bluuebunny/crossref_metadata_2025 huggingface dataset:
PROVISION OF SOCIAL WORK SERVICES DURING HOME HEALTH CARE: INDIVIDUAL- AND AGENCY-LEVEL DETERMINANTS OF ACCESS
Authors: Burgdorf Julia , Barron-Vaya Yolanda , Goodman Jeri , McDonald Margaret
Published: January 2025

Medicare-funded Home Health (HH) delivers skilled health care services via visits to patients’ homes. Social work (SW) services are included within the HH benefit, and qualitative research suggests SW positively impacts outcomes for HH patients with complex needs. However, no prior work has quantitatively assessed SW provision during HH. We examined 2018 linked HH claims, assessment, and HH agency data for a national sample of 1,372,563 Medicare HH patients. Just 11.3% of HH patients received SW; those who received SW had a mean of 1.3 (SD=0.6) SW visits and a mean of 8.8 days (SD=6.6) from HH admission until the first SW visit. We modeled odds of receiving SW using a multilevel logistic model clustering at the HH agency level and adjusting for patient sociodemographic characteristics and clinical status and HH agency characteristics. The patient-level factors most significantly associated with receiving SW included being Black compared to White (aOR: 1.66; 95% CI: 1.62-1.71), being Medicaid-enrolled (aOR: 1.24; 95% CI: 1.19-1.30), having no family caregiver (aOR: 3.83; 95% CI: 3.62-4.07), and having depression (aOR: 2.26; 95% CI: 2.20-2.33). HH agency-level factors associated with receiving SW were non-profit ownership (aOR: 1.40; 95% CI: 1.29-1.52), urban service area (aOR: 1.48; 95% CI: 1.33-1.64), 60 or more full-time employees (aOR: 1.89; 95% CI: 1.70-2.09), and having social workers on staff, compared to providing SW via contract (aOR:2.23; 95% CI: 2.05-2.41). Findings indicate that SW access remains rare during HH and is driven by both demand-side (i.e., patient needs) and supply-side (i.e., agency capacity) factors.
UNDERSTANDING SEVERITY OF ELDER MISTREATMENT: FINDINGS FROM THE CANADIAN LONGITUDINAL STUDY ON AGING
Authors: Burnes David , Lachs Mark , Pillemer Karl
Published: January 2025

Basic elder mistreatment knowledge on risk factors and prevalence has advanced substantially over the past two decades. However, research in this area has predominantly framed our understanding of elder mistreatment in binary (no/yes) terms. While a binary understanding of elder mistreatment is necessary to determine prevalence/incidence, this conventional framing obscures the variation in lived experiences across cases and provides limited clinical insights for response interventions seeking to reduce harm. Building on prior research examining elder mistreatment through a lens of severity, this study analyzed data from the population-based Canadian Longitudinal Study on Aging to both describe the range of elder mistreatment severity across cases and identify longitudinal risk/protective factors associated with severity levels. An ecological-systems perspective organized potential risk/protective factors from several levels of influence. Drawing on a nationally stratified, random sample (n=23,468) of community-dwelling adults aged 65 or older interviewed over a three-year period, the current study analyzed a subsample (n=2368) of older adults identifying as victims of emotional, physical, or financial mistreatment. Severity was operationalized according to past-year frequency and multiplicity of mistreatment behaviors experienced. Ordinal/multinomial logistic regression was used to examine static and change risk/protective factors for elder mistreatment in general and for separate subtypes. Older adults with lower physical, cognitive and mental health, higher levels of child maltreatment, who lived with their perpetrator, and identified as female were more likely to experience severe forms of mistreatment. Findings from this study advance our basic knowledge on elder mistreatment phenomena and inform practice in community-based response programs.
LONELINESS AND RISK OF ELDER ABUSE: DOES SIZE OF SOCIAL NETWORK MAKE A DIFFERENCE?
Authors: To Louis , He Jasmin , Leung Lok Man , Tsui Ronald , Wan Debby , Yan Elsie
Published: January 2025

Elder abuse is a serious public health issue. Research demonstrated that loneliness is a risk factor for abuse. The present study examined the association between loneliness and elder abuse in a convenient sample of 686 community dwelling older persons in Hong Kong. Participants were recruited from senior community centers across the territory. They provided information on their demographic characteristics, sense of loneliness (DJGLS-6), social network (LSNS-6), and risk of elder abuse (EASI and VASS-10). 37.4% of the participants were screened positive on EASI or VASS-10. Results of logistical regression show that participants who were female (OR=-.505), married (OR=-.951), of a younger age (OR=-.044), reported greater sense of loneliness (OR=.266) were more likely to report risk of being abused. Co-residence with a family member and size of social network was not significant in the model (p>.05). Multiple regression analysis was conducted to identify factor associated with sense of loneliness. Participants of a younger age (Beta=-.019), living alone (Beta=-.170), and had a smaller social network (Beta=.-085) reported greater sense of loneliness. Findings from the present study adds to the larger literature on the impact of various demographic factors and sense of loneliness on elder abuse. Prevention and intervention efforts should focus on female young-olds in a marital relationship. Efforts to mitigate sense of loneliness could potentially help tackle elder abuse. Although increasing social network size does not have a direct impact on risk of elder abuse, it could potentially mitigate sense of loneliness thereby decrease risk of abuse.
ENHANCING PALLIATIVE CARE THROUGH THE INTEGRATION OF THE SOCIAL CONVOY: A USER-CENTERED DESIGN APPROACH
Authors: DeGroot Lyndsay
Published: January 2025

