bluuebunny/crossref_metadata_2025 huggingface dataset:
ADDRESSING THE NURSING WORKFORCE GAP IN SKILLED NURSING FACILITIES WITH AN AGE-FRIENDLY CURRICULUM
Authors: Brown Diane , Fosnight Sue , Drost Jennifer , Gergis Mary , Hovland Cynthia , Sanders Margaret , Kropp Denise , Gareri Michele
Published: January 2025

Skilled nursing home quality and staffing are positively correlated. Staffing shortages have been a long-standing problem however, COVID-19 exacerbated the issue. Currently, more than one in four US nursing homes report staff shortages, especially those in direct care to residents, nurse aides and nurses. To encourage workforce growth, a 12-module virtual curriculum was developed including Age-Friendly Health Systems care, interprofessional teamwork, and other relevant topics. Each module included a recorded didactic, pre-post module quizzes, discussion boards, and supplemental videos and articles. Trainees also spent 10 hours shadowing the interprofessional team in a skilled nursing facility. Two cohorts of undergraduate senior nursing students (n=18, and n=35), nurse assistants in training (n=9, cohort 1), and social work students (n=9, cohort 2) have been trained. Outcome measure were pre and post-education using surveys: Nursing Home Attitude, PES-NWI work environment, and ISVS-9 for teamwork attitude. Results of the first nursing cohort rated the highest nursing home attitude items: ability to provide comfort, flexible scheduling and spending time with clients with the lowest rating for working with persons with dementia. The PES-NWI survey showed highest concern for teamwork, adequate staffing and supportive administration with the lowest concern related to use of nursing diagnoses. The ISVS showed similarities pre and post with highest scores for client involvement in care and importance to work as a team, and lowest for comfort leading a team. Administrators of skilled nursing and educators can use this information to close the gap on improving interest in this setting for new graduates.
AGING SCIENCE EDUCATION: OLLI COLLABORATION BENEFITS UNDERREPRESENTED STUDENTS
Authors: Laflamme Maeva , Mallers Melanie Horn , Zettel-Watson Laura , Piazza Jennifer
Published: January 2025

The aging population is growing and diversifying, generating a need for workforce specialists (e.g., scientists, physicians) prepared to integrate knowledge about aging into their respective fields. Unfortunately, the fields that bring innovative change to improve the lives of older adults are the fields that continue to lack diversity due to a “leaky pipeline,” whereby underrepresented students are often lost or pushed out academically from MSTEM fields. To increase diversity in the aging-science workforce, a critical goal is to implement training programs that advance the study of aging within MSTEM. With the support of NIH funding, we designed an empirically derived, multi-pronged program to purposefully intersect the study of aging with science and research. To increase student involvement with older adults, we partnered with our campus-based Osher Lifelong Learning Institute (OLLI) members, many of whom are scientists themselves, regularly serve as panelists, interview participants, proofread students’ works, and act as audience members for our students. They also informally interact with students through community-based service learning opportunities, outreach, and volunteer activities. After collaborating with OLLI for one year, students report greater empathy and joy when interacting with older adults, increased interest and motivation to work in aging sciences, and decreased ageism. The MSTEM-OLLI collaboration has served as a critical component of advancing our goal of recruiting, retaining, and preparing underrepresented undergraduates for a future in MSTEM aging research. Our findings indicate that strengthening and expanding meaningful partnerships between older adults and students is a key priority to enhancing aging science programs.
DEVELOPING A TYPOLOGY OF SENIOR CENTERS: CONCEPTUAL AND METHODOLOGICAL CONSIDERATIONS
Authors: Somerville Ceara , Mutchler Jan
Published: January 2025

Senior centers are important resources for older adults and their families, intended to serve their communities by tailoring programs and services to meet the needs and interests of those in their local environment. The network of senior centers across the nation and within states is heterogenous, but there is limited research focused on senior centers’ organizational capacity. This project uses a novel dataset from a comprehensive database of all senior centers in Massachusetts (n=342) to explore the commonalities and differences in models of senior center operations. A factor-cluster approach was applied to a subsample of 278 senior centers. Nearly 40 indicators of organizational goals, structure, people, resources, and policies were included in a nonlinear principal components analysis, resulting in 11 standardized scales representing components of organizational capacity (e.g., leadership, governance, core programs and services). These scores were then entered into a two-step cluster algorithm to determine the optimal grouping of senior centers into distinct types of operational models. Three clusters emerged; the most notable differences between them occurred on measures of wellness programs, core programs and services, staff capacity, space capacity, and social and financial resources. Differences between clusters on several demographic characteristics of the community (e.g., population size and density, racial and ethnic composition) were observed, providing empirical support of senior centers operating in response to their local populations. Senior centers are locally focused, but identifying common operational types and their relation to the wider community can inform research, policy, and practice to better support the network.
GENDER DIFFERENCES IN DISEASE BURDEN AND QUALITY-OF-LIFE TRAJECTORIES AMONG OLDER ADULTS LIVING WITH MULTIMORBIDITY
Authors: Lim Arum , Benjasirisan Chitchanok , Tebay Jordan , Himmelfarb Cheryl Dennison , Davidson Patricia , Koirala Binu
Published: January 2025

