bluuebunny/crossref_metadata_2025 huggingface dataset:
EMPOWERING OLDER ADULTS THROUGH SMART TECHNOLOGY: A NEW ERA IN AGING-IN-PLACE AND HOME HEALTH CARE
Authors: Kim Daejin
Published: January 2025

Demographic aging presents unique global challenges, especially regarding the preference of many older adults to age in place. Traditional physical environments often inadequately support the complex needs of this demographic, highlighting the need for innovative approaches. This presentation focuses on the integration of smart home technologies that are powered by machine-learning algorithms to facilitate successful aging in place. Smart home technologies encompass an array of sensors, devices, and machine-learning analysis, and can significantly enhance the wellness and independence for older adults through home automation, health monitoring, and daily activity tracking through machine learning algorithms. They provide essential insights into the functional, cognitive, and social well-being of older individuals, thus supporting their independence and enriching their quality of life. Despite their immense potential, a knowledge gap persists regarding the availability and integration of smart home technologies in homes designed for older adults. This presentation addresses this gap by highlighting the practical applications of these technologies for healthcare professionals, architects, and policy makers. It discusses challenges like privacy, user-friendliness, and affordability, and explores future advancements in this field. The presentation also emphasizes the importance of adopting technological solutions to transform built environments for older adults through a comprehensive overview of the critical role of smart home technologies. It underscores how tailored, effective technological support can significantly improve living conditions for older adults, enabling them to live safely and independently in their preferred environment. The presentation is a call to action for creating more supportive and adaptable living spaces for our aging society.
MARITAL STATUS AND QUALITY OF END-OF-LIFE EXPERIENCES AMONG OLDER US ADULTS
Authors: Mahmoud Kafayat , Carr Deborah , Onge Jarron Saint
Published: January 2025

Understanding the quality of end-of-life experiences is a critical goal, because many older adults experience discomfort or care discordant with their preferences at the end of life. While extensive research documents the protective effects of marriage for health, we know of no studies focusing specifically on marital status differences in end-of-life well-being and care. We examine the extent to which marital status (married, remarried, divorced, widowed, never married) affects end-of-life physical and emotional well-being, quality of care, and dignified care, and whether these associations differ by gender. Using 13 waves of data from the National Health and Aging Trends Study (NHATS), we estimate multivariable multinomial and binomial logistic regression models to evaluate how marital statuses affect diverse indicators of end-of-life well-being and gender differences therein. Our analyses show that married persons do not fare uniformly better than their unmarried counterparts; rather, patterns differ across outcomes. Widowed and remarried persons have a higher likelihood of reporting excellent or very good care at the end of life, relative to married persons. Widowed older adults also are more likely to report receiving care concordant with their preferences. Divorced older adults report poorer pain management, while remarried and never married older adults report less sadness relative to married persons. Patterns do not differ significantly by gender. Unmarried or remarried persons may perceive a more urgent need to do advance care planning, which can enhance the quality of dying experiences. We discuss how marital relationships more broadly shape end-of-life experiences.
PLANS4CARE: TRANSLATING EVIDENCE FROM IN-PERSON CAREGIVER INTERVENTIONS TO A DIGITAL PLATFORM
Authors: Jutkowitz Eric , Piersol Catherine , Koeuth Sokha , Gitlin Laura
Published: January 2025

Our research group has developed and/or evaluated numerous evidence-based non-drug dementia caregiver interventions (e.g., Tailored Activity Program and Skills2Care). For these interventions, healthcare professionals conduct in-home assessments to evaluate cognitive function of the person living with dementia, determine the caregiver’s care challenges (e.g., behaviors), and provide tailored strategies. In randomized trials, these interventions improved caregiver outcomes (e.g., less time caregiving), person with dementia outcomes (e.g., reduced behavioral symptoms), and health system outcomes (e.g., cost savings). Informed by this evidence, our team engaged in an iterative process to create a digital platform that caregivers can use on-demand. First, we mined the clinical trial data and identified 80 caregiver challenges that we grouped into 8 domains: for persons with dementia, behaviors, self-care mobility, household tasks, leisure participation, and healthcare; caregiver-centered challenges (need for respite), and general dementia care practices. Second, we reviewed unique strategies documented and published, which we grouped into 6 categories: communication, cueing, simplifying activity, enhancing, engagement, modifying environment, and taking care of self. Third, two healthcare providers on our team independently mapped care challenges to evidence-based strategies based on the level of cognitive function. Our approach generated a database of 80 care challenges linked to >1500 evidence-based strategies classified by six levels of cognitive functioning (high to low), and a simple user interface for caregivers to generate personalized care plans. Translating in-person sessions to digital platforms and maintaining tailoring and clinical relevance requires an iterative developmental process that is data-driven and informed by caregiver input.
FOSTERING ENGAGEMENT: AN EXPLORATION OF INNOVATIVE DEMENTIA ENVIRONMENTS FROM FOUR COUNTRIES
Authors: Verbeek Hilde
Published: January 2025