Digital health offers considerable potential for enhancing palliative care but often neglects to integrate the patient’s caregiving “social convoy”, i.e. partners, family, and friends. The Social Convoy Palliative Care (Convoy-Pal) mobile intervention was developed using a user-centered design approach involving interprofessional healthcare providers, older adults with serious illness, and their social convoy (N=81). Convoy-Pal, a 12-week intervention, provides a tablet, smartwatch, and options for mobile phone access, with shared access among participants and their convoy. It facilitates assessment, symptom tracking, and provision of palliative care resources based on user responses. Initial usability feedback among 26 participants (16 older adults/10 social convoys) was favorable, particularly regarding the information provided (User Mobile Application Rating Scale-uMARS: 4.22±.8/5). Based on feedback, final iterations were made to improve goal setting, monitoring tools, and convoy assessment. We then conducted a single-site waitlist randomized control trial among N=46 (31 older adults/14 social convoys) to pilot-test the feasibility of delivering Convoy-Pal. Participants were 76.3 years of age, and social convoys 71.6, primarily White, but not all had access to a mobile device/computer. Recruitment of multiple caregivers was challenging; when enrolled the study maintained a 67.4% retention rate with 4.6% missing subscales on surveys. Intervention participants reported improvements in social functioning (SF-36: 64.6±25.8 vs. 73.2±31.3) and social convoys reported increased perceptions of positive aspects of caregiving (29.5±5.28 vs. 35.0±5.35). Usability scores for information provided were again well-rated (uMARS: 3.96±.57/5). This research underscores the importance of incorporating diverse key informant perspectives to develop meaningful and relevant digital palliative care interventions.
IN THE PALM OF OUR HAND: HUMAN-LED ADMINISTRATIVE DATA LINKAGE TO AUGMENT LONGITUDINAL AGING STUDIES
Authors: Dorame Ashley N , Antic Mina , Ferrie Joseph , Waldinger Robert , III Avron Spiro , Mroczek Daniel , Lee Lewina
Published: January 2025

A robust literature has documented associations of adverse early experiences with poor lifespan health (Hughes et al., 2017). The evidence with respect to aging-related outcomes has been largely derived from population-based longitudinal studies, which predominantly rely on retrospective assessments of childhood experiences. Given the modest agreement between prospective and retrospective measures of early life exposures (Baldwin et al., 2019), it is unknown whether the well-established associations of early adversity with later-life health may replicate in prospective designs. This presentation uses the Boston Early Adversity and Mortality Study (BEAMS) to illustrate a novel approach leveraging recently-digitalized, full-count U.S. Censuses from 1900 to 1940 to obtain prospective data on the early-life family and neighborhood conditions for participants in three, all-male longitudinal aging studies (Normative Aging Study, 1961+, n=2280; Harvard Study of Adult Development, 1938+: Grant cohort, n=458, Glueck cohort, n=267). The authors will describe key steps of the human-led data linkage (“hand-linkage”) process, and present results on linkage performance and value added to the longitudinal studies. Hand-linkage identified 10,146 female and male siblings of the original cohort members. Among original cohort members born prior to each Census, hand-linkage identified 68.6% (1900), 76.3% (1910), 88.5% (1920), 88.0% (1930), and 87.9% (1940) participants, compared to match rates of 24%-36% via a commonly used algorithm (Abramitzky et al., 2021 with Jaro-Winkler adjustment). Relative to hand-linkage, the sensitivity and specificity of the algorithmic approach was 31.2% and 98.2%, respectively. Findings support human-led linkage as an effective strategy to augment the scientific value of longitudinal aging studies.
THE UNEXPECTED FAMILY CAREGIVER: UNVEILING THE CHARACTERISTICS OF YOUNGER ADULT CAREGIVERS
Authors: Spears Katie , Gore Janelle , Bouldin Erin , Ali Akilah , Walker Jenny , Olivari Benjamin , McGuire Lisa
Published: January 2025

With the growing proportion of older adults in the US population, both the number of persons who will need care and the need for family caregivers will increase. Previous studies have found most caregivers to be middle-aged or older adults, but due to a widening gap in care needs and caregivers available, the importance of younger adult caregivers is growing. This analysis uses Behavioral Risk Factor Surveillance System data from the optional Caregiver Module administered in 2021-2022 in 47 states and Puerto Rico. We described the health characteristics of young adults aged 18-34 (n=45,627), who we classified as current caregivers, anticipated caregivers (expected to provide care in the next 2 years), and non-caregivers. We calculated weighted estimates and made comparisons using chi-square tests. Caregivers reported significantly higher prevalence of obesity (34.3%), depression (35.2%), and current cigarette smoking (17.2%) compared to anticipated caregivers and non-caregivers. Caregivers also reported a higher prevalence of frequent mental distress (14 days or more of poor mental health in the past month) (32.5%) compared to anticipated caregivers and non-caregivers. Most caregivers provided less than 9 hours of care a week (57.8%, 95% CI=54.7-60.9) and helped with personal care tasks (51%, 95% CI=47.9-54.1). Caregivers had more risk factors for chronic disease and poorer mental health than those not currently or anticipated to provide care. Public health efforts can recognize and include younger caregivers in their efforts to maximize physical and mental health for all caregivers to assure care recipients are well-supported.
EFFECTS OF POSTRETIREMENT ACTIVITIES ON RETIREES’ WELL-BEING: THE MODERATING ROLE OF CHILDLESSNESS
Authors: Lin Gloria , Chung Edwin Ka Hung , Yeung Dannii Y , Ho Alvin , Ng Amy
Published: January 2025