Heart failure (HF) is a leading cause of hospitalization and is associated with higher multimorbidity. Despite gender disparities and differences in HF research participation and health outcomes, differences in the trajectories of their lives have not been studied enough. This study aimed to examine the 1-year trajectories of disease burden and quality of life (QoL) for older adults with multimorbidity. Multimorbidity was defined as the presence of HF and one or more conditions among common chronic conditions in older adults. The study prospectively collected socio-demographic, clinical, and outcome data at baseline, 30-day, and 1-year follow-up using an electronic patient portal among adults aged 50 years and older living with multimorbidity. Disease burden and QoL data were collected using a modified disease burden impact scale and the EuroQoL (EQ)-5D-5L. Linear mixed-effect models were used for statistical analyses. A total of 200 patients (102 women and 98 men) completed surveys at the three time points. Participants’ mean±SD age was 71±9.5 years; men were older than women. The disease burden decreased at the 30-day follow-up (23.7±14.9) and the 1-year follow-up (24.6±15.7) compared to baseline (26.3±16.3). In an unadjusted analysis, disease burden was higher in women than men (beta=2.516; p=0.017). QoL was not significantly different by gender and time. After adjusting for age and social support, there were no significant gender differences in disease burden and QoL trajectories and no time and gender interaction. There is a need for gender-based research on multimorbidity to promote health equity.
CONTINUOUS USERS OF LONG-TERM CARE 2.0 IN TAIWAN: PATTERNS AND HEALTH COSTS OVER TIME
Authors: Chen Ya-Mei , Wu Shih-Cyuan , Chao Shiau-Fang , Lin Ming-Jen , Chu Chien-Fang
Published: January 2025

Taiwan has implemented the Long-Term Care 2.0 (LTC 2.0) Plan since 2017, but only about one third of users continuous to remain in the system after 6 months. The current study examined the patterns of the continuous user and their associations to older adults’ health costs overtime. This study utilized Taiwan’s LTC Plan 2.0 database and the National Health Insurance Plan claim dataset, and included 155,220 clients who continuously utilized any LTC Plan 2.0 services for six months between 2017 and 2019. These users’ health costs were examined in the 12 months after 6 months of HCBS continuous use. Latent class analysis and generalized estimating equations were used to investigate the associations between different service use patterns and the changes in health costs. Five subgroups of LTC use patterns were identified, including home-based personal care (PC) group (n= 99,163, 63.9%), home-based medical care (MC) group (n= 13,304, 8.5%), home-based personal care and medical care (PC/MC) group (n = 9,269, 6.0%), Reablement (RA) group (n= 20,132, 13.0%), and community care (CC) group (n= 13,352, 8.6%). When compared to care recipients in PC/MC group, those in the PC group ($5.84/month, p< 0.001), MC group ($8.21/month, p< 0.001), and CC group ($6.79/month, p< 0.001) had increased more health costs overtime. Such trends are more prominent among those with moderate and severe disability, except those in RA group. The integrated services (PC/MC group) and reablement (RA group) demonstrate slower growth in health costs, particularly among those with moderate and severe disabilities.
CURRENT TRENDS IN THE DIRECT CARE WORKFORCE
Authors: Kelly Christopher , Deichert Jerome
Published: January 2025

We used data from the 2020-2022 American Community Survey to examine trends among direct care workers (DCWs) in both occupation and industry. We found the number of nursing assistants, psychiatric aides, and home health aides decreased 5.8%, to nearly 1.9 million, while the number of personal and home care aides decreased 0.8%, to more than 1.3 million. Nursing assistants, psychiatric aides, and home health aides were more likely than personal and home care aides to be female, under age 25, African American, recently divorced, and to receive health insurance from their employer. They were less likely to be age 65 and over, to receive health insurance from Medicare or Medicaid, and to have a disability. Nearly 1.9 million DCWs were employed in home and community-based services, as compared to under 900,000 in residential care facilities and under 500,000 in hospitals. There were increases in the number of DCWs employed by outpatient care centers (10.7%), hospitals (7.2%) and individual and family services (3.7%). The largest decreases were in the number of DCWs employed by skilled nursing facilities (17.4%), assisted living facilities (12.3%), and private households (6.1%). DCWs employed by residential care facilities were more likely to be nursing assistants, psychiatric aides, or home health aides and they were more likely to work year-round and full-time. These findings suggest that changes already underway in the direct care workforce accelerated during/after the COVID-19 pandemic. DCWs are shifting towards jobs requiring less training and/or licensure and away from jobs in residential care facilities.
THE EFFECT OF MEDICAID MANAGED LONG-TERM SERVICES AND SUPPORT ON PARTICIPANT QUALITY OF LIFE AND UNMET NEED
Authors: Degenholtz Howard , Treat Anny , Kastner Keri , Yauch John
Published: January 2025