Dementia is one of the major age-related diseases and challenges those affected, societies, as well as health care systems worldwide. In an effort to better meet the needs of people living with dementia (PlwD), innovative care concepts for community-dwelling PlwD, as well as those in need for long-term care are being developed worldwide. Aiming to strengthen independence and slow down the cognitive decline, efforts concentrate on continuously engaging PlwD in activities of daily life, despite a progression of the disease. This international symposium will provide five presentations on different innovative care environments in the community, which stimulate and support an active daily life of PlwD. The first presentation dissects the care environment of Green Care Farms in the Netherlands and its effects on the engagement of residents. The second presentation discusses activity programming and self-directed behavior in Canadian long-term care. The third presentation presents social participation of PlwD in shared housing arrangements in Germany. The fourth presentation describes how the neighborhood-built environment can contribute to social health aspects for PlwD in German municipalities and the fifth presentation considers the feasibility and effectiveness of a virtual care farm activity in the United States.
SOCIAL PARTICIPATION OF PEOPLE LIVING WITH DEMENTIA IN GERMAN SHARED-HOUSING ARRANGEMENTS
Authors: Wolf-Ostermann Karin , Misonow Julia , Altona Janissa
Published: January 2025

Aspects of social health are increasingly gaining more interest regarding research for people living with dementia (PlwD). Having a range of meaningful social relationships has been identified as crucial for healthy aging, defined by lower mortality rate, and better physical and mental health outcomes. Recent studies show that social connections and participation in social activities are important dimensions of social health and have the potential to act as a buffer in the process of cognitive decline by delaying dementia or even protecting against its development. Shared-housing arrangements (SHA) in Germany are based on the concept of enabling PlwD to lead an everyday life as normal as possible – including especially social activities as well as exercise-related, sensory, cognitive and creative approaches and out-of-home activities. We analyzed data from different studies on SHA in Germany from 2009-2022 (including the period of the COVID-19 pandemic) to evaluate to which extent social activities are actually performed by PlwD in SHA. The most frequently offered and used activities in SHA are entertainment and joint social activities (2009: 67.0%, 2011: 96.6%, 2021: 80,0%, 2022: 87,9%). This is followed by exercise-related activities (2009: 26.2%, 2011: 79.3%, 2021: 73,2%, 2022: 77,8%) and sensory-related activities (2009: 21.9%, 2011: 77.6%, 2021: 47,9%, 2022: 47,0%). The results show that participation in social activities is a lived fact in SHA - despite some reduction during the pandemic - and should be taken into account when discussing care arrangements for PlwD and conditions for living well with dementia.
GERIATRIC URINARY INCONTINENCE AND LOWER URINARY TRACT SYMPTOMS: NEW DATA, TRIALS, AND CLINICAL APPROACHES
Authors: Bauer Scott , Kuchel George
Published: January 2025

Lower urinary tract symptoms (LUTS) is a syndrome of commonly overlapping symptoms that occur when urine is being generated and stored in the bladder, called storage LUTS (e.g., overactive bladder and urinary incontinence), or during the initiation and process of urination, called voiding LUTS (e.g., weak stream). More than 1 out of 3 of older adults report clinically significant LUTS, contributing to poor quality of life and increased risk of falls and fractures, functional and mobility impairment, and death. Although urinary incontinence is a well-established geriatric syndrome, the remaining LUTS share many risk factors and downstream consequences. In this symposium, each session will review the pre-clinical, epidemiologic, and clinical evidence supporting the entire umbrella of male and female LUTS to be considered a geriatric syndrome. Dr. Parker-Autry will describe the rationale and proposed approach for a multi-modal clinical care pathway to treat female geriatric incontinence syndrome that she has begun to implement in her academic geriatric urogynecology clinic. Dr. Al-Naggar then will review how biological hallmarks of aging contribute to LUTS and key considerations for pilot studies of gerotherapeutic interventions targeting urologic conditions based on a randomized, placebo-controlled clinical trial testing MitoQ for overactive bladder in older women with metabolic syndrome. Lastly, Dr. Bauer will review the evidence of male LUTS as a geriatric syndrome and will describe how this novel framework led to a R01-funded clinical trial comparing a remote exercise coaching intervention versus health education control for physically inactive older men with LUTS.
DEVELOPING A RISK ASSESSMENT AND BRIEF INTERVENTION FOR ELDER MISTREATMENT: A MIXED-METHODS STUDY
Authors: Pappadis Monique , Wood Leila , Schlag Karen
Published: January 2025

