, but not White older adults. This study is one of the first to examine racial differences in longitudinal trajectories of social isolation and loneliness. I find race is a salient factor that may influence objective isolation and feelings of loneliness among older adults. Given the established relationship between isolation, loneliness, and health, these findings are useful for identifying potential racial groups at higher risk for these conditions and informing future interventions.
USING INTERVENTION MAPPING TO DEVELOP RESOURCES TO PROMOTE SOCIAL ENGAGEMENT WITH HOMEBOUND OLDER ADULTS
Authors: Thomas Kali , Smith Kristen , Bunker Jennifer , Gans Kim
Published: December 2023

Homebound older adults are at increased risk of social isolation. Drivers who deliver meals to 800,000+ homebound older adults yearly are uniquely positioned to address social isolation through their conversations and daily interactions. The objective of this study was to develop and evaluate resources to educate meal-delivery drivers about social isolation and promote driver-client social engagement. We used Intervention Mapping (IM), a six-step theoretical- and evidence-based planning approach, to develop this intervention. First, we conducted a needs assessment through two focus groups with drivers and 12 interviews with subject matter experts (Step 1). Our literature review revealed the behavior outcomes, determinants, methods, and strategies to target (Steps 2&3). We piloted the intervention materials with stakeholders, meal-delivery drivers, and subject matter experts (Step 4). Our needs assessment indicated that drivers receive no training or education on social isolation. Drawing on the Social Cognitive Theory and Health Belief Model, we developed a 2.5 minute educational video and website with resources for workers who engage with socially isolated homebound older adults. The video and website included the following change methods and strategies: tailoring, modeling, chunking, cuing, raising, framing, and using imagery to influence behaviors. Feedback from drivers and experts on the resources was positive. The presenter will discuss the results implementing and evaluating the intervention (Steps 5&6) with meal-delivery drivers in Mississippi through an online survey. Our findings indicate the benefits of using an iterative, step-by-step intervention development framework to organize and structure an intervention to address social isolation among homebound older adults.
PERSONALITY AND PLASMA BIOMARKERS OF REACTIVE ASTROGLIOSIS (GFAP) AND NEURONAL INJURY (NFL)
Authors: Terracciano Antonio , Walker Keenan , An Yang , Luchetti Martina , Moghekar Abhay R , Sutin Angelina , Ferrucci Luigi , Resnick Susan
Published: December 2023

Personality traits are associated with cognitive functioning and risk of Alzheimer’s disease and related dementias. To understand the biological mechanisms of these associations, it is essential to examine the amyloid (A), tau (T), and neurodegeneration (N) components of the ATN framework. A recent meta-analysis found that neuroticism and conscientiousness are associated with amyloid and tau. However, less is known on whether personality traits are associated with markers of neurodegeneration. This study examines whether personality traits are concurrently related to plasma glial fibrillary acidic protein (GFAP), a marker of reactive astrogliosis, and neurofilament light (NfL), a marker of neuronal injury. Cognitively unimpaired participants from the Baltimore Longitudinal Study on Aging (N=786; age: 22-95) were assayed for plasma GFAP and NfL and completed the Revised NEO Personality Inventory (NEO-PI-R), which measures five domains and 30 facets of personality. Neuroticism (particularly vulnerability to stress, anxiety, and depression facets) was associated with higher GFAP and NfL. Conscientiousness was associated with lower GFAP. Extraversion (particularly positive emotions, assertiveness, and activity facets) was related to lower GFAP and NfL. These associations were independent of demographic, behavioral, and health covariates and not moderated by age, sex, or APOE genotype. The personality correlates of astrogliosis and neuronal injury tend to be similar, are found in individuals without cognitive impairment, and point to potential neurobiological underpinnings of the association between personality traits and neurodegenerative diseases.
MUSIC IN THE EVERYDAY LIFE OF PEOPLE LIVING WITH DEMENTIA
Authors: Kotarba Joseph , Couve Amanda
Published: December 2023

