bluuebunny/crossref_metadata_2025 huggingface dataset:
PUTTING NEGOTIAGE IN ACTION: APPLYING SKILLS FROM AN AI-BASED NEGOTIATION TRAINING FOR CAREGIVERS OF OLDER ADULTS
Authors: Joblin Celie , Murawski Alaine , Tschoe Marianne , Ramirez-Zohfeld Vanessa , Mell Johnathan , Brett Jeanne , Lindquist Lee
Published: January 2025

Family caregivers provide crucial support for older adults, yet this can sometimes lead to conflict. We created NegotiAge, an online AI-based negotiation training to help caregivers resolve conflicts. Through instructional resources and practice with AI-based avatars, caregivers learn to navigate conflicts. We characterized how family caregivers utilized NegotiAge in addressing real-life conflicts with their older adults. Family caregivers participated in a randomized controlled trial of the NegotiAge intervention. A month later, they were surveyed with open-ended questions about their use of knowledge and skills gained with NegotiAge with the older adult they support. Two coders analyzed the data using constant comparative thematic analysis. 119 caregivers (mean age 53.5 yrs, 75.6% female, 32.8% Black) completed the training and the one-month survey. 73% (n=119) of participants managed conflicts related to caregiving in the month following NegotiAge. Conflict themes involved: 1) health-related concerns, 2) daily living tasks, 3) finances, 4) acceptance of assistance, and 5) familial duties. 86% (n=119) of participants reported handling conflicts differently because of the NegotiAge training. Themes that surfaced included: 1) changing behaviors away from power dynamics to shared interests, 2) uncovering the causes of conflict, and 3) enhancing communication. Participants utilized their negotiation skills in various contexts, including professional environments, retail, real estate, and other relationships. NegotiAge positively influenced how family caregivers manage conflicts. They applied skills acquired from NegotiAge to manage conflicts with older adults, family, and others. Subsequent research will explore NegotiAge’s impact on caregiver burden, stress, and the care of older adults.
SANDWICH GENERATION CAREGIVING: NEGATIVE RELATIONSHIP QUALITY AND BURNOUT
Authors: Lohmar Sabine , Fenstermacher Erika , Owsiany Montgomery , Ju Catherine , Edelstein Barry
Published: January 2025

The sandwich generation provides caregiving for both their children and their aging parents. These caregivers often experience low satisfaction, depression, and burnout, yet little is known about their contributing factors. For example, researchers have not investigated the role of relationship quality among sandwich generation caregivers, who face unique challenges. This study is the first to investigate relationship quality as a moderator between informal caregiver burnout and depression. Regression analyses included measures of positive and negative relationship quality and informal caregiver burnout as predictors and depressive symptoms as the criterion. Correlational analyses indicated that positive relationship quality (r = -.414, p <.001; r = -.274, p =.005) and negative relationship quality (r =.721, p <.001; r =.467, p <.001) were significantly associated with informal caregiver burnout and depression, respectively. Positive relationship quality significantly moderated the association between caregiver burnout and depression for sandwich generation caregivers only (R² =.323, F[3, 99] = 15.741, p <.001, β =.019, p =.006), as did negative relationship quality (R² =.307, F[3, 96] = 14.184, p <.001, β = -.016, p =.046). Among sandwich caregivers, positive relationship quality buffered the relation between caregiver burnout and depression, while negative relationship quality enhanced this relation. Positive and negative relationship quality were not significant moderators among individuals who care for parents only or children only. These results suggest that, for sandwich generation caregivers, relationship quality is an important contributing factor for caregiver burnout and depression.
MEDICAL FINANCIAL HARDSHIP AND EMOTIONAL WELL-BEING AMONG US OLDER ADULTS WITH AND WITHOUT ALZHEIMER’S DISEASE
Authors: Choi Shinae , Pisu Maria
Published: January 2025

This study investigated the impact of medical financial hardship (MFH), specifically the inability to make medical payments, on various dimensions of emotional well-being (EWB), including positive and negative affect, life satisfaction, and sense of meaning and purpose in life, among U.S. older adults with and without Alzheimer’s disease and related dementias (ADRD). Data were from the 2016-2020 waves of the Health and Retirement Study (N=12,904). Multivariate regression analyses were computed adjusting for health and sociodemographic factors. Overall, 884 respondents faced MFH, and 352 self-reported a physician diagnosis of ADRD. In people without ADRD, 6.7% faced MFH, while among those with ADRD, the percentage rose to 12.2% (χ2(1)=16.324, p< 0.001). In people without ADRD, MFH was significantly associated with lower life satisfaction (b=-1.195, p< 0.001), positive affect (b=-0.301, p< 0.001), sense of meaning and purpose in life (b=-0.417, p< 0.001), and with higher negative affect (b=0.454, p< 0.001). In those with ADRD, MFH was significantly associated with lower life satisfaction (b=-1.193, p< 0.01) and higher negative affect (b=0.661, p< 0.01); associations with positive affect (b=-0.459) and sense of meaning and purpose in life (b=-0.315) were nonsignificant at the p< 0.05 level. Findings suggest that MFH is twice as likely in people with ADRD, potentially impacting several aspects of their EWB, including life satisfaction and negative affect. The impact is broader for older adults without ADRD, where MFH may also affect their evaluation of meaning and purpose in life. We discuss implications for further research and interventions to improve EWB of older adults facing MFH, both with and without ADRD.
EFFECTIVENESS OF AN AGING-RELATED PREPARATION EDUCATION PROGRAM FOR OLDER CHINESE MIGRANTS IN JAPAN
Authors: Yao Li , Masaki Harue
Published: January 2025