In 2018 the Commonwealth of Pennsylvania began a three year transition of Medicaid Aging and Disabled Waiver programs to Managed Long-Term Services and Supports (MLTSS). The new program, Community HealthChoices, serves adults with disabilities who receive home and community based services (HCBS), live in a nursing facility, and people dually eligible for both Medicaid and Medicare who do not use long-term services and supports (“duals”). Three managed care organizations operate the program through state-wide contracts. The program was implemented statewide over a three year period in three regional phases, creating a unique natural experiment. In other analyses, we have demonstrated significant changes to care management and slowing in the rate of growth of HCBS spending. This is the first study of HCBS participants’ subjective experience. A total of 14,706 prospective telephone interviews were conducted with random samples of participants before the transition to CHC and 18 and 30 months post-transition. We found that psychological well-being was unchanged, but depressive symptoms decreased over time. There was no change in the consequences of unmet need (e.g., having a hot meal or a bath). In general, when compared duals, HCBS users report lower access to primary care and lower self-reported health status. After the implementation, duals users reported higher health status and HCBS users were more likely to report having a medical care coordinator. The transition to MLTSS brought substantial changes to the way Medicaid LTSS is financed and delivered in Pennsylvania. However, the experience of the average participant has been relatively stable.
FROM PAST TO PRESENT: REFINING LONG-TERM CARE POLICIES IN RESPONSE TO CHINA’S AGING POPULATION
Authors: Wang Qingwei , Ma Yu , Chen Jiayu
Published: January 2025

The evolution of long-term care policy in China is a complex response to the nation’s demographic shift and economic changes. Despite extensive policy development, discrepancies between policy intentions and real-world demands of older adults persist. This study employs a longitudinal analysis to dissect the dynamics that have shaped China’s aging policies from the 1940s to 2023. By critically examining legislative documents and top-level directives, this research identifies gaps between policy formulations and market response and the challenges of navigating a fragmented regulatory landscape. A misalignment has emerged between the supply of Home and Community-Based Services and institutional care demand, resulting in resource underutilization and diverging from intended policy outcomes. The research further explores the regulatory fragmentation within China’s long-term care sector, indicating that decentralized supervision is a significant barrier to achieving cohesive governance and effective policy implementation. The findings illustrate the critical need for adaptive policy mechanisms that better align with demographic realities and consumer expectations. This paper contributes to the discourses on long-term care policy by offering insights into the effectiveness of China’s strategic initiatives in recent years and suggesting directions for future policy refinement. It aims to ensure sustainable care by addressing both the discrepancies in policy and market response and the challenges of fragmented authority.
SOCIOECONOMIC AND GENETIC DETERMINANTS OF COGNITIVE FUNCTION IN THE AGING POPULATION IN KAZAKHSTAN
Authors: Supiyev Adil , Gutierrez Angela , Terrera Graciela Muniz
Published: January 2025

Objective There is limited evidence about cognitive performance of older adults in Kazakhstan, a Central Asian nation that was formerly part of the Soviet Union. Our study aims to fill the gaps by assessing cognitive function and its determinants in the population of Astana city and its surrounding rural areas. Methods Between 2012 and 2015, 954 older adults aged 50–74 from urban and rural areas in Central Kazakhstan participated in this study (response rate: 59%). Trained practitioners administered four neuropsychological tests to assess cognitive function, including verbal memory, verbal fluency, attention, and concentration. Additionally, a standardised protocol was used, consisting of a structured questionnaire, objective physical examination, and blood sample collection. Results After controlling for age, sex, and cardiometabolic risk factors, our analysis revealed significant associations between cognitive function and residence, ethnicity, education levels, and selected socioeconomic factors. Notably, APOE4 status showed a strong association with cognitive decline, consistent with prior research. Furthermore, individuals with higher deprivation levels, men, rural residents, and those with lower education levels demonstrated significantly poorer cognitive function outcomes. Conclusion Understanding the association between cognitive function and selected socio-demographic factors within the Central Asian region contributes significantly to global health insights. The contrasts observed in residential environments and levels of deprivation emphasize the urgency of targeted interventions aimed at mitigating cognitive decline risks among vulnerable populations worldwide.
A SYSTEMATIC REVIEW OF MEASURES USED IN STUDIES LINKING SOCIAL ISOLATION, LONELINESS, AND PHYSICAL HEALTH
Authors: Nambisan Priya , Gangula Sushma , Ellis Julie , Taani Murad , Lee Yura
Published: January 2025

Social isolation (SI) and loneliness significantly impact public health, particularly among older adults, leading to adverse physical health outcomes. Despite extensive research in this field, there is considerable variability in how these factors are measured. Our systematic review, following the PRISMA method, identified 22 relevant studies. Among these, 18 primarily utilized secondary data and assessed social isolation through questions covering marital status, contact frequency with family, friends, and participation in social activities. Composite indices and scales were often constructed from these measures, with scores indicating low/high social isolation. However, it’s essential to note that loneliness, which can be felt despite social interaction, requires validated scales for accurate measurement. Out of the 22 studies, 4 didn’t employ validated scales for either SI or loneliness, while 6 lacked validation for SI, and 5 out of 20 for loneliness. Measurement scales varied for loneliness, from simple classifications to Likert scales, with higher scores indicating heightened loneliness. Some studies adopted established scales like the Bude and Lantermann scale, while others employed modified versions or analogues. Our analysis highlights the importance of using validated measures to assess these variables accurately. Markedly, different measurement approaches yielded distinct impacts on health outcomes. Moving forward, standardization and validation of measurement tools are critical for enhancing the reliability and comparability of research findings in this area.
HOW DOES DIGITAL USE AFFECT THE DAILY ACTIVITIES AND LONELINESS AMONG CHINESE OLDER ADULTS?
Authors: Chen Xiayu , Yu Zhan , Xu Qingwen
Published: January 2025