According to role theory, retirees’ work roles are likely diminished upon retirement, but their family and community roles are strengthened. Such pattern however may be different among childless retirees as their family roles are comparatively fewer than retirees with children. Postretirement activities, such as volunteering (Filges et al, 2020) and postretirement employment (Wang, 2007), have been shown to contribute to retirees’ well-being as they compensate for the absence of important roles after retirement. Thereby, this cross-sectional study aimed to investigate whether the relationship between postretirement activities and well-being would be moderated by childlessness. Retirees’ number of children, participation in postretirement activities (volunteering, postretirement employment, both activities, or none), life satisfaction, positive affect, depressive symptoms, and cognitive functioning were measured among 942 older Hong Kong Chinese retirees aged 65 and above (Mage = 71.76, SD = 5.28). The results of two-way ANCOVAs demonstrated significant main effects of postretirement activities and childlessness on most of well-being outcomes. A significant interaction effect of postretirement activities and childlessness on depressive symptoms was found, even after controlling for demographic variables. Specifically, childless retirees participated in volunteering (adj. Mdiff = –2.33, p =.001), postretirement employment (adj. Mdiff = –3.56, p =.001), or both activities (adj. Mdiff = –2.77, p =.010) showed fewer depressive symptoms than those with children. Our findings suggest that beneficial effects of postretirement activities are more salient among childless retirees than those with children, implying that participation in postretirement activities would be a protective factor in maintaining well-being after retirement.
STRENGTHENING RETIREMENT PLANNING: A LONGITUDINAL EXAMINATION OF CONNECTEDNESS TO THE AGED FUTURE-SELF
Authors: Yeung Dannii Y , Lin Gloria , Ho Alvin
Published: January 2025

The overall level of pre-retirement planning among working adults remains low. This study aims to identify effective strategies to strengthen younger and older workers’ preparation for retirement. A total of 401 Hong Kong Chinese workers (170 younger and 231 middle-aged; M=42.34, SD=11.15) were randomly allocated to one of four experimental conditions: future-self with a writing task (FSW), future-self only (FS), current-self with a writing task (CSW), and current-self only (CS). In the experiment, participants in FSW and FS conditions were presented with an aged-morphed photo of their future-self, while those in CSW and CS conditions were presented with a photo of their current-self. The experiment was followed by a 5-day diary study, in which the participants in FSW and CSW wrote down their plans to improve well-being of their future-selves in old age or in three months, respectively. Retirement planning in financial, health and psychosocial domains were assessed at two weeks (T1) and at six months (T2) after the experiment. Preliminary analyses show that participants in FS and FSW reported more negative emotions after viewing the future-self photo (F(3,396)=10.42, p<.001). A significant age group by condition interaction effect (F(3,317)=2.82, p=.039) was found in T1 retirement planning activities, with older workers in FSW reported more preparatory activities than younger workers in FSW, while such age effect was not observed in FS, suggesting that the 5-day writing task could strengthen one’s preparation for retirement. However, such age discrepancy effect diminished in T2. Implications on promotion of retirement planning will be discussed.
HIGH IMPACT ACTIVITIES: ASSESSING THE ASSOCIATION BETWEEN SOCIAL PARTICIPATION FREQUENCY AND COGNITION
Authors: Vogelsang Eric , Moorman Sara
Published: January 2025

There is growing recognition that social participation may help attenuate cognitive decline in older ages. Unfortunately, previous empirical research often relies on social participation “summary indexes”, which may obfuscate associations between cognition and specific social activities. Moreover, there has been little consideration as to whether increased social participation frequency is associated with greater cognitive functioning. We utilize two nationally representative longitudinal surveys of older adults: the Health and Retirement Study (21,705 observations across six waves) and the National Social Life, Health & Aging Project (5,317 observations across two waves). Regression models test how associations between social participation frequency and three cognition measures (a) differ by summary indexes; and (b) differ among specific social activities. We also compare and contrast the ways in which social participation is evaluated in these studies. When using summary participation indexes, for both datasets, each additional social activity and each increase in activity frequency was associated with greater cognitive functioning. However, when segregating social activities, we found disparate associations with cognition. Specifically, volunteering (in one dataset) and social/club membership (in the other) were the only activities whose frequency was positively associated with each cognition measure. Committing to regular social and community activity in older ages may help mitigate the risk of cognitive decline. However, caution is advised when interpreting the health effects of social activity counts or aggregate frequency measures. Surveys would benefit by establishing consistent social participation measurement standards.
ENGLISH PROFICIENCY, IMMIGRATION STATUS, AND COGNITIVE ASSESSMENT VARIABILITY IN OLDER ADULTS
Authors: Kitchens Katherine
Published: January 2025