A common approach to dementia care is the clinical application of music to improve cognition, memory, quality of life, etc. Although the literature on this work continues to expand, relatively little scholarly attention has been given to understanding common, everyday life experiences of music among those living with dementia. The present paper is derived from the qualitative research informing “Music in the Course of Life” (Routledge, 2023). Following the symbolic interactionist/existentialist paradigm, we reconfigured the life course model of organizing aging by seeing life course as a concept of the self that can be observed in various situations, that are not necessarily linearly ordered, in everyday life. We observed music as it is presented and performed in residential facilities, at home, in hospitals and in hospice. The self experience can be portrayed as “Being,” “Becoming,” and “Been There” in the case of many seniors. The primary value of music for dementia care is not predicated on eliciting music from memory or from regenerating cognition. The pleasures of music are exceptionally situational so that the elderly person need not have any prior exposure to or experience with music that now is positive affectively, cognitively and/or socially. The meaningful music situation--especially at end of life--is composed of significant others providing the music, attendees singing or humming along with the music, a caretaker to orchestrate the situation.
INVESTIGATING RELATIONSHIPS BETWEEN MUSIC REWARD AND EMPATHY ACROSS THE ADULT LIFESPAN
Authors: Adjei Naomi , Belfi Amy , Beadle Janelle
Published: December 2023

Music can evoke positive mood and even enhance empathy towards others. Understanding the mechanisms supporting music-based enhancements in emotion are essential for developing interventions for older adults with chronic conditions, such as Alzheimer’s disease. Previous studies have primarily focused on younger adults and have shown that trait empathy can modulate responses to music through engaging empathy-related brain networks. However, little is known about the specific relationship between music reward and trait empathy, especially across the adult lifespan. In the present study, we hypothesized that there would be a positive relationship between music reward and empathy. The sample included healthy adults 19-86 years (N=74; Mage=54.36; 62.2% female; Medu=16.2). Participants completed the Barcelona Music Reward Questionnaire (BMRQ), a 20-item questionnaire assessing music reward/appreciation and the Empathy Quotient Inventory (EQ), a 40-item questionnaire measuring multidimensional empathy (i.e., cognitive empathy, emotional reactivity, and social skills). We conducted a linear regression investigating the degree to which empathy predicted significant variance in music reward (age and gender were covariates of no interest). The overall model was significant (p=.007) and there was a significant, positive relationship between the EQ total score and the BMRQ total score (p=.004). Exploratory analyses demonstrated that the BMRQ total had positive correlations with cognitive (p=.006) and emotional empathy (p=.004). In summary, music reward was positively associated with empathy in this adult lifespan sample, adding to the literature focused on younger adulthood. Future research is needed to examine relationships between empathy and other aspects of music experience across the adult lifespan.
NEIGHBORHOOD SEGREGATION, SOCIOECONOMIC STATUS, AND COGNITIVE FUNCTIONING AMONG OLDER CHINESE IMMIGRANTS
Authors: Tang Fengyan , Jiang Yanping , Li Ke , Rosso Andrea
Published: December 2023

The fast-growing population of older Chinese immigrants and their segregated residence highlight the importance of understanding the role of neighborhood context in cognitive health. The segregation-cognition association is equivocal based on a limited number of studies among Hispanic and Asian Americans. To close the knowledge gap, this study examined the associations of neighborhood segregation and socioeconomic status (NSES) with cognitive functioning among older Chinese immigrants. Four waves of cognitive performance tests were conducted in the Population Study of Chinese Elderly in Chicago (2011-2019) and linked to the 2010-2014 American Community Survey estimates of neighborhood contexts. NSES was a summary z-score of six census variables of education, income/wealth, and occupation. Neighborhood segregation was measured by the Index of Concentrations at the Extremes (ICE) that simultaneously assesses Chinese and English language use within a given census tract. There were 170 census tracts in the present sample of 2,044 participants. Latent growth curve models with adjusted cluster robust standard errors were estimated. On average, cognitive functioning declined over time (b= -0.07, p<.001). After adjusting for individual-level predictors, living in high-NSES neighborhoods was associated with slower cognitive decline (b=0.003, p=0.04). ICE was not associated with cognitive functioning, but boosted the protective effect of high NSES on cognitive decline (b=0.006, p=0.05). Neighborhood socioeconomic advantage was related to slower cognitive decline among older Chinese immigrants, especially among those living in neighborhoods with more English speakers or less segregation. This finding suggests complex associations between neighborhood context and cognitive health among Chinese immigrants.
THE IMPORTANCE OF ROMANTIC PARTNERS FOR HEALTH—SHARED TIME, DAILY ACTIVITIES, AND COUPLE DYNAMICS
Authors: Luchetti Martina
Published: December 2023

