bluuebunny/crossref_metadata_2025 huggingface dataset:
THE POTENTIAL OF EXTENDED REALITY SOLUTIONS TO SUPPORT OLDER ADULTS WITH AND WITHOUT COGNITIVE IMPAIRMENTS
Authors: Boot Walter , Dilanchian Andrew , Kalantari Saleh
Published: January 2025

We are living in an era of rapid technological innovation, which presents novel opportunities for technology to foster and enhance the independence, productivity, health, safety, social connectivity, and quality of life of older people with and without cognitive impairments. Both established and emerging technologies can play significant roles in achieving these aims, but to meet their fullest potential they must be designed with a user-centered approach that considers the needs, abilities, and preferences of diverse populations of older people, should be evaluated for usability, and rigorously assessed to determine if they are achieving their intended outcomes. This talk will focus specifically on the potential of novel Extended Reality (XR) solutions, including Virtual Reality (VR) and Augmented Reality (XR), to support activities vital to older people’s brain health, wellbeing, and independence. It will begin with an introduction to the capabilities of these technologies and how these technologies are well-suited to support aging adults, followed by the potential of these tools to support older people with and without cognitive impairments in domains such as cognitive health, social connectivity, wellness, way-finding, and leisure. Evidence for the efficacy of these interventions will be summarized, followed by a presentation of best practices and design guidelines for the use of XR among aging persons based on the latest empirical evidence. We will conclude with a discussion of the future of these technologies and outline a research agenda moving forward.
INCOME POOLING IN MIDLIFE: A COMPARISON OF REMARRIED AND COHABITING RELATIONSHIPS
Authors: Wright Matthew , Schwartz Tatum , Brown Susan , Manning Wendy
Published: January 2025

The share of midlife cohabitors has risen in recent decades, though little is known about their income pooling practices. Cohabitation could be attractive because partners may be able to preserve their economic autonomy and maintain assets for the next generation. Conversely, cohabitation may operate as an alternative to marriage, allowing couples to combine their resources to achieve economies of scale without the legal obligations of marriage. We used the nationally representative Families and Relationships Survey to compare income pooling among cohabiting and remarried U.S. adults aged 50-65 (N = 888). Aligning with the hypothesis that cohabitation and remarriage are distinct in middle age, the odds of income pooling were lower for cohabitors than remarrieds. However, the gap between cohabitors and remarrieds narrowed by later ages. This study provides insight into the economic organization of midlife cohabiting relationships, which may have implications for individual well-being and relationship decision-making among middle-aged couples.
FACILITATORS OF BEHAVIORAL HEALTH CARE ACCESS AND UTILIZATION FOR TRANSGENDER OLDER ADULTS
Authors: Lampe Nik , Rodill Zena , Nowakowski Alexandra
Published: January 2025

Transgender older adults in the United States (US) experience significant disparities in behavioral healthcare access and utilization. However, the specific facilitators that contribute to positive or adequate behavioral healthcare experiences among this vulnerable aging population remain uncertain. Understanding the unique facilitators that shape positive behavioral healthcare experiences for transgender (trans hereafter) older patients can assist medical practitioners in integrating these lessons into their practices, thereby promoting cultural responsiveness in care. In this qualitative study, we aim to address the question: What factors facilitate positive behavioral healthcare access and treatment among transgender older adults in the US? Between September 2021 and January 2022, the first author conducted 47 semi-structured, individual interviews with transgender adults aged 65 or older residing in the US. Analyses focused on the behavioral healthcare access and utilization experiences of interview respondents. Data analyses were conducted collaboratively by the authors using NVivo (Release 1.6) software inductively using a grounded theory approach. Findings suggest opportunities for enhancing behavioral health support and resources for transgender older communities. Four main themes emerged from the data: (1) engaging with behavioral healthcare practitioners who offer compassionate, patient-centered care; (2) utilizing culturally tailored peer-support services; (3) ensuring equitable access to gender-affirming medical interventions; and (4) addressing financial and logistical barriers to behavioral healthcare access. These insights highlight opportunities for enhancing behavioral health support and resources for transgender older communities while emphasizing the importance of incorporating these factors into behavioral healthcare research and practice to promote cultural responsiveness in care for this vulnerable aging population.
PUBLIC HEALTH RESPONSES TO DEMENTIA IN RURAL AND TRIBAL AREAS: BOLD AND BEYOND
Authors: Spears Katie , Bouldin Erin , McGuire Lisa
Published: January 2025