The increasing integration of digital technology into everyday life has significant implications for the aging population. This study explores the relationship between Internet use and the psychosocial well-being of older adults, particularly examines whether digital engagement would have replaced (or enhanced) traditional activities and social interactions, and to what extent digital engagement has contributed to alleviating loneliness among older adults within the Chinese community-dwelling context. Utilizing data from the Chinese General Social Survey, which included 4,283 respondents aged 60 and over, we performed various regression models to examine the relationship among Internet use and daily activities, as well as Internet use and loneliness. Our research reveals the digital divide within the older population in China, where Internet users were the majority those with access to resources and learning and physical capacity, suggesting a deeper concern for technology equity. Our findings also indicate that Internet use among older adults is associated with increased participation in traditional activities, such as shopping, information seeking, and socializing with friends and relatives. Additionally, a higher intensity of Internet use correlates with lower levels of reported loneliness, indicating that Internet use could enhance social connections and overall well-being among older adults. These results highlight the potential of digital technologies to support active aging by fostering enhanced social interactions and engagement in daily life. It calls for developing holistic digital integration strategies and creating an age-friendly digital environment. The findings also provide valuable insights for policymakers and stakeholders in China and potentially in other contexts.
NEIGHBORHOOD AND PSYCHOSOCIAL PREDICTORS OF ALLOSTATIC LOAD AMONG LATINX ADULTS IN THE UNITED STATES
Authors: Gutierrez Angela , Supiyev Adil , Tobin Courtney Thomas , Sevi Barış , Terrera Graciela Muniz
Published: January 2025

Prior research highlights the independent roles of neighborhood and psychosocial risk and protective factors for accelerated physiological aging. However, the combined role of risk and protective neighborhood and psychosocial factors on allostatic load (AL) among middle-aged and older Latinx adults in the U.S. remains unclear. Utilizing data from Latinx adults ages 50 and older (n = 319) in the Health and Retirement Study (Time 1 = 2006/2008; Time 2 = 2010/2012; Time 3 = 2014/2016), this study aimed to examine the role of neighborhood (perceived physical disorder, neighborhood social cohesion) and psychosocial (loneliness, social support) factors in shaping baseline AL and change in allostatic load. Linear mixed models were used to estimate baseline AL and rate of change in AL, adjusting for sociodemographic factors. Higher loneliness was associated with higher baseline AL, p = 0.028. This association persisted when considering neighborhood factors, p = 0.025. When social support was added to the model, the association between loneliness and AL was attenuated and no longer statistically significant, p = 0.174. Findings provide evidence of a positive association between loneliness and baseline allostatic load. Finding also highlight social support as a protective factor for baseline AL among Latinx adults. Health promotion efforts should consider implementing culturally relevant approaches to foster social support and to promote healthy aging among Latinx adults.
GAME ENGAGEMENT AMONG MIDDLE-AGED AND OLDER ADULTS PREDICTS LATER-LIFE COGNITIVE PERFORMANCE
Authors: Mansoor Marrium , Katz Ben
Published: January 2025

Although previous literature has linked intellectually stimulating activities to better cognitive outcomes for older adults through cross-sectional and experimental paradigms, fewer studies have looked at the relationship between gameplay at earlier ages and cognitive performance many years later in life. Here, a nationally representative sample of ~1200 middle and older adults drawn from the Health and Retirement Study (M=64.91 years, SD=7.68; Range = 50-91) was used to examine links between global cognition 14 years following self-reported gameplay frequency of two different types of gameplay - word games (WG) and card games (CG) - while accounting for baseline global cognition, age, gender, and years of education. Results indicated that only WG predicts global cognition (B= 0.05, p=0.039) such that more frequent gameplay earlier on was linked to better global cognition scores 14 years later. Although this association is modest and requires further exploration through cross-lagged models and more granular longitudinal studies, these results indicate that word games may play a role in cognitive engagement in later life that is similar to the protective effects of other intellectually stimulating activities. As computer and videogame play become more pervasive in older adult populations, future research should also focus on different types of games (including video games, mobile games, and/or board and puzzle games) to explore the nuances of game engagement throughout the life course and cognitive performance in later life.
TIME-TO-EVENT ANALYSIS IN EVALUATING THE ASSOCIATION OF FALL RISK APPRAISALS AND PHYSICAL ACTIVITY IN OLDER ADULTS
Authors: Nguyen Tho , Thiamwong Ladda , Liu Chang , Suarez Jethro Raphael , Park Joon-Hyuk , Xie Rui
Published: January 2025