Recent studies provide evidence that immigration status is a risk factor for developing dementia among older adults and that English proficiency moderates this relationship. This study aimed to analyze the factor structure of the National Health and Aging Trends Study’s (NHATS) cognitive battery to investigate whether this structure varies by English proficiency among the Medicare population and to assess the association between English proficiency, immigration status, and cognition. Utilizing the 2021 NHATS data from a nationally representative sample of Medicare beneficiaries (N = 5,628), a multi-group confirmatory factor analysis (CFA) was used to examine the factor structure of the cognition battery by English proficiency. Three multivariable linear regression models tested the relationship between English proficiency, immigration status, and a standardized cognition score weighted by factor loadings. The multi-group CFA revealed variations in factor loadings and error variances, suggesting differences in how cognition is captured among individuals with varying English proficiency. English proficiency emerged as a significant predictor of better cognitive z-scores, independent of immigration status (b = 0.70, p <.001). Variance in latent cognition construct scores across groups suggests that English proficiency impacts cognitive assessment accuracy, possibly underestimating the cognitive abilities of those with lower English proficiency due to language or cultural barriers. The association between English proficiency, detached from immigration status, counters the perception of immigration status as a cognitive risk factor and calls for cognitive assessments that are culturally and linguistically appropriate and nuanced public health strategies that address diverse immigration experiences and social determinants.
SHORT-TERM COUPLING ASSOCIATIONS BETWEEN STATE LONELINESS AND COGNITIVE PERFORMANCE IN DAILY LIFE
Authors: Kang Jee eun , Graham-Engeland Jennifer , Martire Lynn , Almeida David , Sliwinski Martin
Published: January 2025

Although loneliness and neurocognitive health have been linked, little attention has been given to associations between fluctuations in state loneliness and cognitive performance. This work examines the association between within-person variation in state loneliness and cognitive performance assessed objectively in daily life, focusing on the timing and direction of the relationship. Participants from a wave of the Einstein Aging Study (EAS) were included (N=313, Mage=78 [range=70-90], 68% women, 46% White, 41% Black; average 15 years education). Over a 14-day period, participants engaged in ambulatory ecological momentary assessment burst using mobile phones, completing self-reports (including about feeling lonely at the moment) and mobile cognitive tests up to five times daily. The mobile cognitive tests assessed visual associative memory, processing speed, and spatial memory. Multilevel modeling was employed to examine day-to-day and moment-to-moment changes in loneliness and their relationship with cognitive performance, with a specific focus on concurrent, time-lagged, and reverse-lagged associations. Results revealed that higher daily loneliness negatively correlated with cognitive performance on the same day and predicted worse performance the following day, illustrating a prospective association. Within a single day, momentary loneliness negatively correlated with immediate cognitive performance, but did not predict later decreases; however, lower cognitive performance in a given moment predicted elevated loneliness later in the day. Overall, these findings highlight a complex, reciprocal relationship – loneliness predicting and being predicted by cognitive performance depending on timescale. Deepening our understanding of such temporal dynamics will be important to inform ways to break the cycle between loneliness and cognition.
AGE DIFFERENCES AND CHANGE IN COPING STRATEGIES ACROSS 10 YEARS: FINDINGS FROM THE MIDUS STUDY
Authors: Kurth Maria , Witzel Dakota , Cerino Eric , Almeida David
Published: January 2025

Although age differences in coping strategies across adulthood are well-established (Aldwin et al., 2021), little is known about how coping strategies change, especially into later life. Further, studies focused on changes in coping relied on convenience samples (e.g., Brennan et al., 2012; Martin et al., 2008), which may not generalize to all midlife and older adults. Using data from waves two and three of the Midlife in the United States study, we examined (1) how coping changed over 10 years and (2) age differences therein. Participants (N = 2661, Mage_waveII = 54.56, age range: 30-84, 58% women, 87% White) completed 24 items from the COPE Inventory (Carver et al., 1989) at each wave. Four coping factors emerged from an exploratory factor analysis and confirmed via confirmatory factor analysis (Witzel & Kurth, 2023): instrumental action; denial/disengagement; positive reappraisal; focus/venting of emotions. Invariance was established across time and age. Two-level multilevel models, conducted separately for each coping strategy, revealed a significant decrease across 10 years for all strategies, even after controlling for race, gender, education, and sample type (core, Milwaukee). Older participants, compared to younger participants, decreased in their use of instrumental action and positive reappraisal, while denial/disengagement strategies increased; age did not moderate focus/venting of emotions. Preliminary evidence suggested non-linear changes by age for denial/disengagement and positive reappraisal. Discussion will surround the variability in how different types of coping changes across midlife and into older adulthood, and ways in which the rate and direction of this change depends on age.
INVESTIGATING THE DAILY RELATIONSHIP BETWEEN SUBJECTIVE AGE AND DAILY EVENTS
Authors: Klaiber Patrick , Pauly Theresa
Published: January 2025