Rural and tribal communities have unique characteristics specific to their geographical location and cultures that can influence how disease prevention and health promotion programs are delivered in these areas. Public health officials may need to adapt traditional strategies to improve uptake, effectiveness, and reach in rural and tribal settings. CDC’s Healthy Brain Initiative (HBI) Road Map Series identifies priority actions public health agencies can take to promote brain health and support caregivers. The Road Map Series includes one designed for local and state agencies and another for Indian Country. CDC’s Building Our Largest Dementia (BOLD) Infrastructure for Alzheimer’s Public Health Program awardees carry out Road Map actions to develop and strengthen the public health infrastructure. This session will illustrate how public health entities have developed dementia resources within rural and tribal areas in their jurisdictions. Four states – Maine, Mississippi, Utah, and Washington – and a tribal board – the Northwest Portland Area Indian Health Board – will be presenters. They will characterize their population, identify the dementia programs and services they offer, describe challenges faced, and discuss the impact of rurality and tribes on their approach to service delivery and outreach. Presenters will discuss resources and collaborative approaches used to ensure success. Together, these presentations will highlight public health strategies that have been effective at supporting brain health in all communities across the lifespan.
TRANSFORMING BRAIN HEALTH IN RURAL COMMUNITIES IN WASHINGTON STATE
Authors: Fadel Meghan , Getz Marci , Ward Angela
Published: January 2025

Rural communities experience unique strengths and barriers as they work to address dementia, making strategic action on brain health and caregiving particularly important. Since 2005, the Healthy Brain Initiative (HBI) has been working to support public health strategies that promote brain health, address dementia, and support individuals living with dementia and their caregivers in all communities. As a part of the HBI effort, the Road Map Series has served as a basis for action in rural communities by guiding local, state, and tribal public health leaders on strategies as they prioritize actions to address brain health and caregiving. The HBI also provides resources to aid in evaluation and implementation of public health approaches. One such effort is the annual Road Map Strategists Program, which helps build the capacity of local health departments and tribal organizations to address brain health. Examples of other tools include an implementation guide, a guide for health improvement planning, and an evaluation toolkit. Washington State has taken great strides in addressing brain health. Efforts include local health department participation in the HBI Road Map Strategists Program, federally funded action through a Building Our Largest Infrastructure Dementia (BOLD) Infrastructure for Alzheimer’s grant, and several initiatives led by the Washington State Dementia Action Collaborative. Lessons learned from implementing the HBI Road Map and prioritizing strategic action in rural communities and tribal nations offer valuable models for expanding work in Washington and beyond.
PERCEIVED BURDEN ON OTHERS, LONELINESS, AND SUICIDE RISK IN CAREGIVERS
Authors: Van Orden Kimberly
Published: January 2025

Caregiving can foster increased purpose and mastery, but also anxiety, depression, and suicide ideation. Mechanisms whereby caregiving impacts suicide risk in dementia caregivers are not well characterized. The Interpersonal Theory of Suicide posits that stressors such as caregiving increase suicide risk by producing feelings of not belong to valued relationships/groups (low belonging, loneliness) and like one is a burden on others (perceived burden). Given that caregivers by definition are caring for others, they may be protected against perceived burden. This presentation will examine the relevance of the Interpersonal Theory of Suicide to understanding mechanisms whereby caregiving may increase suicide risk, with a particular focus on perceived burden on others. Data come from 106 caregivers who reported both significant loneliness and caregiving stress (i.e., required inclusion characteristics for studies funded by Rochester Roybal Center for Social Ties & Aging Research). Subjects completed semi-structured interviews (Columbia Suicide Severity Rating Scale) and self-report measures of social disconnection (Interpersonal Needs Questionnaire), depressive symptoms, caregiving burden, and neuropsychiatric symptoms. Results indicate that 10% reported suicide ideation (past month) and 14% reported feeling like a burden on others (past month). Caregivers who reported perceived burden were 3.5 times more likely to report suicide ideation. Findings suggest that perceived burden is as least as common as suicide ideation, supporting relevance of the Interpersonal Theory. Additional analyses will examine characteristics of those who reported perceived burden to explore potential contributors to developing perceptions of burden despite providing dementia care.
URBAN ENVIRONMENT EXPOSURES AND COGNITIVE HEALTH: AN EVIDENCE GAP MAP OF SYSTEMATIC REVIEWS
Authors: Cleland Claire , Hunter Ruth
Published: January 2025

With a rapidly ageing global population and continued trends in urbanisation, it is crucial we understand the influence of the urban environment on cognitive health. To address gaps in the evidence, we must first understand the current evidence base. The aim of the current study was to create an Evidence Gap Map (EGM) that identifies and presents all systematic reviews investigating urban environment exposure and its impact on cognitive health outcomes. A total of 57 reviews (with 257 outcomes) were included in the EGM. Five reviews were classified as high quality, 43 as moderate quality and nine as low quality. The EGM indicates that the evidence base is concentrated on ‘environmental by-products’ and ‘social environment’ and their impact on outcomes of dementia, Alzheimer’s disease, and cognitive impairment. Areas also saturated were air pollution within ‘environmental by-products’ and educational attainment within the ‘social environment’. Areas with limited evidence included exposure to ‘traffic-related behaviours and all cognitive outcomes, and all four exposures (‘environmental by-products’, ‘social environment’, ‘urban design’ and ‘traffic related behaviours’) and child cognitive measures. The study provides an overview of the current evidence base regarding built, natural and social environmental exposures and cognitive health outcomes. The EGM provides a live, interactive, visual representation of the evidence. We identify key evidence gaps to be addressed including environmental exposures and cognitive outcomes, traffic-related behaviours, and urban by-products such as noise pollution and light pollution.
APPLICATION OF THE CLAIM-BASED FRAILTY INDEX (CFI) TO STRUCTURED ELECTRONIC HEALTH RECORD (EHR) DATA
Authors: Kwak Min Ji , Schaefer Caroline , Kim Youngran , Fu Sunyang , Dhoble Abhjieet , Rianon Nahid , Holmes Holly , Kim Dae Hyun
Published: January 2025