Elder mistreatment (EM) is public health and safety concern for older adults, especially those with mild cognitive impairment and Alzheimer’s Disease and Related Dementias (MCI/ADRD); however, few tools exist to assess risk or address risks, especially those that may come from caregivers or the social environment. To address these gaps, we used Medicare outpatient data (2015-2018) and semi-structured interviews with providers, older people with MCI/ADRD, and family caregivers to: 1) Identify risk and protective factors for EM, 2) Understand education and training gaps that may contribute to risk, and 3) Develop a screening, brief intervention, and referral to treatment (SBIRT) model for caregivers and older adults with MCI/ADRD to address risks for EM. Our preliminary findings indicate that social determinants of health, such as housing, financial instability, and social isolation, along with frailty, contribute to EM risk. Caregiver stress, often from financial instability, can increase risk conditions for EM. The lack of caregiver and provider education on EM contributes to a lack of identification of risk factors. Thus, the developed SBIRT model centers on risk assessment, universal education, and referral to support based on the results of the risk assessment. Preliminary feasibility and acceptability of the SBIRT intervention will be reviewed, along with a review of risk assessment protocols. The session will end with describing the next steps to expanding the SBIRT intervention to a greater number of primary care clinics across a large academic health science center’s system.
DEVELOPMENT OF A RISK SCREEN OF ELDER ABUSE IN CAREGIVERS OF PEOPLE LIVING WITH DEMENTIA
Authors: Olsen Bonnie , Mosqueda Laura
Published: January 2025

Significant advances have been made in understanding risk factors of abuse of persons living with dementia (PLWD) by their caregivers. Intervention focused on the modifiable caregiver risk factors provides a possible avenue to primary prevention. This project developed a caregiver risk assessment screen, linked to an abuse prevention intervention. To develop the tool, we administered surveys of validated measures of risk factors to caregivers of PLWD (N=95), had an expert panel rank responses according to risk, and used these risk levels to identify items that are most predictive of risk. The sample had a mean age of 49.5 years (SD=14.4), mostly female (68.1%), mostly Latine (52.1%), predominantly family members (14.7% spouse, 43.1% child, 20.0% other). The PLWD had a mean age of 78.6 years (SD=10.8), mostly female (62.4%). Expert panel-assigned risk levels were evenly distributed, with 35.8% high, 30.5% medium, and 33.7% low risk. Using a 2:1 train/test split, the training sample demonstrated strong single-item prediction, with maximum single-item AUC (area under the curve) of 0.861 (39 items had AUC≥0.7, of which 5 had AUC≥0.8). The top performing items included: caregiver’s satisfaction with their life; acting in an emotionally aggressive manner; feeling angry when around the PLWD; being bothered by feeling nervous, anxious, or on edge; and finding looking after the PLWD to be a burden. This presentation will discuss the process of creating an abuse screening tool for caregivers of PLWD. In the next phase, we will assess the effectiveness of our intervention in reducing risk for abuse.
ADAPTING THE DETECT TOOL FOR HOME-BASED PRIMARY CARE: INSIGHTS ON POLICIES, PROVIDER PERSPECTIVES, AND TOOL DESIGN
Authors: Haggerty Kristin Lees , Cannell Brad , Ojelabi Olanike , Campetti Randi , Burnett Jason , Pickering Carolyn , Livingston Melvin
Published: January 2025

Elder mistreatment (EM) is difficult to detect and often goes unrecognized. Home-based primary care (HBPC) providers have enduring relationships with patients who are vulnerable to EM and the ability to see patients’ homes first-hand. Effective and efficient screening tools are urgently needed to support these providers in consistently assessing patients for signs of EM. This project includes a two-stage approach to adapting and rigorously evaluating an evidence-based EM screening tool, Detection of Elder mistreatment Through Emergency Care Technicians (DETECT), for use in home-based primary care (HBPC). In this presentation, we share results from a qualitative study conducted to inform tool adaptation and implementation strategy for DETECT revised for primary care (DETECT-RPC). This study addressed three research questions: 1) what are the implications of state- and site-specific policies on DETECT-RPC implementation, 2) what are the perceived barriers and facilitators to recognizing and reporting EM among HBPC providers, and 3) What adaptations need to be made to make DETECT-RPC feasible and effective in HBPC? Data collection included review of publicly available information and interviews and focus groups with HBPC staff from seven sites (N=16). Interview and focus group data were transcribed and coded using a thematic analysis approach. We will present key themes from the qualitative study including implications for the DETECT-RPC tool design and workflow, and key considerations for developing reporting guidelines structure.
IMPACT OF VALUE-BASED PURCHASE MODEL ON RACIAL DISPARITIES IN ACCESSING HIGH-QUALITY HOME HEALTH CARE
Authors: Ma Chenjuan , Wu Shaohui , Fletcher Jason
Published: January 2025

Home healthcare (HHC) plays a pivotal role in serving Americans who “Age in Place”, particularly persons living with dementia (PLWD). Along with its rapid growth, there are increasing concerns of care disparities under the current HHC system and policies. This study aimed to examine racial/ethnic disparities in accessing high quality HHC among PLWD and identify the impact of home health value-based purchasing model (HHVBP), a policy designed for improving overall care quality, on such disparities. This study used two years of CMS HHC assessment data (i.e., OASIS) and HHC Compare Data. High quality HHC was identified based on agency care quality star rating (>=4.5 stars). HHVBP status was indicated by a dummy variable. A total of 743,860 PLWD from 6,410 agencies were studied, including 80.9% White, 11.9% Black, 5.6% Hispanic, and 1.6% Asian. Nearly one-third (32.6%) of agencies were with high quality care. Our risk-adjusted model shows that Blacks were 2% more likely to access high quality care while Hispanics and Asians were both about 20% less likely to access high quality care, compared to Whites. HHVBP increased the odds of accessing high quality HHC for all racial/ethnic groups (significant interaction terms all ORs>1) with most substantial among Hispanics (OR=1.60), followed by Asians (OR=1.28) and Blacks (OR=1.11). Stratification analysis indicated while the racial/ethnic disparities continue to exist in non-HHVBP states, such disparities disappeared in HHVBP states. Our study demonstrated the existence of racial/ethnic disparities in accessing high quality HHC and the effect of HHVBP in reducing such disparities.
HOME HEALTH CARE USE AND OUTCOMES AMONG PERSONS WITH DEMENTIA: A SCOPING REVIEW
Authors: Smith Jamie , Burgdorf Julia , Riser Tiffany , Ryvicker Miriam
Published: January 2025