Introduction and objectives

To resolve the long-term care issues of older Chinese migrants in Japan, we developed an aging-related education program focused on preparation for long-term care consisting of six modules with lectures and discussions through real-time videoconferences. This study aimed to evaluate the effectiveness of this developed education program among older Chinese in Japan.

Methods

Older Chinese people and their family members living at home independently in the Tokyo and Kansai areas were recruited. The before-after study was conducted to collect the data from the Preparation for Future Care Needs Scale-14 (PFCN-14) and Attitudes to Aging Questionnaire (AAQ). Data was analyzed by descriptive statistics and the Friedman non-parametric repeated measures ANOVA test.

Results

Twenty-two participants with an average age of 73.0 (SD= ±7.18) years completed all questionnaires, of which 14 (63.6%) were female. The median (IQR) PFCN-14 total scores before intervention, after intervention, and one month after intervention were 40.00 (7)%, 46.50 (13)%, and 48.50 (8)% (χ²=18.644, P< 0.001). There were significant differences between before and after intervention (P=0.016) and between before and one month after intervention (P< 0.001). The median (IQR) AAQ total scores were 82.00 (23)%, 80.50 (22)%, and 79.00 (21)%, respectively, with no significant differences (χ²=2.533, P=0.279).

Conclusion

This education program improved participants’ status of preparing for long-term care by promoting awareness, decision-making, and concrete planning actions. It can be used to improve health literacy and the autonomy of later life for older Chinese migrants in Japan.
UNVEILING THE AGING EXPERIENCES OF CHINESE IMMIGRANTS WITH SOCIAL MEDIA POSTS
Authors: Chen Xiayu , Wen Wan
Published: January 2025

Chinese immigrants are among the largest immigrant groups worldwide. As they age, they may encounter a complex array of cultural and social challenges, striving to find a balance between maintaining their cultural values and adapting to the social norms of the migrated countries. With the aim of understanding the community integration and well-being of the aging Chinese immigrants, this study analyzed social media data to uncover topics that reflect their daily living experience. We collected 3,756 posts from January 1, 2013, to January 1, 2024, from the “Evergreen Life” subforum on Wenxuecity.com, a leading Chinese-language BBS forum catering to the overseas Chinese community. Using Latent Dirichlet Allocation topic modeling approach, this study identified five key topics reflecting their aging experiences, including (1) society and life, focusing on navigating societal norms and healthcare systems in migrated countries and life comparisons between China and abroad; (2) overseas cultural experiences, emphasizing personal adaptation stories; (3) family daily life, highlighting intergenerational dynamics and the importance of family support in aging life; (4) physical activities and personal growth, showing efforts towards well-being improvement through exercise and hobbies; (5) religion and spiritual life, demonstrating the role of spirituality in community connection. These findings offer a comprehensive view of the social, cultural, familial, physical, and spiritual aspects of aging among Chinese immigrants, emphasizing the need for culturally sensitive support services to foster a more inclusive environment for this population.
DEVELOPMENT OF A MEASURE OF ALF RESIDENTS’ ACTIVITY PREFERENCES AND REINFORCERS
Authors: Praska Nicole , Houlihan Daniel , Buchanan Jeff , Weiskittle Rachel
Published: January 2025

The population of individuals aged 65 and older has grown steadily since the 1990s, consequating a corresponding rise in the resident population of Assisted Living Facilities (ALFs). This significant increase has highlighted the importance of monitoring residents’ quality of life and reinforcers of enjoyable activity engagement. However, the resident preference assessments currently used for this purpose are outdated and lack specificity. To address this limitation, this study aimed to create an updated measure of ALF residents’ activity engagement reinforcers. The study involved a two-step process. First, 10 subject matter experts in the geriatric field compiled a list of 107 potential reinforcers. This list was then refined into a likert-scale survey of 60 selected items and administered to 612 older adults. Exploratory factor analysis identified five factors (social, traditions, food and activities, family and friends, and outings), and resulted in a 33-item survey. Results of this study provide an effective tool for ALF activity directors and staff to accurately assess ALF residents’ interests and motivators for activity engagement. Clinical implications include connecting at risk ALF residents with individualized program scheduling that may improve their quality of life. This poster reviews the methodology and further results of this survey development.
INDIVIDUAL AND ORGANIZATIONAL BENEFITS OF CO-LOCATING NURSING HOME AND CHILD CARE SERVICES
Authors: Wang Helen , Jarrott Shannon , Ma Mengyao
Published: January 2025