Research has shown that social relationships, particularly with a spouse or romantic partner, affect health, for better or worse. More work is needed to better understand relational dynamics within couples and their cascade effects on health throughout the life course. This symposium brings together four empirical studies that examine the importance of romantic relationships for multiple aspects of health, from biological markers (i.e., inflammation) to mental health and social connection, using diverse methodologies, from macro (long-term) and micro (short-term) longitudinal assessments to dyadic analysis. First, Dr. Stokes and colleagues examine marital status in the Health and Retirement Study and find that transitions, such as becoming widowed (as compared to remaining married), heighten inflammation and potentially harm health. Second, Dr. Karakose and colleagues examine perceptions of time spent together within married couples and find that time together is protective against stress for both partners, and against depressive symptoms for wives. Third, Dr. Luchetti and colleagues examine momentary, phone-based assessments of loneliness within romantic couples and find loneliness in males to affect subsequent loneliness in their female partners. Finally, Dr. Nikitin and colleagues examine possible sources of loneliness within couples and find an association between low-quality daily activities with partners and momentary/daily loneliness. These studies focus on adults across the lifespan, including middle adulthood, which is a critical yet under studied period of life and regarded as a window of opportunity for interventions to improve health. Results highlight the importance of couple dynamics for the health and well-being of aging adults.
QUALITY OF DAILY ACTIVITIES AND LONELINESS IN A ROMANTIC RELATIONSHIP
Authors: Nikitin Jana , Selovin Fabio , Rupprecht Fiona
Published: December 2023

Romantic relationships can be a source of both the most positive and the most negative experiences. Thus, partners can feel fully integrated or lonely in a romantic relationship, depending on the quality of the relationship. Cross-sectional and longitudinal studies have shown that loneliness (defined as a subjectively perceived deficiency in a person’s social relationship) is more pronounced in low-quality relationships. Little is known about daily sources of loneliness within a couple. To explore this question, we investigated whether low-quality activities in a partnership can lead to feelings of loneliness in daily situations. To examine this question, we analyzed data from 72 individuals (M age = 43 years, range = 18 - 82 years; 64% female) who provided 576 measurement occasions on seven consecutive days in which they were involved in activities with their romantic partners. Participants indicated how they experienced the activity in each situation (positively or negatively) and how lonely they felt. Results showed that participants who reported lower-quality activities with their partner reported higher levels of daily loneliness (47% explained variance); and on occasions when participants reported lower-quality activities than usual, they also reported higher levels of loneliness (25% explained variance). Moreover, individuals who reported higher levels of loneliness during the 7-day assessment benefited less from high-quality activities with their partner in terms of reduced loneliness. Thus, loneliness not only results from, but also contributes to, how people experience daily activities with their partners. Gender and age had no effect on these associations, suggesting generalizability of the results.
OLDER ADULTS WITH MULTIPLE CHRONIC CONDITIONS FROM VULNERABLE POPULATIONS: THE SUCCESS OF PATIENT PRIORITIES CARE
Authors: Samper-Ternent Rafael , Jennings Lee
Published: December 2023