Subjective Age, also known as felt age, refers to individuals’ perception of their age compared to their chronological age. Daily fluctuations in subjective age are linked to daily affective experiences; feeling older than usual has been associated with experiencing more same-day stressors and higher negative affect. Feeling older than usual may indicate depleted psychosocial resources, increasing the likelihood of interpreting everyday situations as stressful and reacting more intensely to them. Conversely, feeling younger than usual may indicate greater psychosocial resources, leading to increased engagement in and responsiveness to positive events. Thus, this study investigated fluctuations in subjective age as a predictor of same-day event engagement (stressors and positive events) and affective responses to these events using 14-day diary data from a sample of 108 older Swiss adults (aged 65-92). On average, participants felt approximately 8 years younger than their chronological age, with significant day-to-day variability (ICC =.69). We found that on days when individuals felt older than usual, they reported more stressors and fewer positive events. Older subjective age was also associated with lower same-day positive affect, but also greater increases in positive affect when positive events occurred. Similarly, older subjective age was related to greater same-day negative affect, yet also to more pronounced decreases in negative affect when positive events occurred. However, stress reactivity, as indicated by stressor-related affect, was not associated with subjective age. These findings underscore the importance of subjective age as a dynamic psychological construct potentially shaping individuals’ daily affective experiences.
EMOTION BELIEFS AND DAILY AFFECTIVE EXPERIENCES ACROSS THE ADULT LIFESPAN
Authors: Rutledge Jocelyn
Published: January 2025

Emotion beliefs refer to the extent to which people believe emotions “should” and “can” be controlled. Importantly, past research has linked peoples’ emotion beliefs to the extent to which they utilize effective emotional regulation strategies, and psychological well-being. To our knowledge, research has yet to examine the association between emotional beliefs and affective experiences at the daily-level, and how developmental factors are associated with emotion control beliefs in adults. The present research sought to examine age differences in within-person associations of daily emotion beliefs and daily positive and negative affect. To do so, we used 14-day daily diary data from an adult lifespan community sample [N = 91, age range = 19-92]. Multilevel models revealed that when younger (but not older) people endorsed higher-than-normal beliefs they “should” control their emotions they reported greater negative affect, while higher-than-normal beliefs they “can” control their emotions were associated with higher positive affect. In addition, when older (but not younger) people endorsed higher-than-normal beliefs that they “can” control their emotions they experienced greater declines in negative affect. These findings add to theory and research on emotional aging by highlighting that: 1) emotion beliefs are differentially associated with affective experience on a daily-level, and 2) these associations change across the adult lifespan.
TRANSITIONAL PALLIATIVE CARE FOR RURAL FAMILY CAREGIVERS USING VIDEO TECHNOLOGY: RECRUITMENT, METHODS, AND FINDINGS
Authors: Griffin Joan
Published: January 2025

People with severe, life-limiting illnesses face serious risks for adverse events and symptom escalation when transitioning care from hospital to home. When new approaches to care, such as palliative care, are introduced before discharge, these risks increase further. Family caregivers (FCG) often help manage care during these transitions and ensure care recipient safety and quality of care after discharge. These new or added responsibilities can strain FCG health and well-being, thus compromising FCG and care recipient health. This is especially true for FCGs in rural and underserved areas who typically have fewer resources and limited access to care. This symposium presents lessons learned, methodological challenges, and findings from a FCG study aimed at addressing transitional care and palliative care on FCGs health and well-being. The intervention tested a model of care to address unmet needs of FCGs caring for seriously ill and elderly patients in rural areas through teaching, guidance, and counseling via video visits. Preliminary findings show this intervention improves FCG outcomes and is cost-effective. The first presentation provides an overview of the trial (Griffin). The second presentation describes challenges with recruiting and differences between recruiting FCG participants in-person and remotely (Gustafson). The third presentation includes findings on internet connectivity when conducting a virtual clinical trial with FCGs living in rural and underserved areas (Holland). The fourth presentation describes study findings on FCG and care recipient health and well-being (Griffin). The fifth presentation includes a discussion of the differences in caregiving and utilization costs associated with the intervention (Kaufman).
HEALTH CARE USE AND OUT-OF-POCKET COSTS FOR RURAL FAMILY CAREGIVERS AND CARE RECIPIENTS IN TRANSITIONAL PALLIATIVE CARE
Authors: Kaufman Brystana , Huang Ro , Holland Diane , Vanderboom Catherine , Mandrekar Jay , Gustavson Allison , Griffin Joan
Published: January 2025