Co-location nursing homes with childcare services has gained recognition for fostering positive intergenerational relationships. Researchers have identified benefits to individual participants, but little attention has been paid to organizational outcomes. Using econometrics methods, we analyzed historical data of all 19,641 unique US nursing homes from 2015Q1 to 2020Q1 to assess the association between co-location and nursing home quality measures, including deficiency reports and resident performance measures. Leveraging Centers for Medicare & Medicaid Services (CMS) and Data Axle data, our empirical model tested the association between on-site childcare and nursing home quality. We controlled for potential confounds, including nursing home characteristics (e.g., capacity and ownership), regional socioeconomic status, and year and zip code fixed effects. Combining business location data and public information sources, we identified 139 nursing homes with on-site childcare services operating in our sample period. Regression analyses indicated that nursing homes with on-site childcare had 9.94% lower yearly deficiency case reports than homes without childcare (p < 0.01) due to lower health deficiency rates but not fire safety deficiencies. Considering quarterly resident and institution measures, nursing homes with on-site childcare centers demonstrated 1.1% to 5.8% higher resident vaccination rates (p < 0.01) and significantly lower psychotropic medication use (p < 0.001) than those without childcare. Our study highlights that co-locating childcare and nursing homes is associated with better nursing home performance, benefiting residents and organizations. Further research should address mechanisms by which outcomes are achieved. Intergenerational program co-location may support benefits beyond those experienced by younger and older participants.
LONG-TERM CARE TRAJECTORIES AFTER STROKE IN SWEDEN AND THE UNITED STATES
Authors: Modig Karin , Arling Greg
Published: January 2025

Stroke is a major cause of mortality and disability in old age worldwide, often requiring ongoing formal long-term care (LTC). Only a handful of studies examining longitudinal patterns of institutional and community based LTC beyond the immediate post-stroke period. In order to better understand the impact of LTC use by stroke survivors, we compared findings from studies of LTC trajectories among people discharged from the hospital after a stroke in Sweden and the United States. The Swedish study modeled LTC trajectories over a three-year period for a nationally representative cohort of 31,560 stroke survivors age 70 and older during 2015 to 2017, while the US study modeled LTC trajectories over 12 months among a sample of 3,811 Veterans discharged from Veterans Administration (VA) hospitals after stroke during 2007. Approximately half of the sample in each study was alive and without a history of LTC use at one year. Use of LTC in both studies was associated with LTC use prior to stroke, advanced age, number of comorbid conditions including dementia, and frailty/dependency. In the Swedish study, transitions into formal LTC tended to be unidirectional - few people entering formal LTC ever returned to no care, and few people entering care homes ever transitioned back to home care. In the VA study, frequent transitions occurred between nursing homes and home-based LTC, as well as out of the LTC system entirely. We discuss how differences in LTC policies, particularly the role of the nursing home, affect LTC trajectories in the two countries.
STAFF PERSPECTIVE ON VIRTUAL TEAM-BASED CARE IN THE PROCESS OF TRANSITION TO LONG-TERM CARE
Authors: Hung Lillian , Chan Chin Pang Ian , Yous Marie-Lee , Connelly Denise , Wong Karen , Sakamoto Mariko , Santaella-Tafolla Paulina , Ge Huini
Published: January 2025

Transitioning from hospital to long-term care (LTC) is a vulnerable time for older patients and families. Successful care transitions require interdisciplinary team and cross-sectoral coordination, as well as engagement of patients and families in care planning. This study aimed to identify enablers and barriers to delivering virtual team-based care to support older adult care transitions from hospital to LTC. Patton’s utilization-focused approach informed the study design. Our research methods included semi-structured interviews, focus groups, and organizational policy reviews. The study involved 52 multidisciplinary team members, including nurses, physicians, rehabilitation practitioners, healthcare leaders, and older patients and family members. Thematic analysis identified key enablers (team engagement, training and support, and access to digital equipment) and barriers (technology infrastructure, resources, privacy and security). Our findings suggest that virtual team-based care is perceived by healthcare staff as acceptable, efficient, and cost-saving. Older persons and their families have complex care needs, and prioritizing their involvement in virtual team-based care planning is key to addressing barriers in the process of care transition success. Clear policies and guidelines are needed to support the integration of virtual team-based care into practice to optimize support to families and patient health outcomes. Future research should investigate effective strategies to include older persons and families through virtual team-based care planning technology.
TRAJECTORY OF DECLINING PHYSICAL FUNCTION AMONG NURSING HOME RESIDENTS IN JAPAN
Authors: Ikuta Kasumi , Noguchi-Watanabe Maiko , Aishima Miya , Fukui Sakiko
Published: January 2025