As older adults in the USA grow more diverse, equitable translation of knowledge and best practices to vulnerable groups is essential. Older adults with multiple chronic conditions (MCC) benefit from care focused on the health priorities of individuals. Health priorities include: 1) core values that provide meaning to life; 2) specific, actionable, and realistic health goals that reflect these values; and 3) care preferences that include what individuals are able and willing to do (or not) to achieve their goals. For vulnerable older adults, adverse life experiences provide context to their values. A diverse panel will review the Patient Priorities Care (PPC) approach and describe how PPC has been successfully adapted at different institutions. The first presentation will describe PPC and the importance of identifying values, goals, and health preferences for older adults with MCC. The presenter will show that PPC improves outcomes among older adults, their families, and healthcare providers. The second presentation will describe the implementation of PPC in the VA system. The presenter will describe the impact of PPC and efforts to disseminate it. The third and fourth presentations will describe the cultural adaptation of PPC for older African Americans and older Hispanics respectively. The presenters will describe the adaptation process and discuss the barriers they faced, and the lessons learned from each population group. The panel will conclude by providing suggestions on how to disseminate and increase the adoption of PPC to identify what matters most for diverse older adults.
PATIENT PRIORITIES CARE FOR VETERANS
Authors: Mecca Marcia
Published: December 2023

People receiving care in the Veterans Affairs (VA) health system are older, have greater socioeconomic disadvantage, and more chronic conditions than those receiving healthcare outside of VA. PPC is well-suited for older adults with multiple chronic conditions and aligns with the VA’s Whole Health movement. A small VA PPC pilot study demonstrated that those receiving PPC compared to usual care had fewer medications added and more home and community services aligned with priorities. VA primary care is a cornerstone and hub for veteran care utilizing a team-based approach. A two-site randomized controlled trial exploring the implementation of PPC in VA primary care is currently recruiting veterans. The early phase of the project involved semi-structured formative assessment interviews with key stakeholders to obtain feedback and perspectives on PPC implementation in VA primary care. Interviews were audio recorded, transcribed verbatim, and analyzed using thematic analysis. Concerns elicited were time constraints, follow up and documentation of changes in priorities over time, managing patient expectation, communication between primary care and specialty care, as well as how PPC would impact quality metrics. In response to these findings, the patient priorities note template was shortened and streamlined, and the study communications workflow was adapted to align with clinician preferences. Succinct templated language for care alignment was crafted and shared with study providers. Education for clinicians highlighted ways in which priorities could be used to optimize communication. Study procedures were added to identify quality metric exclusions. The study will explore how PPC impacts veteran care and experience.
SOCIAL HEALTH IN PEOPLE WITH DEMENTIA AND THEIR CARERS. PRELIMINARY FINDINGS FROM THE IDEAL PROGRAM
Authors: Victor Christina , Rippon Isla
Published: December 2023

WHO defines health as a state of complete physical, mental, and social wellbeing. There is an extensive literature examining physical and mental health in later life and, typically, measures of healthy ageing focus upon physical and/or mental health. In the IDEAL dementia research programme we investigated social health outcomes because of their importance in understanding the experience of ‘living well’ for people with dementia. Using data from the IDEAL cohort study, we examined the prevalence and predictors of social isolation in 1,052 people with mild-to-moderate dementia and 928 caregivers who were followed up at 12 and 24 months. Social isolation was assessed using the six-item Lubben Social Network Scale where a score of less than 12 suggests participants are at risk of social isolation. Linear mixed models showed that both people with dementia and caregivers experienced increased social isolation across the two-year period. At baseline 29% of people with dementia were categorised as being socially isolated compared with 14% of caregivers. For both people with dementia and caregivers, loneliness and depression were associated with greater social isolation whilst increased cultural engagement mitigated the impact of social isolation. For people with dementia cognition, the number of green and blue spaces nearby and higher trust in the local community were also important factors. Interventions aimed at increasing cultural engagement and interaction with blue and green spaces may go some way to reducing social isolation.
CERVICAL “INFLAMM-AGING” AND GENITOURINARY SYNDROME OF MENOPAUSE: A GEROSCIENCE CASE-CONTROL STUDY
Authors: Stennett Christina , Gravitt Patti , Brotman Rebecca , Shardell Michelle
Published: December 2023

