bluuebunny/crossref_metadata_2025 huggingface dataset:
LIFE COURSE TIMING OF ADVERSITY AND DIURNAL CORTISOL IN LATER LIFE
Authors: Sikora Nadine , Mezuk Briana , Abelson James , Rafferty Jane , Abelson Jamie , Allen Julie Ober
Published: December 2023

Exposure to adversity is believed to alter stress sensitive biological processes. One manifestation of this, flatter diurnal cortisol slopes, has been linked to cardiometabolic problems. Questions remain about whether the timing of adversity within the life course influences its effect on cortisol slopes in later life. Two longitudinal cohort studies (Cardiac Rehabilitation and The Experience [CREATE], Tracking Risk Identification for Adult Diabetes [TRIAD]) with identical measures were merged for analysis (merged N = 175, Mage 60.8) using multilevel modeling. Measures included retrospective self-report of childhood trauma (CTQ), major life stressors in adulthood (number and recency of stressful events, affected domains, everyday discrimination), and peak-to-bedtime cortisol slopes (≤12 collected over 15 months). Report of any moderate and severe childhood adversity was not associated with adult cortisol slopes (p>.05). When we probed specific types, emotional abuse was associated with cortisol slopes (b=.006, SE=.003, p=.015). For adult adversity, total number of stressful events (b=.001, SE=.0002, p=.009) and recent stressful events (b=.003, SE=.001, p=.041) were associated with cortisol slopes. When simultaneously modeling all measures of adversity over the life course, number of stressful events in adulthood (b=. 001, SE=.0002, p=.018) and childhood emotional abuse (b=.007, SE=.004, p=.064) were the strongest predictors of flatter diurnal cortisol slopes in adulthood. Given that those reporting childhood adversity were also more likely to have experienced adulthood adversity (r=.08-.39), early life adversity may be an important risk factor for flattened cortisol slopes and associated cardiometabolic outcomes in later life via multiple pathways. Implications for intervention will be discussed.
MEASURING DISTRESS IN DEMENTIA: A PILOT STUDY ON PERCEIVED MEMORY, DYADIC RELATIONSHIPS, AND SELF-EFFICACY
Authors: MacNeil Amanda , Judge Katherine
Published: December 2023

Prior literature has suggested that some individuals with dementia are capable of self-reporting details of their lived experience. With this, researchers have been increasingly interested in understanding what it is like to live with dementia from the individual’s perspective. To capture a more holistic image of the illness experience of individuals with dementia, it is important to consider how they perceive and cope with various aspects of their illness. While some work has suggested that the perceptions that individuals with dementia have about their illness are important to things such as well-being outcomes, no prior work has addressed the distress that results from these perceptions. This pilot study (N = 26) examined perceptions of difficulties and feelings of distress related to three different areas of the illness: one’s memory, the relationship with their caregiver, and self-efficacy. Results suggest that perceived memory distress (α = 0.71), dyadic relationship strain distress (α = 0.80), and self-efficacy distress (α = 0.82) are reliable measures when used in a sample of individuals with mild to moderate dementia (MMSE M = 20.5, SD = 5.20). Interestingly, some of these measures may even be related such as perceived memory distress and self-efficacy distress (r (24) = .50, p = .01). Including distress felt because of perceiving difficulties in various areas of one’s illness adds a layer of understanding to the illness experience. This can aid in addressing well-being outcomes and serve as intervention targets in future work.
MISSING IN ACTION: STRATEGIES FOR DEMONSTRATING ORGANIZATIONAL COMMUNICATION IN NURSING HOMES
Authors: Smith Patsy , Gordon Julie
Published: December 2023