The claim-based frailty index (CFI) was initially developed to identify frailty in Medicare claims. However, the application of CFI to structured data from an Electronic Health Record (EHR) has not been thoroughly studied. We aimed to apply CFI to structured EHR data, The Merative™ Explorys® Therapeutic Dataset Delivered, and estimate the validity of CFI compared to the 5% random sample of Medicare fee-for-service claims (2017-2018). We identified older adults (≥65 years old) with heart failure (HF) in Explorys data (n=52,295) and in Medicare claims (n=33,217). The CFI was calculated from each dataset separately. The CFI from Medicare claims showed a right-skewed distribution (mode of the CFI = 0.210) with a wider shape, whereas the CFI from Explorys data was also right-skewed but with a longer tail and had a narrower distribution (mode of the CFI = 0.186). When we assessed the prevalence of the 93 components of CFI, the components based on procedure codes were more prevalent in Medicare claims than in Explorys data. When frailty was defined as CFI ≥0.25, Explorys data identified fewer cases of frailty (18.1% vs 42.4% in Medicare claims). However, CFI from Explorys data had better discrimination (C-statistic: 0.636 vs 0.608 in Medicare claims) in predicting hospital admission or emergency room visits 1 year after the index visit. These results suggest that CFI may be implemented in EHR data and used for predicting adverse clinical events in HF patients.
FINANCIAL IMPLICATIONS OF DEMENTIA: AN EIGHT-YEAR FOLLOW-UP OF MATCHED SAMPLES
Authors: Choi HwaJung , Langa Kenneth , Norton Edward , Cho Tsai-Chin , Connell Cathleen
Published: January 2025

Financial consequences of dementia could be devastating because of the extensive care needs and high care costs associated with dementia. This study is to determine the financial status of older adults before and after the onset of dementia and assess the potential implications for individuals, families, and socieity. This population-based cohort study compared two matched samples of U.S. adults aged 55 years or older from national, longitudinal data. To create matched samples (dementia vs. control), the study included extensive baseline variables of sociodemographic characteristics, economic status, family availability, health conditions, disability status, and outpatient care use. In total, 2387 adults experienced the onset of dementia during the 2-year follow-up (dementia group) and 2387 adults did not (control group). Participants were followed up for 8 years from the baseline. Over the 8-year follow-up in the dementia group, the 2-year out-of-pocket medical costs increased from $4005 to $ 10,006, median wealth was reduced from $79,339 to $30,490, and those enrolling in Medicaid increased from 16.1% to 29.7%. No statistically significant changes in financial outcomes were found in the control group. The study found that in-home medical care, hospital stay, and nursing home facility stay increased dramatically, especially within two years after the onset of dementia. Greater family care availability is significantly associated with a lower level of transition to a nursing home, which is the most expensive care setting. The potential mitigating effect of family care availability should be accounted for in developing an intervention to reduce the financial effects of dementia.
FRAILTY THERAPEUTICS: CLOSING THE PHYSICAL ACTIVITY GAP FOR FRAIL ADULTS
Authors: Huisingh-Scheetz Megan , Bryant Brittni , Foster Brandon , Taylor Corliss , Parkhideh Arianna , Mendez Benjamin , Brown Sylvia , Thomas Nikita
Published: January 2025

Physical activity has been described as the ‘ideal’ intervention for frailty. In fact, exercise is the most effective frailty mitigation intervention studied to date. Yet, frail older adults face great challenges to physical activity over time. These challenges include decreased physiologic capability, greater barriers, fewer resources, narrower availability, reduced self-efficacy, poorer outcome expectations and restricted payor coverage for long-term activity programming. In this presentation, we will review the challenges frail adults face to participating in the most promising frailty intervention. To do this, we will summarize barriers noted in prior frailty exercise trials and will also report findings from our local survey study assessing physical activity behavior change factors among non-frail, pre-frail and frail older adults (n=101, 93% African-American). We will also review the current restricted payment structure for community-based long-term care services like exercise programs. We will then describe a novel exercise intervention designed to address several of these unique challenges, currently undergoing efficacy testing in a randomized controlled trial. The EngAGE trial is a multisite randomized controlled trial designed to compare an exercise intervention delivered over a voice-activated device in the home (EngAGE) versus paper-based exercises in n=124 frail, homebound, African-American older adults. We will share the EngAGE trial design, methods, measures and preliminary study fundings. We will close by summarizing key remaining issues that need to be addressed to close the physical activity gap for frail adults and will offer ideas for future research directions. Trial registration: ClinicalTrials.gov NCT05337514
AGING IN PLACE IN BRAZIL: SOME NEW EMPIRICAL EVIDENCE AND REMARKS ON THE ROLE OF ENVIRONMENTS FOR EDUCATION
Authors: Oswald Frank , Doll Johannes , Neumann Lycia Tramujas Vasconcellos
Published: January 2025