One-third of home healthcare (HHC) recipients are persons living with dementia (PLWD). HHC provides skilled nursing and therapy delivered in the patient’s home. Amid population aging and a shift towards home- and community-based care, there is a growing need for HHC services for PLWD. However, dementia care research has historically focused on institutional care settings, and HHC has been understudied. We conducted a scoping review to summarize the current research landscape regarding HHC utilization and clinical outcomes for PLWD and recommend future research directions. We applied Arksey & O’Malley’s methodology and identified 32 articles that met inclusion criteria. Of these, 22 studies examined utilization, finding that PLWD used HHC differently than persons without dementia, having a higher likelihood of community referral, longer episode length, greater use of nursing and aide services, and increased costs. Sixteen papers reported on clinical outcomes: function, hospitalization, skilled nursing facility admission, and mortality. Analyses varied widely in their approach to defining dementia and measuring key outcomes. However, literature suggests an increased risk for negative outcomes, including hospitalization and institutionalization among PLWD. Findings highlight several areas for future research, most saliently, the need for analyses that consider contextual factors (e.g., market factors, racial/ethnic disparities, rurality) when examining HHC for PLWD. Future work should assess the impacts of payment model revisions and expanding Medicare Advantage coverage on utilization and care delivery for this population. A rigorous examination of care delivery and outcomes is needed to inform practice models to adapt to the unique care needs of PLWD.
BARRIERS AND FACILITATORS TO HELP-SEEKING FOR ELDER ABUSE: A QUALITATIVE STUDY FROM THE PERSPECTIVE OF VICTIMS
Authors: MacNeil Andie , Hsieh Jessica , Rollandi Isabel , Sirey Jo Anne , Lachs Mark , Burnes David
Published: January 2025

Understanding help-seeking among victims of elder abuse (EA) is a major challenge and significant knowledge gap in the field. The vast majority of EA victims are not connected with formal response systems, such as Adult Protective Services, law enforcement, and other agencies responsible for addressing this issue in the community. The current study sought to understand barriers and facilitators to help-seeking from the perspective of EA victims. Using a descriptive phenomenological approach, this study conducted in-depth, individual, qualitative interviews with a diverse sample (n = 32) of EA victims living in New York City and Los Angeles, United States. Analysis followed a constant comparison process involving two independent coders of verbatim transcripts. Major themes that emerged as barriers to help-seeking included: embarrassment or shame, self-blame or guilt, fear of perpetrator retaliation, fear of what could happen to perpetrator, concern for family preservation, and lack of awareness of services. Facilitators in the process of help-seeking included: reaching a “tipping point”, concern for self-preservation, accessibility and convenience of services, and having knowledge about where and how to seek support. These findings emphasize that barriers and facilitators to help-seeking span various levels of ecological influence, including the individual victim, the individual perpetrator, the victim-perpetrator relationship, and the family system. To promote greater help-seeking among EA victims, there must be accessible interventions that help address the complex and interrelated psychological, emotional, relational, and familial factors that impact help-seeking behavior among EA victims.
THE EFFECT OF SOCIAL SUPPORT ON THE RELATIONSHIP BETWEEN ELDER MISTREATMENT AND HEALTH IN OLDER CHINESE IMMIGRANTS
Authors: Kwon Soonhyung , Da Wendi , Tang Fengyan , Jiang Yanping
Published: January 2025

Elder mistreatment experiences cause severe health consequences such as lower self-rated health. Despite such documented adverse effects, it is less known the potential factors that can mitigate the adverse effects of elder mistreatment on health to facilitate intervention development further. Thus, our study aims to examine the moderating role of social support from friends on the relationship between elder mistreatment and self-rated health among older Chinese immigrants. This study used five waves of PINE study involving 2,835 older Chinese immigrants aged 60 years and older. We used latent growth curve modeling (LGCM) to investigate the trajectory of self-rated health. Elder mistreatment (psychological, physical, and sexual abuse, financial exploitation, and caregiver neglect), social support from friends, and self-rated health were assessed across five waves. Our study showed social support from friends significantly moderated the adverse effects of elder mistreatment on the trajectory of self-rated health. Specifically, the detrimental effect of elder mistreatment on a faster decline in self-rated health over time was smaller at higher levels of social support from friends, showing the buffering effects of strong social support from friends on the relationship between elder mistreatment and self-reported health. Our findings suggest that transitioning friend social support from low to medium might be promising to reduce the negative effect of elder mistreatment on self-reported health among older Chinese immigrants.
NOVEL APPROACHES AND DATA SOURCES TO INVESTIGATE LIFESPAN ASSOCIATIONS FROM EARLY EXPOSURES TO LATER LIFE HEALTH
Authors: Lee Lewina
Published: January 2025