Few studies have reliable estimates on costs of informal care following hospitalization, including health care use and out-of-pocket costs for family caregivers (FCGs) and their care recipients (CR). This presentation discusses results from a Transitional Palliative Care (TPC) intervention on healthcare use and out-of-pocket spending for both FCGs and CRs. The study used data from the Technology-Enhanced TPC study, a trial comparing the TPC intervention to support FCGs of seriously ill CRs to an attention control condition. TPC FCGs received teaching, guidance, and counseling via video calls for 8 weeks following CR hospital discharge. After discharge, a research assistant called FCGs once a month for up to 6 months or CR death to collect healthcare utilization (e.g. outpatient, emergency department, and hospital), out-of-pocket healthcare spending (e.g. deductibles and coinsurance), and health-related travel costs (e.g., transportation, lodging, food) for FCGs and CRs. Incidence rate ratios (IRR) were estimated using negative binomial regressions. The study included 282 FCG-CR dyads across 3 US states. TPC reduced nights in the hospital for CR (IRR = 0.75; 95% CI = 0.56 – 0. 99). Total out-of-pocket spending was not significantly different for TPC versus control; however, TPC dyads reported lower lodging costs (IRR = 0.71; 95% CI = 0.56-0.89). Across groups, mean out-of-pocket spending for dyads was $1401.85, with healthcare payments contributing $1048.58 and transportation expenses contributing $136.79. This study contributes to evidence that palliative care interventions reduce unnecessary hospitalization for seriously ill patients, yet the financial costs to caregivers remain high.
CONNECTIVITY ISSUES WHEN CONDUCTING A VIRTUAL CLINICAL TRIAL WITH FAMILY CAREGIVERS IN RURAL OR UNDERSERVED AREAS
Authors: Holland Diane , Vanderboom Catherine , Mandrekar Jay , Gustavson Allison , Kaufman Brystana , Griffin Joan , Wild Ellen , Dose Ann Marie
Published: January 2025

In the research literature and amongst grant reviewers, there are persistent questions about whether internet connectivity challenges, especially in rural populations, will limit the potential for virtual or decentralized clinical trials to improve participation of underrepresented groups. In clinical practice, e-health and telehealth advancements have been touted as potential models of care to address health disparities associated with access to care, but without reliable internet connectivity, these disparities may perpetuate or even widen. In this presentation Dr. Holland examines the prevalence of connectivity problems during the Technology-Enhanced Transitional Palliative Care (TPC) study, a virtual clinical trial across three Midwestern states, and provides guidance on the challenges faced. Data are from structured notes from nurse interventionists who documented any connectivity issues in the study’s electronic health record. Of the 1003 visits reviewed, only 11% of visits (115/1003) contained a documented problem with internet connectivity. None of the participants withdrew from the trial due to problems with their internet connections. The findings support the effective use of virtual visits in research involving participants living in rural locations. Virtual randomized controlled trials provide a strategy that enables participation for rural individuals who may not otherwise have access to clinical trials conducted in-person in urban settings. Utilizing internet access to connect with and support people who live in rural areas is critically needed to advance clinical research.
UNDERSTANDING AND SUPPORTING TECHNOLOGY EQUITY AND ACCESS FOR THE BENEFIT OF AGING ADULTS
Authors: Boot Walter , Lin Xin Yao , Chung Jane
Published: January 2025

Despite advancements, a significant “digital divide” persists, with older adults lagging in technology ownership, use, and proficiency compared to younger individuals. This session examines the digital divide’s causes, impacts, and solutions for aiding older adults. Melissa deCardi Hladek, PhD, CRNP, FNP-BC, proposes a personalized, values-driven intervention to enhance digital literacy among older adults, focusing on overcoming access and connectivity disparities, especially in communities of color, to foster inclusion and better health outcomes. Shannon Mejia, PhD, FGSA, investigates the emotional dynamics of older adults interacting with smart devices, such as voice assistants, and how these interactions are affected by other smart elements like fireplaces. Li Chu, PhD, highlights the importance of aligning technological information with age-relevant motivations, indicating that a focus on emotional meaning could boost older adults’ engagement with new technologies. Ladda Thiamwong, PhD, RN, FAAN, introduces the PEER intervention, a technology-based program aimed at preventing falls in low-income older adults through physio-feedback and peer-led exercises, emphasizing its role in transforming fall risk perceptions. Finally, Shenghao Zhang, PhD, questions the link between cognitive decline and the digital divide, suggesting that the relationship between age, general fluid abilities, and technology proficiency is more complex, offering new perspectives on technology learning and usage among older adults. Jane Chung, PhD, RN, will serve as discussant.
EMOTIONAL RESPONSES TO SUPPORT FROM VOICE ASSISTANTS WITHIN AN ECOLOGY OF SMART DEVICES
Authors: Mejia Shannon , Wen Wan , Desai Smit , Snipe Brandon , Fernandez Otniel , Hong Sungjae , Chin Jessie
Published: January 2025