Older adults are encouraged to participate in moderate-to-vigorous physical activity (MVPA) for 75 to 300 minutes per week for health benefits. However, the association of fall risk appraisal (FRA) with meeting the recommended activity levels remains uncertain. We assessed FRA in 134 participants aged 61 to 89 (mean age=74.26±6.85 years, 88.8% female, and 70.15% no history of falls) using the Short Fall Efficacy Scale-International and a static balance assessment, and categorized them into four FRA groups: rational (10.5%, low fear of falling (FOF) and normal balance), irrational (42.9%, high FOF but normal balance), incongruent (25.6%, low FOF and poor balance), and congruent (21.1%, high FOF but poor balance). Using time-to-event analysis based on daily accelerometer activity count data, we examined the impact of FRA on the duration of MVPA, light physical activity (LPA), and sedentary behavior (SB) across seven consecutive days. Kaplan-Meier curves demonstrate that older adults in the rational FRA group had the highest probability of sustaining MVPA throughout the day, whereas those in the congruent group had the lowest probability (log-rank p < 0.001). Conversely, participants in the congruent group exhibited the highest likelihood of extending SB duration, while those in the rational group had the lowest (log-rank p < 0.001). No significant differences were observed among FRA groups regarding LPA duration. The findings underscore the significance of mitigating a sedentary lifestyle and emphasize the importance of implementing targeted interventions to enhance the duration of MVPA as a pivotal determinant in diminishing the fall risks among older adults.
MULTIDIMENSIONAL SOCIAL RELATIONSHIP AND LONELINESS AMONG OLDER ADULTS WITH COGNITIVE IMPAIRMENT
Authors: Park Soobin , Park Sojung , Kim BoRin , Amano Takashi , Baek Jihye
Published: January 2025

As a modifiable risk factor of cognitive impairment, loneliness has received growing attention in research. By focusing on older adults with cognitive impairment, this study aims to add to the knowledge about the complex association among cognitive impairment, social relationships, and loneliness We explored distinct patterns of multidimensional social relationships and examined how these patterns influence social and emotional loneliness among older adults with cognitive impairments. Data came from the 2018 Health and Retirement Study and aged over 65 years. To focus on older adults with cognitive impairments, we excluded respondents with high cognitive function measured by the Telephone Interview for Cognitive Status (TICS) score (N=640). Latent class analysis was used to identify subgroups of social relations using multidimensional indicators of social relations including quantity (e.g., frequency of social contact with varying modes, social network size) and quality (e.g., positive and negative social support). Five patterns of social relationships emerged: Lack Friends/Weak (16%), Lack Children/Positive Friends (10%), Lack Family (11%), Virtual Diverse (52%), and Diverse/Negative (11%). Regression analyses showed Diverse/Negative group (p< 0.01) was significantly associated with a higher level of emotional loneliness compared to the Virtual Diverse group. All three groups (p< 0.05) except Lack Children/Positive Friends (p>.1) had significantly a higher level of social loneliness. Interestingly, more than half had a quantitatively diverse social relationship, maintaining rich social networks despite their cognitive impairment. Our findings highlight the importance of efforts that help decrease negative and secure positive or meaningful support as ways to reduce loneliness among cognitively impaired older adults.
PEER-LED EXERCISE RESULTS IN IMPROVED SLEEP EFFICIENCY WITHOUT CONCURRENT CHANGES IN MOOD
Authors: Banarjee Chitra , Lafontant Kworweinski , Suarez Jethro Raphael , Park Joon-Hyuk , Fukuda David , Stout Jeffrey , Lighthall Nichole , Thiamwong Ladda
Published: January 2025

Sleep is an important physiological process for recovery and regulation of homeostatic processes in the human body. Changes in sleep have additionally been shown to affect mood, including anxiety and depression. The present study implements multimodal assessment of sleep and mood using the wearable FitBit® Charge 5, as well as subjective surveys, the PHQ-9 and GAI, evaluating anxiety and depression, respectively. The study sample included 108 community-dwelling older adults (mean age = 74.19 years ± 6.96; 89.8% female). Of these adults, 58 participated in weekly peer-led exercise and exercise, (strength-training and walking) at least 30 mins twice a week for eight weeks. Participants wore a FitBit® for a mean of 76.5 days ± 59.24, including at night. Using the FitBit®, the study evaluated time asleep and sleep efficiency, calculated based on the time asleep, deep and REM sleep, and restoration. Participants undergoing intervention exhibited a significant increase in both sleep duration (p< 0.001; intervention=297.2 minutes, control=274.8 minutes) and efficiency (p< 0.001; intervention=93.6, control=92.2), as evaluated by Wilcoxon tests. However, subjective assessments of anxiety (p=0.288) and depression (p=0.986) did not reveal significant differences. These results indicate that peer-led exercise results in a significant improvement in sleep, which is consistent with previous research. The lack of concordant results in mood suggests that more intensive exercise may be necessary to improve mood. Additionally, the study was limited by individual variability in FitBit® wear time. Future research should evaluate the long-term effects of increasing the time and intensity of peer-led exercise on sleep and mood.
SUPPORTING SOCIAL INTERACTION OF OLDER FAMILY CARE PARTNERS THROUGH A DIGITAL HEALTH PHYSICAL ACTIVITY PROGRAM
Authors: Baik Dawon
Published: January 2025