The timing and speed of physical function decline among nursing home residents vary, and the decline trajectory remains unclear. Therefore, this multicenter retrospective study was aimed at identifying the trajectory of declining physical function among Japanese nursing home residents. We included new nursing home residents who were admitted between July 2021 and March 2023, who had a high physical function score (Barthel Index [BI]: >60), and whose physical function declined during the period from admission to 6 months after. We evaluated the BI monthly as an indicator of the residents’ physical function status. We conducted a group-based trajectory model analysis to find the physical functional decline. Four types of models were identified. Furthermore, we compared the trajectory model to other trajectory models using the Akaike Information Criterion. Based on the results, we included 163 new residents, including 106 women (65.0%), with a mean age of 86.16 years (SD = 5.84). We selected the five groups trajectory model: slight decline, slightly larger decline, maintenance after decline, decline after maintenance, and large decline. The characteristics of the large-decline group were a diagnosis of dementia and low motivation and those of the maintenance-after-decline group were female sex and low body mass index and oral function. We identified the trajectory group based on the timing and speed of physical function decline. We believe that nursing home staff assess the trajectories of physical function decline and individualize residents’ interventions accordingly.
INTERGENERATIONAL EQUITY: AN URGENT CALL FOR AGING POLICIES IN SUB-SAHARAN AFRICA
Authors: Teshome Abraham , Adeniji Dolapo , Ashirifi Gifty , Adamek Margaret
Published: January 2025

Contrary to popular belief, family-based care and support for older people in Sub-Saharan Africa is gradually eroding due to various factors, including urbanization, migration, and modernization. As the issues of older people and aging are not mainstreamed into national economic and development agenda and policies, most older people in the region live in abject poverty, which has undermined their healthy aging and quality of life. Although many Sub-Saharan African countries are signatories to the 2002 Madrid International Plan of Action on Ageing (MIPAA), only a few have developed national aging policies to meet the needs of their older population. Against this backdrop, we conducted cross-sectional qualitative study to learn why public policy in Sub-Saharan Africa is sluggish in responding to the needs of the region’s growing older population. We conducted an online survey (n=78) and three FGDs (n=13) with African scholars and practitioners from 12 nations. Based on descriptive and thematic analyses, our study revealed five themes: a) lack of political will, b) disconnect between researchers and policymakers, c) lack of research and comprehensive data related to older people, d) inappropriate aging policy, and e) budget constraints. Our study’s findings call for more research and comprehensive data regarding the needs and challenges of the region’s older population, policy advocacy, and awareness-raising about older adults’ issues among policymakers, involvement of all stakeholders in aging policy development, and regular dialogues between policymakers, researchers, older adults, and other stakeholders.
CO-DESIGNING RESEARCH IN COLLABORATION WITH PEOPLE WHO ARE RESIDENTS AND STAFF IN LONG-TERM CARE FOR OLDER ADULTS
Authors: Shannon Kay , Jones David , Featherstone Katie
Published: January 2025

One New Zealand provider of long-term care for older adults has shown fortitude in overcoming obstacles to developing a homelike facility where 81 residents live in small houses and continue with activities that connect them with lifelong identities. The CARE Village, Te Manaaki a Tura is the host organization for the sequential mixed methods study, which aims to compare resident experiences and outcomes in homelike and traditional facilities. Phase one determined the impact of the homelike model of care on International Resident Assessment Instrument (interRAI) quality indicators. The phase two qualitative study to understand the operationalization of nursing care at both types of facilities was co-designed with residents and staff of The CARE Village, Te Manaaki a Tura, including the staff-led Māori Cultural Awareness Team. The presentation reports on the co-design process. This presentation will discuss the co-design process and the meaningful contributions and insights to designing the qualitative research including developing questions for research participants and developing the strategy for analysing the data. Co-designers who are residents demonstrated their fortitude in continuing to provide service to the community. Co-design is becoming increasingly important as researchers and practitioners must include the perspectives of clients and other stakeholders in their work. Therefore, this presentation offers advice for those wanting to learn about the practical elements of the process.
DESIGN ELEMENTS OF EDUCATIONAL TOYS FOR PATIENTS WITH MILD ALZHEIMER’S DISEASE: A QUALITATIVE STUDY
Authors: Jia HongFei , Ding YaPing , Zhu Ling
Published: January 2025

Background

Alzheimer’s disease (AD) is a fatal chronic neurodegenerative disease, and its incidence and mortality rate are closely related to age. Once diagnosed, patients need to take long-term medication, which seriously affects the quality of life of those who are ill. Research has demonstrated that the educational toy is an effective intervention to improve cognitive function among patients with mild Alzheimer’s disease. Despite the rapid growth in developing educational toys, incorporation of stakeholders’ views has been limited. Objective: This project aimed to identify the design elements that should be considered during development of educational toys for patients, from the perspectives of patients with mild Alzheimer’s disease and their caregivers. Materials and

methods

A total of 10 patients with mild Alzheimer’s disease and 12 caregivers were selected. Participants were recruited using purposive sampling. Semi-structured interviews were conducted between August and November 2023. The content analysis method was used to summarize the interview data and refine the themes.

Results

Main themes that emerged from the data analysis included the following: (1) materials; (2) structure; (3) function; (4) color; (5) shape.