Aging in Place and the changing role of place for aging in modern societies has become an increasingly important topic both from an empirical and applied perspective. Studies have demonstrated effects of improving the environment, however, research on complex interactions of place, aging and education is scarce, although particularly a tradition of educational theory exists in Brazil. This symposium aims to address links between place, aging, and education in later life in Brazil for health and well-being. The first contribution by Frank Oswald aims to rethink place and aging relationships and to focus on enduring and novel challenges in this regard to provide an overview over selected theories in environmental gerontology and beyond. Second, Mariana Alves da Silva do Nascimento presents qualitative data from a study conducted in São Paulo with community residents on perceptions, preferences, and expectations of aging in place from an Architecture and Urban Planning perspective. The third contribution by Sérgio Luiz Valente Tomasini uses a participatory approach to shed light on planning of outdoor spaces (gardens) within Long-Term Care Facilities in Brazil, emphasizing that participatory methods can positively impact adaptive outcomes of older adults in institutional settings. Fourth, Johannes Doll and Estela Kohlrausch emphasize the significance of educational aspects for environmental gerontological perspectives on place and aging in societies that face globalization, urbanization, digitalization and climate change, which can help to better understand environment in a broader context by “reading the world” (Paulo Freire) differently. Finally, Lycia Tramujas Vasconcellos Neumann will serve as the session’s discussant.
RETHINKING THE PLACE OF PLACE FOR AGING: ENDURING AND NEW CHALLENGES FOR ENVIRONMENTAL GERONTOLOGY
Authors: Oswald Frank
Published: January 2025

Environmental gerontology emphasizes the relationship between place and aging from a conceptual perspective while also aiming to empirically analyze person-environment (P-E) relationships to improve quality of life and health in later life. After decades of empirical research, a critical discussion of theorizing place and aging is needed to better address not only enduring but also new challenges of P-E processes in rapidly changing societies worldwide, including challenges of housing, mobility, accessibility and participation for older adults in the “third” and “fourth” age. This contribution aims to (1) rethink the place of place for aging in modern societies from different disciplines, (2) identify a set of enduring and novel issues of P-E relationships. This is underpinned by specific references to empirical findings from selected studies, often over-representing ageing in Western societies. An example of an enduring issue would be the essential understanding of how an aging individual interacts with the home environment. An example of a novel issue would be technology use in later life in an increasingly digitalized world. Moreover, the contribution aims to (3) provide an overview over selected theories addressing place and aging interrelations, and emphasizing fundamental concepts such as interaction, transaction, co-construction and co-constitution to understand P-E interrelations, and finally to (4) offer a synthesis of how theories can address enduring and novel challenges and identify open questions that remain.
AGING AT HOME IN BRAZIL: COMMUNITY RESEARCH FROM AN ARCHITECTURAL PERSPECTIVE
Authors: da Nascimento Mariana Alves Silva do
Published: January 2025

Environmental Gerontology has been an essential aspect of aging studies worldwide for years. However, its integration into fields like Architecture and Urban Planning is still limited in Brazil. Professionals who design urban spaces must consider how their decisions impact people’s lives, especially the older population who often face challenges accessing the city’s amenities. This presentation shares insights from a qualitative study conducted in São Paulo, Brazil with community residents aged 56 to 74 (N=23; mean age=64; 73% women). Using the Collective Subject Discourse (CSD) analysis technique to investigate their perceptions, preferences, and expectations of aging in place, participants highlighted the importance of features such as sidewalks, green spaces, subway lines, and accessible shops and services, to support daily activities and enable aging in place. Participants also expressed a desire for a range of activities and amenities tailored to older adults, reducing their reliance on relatives to fulfill their social needs. Furthermore, 39% of participants expressed a sense of attachment desiring to age in their current homes, indicating that home environments should also be continuously adapted to the wishes and needs of older individuals. This study contributes to the field by highlighting the importance of interdisciplinary education and of collaboration among professionals in aging, architecture, and urban planning to ensure the inclusion of older adults in the creation of age-inclusive environments for all.
PROPHYLACTIC AND LONG-LASTING THERAPEUTIC EFFICACY OF SENOLYTIC CAR T CELLS AGAINST AGE-RELATED PHENOTYPES
Authors: Amor Corina
Published: January 2025