The genitourinary syndrome of menopause (GSM) is a reproductive aging condition that describes signs and symptoms of the female reproductive tract associated with declining estrogen that women experience during menopause. Up to 84% of menopausal women experience signs and symptoms of GSM, including vaginal dryness and vulvovaginal pain. “Inflamm-aging” is a chronic aging-related elevation of proinflammatory markers that has been linked with multiple aging-related health conditions, but little geroscience research has examined cervical inflammation and GSM. To fill this gap, we carried out a case-control study (N=133) of cisgender women aged 35-60 years, where women with clinical signs of GSM (cases) were matched with up to 3 controls based on age and vaginal microbiota composition, which are known to track with reproductive stage. Participants’ cervical secretion samples were assayed to quantify immune marker concentrations. Samples with at least three out of seven predetermined proinflammatory cytokines and chemokines (IL-1ß, IL-8, IL-23, MIP-1α, MIP-1ß, IP-10, RANTES) in the highest quartile were classified as having a proinflammatory state. Of 133 participants, 35 (17/47 cases, 18/86 controls) had a proinflammatory state. A proinflammatory state was associated with higher odds of GSM in conditional logistic regression additionally adjusted for education and body mass index (aOR=2.39; 95% CI: 1.05-5.46). Findings demonstrate that participants with GSM signs had higher odds of a proinflammatory (“inflamm-aging”) state, independent of multiple characteristics, including vaginal microbiota. Additional geroscience research is needed to identify pathways connecting immune markers with GSM to discover interventions that may slow the pace of genitourinary aging.
THE ROLE OF REPRODUCTIVE AGING FOR ALZHEIMER’S DISEASE AND RELATED DEMENTIAS IN THE CARDIOVASCULAR HEALTH STUDY
Authors: Reeves Alexis , Lopez Oscar , Shardell Michelle , Odden Michelle
Published: December 2023

Most US individuals with ADRD are women. As early as midlife, Black individuals have nearly double the ADRD risk than Whites. Menopause occurs in midlife, accompanied by declines in potentially neuro-protective and cardio-protective hormones. Earlier menopause possibly means earlier exposure to decreased sex hormones, which increases ADRD risk. Surgical menopause via reproductive surgeries causes a sudden loss of hormones and could be a modifiable ADRD risk factor. We used data from 1,977 women prospectively followed for an average of 7.5 years, to determine if menopausal type (natural/surgical) and pre-mature menopause (<40 years) are associated with adjudicated-ADRD. Participants self-reported age of natural menopause and/or surgery (hysterectomy and/or bilateral-oophorectomy), hormone-therapy, education, and race (Black/White). Adjudication for ADRD was conducted by neurologist/psychiatrist committee review using neuropsychological tests, neurological examinations, medical records, physician questionnaires, and proxy/informant interviews. Mean age was 78, 15% were Black, 25% had less than a high-school education, 18% had ADRD, 13% had pre-mature menopause, and 42% surgical menopause. Black women had higher prevalence of pre-mature (22% versus 12%) and surgical (54% versus 29%) menopause versus White women. Pre-mature menopause was associated with a non-significant higher hormone use-adjusted hazard of ADRD (HR=1.09 [0.95-1.25]), findings were attenuated after adjustment for education (HR=1.08 [0.94-1.24]) and race (HR=1.01 [0.88-1.17]). Surgical menopause was associated with higher hormone use-adjusted hazard of ADRD (HR=1.12 [1.02-1.24]), findings were similar after adjustment for education (HR=1.12 [1.01-1.23]) and attenuated after adjustment for race (HR=1.03 [0.93-1.14]). Further work examining menopause, ADRD, and contributions to Black-White disparities are warranted.
HEALTH AND WELL-BEING OUTCOMES OF THE OASIS INTERGENERATIONAL TUTORING PROGRAM
Authors: Sun Peter , Morrow-Howell Nancy
Published: December 2023