Conclusion

Collecting patients’ and caregivers’ perspectives through qualitative interviews, the developed puzzle toy can serve as a user-friendly and engaging tool to potentially complement traditional interventions in slowing cognitive deterioration in patients with mild Alzheimer’s disease. These design elements can also be considered by developers and researchers when developing and evaluating educational toys for people with mild Alzheimer’s disease.
WEARABLES IN LONG-TERM DEMENTIA RESEARCH: A MIXED METHOD STUDY OF USER EXPERIENCES AND SUPPORT NEEDS
Authors: Peterson Colleen
Published: January 2025

Passive wearables data collection may be specifically beneficial to aging research featuring dementia populations, who have caregiving and cognitive burdens that can make study participation and reliable data collection more difficult, especially as dementia progresses. This three-phase project aims to inform best practice recommendations to enhance recruitment and adherence in long-term wearables research featuring this population. Based on our systematic review and preliminary in-house data testing, we selected three wearables offering different capabilities and form (from Garmin, Pulse HR, and AngelSense) to test real world usability, data quality, and support needs. This is the first study to recruit persons living with dementia and their caregivers to evaluate multiple devices outside of a laboratory or focus group setting (N=12 dyads). The person living with dementia assented to wearing each wearable for two weeks. Their caregiver rated many facets of each device following its use with the Quebec User Evaluation of Satisfaction with Assistive Technology measure. Open-ended questions and a cumulative semi-structured interview provided context and in-depth comparative perspectives of their experiences in the study. Wearable durability, simplicity, and data availability/monitoring capacity were important to participant favorability and adherence. Technical help and check-ins were also deemed highly valuable. Data indicate how the devices suited the dyads’ needs or caused issues, as well as how study staff could better support ongoing use. Collectively, our findings suggest ideal criteria to guide wearable selection and key protocol factors that can enhance participant recruitment and adherence in long-term dementia research.
USING DRIED BLOOD SPOT ANALYSIS IN OLDER ADULTS WITH MILD COGNITIVE IMPAIRMENT: A FEASIBILITY STUDY
Authors: McPhillips Miranda , Li Junxin , Gooneratne Nalaka , Hodgson Nancy
Published: January 2025

Dried blood spots (DBS) are whole blood collected on filter paper and dried. We sought to determine the feasibility of using DBS for a virtually delivered intervention, 4 week, Multicomponent Behavioral Sleep Intervention (MBSI) for insomnia in older adults with mild cognitive impairment, during Covid-19. We explored the mechanisms by which MBSI affected sleep via inflammatory biomarkers (IL-6, IL-1ß, TNF-α, and C-reactive protein). Twenty-seven participants were enrolled; 3 dropped out. Participants were mailed supplies and instructions for collecting DBS at 3 study time points (baseline, immediately post-intervention, and 3-month follow-up). Participants were instructed to keep the ﬁlter paper lying ﬂat at room temperature for 24 hours to dry before putting in a biohazard bag with a desiccant and mailing back in a pre-stamped envelope. All samples were labeled, transported, and stored in a -70°C freezer until ready to be analyzed. We used published methods to extract the blood spots in conjunction with Meso Scale Discovery (MSD) multiplex immunoassay for analysis. 20/27 (74%) of participants mailed the DBS cards back at baseline; 14 of those 20 (70%) mailed back DBS cards at timepoint 2 and timepoint 3. Only 10 participants completed all 3 timepoints (10/27; 37%). For all (n=48) samples, CRP and IL-1β values were all within normal limits. For IL-6, 22/48 (46%) values were below the lower limit of detection (LLOD) and 12/48 (25%) were too low to calculate. For TNF-α, 26/48 (54%) values were below LLOD. We will discuss barriers and facilitators to this type of collection and analysis.
USING SIMULATION IN DEMENTIA CAREGIVER RESEARCH: LESSONS LEARNED
Authors: Lee Cheryl , Jablonski Rita
Published: January 2025

The purpose of this methods presentation is to describe how simulation-based training was used to impart critical skills for two members of a dementia caregiver research team: the interventionist and the person monitoring treatment fidelity. To have sufficient rigor and reproducibility in a randomized clinical trial, highly detailed protocols and training procedures must be developed and consistently followed. Inadequate training of interventionists may result in delivery variations of the same intervention, negatively affecting outcomes and the study’s generalizability. Simulations followed the Healthcare Simulation Standards of Best Practice’s general criteria for prebriefing and debriefing. Four pre-licensure nursing students role-played as simulated family caregivers who faced care-resistant behaviors by persons living with dementia. They co-created their simulated identities with the principal investigator. A treatment fidelity checklist was created to ensure the interventionist adhered to the key components of the intervention protocol. Inter-rater reliability for the treatment fidelity checklist was 100%. Treatment fidelity scores for the interventionist ranged from 23.1% to 52.9%, indicating poor adherence to the intervention protocol. Debriefings with the interventionist revealed that the simulated caregivers were passive during the simulations and that she had difficulty suspending disbelief during the simulations, which contributed to poor adherence. Students shared during their debriefing that their simulated identities should have had more details. Simulation training was continued using two family caregivers with better treatment fidelity results (90%-95%). Simulation is a viable method for training research personnel, but care is needed to select actors with experiences that mirror the research conditions.
A CAGED DEATH: EFFORTS TO IMPROVE QUALITY OF LIFE AND DEATH FOR AGING INCARCERATED WOMEN
Authors: Eagle Tosha Big , Shatswell L , O’Sullivan Kelly , Weaver Raven , Bolkan Cory
Published: January 2025