Despite substantial evidence linking early adversity to elevated risks of later-life morbidity and mortality, recent findings on the often-poor agreement between retrospective and prospective measures of childhood maltreatment (Κs=.09-.83; Baldwin et al., 2019) have challenged these well-established associations, which were predominantly derived from retrospectively-assessed early exposures in longitudinal cohorts. As most longitudinal aging studies enrolled participants in their adulthood, prospective early-life data combined with long-term tracking of health outcomes are scarce, but necessary for rigorous causal inference regarding the nature and mechanisms by which early exposures shape life span health. This symposium showcases recent methodological developments and new data resources capable of addressing these scientific barriers and amplifying the scientific value of longitudinal aging studies. Ms. Dorame will illustrate a novel approach to acquiring prospective data on childhood familial and environmental exposures by linking three longitudinal cohorts to recently digitalized, 1900-1940 US Censuses in the Boston Early Adversity and Mortality Study (BEAMS). Dr. Marino will report on the prospective associations of childhood and midlife socioeconomic status and all-cause mortality risk using BEAMS Census-linked data. Dr. Casey will describe efforts to assess early-life environmental exposures and evaluate their associations with later-life brain health in the Health and Retirement Study. Dr. Arpawong will consider the extent to which cognitive abilities were retained from adolescence to old age in Project Talent, and the roles of education and gender therein. Finally, Dr. Warren will describe three new, large-scale data resources suitable for interdisciplinary research on the later-life sequelae of early-life exposures. Measurement, Statistics, and Research Design Interest Group Sponsored Symposium
ENVIRONMENTAL EXPOSURES AND AGING OUTCOMES IN THE HRS USING CENSUS DATA
Authors: Casey Joan , Shearston Jenni , Mobley Taylor , Rojas-Saunero L Paloma , Zhou Juliet , Mayeda Elizabeth Rose
Published: January 2025

Incidence of Alzheimer’s disease and related dementias (ADRD) is 40–100% higher among Black compared with White Americans. Differential exposure to air pollution might partially explain this difference. We aim to determine if early-life exposure to poor air quality is related to late-life brain health among non-Hispanic Black and White Health and Retirement Study (HRS) participants. Using 1940 Census-linked enumeration district of residence, we estimate childhood exposure to fine particulate matter (PM2.5), traffic-related air pollution, and fossil fuel energy sources. We construct these exposures using archived climate model outputs from CMIP6 (PM2.5), gasoline sales, street networks, and oil and gas well and power plant locations paired with dispersion modeling techniques. Using multi-level survival analyses, we estimate the association between HRS participant childhood environmental exposures and late-life dementia. We also determine the contribution to Black-White disparities in dementia attributable to differences in early-life exposure. Preliminary analyses indicate that Black vs. White HRS participants had lower power plant emissions exposures but higher PM2.5 and traffic-related air pollution exposures in 1940. Regression analyses will evaluate whether 1940 environmental pollutant exposure is associated with dementia or dementia disparities by race. Identifying modifiable risk factors for ADRD could help protect cognitive health of the aging US population.
THREE INNOVATIVE DATA RESOURCES: EDSHARE, THE MULTIGENERATIONAL LONGITUDINAL PANEL, AND THE 1940 CENSUS
Authors: Warren John
Published: January 2025

Scientists interested in studying the long-term health consequences of early life social, economic, policy, environmental, or other exposures have historically suffered from a lack of suitable data. Large, nationally representative studies of early life (e.g., Add Health) rarely extend late enough into older ages. At the same time, large, nationally representative studies of later life (e.g., HRS, NSHAP) rarely contain prospectively gathered, high resolution information about early life exposures. This talk will describe three new and extraordinary new data resources that overcome these problems. FIRST, the Education Studies for Health Aging Research (EdSHARe) project has re-purposed two large national studies of adolescence and education started in the 1970s and 1980 to be studies of health and aging; the talk will focus on these cohort studies utility for understanding the social and biological pathways through which early life factors --- especially education --- impact later life health and cognition. SECOND, the Multigenerational Longitudinal Panel (MLP) includes linked complete-count U.S. census records for every American from 1850 through 2020 plus other mortality, vital records, and other kinds of data. THIRD, as an offshoot of MLP, we have linked records about older people from the HRS, NSHAP, PSID, WLS, and NHATS to the 1940 Census in which aging survey participants are seen in childhood along with their parents and other family members. All three data resources are or soon will be available to the research community; all stand to transform aging research.
NOVEL APPROACHES FOR CROSS-NATIONAL COGNITIVE AGING RESEARCH
Authors: Gross Alden , Kobayashi Lindsay , Langa Kenneth
Published: January 2025