Older Family care partners (FCPs) experience more social isolation, mental and physical health issues than younger FCPs. Loneliness and social disconnectedness in older FCPs can lead to an increased risk of poor health and low well-being. To support social interaction and connectedness in older FCPs of persons with heart failure (HF-FCPs), we identified their needs and preferences on a technology-supported physical activity (PA) program using scenario-based design methods. The program included one-on-one PA coaching, using a fitness tracker and motivational text messaging. Fifteen HF-FCPs were recruited at a University Hospital between September and December 2022. We conducted semi-structured qualitative interviews. Participants were aged 65.9±4.4 years (M±SD), female (73%), and spouses (87%). HF-FCPs perceived that the program could support their social connectedness. Participants reported that interaction with a health coach via videoconferencing would be valuable for their social health in the context of caregiving (e, g., time constraints, caregiving duties limiting FCPs to the home). A group-based program was suggested to increase motivation for support and feedback from other FCPs. They indicated that texting would be useful to share their PA and caregiving experience and provide support and encouragement to other FCPs. Participants highlighted the need for their own social groups, because as one described: “There is a support group for people with the same condition and their caregivers, but it’s really talking about the condition itself, not about how we take care of ourselves.” Future studies should develop and test technology-based, caregiver-centered interventions for sedentary and socially isolated older FCPs.
DOMINANT BUT NOT NONDOMINANT HANDGRIP ASYMMETRY INFLUENCES ACTIVITY AND COGNITIVE FUNCTION CHANGE
Authors: Chen Liangchi , Han Sae Hwang , Lockman Jeffrey
Published: January 2025

Handgrip strength (HGS) is commonly used in clinical and research settings for examining muscle function. Additionally, HGS asymmetry is often used as a screening tool for identifying functional and cognitive limitations among older adults. This longitudinal study examined changes in activity limitations and cognitive function associated with baseline handgrip asymmetry. We analyzed 8 waves of biennial data collected from adults 51 and older in the nationally representative Health and Retirement Study (2006–2020, N=7,053). HGS asymmetry ratio was measured at baseline and was calculated as nondominant HGS/dominant HGS; following earlier works, individuals with HGS asymmetry ratio smaller than 0.80 and higher than 1.20 were considered to have dominant and nondominant handgrip asymmetry, respectively. We used multilevel models to investigate whether HGS asymmetry was linked to a faster rate of change in activity limitations (evaluated with activities and instrumental activities of daily living items; range: 0–11) and cognitive function (evaluated with Telephone Interview for Cognitive Status; range: 0–27) during the observation period. Results indicated that individuals with dominant HGS asymmetry, but not non-dominant HGS asymmetry, developed activity limitations at a faster rate (b=.015, p=.030) and also showed a faster rate of cognitive decline (b=-.053, p=.005) compared to individuals with HGS symmetry. While the present findings are based on a U.S. sample, future research endeavors are aimed at investigating similar issues beyond the confines of the U.S. population.
INTERDISCIPLINARY COLLABORATION TO SUPPORT AGE FRIENDLINESS AND PREPARATION FOR INTERGENERATIONAL PROGRAMMING
Authors: Munly Kelly , Frederick Jared , Gaston Harriett
Published: January 2025

Human Development and Family Studies (HDFS) and History Programs at a small campus collaborated to support Adult Development and Aging students (N=72) to understand the life course context of older adults they prepared to work with in a long-term care practicum experience. This effort to prepare students for intergenerational programming is part of a larger effort toward Age Friendliness at this campus and in the surrounding community. Life course theory is the foundation of project aims and design. After HDFS faculty established a plan for collaboration with the History Program, they were able to provide two classes of Adult Development and Aging students (N=72) with historical insights on the life course experiences of the older adults that students would be working with. Context and life course experiences discussed included dynamics related to diversity—often considered invisible—resulting from the Great Migration, as well as socioeconomic moments in time that would also influence the life course for multiple generations. After each class of discussion facilitated by the History Program, students were asked to provide reflections on their Canvas course online platform on what they had heard in light of their imminent practicum experiences. Initial thematic analysis of student reflections suggest that discussions facilitated between the History and Human Development and Family Studies Programs across two classes enhanced student understanding and supported a stronger foundation toward Age Friendliness and readiness to engage in intergenerational programming.
SUPER AGE: THE RISE OF BIOSOCIAL SUPER AGE ESTIMATES AS ALTERNATIVES TO CHRONOLOGICAL AGE
Authors: Perzynski Adam , Gunzler Douglas , Dalton Jarrod , Berg Kristen
Published: January 2025