Senescent cells accumulate in organisms over their lifespan and play a key role in age-related tissue decline and the development of chronic aging pathologies. Thus, effective strategies to eliminate senescent cells (senolytics) could have broad therapeutic implications. In a departure from conventional chemical approaches we developed the first cell-based senolytic therapy based on chimeric antigen receptor (CAR) T cells targeting uPAR, a cell-surface protein upregulated on senescent cells. Our initial proof of concept showed their efficiency in young animal models of liver fibrosis and cancer. We now show that uPAR-positive senescent cells accumulate during physiological aging and characterize their cell types and expression profiles. Importantly, we find that they can be safely targeted with senolytic CAR T cells in aged animals where they result in significant improvements in both tissue regeneration and metabolic function. Of note, we find that the beneficial effects of senolytic CAR T cells are long lasting; single administration of a low dose is sufficient to safely achieve long-term therapeutic and preventive effects in healthspan.
MOLECULAR DETERMINANTS OF POOR T CELL MEMORY DURABILITY IN OLDER ADULTS
Authors: Sturmlechner Ines , Jain Abhinav , Goronzy Jorg
Published: January 2025

Generation of a protective and long-lasting immune memory is central to effective vaccination strategies and healthy aging. However, age-associated changes in immune cells, particularly T cells, impair immune memory generation and maintenance rendering older adults vulnerable to infectious diseases. Here, we investigated signatures of age-related memory T cell dysfunction and uncovered molecular determinants of a protective, persistent T cell memory in older individuals. We leveraged the contrasting T cell memory elicited in younger (<30 years) and older adults (>55 years) by vaccination against varicella zoster virus (VZV). Using ex vivo peptide stimulation of peripheral blood mononuclear cells of vaccine recipients several years after vaccination, we collected antigen-specific CD4+ and CD8+ T cells for high-dimensional spectral flow cytometry and tri-modal single-cell sequencing analyses. We found that older vaccine recipients predominantly suffer from a quantitatively and qualitatively impaired CD8+ T cell memory response compared to younger adults receiving the same vaccine type. Conversely, comparisons of two VZV vaccine strategies with contrasting efficacies in older adults demonstrated that a CD4+ T cell response rich in self-renewing Th17-like and low in regulatory T cells overcomes the age-associated T cell memory defect and associates with a durable, protective T cell memory. Collectively, we propose that vaccine strategies targeted towards older adults benefit from a Th17-focused CD4+ T cell memory response. Our results not only uncover traits of immune cell dysfunction with aging, but also inform vaccination efforts tailored towards healthy aging.
INVESTIGATION OF TRANSCRIPTIONAL CHANGES IN IMMUNE CELL POPULATIONS OF MICE TREATED WITH RAPAMYCIN
Authors: Yousefzadeh Matt
Published: January 2025

Aging is the greatest risk factor for many chronic degenerative diseases, for example osteoarthritis, dementia and heart disease. This robs individuals of quality of life and is very costly to treat. This has led to great interest in finding rational strategies for extending health span, the years of disease-free life at the end of one’s lifespan. Theoretically, if we could treat aging itself, all of the diseases associated with old age would be prevented, delayed or attenuated simultaneously. Thus, discovering fundamental mechanisms of aging is a priority. Aging is generally thought to be driven by an accumulation of damage in cells over time. The progressive decline of immune function with age, known as immunosenescence, plays a pivot role in not only the aging process but also susceptibility to infections and reduced vaccine responses. Thus it is critical to find interventions to potentially correct the age-related deficits in immune function. The potent mTOR inhibitor rapamycin has been shown to extend lifespan in mice and reduce age-related pathologies. Over the past decade the use of rapamycin or analogs of rapamycin have been investigated for its ability to rejuvenate aged immune systems. Treatment of elderly human participants with a rapalog was able to significantly enhance antibody titer levels to the annual influenza vaccination as well as reduce immune exhaustion markers. I was able to recapitulate some of these findings in a mouse model of immune aging. However, which immune cell populations are benefited from rapamycin treatment remains to be seen. My working hypothesis is that rapamycin is able to restore function to aged T cells and possibly other immune cell types. In order to test this hypothesis 18-month-old WT C57BL/6 mice were placed onto chow containing encapsulated rapamycin (126 ppm) or control chow for 7 months. Spleens were harvested from these mice and 5-month-old young control mice (n=3-4 per sex per group). Splenic samples are currently undergoing single-nuclei RNA sequencing to investigate the effect of rapamycin on gene expression changes in different immune cell populations of the spleen and address the following questions: Question 1: What are the differences in gene expression profiles in the different immune cell populations between young versus old splenic samples? Question 2: Does treatment with rapamycin in old mice restore a more “youthful” expression profile to all immune cell types or just a subset of them? Question 3: Are there sex-based differences in the gene expression patterns of aged immune cells or in response to rapamycin treatment?
BALANCING HEALTH AND CAREGIVING: ADULT CHILDREN’S HEALTH PROBLEMS IMPACT ON CAREGIVING
Authors: Stepniak Catherine , Suitor J Jill , Gilligan Megan
Published: January 2025