A scoping review was conducted to learn more about strategic organizational communication within long-term care. Strategic organizational communication is a purposeful, system-wide, and system-level effort to transform the organization and delivery of care and services to make it easier to navigate, understand, and coordinate care. Care in nursing homes is complex and must consider residents’ goals, values, and preferences. Communication strategies enacted at the system-level may include direct care staff, human resources, nursing-to-resident and family interactions, and care planning. Strategies at the institutional or system-wide level also include corporate stakeholders, administration, and employee leadership. The aim of the literature search was to locate evidence of communication strategies that reflect corporate and organizational goals, and that exemplify the processes by which communication influences administrative policy. Key words in the search were entered in varying iterations and combinations with the guidance of a skillful research librarian. Key words were long-term care, communication, feedback, nursing homes, patient-centered care, quality improvement. Returns were greater than 2,000, yet seemingly relevant abstracts were fewer than 300, and selected articles were fewer than 30. The research reports reviewed were explanatory or explorative and just one article was found to explore the role of communication strategies and the impact on organizational outcomes. Further, no research reports were found to discuss strategic organizational communication and a combination of resident and organizational outcomes. Rather, most work described specific communication interventions among key groups, many of which lacked sustainable impact. Study results, limitations, and examples of communication strategies are presented herein.
NARRATIVE EXPLORATIONS OF CARE: THE TRANSFORMATIVE POWER OF CAREGIVING IN THE CONTEXT OF MENTAL HEALTH AND CANCER
Authors: Weiss Charlotte , Johnson-Koenke Rachel , Sousa Karen , Ulrich Connie , Hirschman Karen
Published: December 2023

Embracing the “narrative turn,” we used the post-modern and feminist informed research methodologies of narrative inquiry alongside photo elicitation to co-create an in-depth cancer family caregiver narrative with a 50-year-old daughter who cared for her mother (age 80) affected by lifelong schizophrenia and recent metastatic breast cancer. The participant was invited to share personal photos to support her in co-creating a caregiver narrative within the narrative interview environment. While these photos were not analyzed for content, they prompted the participant to share stories about her private caring experiences and make meaning of them. The I-statements of these stories were then used to create a research poem which explores a life lived alongside a parent with mental health issues, while highlighting the transformation and healing potential that life-limiting cancer introduced to their complex relationship affected by mental health barriers. The I-Poem rendering was analyzed for cognitive and emotional meaning resonant of the human experience. Emergent thematic threads of personal humanistic values include altruism, love, and forgiveness. Additionally, this I-Poem analysis contributes to new knowledge situated in human story telling while capturing a transformational personal experience of caring as an exemplar which resists discrimination and disunity among older persons and their family caregivers on the basis of mental health with concomitant serious illness.
OCCUPATIONAL COGNITIVE DEMANDS AND RISK OF MILD COGNITIVE IMPAIRMENT AND DEMENTIA: THE HUNT STUDY
Authors: Strand Bjorn Heine , Edwin Trine Holt , Zotcheva Ekaterina , Håberg Asta , Bratsberg Bernt , Mekonnen Teferi , Stern Yaakov , Skirbekk Vegard
Published: December 2023

The cognitive reserve hypothesis posits that cognitively stimulating work may delay onset of mild cognitive impairment (MCI) and dementia. However, the impact of work histories across midlife on the risk of these conditions is unclear. We evaluated trajectories of work-related cognitive demands from ages 33-65y and their association with later clinical MCI/dementia. The HUNT4 70+ Study was used (N= 7003 participants, 49.8% women, 2017-19). Group-based-trajectory-modeling was used to identify trajectories of work-related cognitive demands, measured by routine task intensity (RTI) index (Lower RTI indicates less routine-oriented work) from online Occupational Information Network (O*NET). Multinomial regression was used to estimate the relative risk ratios (RRR) of MCI/dementia after adjusting for covariates age, sex and education, income, hypertension, obesity, diabetes, psychiatric impairment, hearing impairment, feeling of loneliness, smoking status, and physical inactivity. Four trajectories were identified; low RTI (20.4%), intermediate-low RTI (22.7%), intermediate-high RTI (36.9%), and high RTI (20.1%). Participants in the high RTI group had higher risk of MCI (RRR 1.74, 95% CI: 1.41,2.14) and dementia (RRR 1.37, 95% CI: 1.01, 1.86) after adjusting for age, sex, and education compared to participants in the low RTI group. When accounting for potential mediators, the increased risk remained for MCI but was no longer significant for dementia, indicating these mediators may account for part of the observed relationship. Our results highlight the importance of cognitive stimulation in the workplace for maintaining cognitive function. This should be taken into account, together with other known risk factors to help prevent cognitive decline in older adults.
OLDER US ADULTS PREFER SHORT, FREQUENT RESISTANCE TRAINING PROGRAMS, ESPECIALLY THOSE WITH DIFFICULTY WALKING
Authors: Kurth Jordan , Sciamanna Christopher , Herrell Cheyenne , Danilovich Margaret , Conroy David , Schmitz Kathryn , Silvis Matthew , Ladwig Matthew
Published: December 2023