Cross-national comparisons of cognitive outcomes are increasingly feasible given availability of newer data resources. Given a broad, global study population, cross-national research may uncover mechanistic insights that would not be clear from one country or a socioeconomically homogeneous set of countries. Despite its promise, cross-national data present with numerous methodological and interpretational challenges, which will be highlighted in this symposium. In this symposium, Kobayashi and Gross (co-chairs) will lead with best practices for cross-national research, highlighting findings from the Harmonized Cognitive Assessment Protocols (HCAPs), a major NIA-funded platform for valid cross-national comparisons of ADRD. Cai will present a novel platform for deriving classification algorithms for dementia, based on neuropsychological criteria standardized to a robust normative group. Leveraging HCAP studies from the US, England, and India, they applied variations of classification algorithms. Next, Wu and colleagues, using longitudinal data from China’s HCAP (N=6,830), present a challenge–form differences introduced by changing test stimuli across waves–and a solution–weighted equipercentile equating–for when parallel but non-equivalent memory tests are administered longitudinally in surveys. Third, out of recognition that culturally diverse and low-resource settings can affect reliability and validity of cognitive tests, Mani and colleagues present psychometric properties of a brief pilot HCAP in Kenya (N=203). Finally, Zhang will present simulation results and demonstration of an R/Shiny-App regarding effects of differential pre-baseline selection on inferences for cross-national studies. Pre-baseline selection refers to selective survival in a target population occurring before a study’s baseline, and can vary dramatically between high-income and low-income countries.
PREBASELINE SELECTION BIAS IN THE ESTIMATED EFFECT OF T2D ON COGNITIVE DECLINE: CROSS-NATIONAL SIMULATIONS
Authors: Zhang Pengyuan (Kelvin) , Mani Sneha , Kobayashi Lindsay , Gross Alden , Weuve Jennifer , Andrews Ryan
Published: January 2025

Selection bias is a common threat to the validity of effect estimates, including those of various exposures on late-life cognitive outcomes. Although selection bias can arise for many reasons, a challenging subtype is driven by differential mortality in a study’s source population prior to baseline. In other words, individuals who survive long enough to be eligible for studies of late-life cognition are systematically different from those who do not. Because data are not collected on individuals who do not survive to study enrollment, analytic methods to address selection bias cannot be applied. Furthermore, this “pre-baseline survival” bias makes cross-national comparisons difficult, as different countries have differing mortality rates and determinants of mortality. Using the example of cross-national comparisons of the effect of type-2 diabetes on cognitive decline, we demonstrate how simulations can help quantify pre-baseline survival bias. We simulated large (N=300,000) country-specific cohorts of adults in the US, India, and China under seven causal scenarios governing the relationships between type-2 diabetes, pre-baseline survival, and cognitive decline. After assigning each simulated participant a vital status (dead/alive by a certain age), we recruited 2,000 country-specific study samples of 2,000 “survivors” and estimated the association between type-2 diabetes and cognitive decline within these cohorts. We found that even under relatively mild differences in pre-baseline survival, the cross-national effect of diabetes on cognitive decline could be underestimated by up to 34%. To assist others with conducting similar simulation studies, we developed a user-friendly platform based on the R-Shiny package.
NEIGHBORHOOD SOCIOECONOMIC DISADVANTAGE AND RECOVERY AFTER HIP FRACTURE: EVIDENCE FROM REAL-WORLD MEDICARE DATA
Authors: Falvey Jason , Mathis Lindsey , Sun Na , Kumar Amit
Published: January 2025

Neighborhood environments—or the exposome—are a powerful influence on function recovery among older adults. This study examines the influence of neighborhood socioeconomic disadvantage on the recovery trajectory of older adults following a fall-related hip fracture. Utilizing Medicare fee-for-service claims data, we identified 52,012 older adults with hip fractures via ICD-9 and ICD-10 codes, and identified fall-related mechanisms using validated E codes in claims. These individuals were linked to the Area Deprivation Index (ADI) using 9-digit ZIP codes, categorizing them into the top 10%, bottom 10%, and middle 80%. Days at home, a validated claims-based measure, was calculated for each participant over 6 months. We employed weighted generalized estimating equations with a Poisson distribution to account for the time-varying probability of death in each post-fracture month, and adjusting for age, sex, medical complexity, time (quadratic), and pre-fracture days at home to estimate rate ratios and predicted mean counts of days at home by ADI group. The cohort’s mean age was 82.1 years (SD = 8.1), with 74% female sex. In adjusted models, individuals in the lowest socioeconomic neighborhoods spent more than 7% fewer days at home (RR=0.93, 95% CI 0.91, 0.94) compared to their counterparts in the wealthiest 10%, translating to nearly 8 more days alive and in facilities—exceeding clinically important differences reported in prior work. The study highlights the need for tailored rehabilitation strategies and community support systems that address the unique barriers encountered by this vulnerable population, promoting equitable recovery outcomes across different socioeconomic contexts.
ADVERSE CHILDHOOD EXPERIENCES AND LATER LIFE COGNITION: THE MISSING COMPONENT OF MORAL DEVELOPMENT
Authors: Missell-Gray Rachel , Eustice-Corwin Alexander , Sörensen Silvia
Published: January 2025