Smart-environments deploy an ecology of smart devices such as voice-assistants (VA), telehealth portals, and smart-fireplaces to support aging in place by providing assistance, remote-assessment, and restoration. Although asking for support is a foundational task within a smart environment, the socioemotional implications of asking smart devices for assistance is largely undefined. This study (N=51, observations=204, age:50-80, 54%female), conducted within a simulated “home office,” employed a 2x2 (fireplace vs. not × neurologist remote-assessment vs. not) within-subjects experiment to test emotional responses to requests for VA assistance under varying smart ecologies. In each condition, a simulated VA instructed participants to play a game and report affect by endorsing adjectives representing their feelings. Participant-initiated requests for VA assistance were extracted from transcripts. Participants’ beliefs in our simulation were evaluated during post-interviews to determine whether interactions were perceived as genuine with a VA (VA-True; 54%) or with a human through a speaker (VA-Human). Multilevel-models indicated higher negative affect (emotional cost) when participants requested VA assistance, and this cost was less pronounced when the smart-fireplace was activated. Cross-level interactions by beliefs differentiated emotional costs of asking for assistance. In general, compared to the VA-Human group, the emotional cost of asking for assistance was less pronounced for the VA-True group. However, while emotional cost was reduced for the VA-Human group when remote-assessment or fireplace was activated, emotional cost was amplified under these conditions for the VA-True group. Findings are situated within life-span perspectives of control and dependency scripts to inform the development of smart-ecologies to support aging-well.
MOTIVATING INFORMATION-SEEKING BEHAVIORS FOR NEW TECHNOLOGY ACROSS THE LIFE SPAN
Authors: Chu Li , Patterson kayla , Kim Tasha , Srivastava Sanjana , Zhang Ruohan , Wu Jiajun , Fei-Fei Li , Carstensen Laura
Published: January 2025

Rapid technological advancements demand constant adaptation, which may be particularly unappealing for older adults. As people age, goal priorities shift from exploration to emotional meaning, but modern technology often overlooks this aspect, reducing motivation for older adults to learn. This pre-registered study aims to understand how alignment of information with age-relevant motivation may change people’s information-seeking behaviors. We hypothesized a negative association between age and information-seeking behaviors. Moreover, this association is hypothesized to be moderated by emotional meaning, such that the positive relationship is amplified when technology emphasizes emotional meaning, indicating that older adults are as, if not more, interested in technology compared to younger adults when technology aligns with one’s age-related motivation. We will report findings from an online experiment on a life-span sample of approximately 300 participants. On the data collection website, participants will view eight technological products and choose which ones to explore further. By clicking on the product, a new sentence about the product will be displayed, so the number of clicks and the duration of reading each product may be indices of people’s information-seeking tendencies. Products are randomly assigned to emphasize exploration, social networking, entertainment, or deepening connections with loved ones (the emotionally meaningful option).
HEALTH-PROMOTING NEIGHBORHOOD RESOURCES ASSOCIATED WITH REDUCED NEURODEGENERATION AND CEREBROVASCULAR DISEASE
Authors: Besser Lilah , Maillard Pauline , Le Elaine , Mitsova Diana , Galvin James , DeCarli Charles , Meyer Oanh
Published: January 2025

We aimed to determine if health-promoting neighborhood resources are associated with better brain health measured via structural magnetic resonance imaging (MRI) of older adults. We used data on 195 participants with normal cognition or cognitive impairment from the University of California, Davis Alzheimer’s Disease Research Center. Participants addresses were geocoded to derive neighborhood (Census tract) measures of presence of a library, density of churches, percentage of retail space, and percentage park space. MRI measures included total grey matter volume and white matter hyperintensity volume (WMH), markers of future dementia and cerebrovascular disease risk. Multivariable linear regression that accounted for clustering by Census tract tested associations between the neighborhood characteristics and MRI outcomes, controlling for demographics (e.g., age, race/ethnicity), cognitive status (Clinical Dementia Rating), intracranial volume, population density, and neighborhood socioeconomic status (SES). Models were also stratified by high and low neighborhood SES. Participants were on average 74.9±7.2 years old, had 13.7±4.5 years of education, and 24.1% were Black, 28.9% Hispanic, and 47.1% non-Hispanic White. Individuals in neighborhoods with a library or a higher density of churches had lower WMH volumes, while those in neighborhoods with more churches had greater total grey matter volume. Presence of a library was associated with lower WMH volume for those in low SES neighborhoods, while no associations were observed for those in high SES neighborhoods. Neighborhoods with cognitively stimulating and socially engaging destinations (i.e., libraries and churches) may help reduce cerebrovascular disease and dementia risk by protecting against white matter disease and brain atrophy.
LEVERAGING TIME USE DATA TO EXPLORE MIGRANT HEALTH, SOCIALIZING, AND TECHNOLOGY USE
Authors: DeJohn Amber , Widener Michael , Liu Bochu , Ma Xinlin , Liu Zhilin
Published: January 2025

Migrant populations tend to locate near other migrants upon arrival in their receiving country. These residential locations are the result of culturally specific social networks, and they result in differing social networks and cultural contexts relative to the native-born population and other migrant groups. Beyond their physical social networks, migrants also use information and communication technology (ICT) to maintain social connections in their sending country. During the COVID-19 pandemic, public health initiatives to discourage socializing (e.g., closing third places) generated concern about social isolation among older adults, especially due to its association with health. In Toronto, Canada, COVID-era lockdown initiatives were particularly prolonged. During this extended lockdown, we fielded a survey and time-use diary on a convenience sample of older Chinese migrants (n = 77) in the Greater Toronto Area. Using the single-day activity diaries, we grouped respondents using a k-means clustering approach, which resulted in four categories of socializing characteristics. We then used ANOVA tests and multinomial logistic regression to understand the geographic contexts for these socializing behaviors. Findings reveal that this older migrant community was largely socializing online, but a small group reported socializing in person. Regression results reveal that living conditions, physical health, and the location of social networks are associated with how migrants socialize. This study presents a novel method for exploring geographies and activities within the home in tandem.
THE JOINT EFFECTS OF WORK AND INFORMAL CAREGIVING ON MENTAL WELL-BEING AMONG CHINESE MIDDLE- TO OLDER-AGED ADULTS
Authors: Ye Jing
Published: January 2025