Though resistance training (RT) improves strength and physical function, fewer than 20% of older adults do RT at least twice weekly, as recommended by national guidelines. Even when programs are free, such as Silver Sneakers, fewer than 25% participate and those that do rarely attend (averaging < 20 visits/year). Many individuals cite “lack of time” as the primary reason for not attending. Therefore, one approach to increase participation in RT programs could be making sessions shorter. However, little is known about older adult RT program preferences. Therefore, we conducted a nationwide survey among 611 US adults aged 65 and over. We compared their interest in a traditional (45 minutes, three days/week) RT program to a shorter, more frequent (5-minute, every day) RT program. Overall, 2.2 times as many older adults preferred the shorter vs. the traditional RT program (68.4% v. 31.6%; p< 0.001). Furthermore, barrier self-efficacy for the shorter program was 50% greater than the traditional program. Adults with health concerns, like poorer self-rated health and a history of falls, were significantly more likely to be interested in the shorter program. Notably, 87% of older adults with difficulty walking also preferred the shorter program. These findings suggest strong interest in short RT programs among older adults, especially those with poorer health and mobility disabilities for whom traditional RT programs may be too challenging. Reducing the duration of RT programs may be an appealing option to engage older adults in RT, particularly among those for whom the program would provide the most benefit.
PERSONALIZED DEMENTIA PREVENTION IN LUXEMBOURG: INSIGHTS INTO THE PROGRAMME DEMENTIA PREVENTION (PDP)
Authors: Schröder Valerie , Skrozic Amna , Erz Dorothee , Kaysen Anne , Fritz Joëlle , Loureiro Joao , McIntyre Deborah , Krueger Rejko
Published: December 2023

BACKGROUND

Given that in an increasingly ageing society, the number of people with cognitive impairment is expected to increase, prevention strategies to reduce the high personal and societal burden of neurodegenerative diseases leading to dementia is of essence.

METHODS

As part of the “Dementia Prevention Programme (pdp)” in Luxembourg, individuals with Mild Cognitive Impairment (MCI) or Subjective Cognitive Decline (SCD) are recruited via referring physicians and other sources. All participants undergo a comprehensive neuropsychological evaluation and a risk factor profile is created. Factors known to increase the risk to develop dementia include hypertension, hypercholesterolaemia, physical or cognitive inactivity, depression, social isolation or hearing loss. Based on the results of this analysis, personalised lifestyle interventions are recommended to each participant, such as cognitive training, physical activities, psychological counselling or nutritional advice.

RESULTS

To date, 491 participants (mean age = 69.0 years; SD = 11.2) have been recruited at various sites across the country, of whom 424 (86.4%) present with MCI and 42 (8.6%) with SCD. 25 participants (5.1%) showed more advanced cognitive difficulties associated with loss of autonomy or had neither subjective nor objective cognitive difficulties and thus did not belong to the target group.