Recent discoveries have established conceptual and empirical linkages between the social characteristics of communities, biological and physiological variation and disease onset and outcomes. Cellular and molecular markers appear to be at least partially indicative of an accelerated aging process. We are approaching the widespread availability of “Super Ages”, highly accurate biosocial estimates of the aging of a human person. Super Ages have more predictive validity for disease and disability than chronological age. As compared with chronological age, Super Age estimates can be described as having an accelerated (hyper-aging) or decelerated (hypo-aging) character. We ask: What types of social changes– beneficial or detrimental– might be postulated based upon a shift toward incorporating biosocial measures of aging in age-graded policy and care delivery? We present case-based scenarios illustrative of the coming biosocial dilemma. Consider two matched neighborhoods each containing 400 adults with a chronological age between 40 and 50 years who have aged in place (Neighborhood A and Neighborhood B). All persons in Neighborhood A experience uniform social and environmental hazards while hazards are minimal in Neighborhood B. Molecular analyses find Neighborhood A adults experience hyper-aging of chronological age plus 4 to 7 years. Neighborhood B are as much as 3 to 5 years “younger” creating between community biosocial age gap of 9.5 years. Both neighborhoods experience equal access to health services. Guideline-based screening (i.e. breast, lung and colon cancer screening) is age-graded but Neighborhood A is more vulnerable. Super Age estimates are fraught with new policy and care delivery challenges.
GERIATRIC PSYCHIATRY OUTPATIENT REACTIONS TO A POST-COVID TRANSITION FROM VIRTUAL TO IN-PERSON CARE
Authors: Mertz Kathryn , Baldinger Samantha , RIvas Jennifer , Nikzad Amir , Scarpelli Michael , Greenwald Blaine
Published: January 2025

Because of social distancing/quarantining, the COVID-19 pandemic catalyzed necessary shifts to telepsychiatry in outpatient mental health settings. To enable access and reimbursement for elders, the Centers for Medicaid and Medicare Services (CMS) liberalized restrictive telemedicine regulations. In our Geriatric Psychiatry Clinic, in-person visits quickly shifted to virtual. Tele-video and audio-only services became universally operative between Spring 2020 through May 2023, when – with the public health emergency (PHE) ending - CMS determined hospital-based clinics were ineligible for the ‘facility fee’ if patients were seen virtually, so return to in-person care was strongly encouraged. Shortly thereafter, to determine impact, consecutive geriatric psychiatry clinic patients over a several days period were surveyed re: satisfaction with virtual versus in-person care, and about challenges experienced returning in-person. Of 134 patients surveyed, 43% had engaged in tele-video, 43% in audio-only, and 17% utilized both. Utilizing a 5 -point Likert scale (very unsatisfied = 1 to very satisfied = 5), virtual (video, audio or both) (mean = 4.1) and in-person (mean = 4.2) care did not differ (p-value = 0.82 [Wilcoxon signed-rank test]). Amongst challenges associated with returning to in-person, 75% identified medical issues as very difficult/difficult, 46% financial issues, 25% distance to clinic, 23% transportation concerns, and 16% caregiving responsibilities. Taken together, findings suggest that geriatric psychiatry outpatients are comparably satisfied with virtual and in-person visits, however notable proportions experienced challenges reverting to in-person, especially because of medical and financial issues. As such, continuing advocacy supporting virtual options in psychiatric care of elders is warranted.
LONELINESS, SOCIAL ENGAGEMENT, AND COGNITIVE STATUS AMONG OLDER BLACK AND WHITE ADULTS
Authors: Beech Bettina , Bruce Marino , Udo Charles , Velazquez Ana , Thorpe Roland
Published: January 2025

Social connection has been consistently shown to influence health status and recent research findings suggest that an absence of relationships with significant others can increase risks for cognitive impairment. Few studies have examined how the presence or absence of social connections have implications for cognitive impairment and even fewer have considered how these associations can vary by race and gender. The purpose of this study was to examine race and gender differences in the associations between loneliness, social engagement, and cognitive impairment among Black and White adults in the Health and Retirement Study (HRS). Data were drawn from participants who completed the Core and Leave Behind Questionnaire items in the 2016 HRS. Any cognitive impairment, a dichotomous variable derived from the Telephone Interview for Cognitive Status, was the outcome of interest. Loneliness and social engagement were the primary independent variables. Black men (35.5%) and Black women (27.0%) were disproportionately represented among respondents with any cognitive impairment relative to White men (14.6%) and White women (16.2%). Results from race- and gender-stratified Modified Poisson Regression models indicated that loneliness was associated with a higher prevalence of any cognitive impairment (PR=1.29, CI:1.07-1.57) among White women. Social engagement was inversely related with any cognitive impairment among White men (PR=0.97, CI:0.95-0.99). Neither of the main independent variables were significant for Black men or women in the study. Studies with robust and inclusive social connection measures are needed to further examine the association between loneliness, social engagement, and cognitive functioning among diverse populations.
MULTIMORBIDITY, MUSCLE STRENGTH, AND FALLS AMONG OLDER MEXICAN AMERICANS
Authors: Uribe Alondra , Snih Soham Al
Published: January 2025

Abstract objectives

To determine the relationship of multimorbidity and muscle strength with falls among older Mexican Americans without a history of falls at baseline. Design: Longitudinal study. Setting and Participants: This 12-year prospective cohort study included 899 non-institutionalized Mexican Americans aged ≥75 residing in Arizona, California, Colorado, New Mexico, and Texas from the Hispanic Established Population for the Epidemiologic Study of the Elderly.