Older incarcerated women are overlooked in research despite facing significant challenges; many remain incarcerated until death, even though prisons are not designed to provide sufficient geriatric or end-of-life care. This scoping review investigated the intersectionality between aging, incarceration, and health outcomes, focusing on older women, particularly those from historically marginalized social identities. With limited research on the effects of incarceration, especially for older, minoritized populations, we adopted a comprehensive approach, spanning between 1990 - 2023 and utilizing Academic Search Complete, APA PsycINFO, CINAHL, and PubMed databases. The search employed tiered keywords related to incarceration, jail/prison; aging, older adults; support, services, health; and women, race/ethnicity, culture. Two independent reviewers screened and identified 85 relevant articles for detailed analyses. Findings suggest that health outcomes, including disruption to physical, cognitive, and psychosocial development, are exacerbated among older women. Further, women ‘s prisons lack peer caregiving programs available in some men’s prisons, highlighting gender inequities. Results underscore the critical role of adequate healthcare access to improve quality of life and death during incarceration, and successful re-entry into society, when applicable. There is also a dire need for gender-specific care, preventative healthcare, and early intervention strategies to address the unique health needs of incarcerated women as they age and die in prison. Few examples of programs/policies providing equitable access to comprehensive healthcare services are available. Future research contextualizing the intersectionality of aging, incarceration, and health outcomes, can contribute to this underexplored field, urging an inclusive and holistic approach to the well-being of incarcerated older women.
INCREASING DIGITAL EQUITY IN RURAL EASTERN NORTH CAROLINA
Authors: Schwartz Abby , Richman Alice , Cofie Leslie , Mizell Nate , Osorio Leslie
Published: January 2025

Rural eastern North Carolina is largely an economically distressed region with limited access to broadband internet. In most places in the US, access to internet and technology is integral to daily life and is critical to accessing healthcare and social services, however in the 18 counties included in the present study, fewer than 25% of the households have broadband access. Residents in these counties experience a dire digital divide. We aim to bridge this divide by delivering an educational intervention and through the development of a technology (iPads, hotspots) library lending program in each of the counties. This poster presents results from the formative evaluation that was completed to identify the internet connectivity, technology, and resource needs in the study counties. Twenty-five interviews were completed with key informants including trusted leaders, heads of libraries/staff, and residents. The mean age of resident respondents was 51 years old, and most were female (70%) with all identifying as African American. Interviews were completed by telephone or virtually and lasted ~45 minutes each. Thematic analysis was used to analyze the interview transcripts, and key themes that emerged across the interviews highlighted the critical need and interest in a digital lending program, desired topics for educational trainings (e.g., online job searches, support in completing social service forms online), and ways to engage residents in the programs. The poster concludes with a discussion of how the themes informed the development of lending library and educational programming, and considerations when implementing these programs in rural settings.
CHILDHOOD DIFFICULTIES AND LATE-LIFE DEPRESSIVE SYMPTOMS: THE ROLE OF EDUCATION AND FAMILY COPING
Authors: Lee Seolah , Seong Minju , Kang Miseon , Jung Inhye , Lee Hyo Jung
Published: January 2025

This study aims to examine how childhood difficulties are associated with late-life psychological well-being. Both adverse experience in origin family, such as family dysfunction and economic hardship, and adulthood economic hardship are known to impede healthy coping and family satisfaction. Thus, using the Cumulative Advantage/Disadvantage Theory, current study further explores how individual’s socio-economic status and family relational aspects in late life mediates the associations between childhood difficulties and depressive symptoms among older Koreans.We use the nationally representative Korean Welfare Panel Study (KoWePS), and select respondents aged 60-79 years old (n = 3,234). A serial mediation model was performed using the Hayes’s PROCESS Macro, bootstrapped 5,000 resamples. The indirect and total effects of childhood difficulties on depressive symptoms in late life were significant. Level of education and coping strategies of family conflict in late life had mediating effects on the relationship between childhood difficulties and older adults’ depressive symptoms. Income in late life, however, hadn’t a mediating effect on the relationship. Family satisfaction in late life had a mediating effect only thorough level of education and coping strategies of family conflict in late life sequentially. Findings suggest that experience of childhood difficulties has an adverse impact on older adults’ psychological well-being through deprivation of education opportunities in childhood and non-constructive coping strategies of family conflict in late life. Tackling inequality in education over one’s life course, as well as helping individuals develop healthy coping strategies, may be considered to mitigate the negative impacts of childhood difficulties on late-life psychological well-being.
CLINICIANS’ PERSPECTIVES REGARDING THE INFLUENCE OF ADVERSE SOCIAL DETERMINANTS ON ACUTE CARE RESOURCE USE
Authors: Osokpo Onome , Hirschman Karen , Shaid Elizabeth , McCauley Kathleen , Naylor Mary
Published: January 2025