Recent empirical studies on the relationship between Adverse Childhood Experiences (ACEs) and later life cognition have found an inconsistent association between these two variables. Some studies have determined that a higher number of ACEs are associated with decreased cognitive performance later in life (ages 50 and up), while others have determined that there is no relation. Despite these ambiguous findings, both theory and empirical research provide us with reasons to believe that a relationship between ACEs and later life moral cognition is likely. In the current paper, we argue that self-reported ACEs likely impact older adult moral identity and develop a theoretical framework to guide directions for future research. First, we will summarize the findings of the empirical literature on ACEs and later life cognition. Second, we will address the limitations of these findings. Third, we will advocate in favor of a neo-Aristotelian framework for the study of moral development, which foregrounds the role of practical wisdom (phronēsis) as an alternate conception of a person’s character over the course of the human lifespan. We also argue that such hardships in early life may lead to increased wisdom, which does not necessarily correlate with the measures of cognitive functioning often applied in late-life cognition studies. We hypothesize that the presence of ACEs may influence the development of practical wisdom. We argue that if ACEs predict decreased cognitive function later in life, then this provides us with the grounds for thinking that ACEs might influence moral development in older adults.
MARITAL DISSOLUTION AND COGNITIVE FUNCTION IN MID- AND LATE ADULTHOOD: FOCUS ON WITHIN-PERSON EFFECTS AND AND TIMING
Authors: Tucker Julia , Farina Mateo , Han Sae Hwang
Published: January 2025

There is a growing literature documenting cognitive health disparities between married individuals and their widowed and divorced counterparts in middle and later adulthood. However, how cognitive function changes within individuals as they experience widowhood and divorce transitions, and whether these changes vary depending on the timing of the marital dissolution, remain understudied. Framed within the life course perspective, this study aimed to examine within–person changes in cognitive function associated with widowhood and divorce transitions in mid– and later life, respectively. We used 11 waves of longitudinal data from the Health and Retirement Study (1998–2018; 121,505 person–wave observations collected from 20,114 persons). Cognitive function was evaluated using a modified version of the Telephone Interview for Cognitive Status (range: 0–27). Multilevel models using person–mean centering were employed to estimate within–person associations between the two forms of marital transitions and subsequent cognitive function. Results indicated that widowhood transitions were associated with within-person changes in cognitive function for women, but in the opposite direction depending on the timing of the transition: midlife widowhood transitions (between ages 51 and 64) were linked to worse cognitive function, whereas late-life widowhood transitions (age 65+) were associated with better cognitive function. Widowhood transitions were unrelated to cognitive function for men, and divorce transitions were unrelated to changes in cognitive function for men or women. These results underscore the heterogeneity in the association between marital transitions and cognitive function, which vary by gender, life course stage, and the nature of marital dissolution.
A VALUES-DRIVEN APPROACH TO BRIDGING THE DIGITAL DIVIDE: A PILOT INTERVENTION FOR OLDER ADULTS
Authors: Hladek Melissa , Rubio Olivia , McDaniel Kennedy , Evelyn-Gustave Allyson , Crews Deidra , DeMarco Mara McAdams , Brennan Daniel , Szanton Sarah
Published: January 2025

Digital literacy, the ability to effectively use technology for information retrieval, evaluation, and communication, is critical in today’s world. Despite advancements, older adults lag behind younger generations with approximately one in four adults over 65 not using the internet and over 35% lacking broadband connectivity. This gap is exacerbated among older adults of color due to disparities in access, connectivity, affordability, and cultural factors. Recognizing older adults’ diverse values and learning styles, we propose a novel intervention tailored to individual values and goals. This one-arm feasibility and acceptability pilot trial enrolls 20 multi-racial older adults with varying levels of digital literacy, delivering a person-directed, values-based intervention in their homes over 4-6 visits. Our intervention targets community-identified barriers such as health literacy, health communication, and social support, aiming to enhance digital literacy with additional outcomes including quality of life and frailty. We view internet access and training not only as means to improve digital literacy but also as vital tools in addressing health disparities. By leveraging individual values and theoretically driven strategies, this intervention tests a potential avenue to narrow the digital divide among older adults, fostering inclusion, empowerment, and improved health outcomes.
THE RELEVANCE OF GENERAL FLUID ABILITIES IN TECHNOLOGY PROFICIENCY IN OLDER ADULTS
Authors: Zhang Shenghao , Boot Walter
Published: January 2025