When older mothers face chronic or acute health problems their adult children often become caregivers, serving as either as the primary or secondary sources of informal care. However, when adult children are facing their own serious health problems, their ability to serve as caregivers may be limited. Surprisingly, the literature provides no clear insight into whether children’s health affects their provision of care to their mothers. In the present study, we shed new light on this question using quantitative and qualitative data collected from 412 adult children nested within 224 families as part of the Within-Family Differences Study. Quantitative analyses showed that adult children with health problems were as likely as their healthy siblings to serve as their mothers’ primary and secondary caregivers. Consistent with the literature, daughters were substantially more likely than sons to serve as caregivers. Qualitative analyses revealed that this gendered pattern occurred even in families in which daughters had serious health problems and sons were healthy. Daughters’ explanations for becoming caregivers despite their health limitations indicated that they had internalized messaging that they were the “naturally better” caregivers compared to their brothers. Adult children caregivers reported higher level of caregiver burden than that reported by healthy caregivers as they shouldered joint responsibility for their own and their mothers’ care. These findings underscore the ways in which gendered expectations for care and health problems across generations intersect to increase the risk of caregiver burden and unmet care needs for members of both generations.
ADAPTING A VIRTUAL MEDICAL PLANNING PROGRAM FOR CARE PARTNERS OF PERSONS WITH COGNITIVE IMPAIRMENT
Authors: Santoyo-Olsson Jasmine , Barnes Deborah , Li Brookelle , Martinez Angelica , Sudore Rebecca
Published: January 2025

Care partners want to help persons with cognitive impairment (PCI) engage in advance care planning (ACP) before they lose decision-making capacity, but report needing more support and access to virtual information. We created the video-based PREPARE for THEIR Care website to support care partners in helping others with their medical planning. However, PREPARE for THEIR Care has not yet been adapted for online, facilitated, synchronous classes to allow participants to ask facilitators ACP-related questions. We conducted virtual semi-structured interviews with experienced virtual group facilitators (n=4) and care partners of PCI (n=10) recruited from a research study of online exercise group classes for PCI and care partners. We used the Capability, Opportunity, Motivation, Behavior (COM-B) framework to explore barriers, enablers, and implementation recommendations and to guide qualitative thematic analysis. All facilitators were women. Care partner mean age was 62.3 (SD=13.8) years and 70% were women. Barriers included ACP complexity; virtual facilitation complexity; complicated dyad relationships; technology limitations; pessimism; fear of death; and lack of readiness. Enablers included ACP, technology, and teaching experience; participating from home; peer support; normalizing and modeling ACP; and belief that ACP is impactful. Implementation recommendations included providing staff trainings/scripts; care partner technology support before and during sessions; easy-to-use written materials; interactive group activities; and facilitating PREPARE for THEIR Care over multiple short (30-60 minute) sessions with > 50% of the session for discussion. Future ACP interventions should include training for facilitators, easy-to-use ACP materials, technology support, and modelling of ACP in virtual sessions.
USING COMMUNITY-BASED PARTNERSHIPS TO SUPPORT ALZHEIMER’S DISEASE AND RELATED DEMENTIAS PROGRAMS
Authors: Cotton Samantha , Long Monica
Published: January 2025

Launched in 2015, the University of Chicago’s SHARE Network and the University of Louisville’s Geriatric Workforce Enhancement Program (GWEP) showcase transformative approaches to aging and dementia care through dynamic community and state partnerships. SHARE Network addresses the needs of Chicago’s South Side, aiming to mitigate health disparities through collaborations that have led to the development of resources like memory cafes and caregiver support groups. This initiative enriches healthy aging and dementia education among healthcare professionals and community organizations.Similarly, the University of Louisville’s GWEP focuses on ensuring accessible services via collaborations with Area Agencies on Aging, senior centers, and other service organizations, alongside strategic partnerships with Kentucky’s health departments. These efforts underscore the development of career pathways for Community Health Workers and Certified Nursing Assistants, supporting workforce development and enhancing dementia care. In this presentation, we will delve into the critical need for community partnerships in dementia care, highlighting how the SHARE Network and the University of Louisville’s GWEP have successfully harnessed these relationships to improve care for those affected by dementia. We will also explore the challenges and barriers encountered in implementing these programs and discuss strategies to overcome them. By sharing insights on engaging diverse stakeholders, navigating systemic obstacles, and leveraging resources for maximum impact, the presentation aims to provide a comprehensive overview of how to strengthen dementia care through effective community collaboration, ultimately leading to improved outcomes for individuals with dementia and their caregivers.
DISCRIMINATION, STRESS, AND AGING ACROSS THE LIFECOURSE
Authors: Thorpe Roland , Hill Carl V
Published: January 2025

Stress and discrimination are posited as two explanations for understanding why race disparities in health and aging across the life course remain elusive. This symposium contains papers seeking to address the impact of discrimination or stress on Black health or health disparities across the life course. First, Thierry and colleagues examined how lifetime exposure to structural stressors and current perceived neighborhood stressors are associated with cognitive function in Black adults in the HRS. They found that life course exposure to multiple domains of neighborhood-based stressors may be important for cognitive function in later life. Second, Cobb and colleagues hypothesized that self-reported instances of everyday discrimination are related to higher levels of cardiometabolic risk among older Black and White adults. The relationship between self-reported instances of everyday discrimination and cardiometabolic risk was significantly weaker for older Black adults than older White adults. Third, Mitchell and colleagues investigated how exposure to chronic stressors during mid-life indirectly affects cognitive function through changes in physiological dysregulation in HRS. Adjusting for age, gender, race/ethnicity and education fully accounted for the significant effects of financial strain and discrimination on changes in cognition. Fourth, Forrester and colleagues examined racial/ethnic differences in the association between self-reported discrimination and brain imaging in the MESA study. Findings suggest that instances of racial discrimination over a lifetime may be detrimental to brain health for Black adults. This collection of papers provides insights into how discrimination or stress impacts Black health or health disparities in middle to late life.
PREDICTING USE OF ADVANCED DRIVER-ASSISTANCE SYSTEMS IN OLDER DRIVERS THROUGH STRUCTURAL EQUATION MODELING
Authors: Hansen Abigail , Kiely Kim , Attuquayefio Tuki , Hosking Diane , Eramudugolla Ranmalee , Anstey Kaarin
Published: January 2025