Adverse Social Determinants of Health (SDoH) factors place older adults living with multiple chronic conditions at risk for poor outcomes during transitions from hospital to home. The Transitional Care Model (TCM) intervention, an advanced practice registered nurse (APRN)–led, team-based care-management strategy, improves outcomes throughout these transitions. However, little is known about the SDoH factors identified by APRNs delivering the TCM that may influence acute-care resource use. Guided by the Healthy People 2030 SDoH framework, we present the results of a descriptive qualitative analysis of 36 quality improvement and support meetings with clinical team members (i.e., APRNs, clinical coordinators) at three healthcare systems (7 hospitals/4 states) responsible for the delivery of the TCM to older adults hospitalized with heart failure, COPD, or pneumonia as part of the MIRROR-TCM trial. A review of clinical team meetings from January-June 2022, where teams met and reviewed and completed root cause analyses related to TCM care delivery challenges and acute-care resource use, revealed that most of the SDoH factors occurred within the Healthcare Access and Quality and Social and Community Context domains of Healthy People 2030 SDoH framework. These challenges include barriers to scheduling appointments, communication lapses amongst providers, reluctance or refusal by patients and/or families for home visits, and language barriers with non-English speakers. Strategies to address these challenges include, advocating for and coordinating follow-up appointments, use of telehealth, and healthcare-community partnerships to address patients’ concerns and unmet health-related social needs. Engaging these transitional care strategies may result in improved posthospitalization outcomes.
CONCEPTUALIZING THE HEALTH CARE WORKFORCE AS A SOCIAL DETERMINANT OF HEALTH IN LONG-TERM CARE SETTINGS
Authors: Thompson Roy , Olanrewaju Sherif , Squires Allison
Published: January 2025

The social determinants of health include environmental conditions where: individuals reside and age that affect their health, functioning, quality of life, and risks. We propose a conceptual model of how the health workforce becomes a social determinant of health resulting from the sustained person-clinician relationship. To illustrate the application of this proposed model, we examine the case of long-stay residents in long-term care settings. These residents spend ≥101 days, oftentimes until death in these facilities and have prolonged healthcare staff interactions which impact their health outcomes. Evidence suggests that sustained contact between residents and the healthcare workforce does impact their quality of life, health outcomes, and risks. We posit that the health workforce can be a contributing factor in inequitable outcomes in long-term care settings, thus becomes a social determinant of health. Their interactions and practices with residents may explain disparities in Black and Hispanic residents who typically have significantly higher rates of pain, falls, antipsychotic use, and pressure injuries relative to their Non-Hispanic White counterparts. Additionally, Black and Hispanic residents receive care in geographically segregated nursing homes. Through multi-level exemplars, we will illustrate how as a social determinant the workforce characteristics like racial and ethnic concordance, skill mix, and hours per resident impact health outcomes. Therefore, studies that conceptualize and operationalize the healthcare workforce as a social determinant of health at the individual, interpersonal and organizational levels are needed to improve staffing interventions to mitigate health disparities across in long-term care settings.
HETEROGENEOUS EFFECTS OF CHILDHOOD ADVERSITY ON LATE-LIFE BRAIN HEALTH: A CAUSAL FOREST APPLICATION
Authors: Hayes-Larson Eleanor , Ikesu Ryo , Inoue Kosuke , Gilsanz Paola , Whitmer Rachel , Glymour M Maria , Mungas Dan , Mayeda Elizabeth Rose
Published: January 2025

Effect heterogeneity across individuals may help explain inconsistent evidence regarding effects of childhood adversity on brain health. We used harmonized Kaiser Healthy Aging and Diverse Life Experiences and Study of Healthy Aging in African Americans (n=617) data to evaluate heterogeneity in effect estimates of childhood adversity (z-score of 7 adverse childhood events factor score, dichotomized at median) on brain white matter hyperintensity volume (WMH, log transformed). We used an honest causal forest with augmented inverse probability weighting and 10-fold cross-validation to estimate conditional average treatment effects (CATEs); this approach captures complex heterogeneity better than traditional regression models. Candidate sources of heterogeneity included age at MRI, demographics, US southern birth, childhood SES measures and interactions between variables. Overall, exposure to at least median childhood adversity was associated with 0.14 higher log units of WMH (95% CI -0.06, 0.35) after covariate adjustment. The best linear fit model for the observed treatment effect had an out-of-bag predicted treatment effect coefficient of 0.81 (P-value=0.02), indicating the heterogeneity in the association. Individuals with estimated CATEs below the median estimated CATE were older (mean age 76.4y vs. 72.5y), more likely to be male (56% vs 63%), and more likely to report low childhood SES (55% vs. 74% average/well-off, 16% vs 7% ever went hungry). This is preliminary work in a relatively small sample; more work is needed to understand the impact of childhood adversity on late-life brain health, including differences across individual characteristics.
INCOME INEQUALITY, INCOME, AND HEALTH OVER THE LATER LIFE COURSE IN EUROPE: A LONGITUDINAL AND CROSS-NATIONAL STUDY
Authors: Cheng Mengling , Sommet Nicolas , Spini Dario
Published: January 2025