CONCLUSION

We provide evidence for the successful implementation of a nationwide dementia prevention programme and efficient recruitment of the target population by building a network of different health care providers. This may serve other countries as an example to rule out similar programmes targeting at promoting healthy ageing among the general population.
PHARMACIST INTERVENTION IS ASSOCIATED WITH MEDICATION ADHERENCE IN OLDER ADULTS WITH CHRONIC CONDITIONS
Authors: Smith-ray Renae , Feng Liang , Singh Tanya , Rudkin Kristi , Emmons Stacey , Groves Erik , Kirkham Heather
Published: December 2023

Hypertension, hyperlipidemia, and type 2 diabetes (T2D) are prevalent chronic diseases among older Americans, but related medication adherence rates are less than optimal. Consequences of poor adherence include increased mortality, healthcare utilization, and costs. Compounding evidence supports the integration of pharmacists in patients’ care across the care continuum. This study’s purpose was to examine the impact of a large national pharmacy chain’s pharmacist-led interventions to improve medication adherence among older adults with hypertension, hyperlipidemia, or T2D. Participants were Medicare D patients who had ≥2 prescription fills in ≥1 of the three therapeutic classes. The primary outcome, optimal adherence (OA), was defined as proportion of days covered (PDC) ≥80%. A difference-in-differences (DID) design with a generalized linear model approach was applied to examine differences between participants exposed to the intervention and controls across the study period (2020-2022). At baseline, intervention participants (n=317,613, age 70.1, female 57.0%) had lower OA for diabetes (76.9% vs. 79.8%), hypertension (79.0% vs. 83.0%), and cholesterol (78.6% vs. 82.1%) compared to controls (n=943.389, age 73.3, female 56.1%). The DID results showed that between 2020 - 2022, OA had significant absolute increases for intervention participants (diabetes: +4.0%, hypertension: +6.3%, cholesterol: +6.1%) versus controls (diabetes: -1.6%, hypertension: -0.4%, cholesterol: -1.4%). All DID models were significant at p< 0.0001. The pharmacist-led intervention was significantly associated with increased OA over 2 years. These findings reinforce the potential for pharmacists as care providers among older adults with chronic conditions. Future research should examine the expansion of pharmacist-provided care.
PHYSICAL ACTIVITY BARRIERS AND INTENTIONS OF ALZHEIMER’S DISEASE (AD) AND RELATED DEMENTIAS (AD/ADRD) CAREGIVERS
Authors: Pickett Andrew , Krukowski Rebecca , Werner Nicole
Published: December 2023

Caregivers of people living with AD/ADRD often experience negative biopsychosocial health outcomes and have reduced capacity to engage in healthy behaviors (e.g., exercise). Physical activity is an established intervention for promoting physical and mental health across many populations. This research explored physical activity intentions and barriers among AD/ADRD caregivers, as well as potential relationships between physical activity intentions, cohabitation status, and caregiver/care recipient relationship. Data were collected via online survey from family caregivers of people living with AD/ADRD (n=117). The sample was predominantly women (n=89; 76.1%), white (n= 89, 76.1%), and averaged 55.3 (SD= 16.45) years old. Participants averaged 56.31 (SD= 49.15) hours per week on care responsibilities. Caregivers expressed strong desire to be more active (M=4.42 / 5; SD= .71) and that caregiving demands were a strong barrier (M=3.85 / 5; SD= 1.15). Significant differences were observed between caregivers who lived, or did not live with, care recipients across both physical activity intention (p= .022) and burden perceptions (p=.002), measured by the short form Burden Scale for Family Caregivers (BSFC-SF). No differences were observed based on caregiver-care recipient relationship (e.g., parent, partner). Primary themes among open-ended responses to physical activity barriers included: lack of time and energy, inability to leave care recipient, and competing responsibilities. Our findings suggest a need for behavioral interventions to facilitate physical activity among AD/ADRD caregivers, particularly those who live with their care recipient. Social network interventions that leverage social connections to support caregivers may increase physical activity by reducing barriers associated with care responsibilities.
PHYSICAL FUNCTION, DEPRESSION, AND COGNITIVE FUNCTION OF OLDER CHINESE AMERICANS: CROSS-LAGGED MODEL
Authors: Kwon Soonhyung , Zhu Yuyang , Tang Fengyan , Jiang Yanping
Published: December 2023