The Oasis Intergenerational Tutoring Program is a national program that connects older adult tutors with elementary children in Grades K-3. We are conducting an ongoing project to assess multiple health and well-being outcomes associated with this tutoring program, especially among four sub-groups: first-time tutors, male tutors, tutors who are caregivers, and tutors who report being lonely. In year one of our project, we have collected data from 329 older adults who tutored children in the 2021-2022 school year. We found that a larger proportion of tutors who felt lonely reported improvements to their health, compared to tutors who did not feel lonely. We also found that first-time tutors experienced larger increases in at least two areas of health (physical, emotional, and cognitive), compared to repeat tutors. When we asked tutors about their experience tutoring during the pandemic, major themes included a sense of purpose in life, increased social engagement, and the negotiation of risks and benefits (e.g., remote vs. in-person tutoring). An upcoming two-year follow-up study will enable us to compare our findings with the Health and Retirement Study, a nationally representative sample of older adults. Findings from this project will inform programs across the nation and policies that seek to harness the power of intergenerational bonds.
IMPLEMENTATION FRAMEWORKS IN ACTION: A QUALITATIVE STUDY OF INTERGENERATIONAL TECHNOLOGY IN HIGHER EDUCATION
Authors: Juris Jill , Scrivano Rachel , Leedahl Skye , Jarrott Shannon
Published: December 2023

Cyber-Seniors is an intergenerational technology program that bridges the digital divide by training younger people to assist older adults with using technology. While higher education is an ideal setting for utilizing this program for service learning or student internship opportunities, there are often challenges to implementing this program in a higher education setting. In this study, implementation factors must be studied to improve sustainability and increase the potential to scale-up the use of Cyber-Seniors programming within higher education. This study is guided by the dynamic sustainability framework (Chambers et al., 2013) with the goal to investigate prominent contextual factors of implementation that permit and prohibit program sustainability. The study will also identify needed adaptations to Cyber-Seniors’ implementation, which will be documented using Stirman and colleagues’ (2019) Framework for Reporting Adaptations and Modifications-Enhanced (FRAME). In this presentation, we will illustrate the process of infusing implementation science frameworks into a multistage qualitative study designed to allow for in-depth understanding of experiences implementing Cyber-Seniors programming in higher education and designing an adapted checklist for program implementation. We will describe how the implementation science frameworks have been used to design the research instruments, protocols, and the analysis plan. The presentation will conclude with next steps for the research project. A key takeaway from this presentation will be for attendees to gain an understanding of how to infuse implementation science frameworks when designing, implementing, and evaluating research programs and interventions.
CONNECTING AGING RURAL VETERANS WITH TELE-GERIATRIC MENTAL HEALTH: REFERRING PROVIDERS’ SURVEYED PERSPECTIVE
Authors: Carlson Chalise , Humber Marika , Trivedi Ranak , Peeples Amanda , Lloyd Althea , Gould Christine
Published: December 2023