Older drivers are an at-risk population when on-road. Normal ageing processes, such as declines in visual, sensorimotor and cognitive processes, impact driving skills and contribute to the increasing crash rate. Advanced Driver-Assistance Systems (ADAS) may provide a solution to keep older drivers safe on the road. This study investigated what technology acceptance and trust factors predict use of ADAS between older drivers who have ADAS in their car and a) use it (n=790) or b) do not use it (n=32). We conducted an online survey to 1330 Australian drivers aged 65 years or older (M=72, SD=6.9, 23% women) in partnership with National Seniors Australia. ADAS acceptance was measured by the Partial Automation Acceptance Scale, measured by the latent factors attitudes towards ADAS, attitudes towards technology, perceived risk and trust. Structural equation modeling examined the structural relationships between use of ADAS, the acceptance scale, locus of control and driver self-efficacy. The results indicated positive attitudes towards ADAS had a significant positive direct effect on use (y =.06, S.E =.02, p =.002 (β =.26)) and trust in ADAS had a significant negative direct effect on use (y = -.03, S.E =.01, p =.024 (β = -.15)). The model tested accounted for 93.4% of the variance in use of ADAS. These findings highlight the importance of older drivers to hold positive attitudes and trust in ADAS in order for them to use it, highlighting potential factors that could be targeted in behavioural change interventions seeing to improve usage rates.
EXTENDING THE FAMILY TREE: NEW FACES OF DEMENTIA CAREGIVERS
Authors: Savla Jyoti , Roberto Karen
Published: January 2025

Research has predominantly focused on spouses and adult children as primary caregivers for individuals living with dementia. However, evolving family dynamics necessitate a critical examination of caregivers beyond this immediate circle. This symposium explores the understudied area of informal dementia caregiving, which includes care provided by extended family members, stepchildren, and chosen kin. This emergent focus is crucial in redefining the family caregiver archetype amid changing family structures. McConnell & Haggar employ social network analysis to underscore variations in family/non-kin participation in care networks, influenced by factors such as disease severity and caregiver availability. Roberto & Savla provide an in-depth exploration of historical and current family dynamics that shape niece and nephew caregivers’ responsibilities, practices, and outcomes. Savla & Roberto address the individual and family challenges faced by older adult sibling caregivers, as well as identify factors that facilitate and impede their caregiving capacities. Silverstein et al. leverage longitudinal data to explore the impact of kinship strength and early relationship histories on stepchildren’s support for stepparents living with dementia. Flatt et al. synthesize insights from their multiple studies on the health outcomes of sexual and gender minority dementia caregivers within biological and chosen familial networks. Collectively, these studies underscore the complexity and diversity of caregiver roles within families, emphasizing the need for supportive programs and policies tailored to their unique circumstances. Findings serve as a call for action to recognize and support the wide range of dementia caregivers in today’s society who demonstrate remarkable resilience in navigating dementia care challenges.
THE CLOSURE OF RURAL CO-HOUSING AND CHANGES IN LONELINESS IN OLDER WOMEN LIVING ALONE
Authors: Park Sojung , Park Soobin , Lee Hyunjoo
Published: January 2025

Prolonged social restrictions during the pandemic have increased loneliness among the population, with people living alone in rural areas being particularly vulnerable due to geographic distances, transportation, and finances. Congregate senior housing may be a helpful alternative living environment that can help address the challenges of social isolation. Drawing on the environmental perspective of aging and the literature on loneliness, we investigated the influence of the pandemic-imposed closure of senior cohousing on the changes in loneliness in older women living alone in Korea. Using a mixed-method approach, we analyzed survey data from 160 participants using structural equation analysis focusing on multiple mediators, such as physical, social, and service environment and depressive symptoms. Also, we conducted a thematic analysis with 18 former cohousing residents. Our synthetic analyses showed that senior cohousing protects against loneliness by serving as a community hub for gathering, sharing, and caring among the housing residents and the members of the whole community. We found that community service plays a critical role in protecting against depressive symptoms and loneliness. Our study setting is a publicly subsidized cohousing program with no embedded program manager. The residents are not necessarily empowered yet to self-organize for online technology learning. Intentional programming that includes social activity and online learning would benefit vulnerable subgroups of older women. Our findings make a significant contribution to the limited knowledge base on the intersection of senior housing and rural aging during the pandemic.
AGING IN PLACE IN A MARGINALIZED COMMUNITY AT RISK OF RURAL DEPOPULATION
Authors: Watanabe Yuichi
Published: January 2025