Evidence from the U.S., UK, and Europe documented that income inequality has modest effects on the social gradient of health. However, few studies investigate how the effect of income inequality on the social gradient of health evolves over the life course. This study aims to examine to what extent, and in what ways, does the effect of income on later-life health trajectory vary across more unequal and less unequal societies. This study used data from the Standardized World Income Inequality Database (SWIID, 2004-2020) and the Survey of Health, Ageing and Retirement in Europe (SHARE, 2004-2010). We used national-level Gini index to measure income inequality. We used life satisfaction as the health outcome. We performed multilevel modelling to analyze the data in which observations (level 1) are nested in participants (level 2), country-years (level 3), and countries (level 4). Our analysis revealed three findings. First, the effect of income on life satisfaction among older adults is more pronounced in unequal countries. Second, the effect of income inequality on life satisfaction weakens as individuals age. Third, the importance of income on life satisfaction across societies of varying levels of income inequality decreases over the life course of an individual. Findings from this study show that contextual-level income inequality can modify the effects of individual income on health as individuals age. This can help the policy makers and practitioners to target the vulnerable population and offer more effective intervention.
LIFETIME TRAUMA AND ALLOSTATIC LOAD: PSYCHOSOCIAL RESOURCES AS BUFFERS?
Authors: Bell Mallory , Zhang Wencheng , Ferraro Kenneth
Published: January 2025

Although past studies report a relationship between stress and allostatic load, less research examines whether psychosocial resources buffer this relationship. Further, most studies examine allostatic load cross-sectionally. The current study uses sixes waves (2006-2016) of the Health and Retirement Study to examine the relationship between lifetime traumas and allostatic load over time. We also examine whether a variety of psychosocial resources, such as neighborhood cohesion, social support, and volunteering, help protect against the deleterious consequences of trauma on physiological dysregulation. Results indicate that higher lifetime trauma is associated with higher allostatic load. Allostatic load did not change over time Further, we found little evidence that psychosocial resources moderate the relationship between lifetime traumas and allostatic load.
MODERATING THE EFFECTS OF COGNITIVE DECLINE ON DAILY FUNCTIONING IN OLDER ADULTS: THE ROLE OF SOCIAL SUPPORT
Authors: Cho Youngmin , Wu Bei , Zou Baiming , Song Lixin , Anderson Ruth , Beeber Anna
Published: January 2025

As cognitive impairments increasingly affect community-dwelling older adults (CDOA), it becomes significant to understand the longitudinal impact of social support factors—such as living arrangements, social network size, and participation in social activities—on the relationship between cognitive status and daily functioning. Daily functioning includes activities of daily living (ADL), instrumental activities of daily living (IADL), physical capacity, and mobility. This study aims to determine whether social support factors moderate the relationship between cognitive status and daily functioning. We analyzed data from the National Health and Aging Trends Study (NHATS), a longitudinal survey of a nationally representative cohort of Medicare beneficiaries aged 65 and over in the US. Our analysis included eight years of data from 6,238 community-dwelling participants. Using linear mixed-effects models, we explored the interaction effect between cognitive status and social support factors on trajectories of daily functioning. Overall, all areas of daily functioning significantly declined over time, with faster decreases observed as cognitive status worsened. Living arrangements moderated the relationship between cognitive status and IADL, specifically mitigating the negative impact of cognitive decline on IADL. Increased participation in social activities eased the decline in ADL for individuals with probable dementia and in physical capacity for those with mild cognitive impairment (MCI); however, the size of the social network had no significant impact. Our findings highlight the importance of incorporating social support factors into tailored interventions to mitigate declines in daily functioning among CDOA, tailored to their specific cognitive status.
NEIGHBORHOOD POLLUTING INFRASTRUCTURE AND COGNITIVE HEALTH IN OLDER ADULTS
Authors: Ku Vivian , Sol Ketlyne , Zahodne Laura
Published: January 2025

Air pollution is known to be associated with poorer brain and cognitive health. Modifiable sources of pollution in neighborhoods such as industrial and hazardous waste facilities may serve as intervention targets. However, less is known about how polluting infrastructure relates to different cognitive domains. This study examines the relationship between polluting infrastructure and cognition within older adults. 475 adults aged 55+ from the Michigan Cognitive Aging Project (MCAP) completed a comprehensive neuropsychological battery measuring cognition across five domains (episodic memory, executive function, processing speed, language, visuospatial function). Participant geocoded addresses were linked to data on polluting infrastructure in the National Neighborhood Data Archive. Polluting infrastructure was operationalized as the presence of Toxic Release Inventory sites and the proportion of highway length to the total length of streets in a census tract. Generalized estimating equations accounting for geographic clustering modeled relationships between polluting infrastructure and cognitive health, controlling for age, sex, education, income, population density, and neighborhood disadvantage. Higher proportions of highways were related to poorer episodic memory (β= -0.660, p= 0.040). A trend was also found between the presence of at least one toxic site and poorer language (β= -0.121, p= 0.056). Both highways and toxic sites represent polluting infrastructure that could reduce cognitive health among older adults. Differential associations between pollution sources and cognitive domains may indicate that different types of pollutants (e.g., airborne fine particulates versus others) influence unique brain pathways.