Providing comprehensive, individualized care to older Veterans with complex needs is particularly challenging in rural areas. Geriatric mental health specialists are scarce but needed for care including psychiatric medication and behavior management, consultation on complex comorbidities, cognition, and caregiver support and education. Tele-geriatric mental health services were initially developed in one VA regional telehealth hub and then expanded to three more regional telehealth hubs. Referring providers (N = 37) to tele-geriatric mental health services during a 1-year period were surveyed via REDCap. Providers came from varied settings in the 4 VA regions with 76% serving rural Veterans. Referring providers included prescribers (N = 26; pharmacists, physicians, physician assistants, nurse practitioners and advanced practice nurses) and non-prescribers (N = 11; psychologists, social workers). Most worked in Patient Aligned Care Teams, mental health clinics, or Community Living Centers and reported geriatric training and comfort with geriatric patients. When asked about their perception of the impact of the services, most providers believed that patients (91.9%) and care teams (94.6%) benefitted from the telehealth services and would recommend the services (94.6%). Most followed through on recommendations (83.7%) and believed the service increased access to geriatric mental health (89.2%). Open-ended feedback included gratefulness for providing care to aging rural Veterans lacking resources. These services are appreciated by providers and may facilitate access to specialized mental health care particularly in rural areas. Having access to specialists to assist with the care of patients with complex needs may ease the care coordination needed by referring providers.
RESPONSE AND RETENTION OF AN ONLINE RESEARCH REGISTRY: ADAPTATIONS MADE FOR RECRUITING ASIAN AMERICANS
Authors: Yu Kexin , Gothard Sarah , Tupper Emily , Golonka Ona , Lindauer Allison , Pierce Aimee
Published: December 2023

Challenges in recruiting research volunteers, especially racial/ethnic minority older adults, have been documented as one of the most significant obstacles to developing effective treatments for Alzheimer’s Disease and Related Dementia (ADRD). To address the need for recruitment and raise awareness about ADRD research, the Layton Aging and Alzheimer’s Disease Research Center built the online dementia research registry, Alzheimer’s Comprehensive Treatment Network of Oregon and Washington (ACTNOW). Individuals aged 18 and above are eligible to join, and prospective participants self-initiated enrollment into the registry. As of March 2023, there are 497 participants (mean age 63.9, 71.6% female, 74% had bachelor’s or above degree, 12% residing in a rural area) registered in ACTNOW, with an average follow-up period of 1.8 years (SD=1.2, Max=5). To date, 20 research projects have used ACTNOW for their recruitment, and 93% of registry volunteers have been referred to at least one requesting study. The current ACTNOW participants are predominantly non-Hispanic White (92.4%). We will describe ACTNOW’s infrastructure expansion to improve the registry’s capacity for engaging and recruiting older Asian American adults with limited English proficiency. We tested the feasibility of using translated informed consent forms and questionnaires, reconciling data collected in different languages with existing data structures, and the effectiveness of community outreach sessions. Developing the capacity to recruit underrepresented populations for future ADRD research projects can be critical to addressing health disparities in dementia awareness, prevention, diagnosis, and care. Standardizing communications with all registry stakeholders, both researchers and volunteers, helps engagement and accurate recruitment efforts.
APPLIED METHODS FOR HEALTH EQUITY AND END-OF-LIFE OUTCOMES RESEARCH USING MEDICARE DATA
Authors: Jarrín Olga , Kim Hyosin
Published: December 2023

This symposium brings together four related and complementary projects on the development of new data sources and methods to analyze the new data to study health equity and end-of-life outcomes research. The first abstract presents the development of the Care Setting Trajectory Database, which integrates data from various CMS data sources for Medicare beneficiaries to create a longitudinal care experience for older adults across healthcare settings. The second abstract describes the creation of a new race/ethnicity variable to augment the Medicare administrative data for minority populations using harmonized, self-reported race/ethnicity data. The third abstract describes the development of harmonized datasets to study geriatric syndromes’ prevalence, cost, and health outcomes over time. The fourth abstract identifies and predicts place of care trajectories during the last three years of life among Medicare beneficiaries, identifying dual trajectories of inpatient/institutional care and skilled home healthcare/home hospice. Finally, the fifth abstract includes an application of the care setting trajectory database and our new, harmonized, self-reported race/ethnicity variable to evaluate the impact of home health care on later use of hospice and place of death in a large cohort of Medicare decedents. This symposium introduces innovative approaches for harmonizing and merging CMS data sources for Medicare beneficiaries. The methodological advances described in this symposium aim to support health services researchers and policymakers to generate and evaluate research improving care coordination, continuity, and quality of life for older adults with serious illnesses.