Although the health implications of employment and caregiving are well-documented, less is known about the joint impact of work and caregiving on the well-being of older adults. This study contributes to filling this research gap by focusing on the well-being implications of combining work and informal caregiving for Chinese older adults 60 years of age and older. The study draws on two theoretical perspectives: role strain theory and role enhancement theory. While the role strain theory assumes lower life satisfaction and higher depressive symptoms due to the double burden of paid work and caregiving, the role enhancement theory predicts an increase in well-being through the accumulation of resources and role fulfillment. Using data from the China Health and Retirement Longitudinal Study (CHARLS 2011-2018), this study aims at investigating whether and how older age working caregivers experience different life satisfaction and depressive symptoms. Besides, the moderating effects of intensity, gender, residence, socioeconomic status, and social isolation level are estimated. Results from the random-effects model show that compared to those who do not work or provide informal care, low-intensity worker-caregivers report higher life satisfaction. Only female worker-caregivers experience higher depressive symptoms, particularly with long hours of work and caregiving. These results support both role enhancement and role strain theories and suggest the need for increased investment in formal care facilities to alleviate the care burdens among older adults.
EXPLORING MEALTIME EXPERIENCES OF FAMILIES LIVING WITH DEMENTIA IN LONG-TERM CARE: A GROUNDED THEORY STUDY
Authors: Alford Heather , Cammer Allison , Ward Heather , Perepelkin Jason
Published: January 2025

Relationship-centered mealtime interventions improve staff-resident relationships and reduce the risk of malnutrition for residents living in long-term care settings. Less is known about the nature, goals, or outcomes of family-resident relationships at mealtimes, particularly for residents living with dementia. This constructivist grounded theory study aimed to explore what is needed to support meaningful family relationships and engagement at mealtimes with residents living with dementia in long-term care homes. Individual interviews were conducted with 13 family caregivers of people living with dementia in long-term care homes in a Western Canadian province. Interviews were recorded, transcribed verbatim, and analyzed using constant-comparison method. Three themes characterized family member participants’ experiences of mealtimes: 1) Changing Ways of Connecting, 2) Nutrition as a Reflection of Dementia Progression, and 3) Adjusting Expectations. Mealtimes are important opportunities for supporting family-resident connection and can facilitate ‘acceptance’ of the illness trajectory in dementia among caregivers. By conceptualizing their mealtime involvement, this study advances understanding of the essentiality of family caregivers for enhancing relationship-centered practices in long-term care settings. By explicating the structure, function, and experience of family involvement in nutritional care, this study addresses the current gap in understanding of how families living with dementia build and preserve relationships through nutritional care and dining.
OLFACTION AND DEMENTIA RISK IN THE ATHEROSCLEROSIS RISK IN COMMUNITIES (ARIC) STUDY
Authors: Chen Honglei , Shrestha Srishti , Zhu Xiaoqian , Kucharska-Newton Anna , Yuan Yaqun , Kamath Vidyulata , Mosley Tom
Published: January 2025

We examined the association of olfaction with incident dementia and characterized this relationship by key demographic subgroups and APOE-ε4 genotype in the ARIC study. We further examined how change in olfaction was associated with dementia incidence. Olfaction was evaluated using the 12-item Sniffin’ Sticks test in 4470 ARIC participants in 2011-2013 (visit 5) and in 2658 participants in 2016-2017 (visit 6). We defined olfaction as good (score 11-12), moderate (9-10), hyposmia (7-8), and anosmia (0-6). Dementia status was ascertained from 2011-2013 through 2020. Of the 4470 participants at baseline (age:75±5 years, 21% Black race, 60% women), 17% developed dementia over 10 years. In multivariable Cox models, moderate olfaction (hazard ratio (HR):1.5, 95%CI:1.3-1.9), hyposmia (HR:2.2, 95%CI:1.8-2.8), and anosmia (HR:3.5, 95%CI:2.8-4.3) were associated with higher dementia rate in a linear, monotonic manner relative to good olfaction. Findings were similar across subgroups of age, sex, race, and APOE-ε4 genotype. We also used logistic regression to estimate marginal dementia probability. We found that, on the risk difference scale, the absolute risk difference between anosmia and good olfaction was higher in APOE-ε4 carriers (0.29, 95%CI:0.20-0.37) compared to that in non-carriers (0.16, 95%CI:0.11-0.21); jointly, APOE-ε4 carriers with anosmia had the greatest cumulative dementia probability. Further, compared to participants who maintained good olfaction from visit 5 to visit 6, those with stable anosmia (HR:5.6, 95%CI:2.7-11.6) and a decline from good to anosmia (HR:4.5, 95%CI:2.2-9.4)) showed comparable associations with dementia incidence. Our study provides important data about how simple noninvasive olfaction tests may inform future dementia risk.