Methods

Measures include socio-demographics, medical conditions, Body Mass Index, disability, handgrip strength (HGS), depressive symptoms, pain, cognitive function, and multimorbidity (≥2 self-reported medical conditions). Participants at baseline were divided into four groups: high HGS and multimorbidity (N=349), low HGS and multimorbidity (N=263), high HGS and without multimorbidity (N=181), and low HGS and without multimorbidity (N=104). Generalized estimating equation models estimated the odds ratio (OR) and 95% Confidence Interval (CI) of falls as a function of multimorbidity and HGS groups controlling for all covariates.

Results

The OR of falls was 0.72 (CI=0.54-0.95) for those with multimorbidity and high HGS, 0.52 (95% CI=0.33-0.82) for those without multimorbidity and high HGS, and 0.46 (95% CI=0.29-0.74) for those without multimorbidity and low HGS, versus those with multimorbidity and low HGS, after controlling for all covariates. Conclusions and Implications: Mexican American older adults with multimorbidity and high HGS had a 28% decreased risk of falls over time. Increasing muscle strength through exercise may help prevent falls among those with multimorbidity.
METABOLOMIC CHARACTERIZATION OF UNINTENTIONAL WEIGHT LOSS AMONG COMMUNITY-DWELLING OLDER ADULTS
Authors: Yao Shanshan , Marron Megan , Farsijani Samaneh , Shah Ravi , Murthy Venkatesh , Newman Anne
Published: January 2025

Unintentional weight loss is associated with higher mortality and impaired mobility in older adults. Metabolomics can provide insight into yet unknown pathways of unintentional weight loss and inform its early prediction and targets for intervention. Here we investigated plasma metabolite associations of subsequent unintentional weight loss over 2 years (mean annual change [SD]=-1.5 [2.0] kg) in 2330 participants (mean age 74.6 years, 51% women, 37% Black) from the Health, Aging and Body Composition study. Metabolites were measured by liquid chromatography-mass spectrometry. Multinomial logistic regression models were used to identify the associations of each of the 478 metabolites with weight loss with/without an intention and weight gain (>3% annual weight gain/loss), relative to weight stability. The metabolite associations of unintentional weight loss differed from those of intentional weight loss and weight gain. Forty-seven metabolites were only significantly associated with unintentional weight loss after age, sex, race, current obesity, and multiple comparison adjustments compared with weight stable (FDR < 0.05). Lower levels of branched-chain amino acids, aromatic amino acids, phospholipids, long-chain poly-unsaturated triglycerides, and higher levels of amino acid derivatives, poly-unsaturated fatty acids, and carbohydrates were associated with higher odds of unintentional weight loss relative to weight stable. The identified metabolite associations were independent of smoking, energy expenditure, diet, inflammation, chronic conditions, and medication (< 20% attenuation). Altered amino acid metabolism, impaired mitochondrial fatty acid oxidation, and inflammaging implicated by the identified metabolites, which have been linked to insulin resistance and sarcopenia in literature, may precede unintentional weight loss in older adults.
A REINFORCEMENT LEARNING APPROACH TO ENHANCE PHYSICAL ACTIVITY AND REDUCE FALL RISK IN OLDER ADULTS
Authors: Liu Chang , Thiamwong Ladda , Nguyen Tho , Suarez Jethro Raphael , Park Joon-Hyuk , Lou Qian , Xie Rui
Published: January 2025

The proliferation of sensing technology enables us to accurately track physical activity (PA) using wearable devices. Consequently, based on the PA patterns provided, it offers us an opportunity to design personalized interventions delivered via notifications, aiming to promote healthy behaviors and eventually reduce fall risk among older adults. We assessed minute-level accelerometer-based PA data, in total 1.24 million observations, from 134 participants (average age 74.26, SD 6.85, female 88.8% and 70.15% have no history of falls) in our Physio-Feedback Exercise Program (PEER) and control groups. The study targets the reduction of fall risk and the improvement of PA levels in economically disadvantaged older adults recruited in 2023. We employed a reinforcement learning (RL) approach with a policy network that continuously learns steps and vector magnitude from participants, aiming to find an optimal policy to encourage participants to take the action of ‘standing’. We assigned a positive reward when participants achieved Moderate to Vigorous Physical Activity status, a neutral reward for Light Physical Activity, and a negative reward for sedentary behavior. A three-layer fully connected neural network with sigmoid activation functions identified a significant difference in action probabilities, with the control group averaging 0.6456 and the PEER group at 0.7192. Significantly, from 9 AM to 6 PM, probabilities surged for both groups, peaking at 0.7438 (control) and 0.8188 (PEER). After 6 PM, probabilities declined across all groups. The probability of an event is directly proportional to its likelihood; therefore, a higher probability corresponds to the greater likelihood of the event occurs.