Introduction

Understanding the complex interactions of physical function, depression, and cognitive function is crucial for understanding healthy aging. However, few studies have empirically tested these relationships. This study examined the directional relationships of physical function, depression, and cognitive function among older Chinese Americans.

Methods

This study included a subsample of participants (n=2,811) from the Population Study of Chinese Elderly in Chicago who completed the baseline survey during 2011-2013 (W1) and at least one of the three follow-up surveys conducted in 2013-2015 (W2), 2015- 2017 (W3), and 2017-2019 (W4). Physical function, depression, and cognitive function were measured by a battery of physical mobility, the 9-item Patient Health Questionnaire, and cognitive performance tests (executive function, memory, and cognitive impairments). A random intercept cross-lagged panel model was performed to examine the bidirectional relationships among physical function, depression, and cognitive function.

Results

The cross-lagged panel model showed that higher levels of depression at W1 were associated with poorer physical function at W2. In turn, poorer physical function at W2 was related to higher levels of depression at W3. Higher levels of depression (W2) were linked to poorer physical function at W3. Poorer physical function at W2 was associated with poorer cognitive function at W3. Finally, poorer cognitive function at W3 was associated with poorer physical function and higher levels of depression at W4.

Discussion

Our results support a bidirectional relationship between physical function and depression. Also, as individuals age, cognitive function plays a key role in predicting physical function and psychological well-being.
POLYMORPHISMS IN INFLAMMATORY CYTOKINES NOT ASSOCIATED WITH COGNITIVE TRAJECTORIES IN OLDER ADULTS
Authors: Lawrence Karen , Gloger Elana , Pinheiro Cristina , Schmitt Frederick , Segerstrom Suzanne
Published: December 2023

Inflammation and key polymorphisms in inflammatory cytokine genes have been associated with increased Alzheimer’s disease (AD) risk. It is unclear if the same polymorphisms also predict domain-specific cognitive decline, that could eventually lead to AD/dementia, in otherwise healthy older adults. We investigated whether specific single nucleotide polymorphisms (SNPs) in three cytokine genes, IL-1β (rs16944; A or AA at -511), IL-6 (rs1800795; C or CC at -174), and TNFα (rs1800629; A or AA at -308), were associated with differential longitudinal trajectories of global cognitive function, episodic memory, attention and working memory, and executive function. Participants were 324 non-demented older adults (Mage=72.8 years at first visit, SD=6.09, age range 57-92 years) who completed 9 research visits, on average. Slopes were examined after adjustment for baseline age, sex, education, conversion to MCI or dementia during study, and APOE ɛ4 status. Findings indicated no statistically significant relationships between the SNPs of interest and longitudinal trajectories (spanning up to 16 years) of cognitive functioning in any cognitive domain examined. Other factors related to AD may be necessary for these SNPs to have significant brain-related effects. Attempts were made to further validate the non-significant findings by conducting post-hoc analyses to determine whether these SNPs were associated with plasma biomarker levels in this sample of healthy older adults. However, variability between and within the assays precluded confidence in the results. Further research is needed to determine whether these SNP genotypes are associated with concentrations of their respective blood-plasma biomarkers in non-demented older adults.
POST COVID-19 PANDEMIC EMPLOYMENT RECOVERY BY HEALTHCARE SECTOR IN US RACIAL MAJORITY-MINORITY COUNTIES
Authors: Xiang Lucille , Sreenivas Kiran
Published: December 2023