Japan is known as one of the most aged societies globally. As of 2022, the aging ratio is approximately 29%. According to the Ministry of Internal Affairs and Communications, in 2019, over 50% of the population in 20,000 neighborhoods, known as “marginalized communities,” are 65 or older. These communities are at a higher risk of rural depopulation or local extinction. Between 2009 and 2019, questionnaire surveys were conducted every two years to assess the experiences and strengths of residents in a marginalized community. The aim was to identify ways to promote sustainable living in the community. As each survey sample size was small, the analysis used all samples as a pooled dataset (N=831). The questionnaire included variables related to people’s anticipation of permanent community living and their engagement in “IBASHO” activities. In Japan, “IBASHO” refers to a place where people can feel secure, have roles, and consider their lives meaningful. A logistic regression analysis was conducted to determine the relationship between anticipation of permanent community living and engagement in “IBASHO” activities. The study revealed that residents who participate in “IBASHO” activities are more likely to feel at ease living in their community permanently, even if they live alone or have poor health. These individuals care for one another in their “IBASHO” community, sharing their strengths and anxieties and providing emotional and practical support. Encouraging “IBASHO” activities can help promote permanent community living, even in areas with an aging population.
MEETING PEOPLE WHERE THEY ARE: IMPLEMENTATION OF AN ACADEMIC DEMENTIA CARE MODEL IN A TEXAS HEALTH PLAN
Authors: Smithroat Noemi
Published: January 2025

Maximizing Independence at Home (MIND at Home), a well-researched holistic, family-centered dementia care coordination program, provides collaborative support to community-dwelling persons living with dementia (PLWD) and their informal care partners (CP). Through comprehensive home-based assessment of 13 memory-care domains covering PLWD and CPs, individualized care plans are created, implemented, monitored, and revised over the course of the illness. Non-clinical Memory Care Coordinators (MCCs) working with an interdisciplinary clinical team provide education and coaching to PLWD and their identified CP and serve as a critical liaison and resource navigators bridging families with medical professionals, and formal and informal community resources. This presentation will describe a pilot implementation of the program within Superior HealthPlan, a managed care organization, across diverse sites in Texas. We will present descriptions of how the program was effectively translated to practice, including the associated dementia support to enhance knowledge and skills, and review key aspects of the implementation experience including how the program was operationalized and adjustments made based on the challenges, obstacles, and opportunities; and summarize, the best practices that have emerged.
HEATHER BERND CLARKE, MBA, LCSW, PA HEALTH & WELLNESS, MECHANICSBURG, PA, UNITED STATES
Authors: Clarke Heather
Published: January 2025

PA Health & Wellness, a managed care organization in Pennsylvania, has collaborated with Johns Hopkins on deploying the academic Maximizing Independence at Home (“MIND at Home”) Program for community-living individuals with cognitive impairment who have Medicaid Long-Term Support Services. This home-based model is aimed at coordinating care and supporting caregivers for individuals who are cognitively complex and at risk for out of home placement. The model consists of a non-clinical Memory Care Coordinator (MCCs) who is supported by a Memory Care Manager RN to provide a holistic approach to assisting the individual remain in the community and decrease caregiver burnout. This is accomplished through a specialized assessment of 13-memory care domains that drive the development of an individualized care plan. Implementation of the care plan by the MCC includes assistance in navigating the managed care system, coordination of provider appointments and benefits, referral to community resources, and disease education and coaching for the family caregiver. This presentation will describe the program implementation within PA Health & Wellness since 2022. We will present key components of program implementation, operations and learned experiences. We will also review preliminary results on program impact showing reductions in inpatient and emergency room visits for individuals enrolled in the program compared to similar, non-enrolled, individuals.
SIBLINGS’ EDUCATIONAL DIFFERENTIALS AND LATER-LIFE COGNITIVE HEALTH
Authors: Qin Yue , Engelman Michal
Published: January 2025

Drawing on data from 3,216 Wisconsin Longitudinal Study participants aged 79-84 years old with at least one sibling, we examined the relationship between siblings’ educational differentials and a unique set of late-life cognitive metrics. Results from OLS and multinomial logit regressions showed that higher educational attainment relative to one’s only sibling is associated with a higher Telephone Screening of Cognitive Status (TICS) score and marginally lower risks of cognitive impairment. For respondents with two or more siblings, however, siblings’ higher educational attainment relative to respondents was associated with a lower risk of cognitive impairment, and particularly a lower risk of Alzheimer’s Disease (AD), compared with individual higher educational attainment than siblings’ average education. Our findings suggest that both individual educational attainment and a better educated set of siblings can act as protective factors for later life cognition. Familial risk may matter more for AD than other types of impairment because of its genetic etiology, but further research should explore additional life-course, family resource, and network mechanisms that shape cognitive risk and resilience among and across siblings.