Previous research showed that general fluid abilities are correlated with technology use, acceptance, and proficiency in older adults. Cognitive decline was constantly proposed as an explanation for digital divide and age-related declines in technology use. However, this explanation has not been examined directly. We tested the relevance of general fluid abilities on technology proficiency in two large samples of normally aging older adults cross-sectionally and longitudinally with structural equation modeling. Results from a cross-sectional sample of older adults with various previous technology experience showed that older adults with higher general fluid abilities (measured by a latent factor consisted of letter set and immediate and delayed recall) also had higher technology proficiency (measured by a latent factor consisted of computer proficiency and mobile device proficiency). However, general fluid abilities were not predictive of technology proficiency after controlling for age, and general fluid abilities did not mediate the relationship between age and technology proficiency. Results from a longitudinal sample in which older adults with little to no previous experience with computers were trained to use and used a computer for 12 months showed that general fluid abilities (measured by a latent factor consisted of measures on processing speed, executive function, working memory, and episodic memory) was not predictive of the baseline or the slope of change of computer proficiency. However, those who are older increased less in proficiency controlling for fluid abilities. Discussion will focus on alternative explanations on age-related digital divide.
ADVANCING GEOGRAPHIES OF AGING AND THE LIFE COURSE
Authors: Finlay Jessica , Desjardins Michael
Published: January 2025

Aging and related health outcomes are not solely individual-level processes. Rather, built, social, and natural environments play a pivotal role in shaping health across the life course, especially among older adults. People also shape and modify surrounding environments throughout their lives in meaningful ways to maximize their well-being. While multiple longitudinal health datasets are available, many are analyzed without linking to spatially-explicit data. Overlooking the nexus between health and place, and not directly accounting for spatial and spatiotemporal processes that underlie the data, may hinder scientific discovery and advancement in understanding multi-scalar longitudinal processes that impact health and well-being. Geographies of aging and the life course critically integrate built, social, and natural environments into meaningful analyses and insights that can inform research, policy, and programs to promote healthy aging. This symposium features talks using innovative qualitative, quantitative, and mixed methods studies to investigate multifaceted and overlapping contextual influences on health. The presenters critically consider mobility across the life course, multi-scalar social determinants of health, environmental impacts of structural racism and classism, and potential interactions among individuals and neighborhoods that influence vulnerability to health exposures. We aim to build capacity around spatial methods and place-based considerations in gerontology. The approaches featured in this symposium highlight accessible ways for scholars across a variety of disciplines to advance understanding of healthy aging through the integration of geospatial approaches.
EXPLAINING DIFFERENCE: LATINX AND STRUCTURAL VULNERABILITY IN ADRD
Authors: Arteaga Ignacia , de Jesús Alma Hernández , Ginn Brandi , Abramson Corey , Dohan Daniel
Published: January 2025

Latinos/as/x (hereafter Latinx) residing in the U.S. are one and a half times more likely than non-Latinx white residents to develop cognitive impairment during their lives. Despite significant heterogeneity in nativity, language, socio-economic status, geographic region of residence, culture, and other factors, US-resident Latinx face shared structural barriers to health that may help explain inequities in incidence, time of diagnosis, and health outcomes of Alzheimer’s Disease and Related Dementias (ADRD). This work uses comparative ethnography to unpack the everyday experiences of Latinx families, including people living with dementia (PLWD) and ADRD. We focus on how PLWD and their caregivers negotiate family dynamics informed by structural vulnerabilities. We draw on 84 in-depth interviews with older adults and their family caregivers alongside three years of participant observation across community centers in California and Maine. We document how ‘familism,’ a cultural orientation understood as the strong reliance on close kin relations to look after the ill, is brought into tension when ADRD, structural vulnerability, and multi-morbidities among family members are at stake. When facing limited access to healthcare and social support, family caregiving and its monetary compensation can become a source of within-family tension and even dispute. This may be especially true for Latinx families for whom caregiving income constitutes an important part of their everyday income-generating strategies. These findings offer an opportunity to reflect on current policy efforts to support structurally marginalized families living with ADRD in the US.
CHOICE IN DIRECTLY-FUNDED HOME CARE
Authors: Dansereau Lisette , Kelly Christine
Published: January 2025

Directly funded (DF) home care, also referred to as direct payments or cash-for care, gives clients (self-managers) or unpaid caregivers (family-managers) a budget to choose their own home support services. DF research tends to be dominated by the assumption that choice is inherently beneficial, and rarely attends to the circumstances or experiences of family-managers. Using feminist care theory and Mol’s ‘logic of care’ as an analytical lens, this study aims to address this gap through a nuanced approach to the concept of choice in care services. The findings are based on focus group discussions held between June-July 2021 with 32 participants using DF home care in Manitoba, Canada. Qualitative thematic analysis was conducted to answer the question “how do DF users experience the tensions of choice, risk and responsibility?” The first theme demonstrates that choice in DF results in high quality care. The second theme illuminates some of the risks involved in exercising choice, particularly when an individual’s responsibility for coordinating formal services is unsupported. The final theme shows that family-managers tend to take on the responsibility of DF not as a first choice but as a last resort after experiencing other care options as substandard and to avoid institutional care for an older adult. We conclude that family-management in DF places new formal responsibilities on informal caregivers, often without support. We recommend reducing private responsibility in the context of DF, and identify four domains where there is potential to enhance choice in professionally-organized home care services.