Health care sector employment trends following the COVID-19 pandemic have revealed a labor force participation gap. Racial/ethnic composition differences between counties may contribute to an uneven labor market recovery. This study’s objectives were to compare post-pandemic employment recovery between five health care sectors (ambulatory services (AS), home health care (HHC), nursing and residential care (NRC), assisted living (AL), nursing facilities/homes (NH)), and to examine whether health care sector recovery differences exist between racial majority-minority (MM) and non-racial MM counties in the USA. First Quarter 2020 and fourth Quarter 2022 data from the US Bureau of Labour Statistics Quarterly Census of Employment and Wages (QCEW) were used to calculate cumulative percentage change in health care sector employment. The Race Origin Variables from the latest 2021 data from the American Community Survey were used to identify racial MM counties. The sector with the greatest number of counties with positive employment recovery was the AS sector in 1562/3176 (49%) counties, and 252/468 (54%) MM counties. The NH sector had the lowest number of counties with positive employment recovery in 170/2818 (6%) counties, and 34/389 (9%) MM counties. This is the first analysis of post-pandemic health care sector employment recovery examining MM counties. Differences in county and state policies may account for varying degrees of recovery. Further research is necessary for the development of best practice guidelines and policies to improve post-pandemic health care employment recovery and the quality of nursing home care among older adults.
PROJECT, PERSUADE, AND PROTECT: ADULT CHILDREN’S PREDICTION OF PARENTS’ HEALTH STATE VALUATIONS
Authors: Hahne Jessica , Buenger Rachel E , Chung Tim , Silverstein Hannah , Carpenter Brian
Published: December 2023

Serious illness decision making for older adults frequently involves their adult children. Thus, it is important that adult children are familiar with parents’ illness preferences. In this mixed methods analysis (total N = 114), we examined concordance between older adults’ valuations of illness states, their children’s predictions of their valuations, reasoning behind children’s predictions, and children’s reactions to discordance between their predictions and parents’ valuations. Thirty-eight older parents (M age= 75.8) provided valuations for five different illness states. Two adult children (M age= 46.0) independently predicted their parent’s answers. Family triads participated in a semi-structured conversation about their responses. One-way random effects, absolute agreement, average measures intraclass correlation coefficients (ICCs) showed that average concordance within families was poor for incontinence (ICC = .172, 95% CI [-.497, .572]), dialysis (ICC = .300, 95% CI [-.264, .639]), tube feeding (ICC = .320, 95% CI [-.228, .649]), and chronic pain (ICC = .438, 95% CI [-.015, .710]), and moderate for Alzheimer disease (ICC = .556, 95% CI [.198,.771]). Results from qualitative thematic analysis indicated that children often projected their own values when attempting to predict parents’ valuations. When faced with discordance, many children attempted to persuade parents to change their valuations, while also making assertions to protect the parent’s autonomy. In summary, adult children navigating surrogate or shared decision making may face challenges inferring parent values versus their own and balancing their input with parent autonomy. Future research and interventions in late-life families could target these challenges.
RACIAL COMPARISONS OF RECEPTIVITY TO A BLOOD-BASED BIOMARKER TEST FOR ALZHEIMER RISK
Authors: Skemp Eleanor , Cho Hyun Jin , Carpenter Brian
Published: December 2023

Blood-based biomarker (BBB) tests to assess risk for developing Alzheimer disease (AD) have recently been approved for clinical use. Little is known about people’s interest and concerns about these new tests, although the relative simplicity of the tests may help reduce disparities in early diagnosis for AD in historically marginalized groups, such as African Americans. The current report uses data from a national survey of adults in the United States (N = 1,274) conducted in 2022, oversampling African Americans. In addition to demographic questions, respondents rated the importance of different factors they would weigh when deciding whether to take a BBB test and their trust with the healthcare system. The sample was diverse in age (M = 48.6, SD = 17.6, range = 18-91), balanced in gender (55.3% female) and race (48.1% African American), and ranging in education (41.1% < BA). A higher percentage of respondents rated the accuracy (69.2%) and usefulness (64.5%) of the test as very important to their decision, compared to cost (40.8%) and convenience (38.0%). However, African Americans rated cost, convenience, confidentiality, and the potential for learning about other medical problems as more important than White respondents (chi-square p’s < .01). Contrary to hypotheses, trust in the healthcare system was not significantly related to decisional factors. Results from this study have implications for how to tailor culturally sensitive messages about new tests for the early detection of dementia risk.
RACIAL DIFFERENCES IN HEARING LOSS AMONG MIDDLE-AGED AND OLDER ADULTS
Authors: West Jessica , Smith Sherri , Dupre Matthew
Published: December 2023

Prior studies have documented how social and systemic factors contribute to racial differences in health; however, less is known about the life course and social determinants of racial differences in hearing loss (HL) among middle-aged and older adults. Evidence from U.S. population-based cohorts indicates that Black adults have better pure-tone thresholds and a 40-70% lower prevalence of HL compared to White adults. However, beyond documenting racial differences in general hearing sensitivity (i.e., degree of HL), it is unknown how the characteristics of HL (e.g., type, laterality, etc.) vary by race. Using ICD codes and the AMCLASS classification system, we will evaluate types of HL (e.g., sensorineural, conductive, and mixed HL); symmetry categories (e.g., symmetrical or asymmetrical HL); and severity categories (by classifying pure-tone average according to standard metrics: normal [-10-15 dB HL], slight [16–25 dB HL], mild [26–40 dB HL], moderate [41–55 dB HL], moderately severe [56–70 dB HL], severe [71–90 dB HL], and profound [>90 dB HL]). We will examine audiological data on 22,905 adults aged 50 and older (17.9% Black, 82.1% White) using electronic health records (EHR) and linked area-level data from a large healthcare system. We will also investigate how socioeconomic (e.g., education, income, health insurance), psychosocial (e.g., mental health), behavioral (e.g., smoking), and clinical factors (e.g., disease comorbidities) are associated with HL characteristics in White and Black adults. Findings will provide important and actionable insights into racial differences in HL.
RACIAL DIFFERENCES IN THE RELATIONSHIP BETWEEN LONELINESS AND COGNITION AMONG OLDER ADULTS IN THE MIDWEST
Authors: Catt Wade , Fowler Nicole , Perry Brea , Peng Siyun , Williams-Farrelly Monica
Published: December 2023

Findings from various studies have revealed a relationship between loneliness and negative health outcomes, including cognitive decline and dementia. The strength and direction of this relationship has been contested as there is wide variability in definitions and testing criteria for loneliness. If loneliness is risk factor for cognitive decline, it may represent a cost-effective site for interventional design. We used data from the Precision Health Initiative’s Person to Person Health Interview Study (P2P), a cross-sectional survey conducted in Indiana from 2020-2021, to investigate the relationship between loneliness (UCLA 3-item loneliness scale) and cognition (The Montreal Cognitive Assessment; MoCA) among older adults and to determine if the strength of the relationship varies for black and white adults. Among our subsample of adults 55 and older, over one quarter (26.7%) reported loneliness, with white respondents reporting more loneliness than black respondents (26.8 and 22.0%, respectively). Being lonely was associated with lower cognition, as was being older, male, black, and having no college education. However, we found that loneliness was associated with worse cognition, for white adults only. Although black respondents in our sample reported more loneliness than older white adults after age 70, we did not have adequate power to determine if advanced age moderated the relationship. Our findings highlight the role of loneliness in cognition for older, white adults and the need for more research to assess this relationship for the “mid-“ and “oldest-old” black adults who may be more susceptible to loneliness due, in part, to racial disparities in mortality.
RECURRENT FALLS IN OLDER ADULTS ARE ASSOCIATED WITH MORTALITY AND HOSPITALIZATION
Authors: Heslin Samita , Schoenfeld Elinor , Keister Melanie , Rajupet Sritha , Ladowski Kristi , Singer Adam
Published: December 2023

Annually, 1 in 4 older adults fall and roughly half have a second fall within 6 months. We studied 57 hospitals in the TriNetX Network. We included all older adults discharged home from the emergency department (ED) after a fall in 2022 for a total of 89,061 patients. Of these, 13,389 (15%) patients returned to the ED for another fall within 6 months. Patients with repeat falls were older (78.7 vs 76.5 years), more likely to have hypertension (76 vs 56%), prior myocardial infarction (14 vs 3%), heart failure (29 vs. 15%), peripheral vascular disease (18 vs 10%), cerebrovascular event (19 vs 10%), chronic obstructive pulmonary disease (COPD) (23 vs 14%), diabetes (40 vs 23%), liver disease (17 vs 11%), chronic kidney disease (30 vs 16%), and cancer (45 vs 32%); P< 0.001. Patients with recurrent falls were more likely to be prescribed cardiovascular medications (84 vs. 66%), central nervous system medications (87 vs 69%), opioids (71 vs 52%), sedatives/hypnotics (59 vs 42%), antipsychotics (23 vs 12%), antidepressants (51 vs 32%), antiparkinsonian agents (9 vs 4%), and antivertigo agents (15 vs 9%); P< 0.001. Patients with a recurrent fall within 6 months had higher hospital admission rate (46.2 vs 15.8%, OR 4.6 [95%CI, 4.4-4.7]) and higher mortality rate (6.2 vs 3.5%, OR 1.83 [95%CI 1.7-2.0]). Older adults discharged home from the ED after falling are at high risk of a second fall and those who have a repeat fall within 6 months are at higher risk of hospital admission and mortality.
RELATIONSHIPS BETWEEN DISTRESS AND NEIGHBORHOOD CHARACTERISTICS FOR MEXICAN AMERICAN CAREGIVERS
Authors: Johnson Florence , Mudrazija Stipica , Robinson-Lane Sheria , Fashaw-Walters Shekinah , Cantu Phillip
Published: December 2023

Previous study demonstrates that caring for older relatives with physical or cognitive disability can increase caregiver stress—particularly if neuropsychiatric symptoms are present. The literature suggests that community features such as the percentage of immigrants may improve Mexican-American caregivers’ mental health. Using matched 2011/2012 data on caregivers and care recipients from the Hispanic Established Population for the Epidemiological Study of the Elderly(H-EPESE) and the 2010 census tract characteristics from the National Neighborhood Data Archive (NANDA) recently, we fit multilevel regression models to assess how neighborhood characteristics (census tract proportion Latino, proportion foreign-born, and proportion in poverty) affect caregiver distress (caregiver depression score, caregiver general stress, caregiver reports of neuropsychiatric behavioral symptoms of cognitive decline and caregiver report of stress from neuropsychiatric behavioral symptoms of cognitive decline). We found that living in an area with a higher proportion of foreign-born adults is related to lower reports of neuropsychiatric symptoms and lower levels of caregiver distress. Family caregivers residing in ethnic enclaves with high proportions of foreign-born persons reported significantly fewer symptoms of feeling stubborn and resistive, being in low spirits, feeling upset when separated from the care recipient, losing interest in usual activities, or experiencing changes in weight. While residing in these communities may reduce behavioral concerns in care recipients and increase social support availability, cultural factors such as ideas about normative aging may influence symptom reporting. Increasing available support for caregivers residing in ethnic enclaves is an important step toward developing dementia-capable communities and reducing caregiver health disparities.
RELIGIOSITY AND SENSE OF PURPOSE IN WHITE AND BLACK OLDER ADULTS
Authors: Toprakkiran Selin , Wilson Megan , Oltmanns Thomas , Bogdan Ryan , Hill Patrick
Published: December 2023

Religiosity is a key factor in the lives of many older Americans, and it may help people develop a sense of purpose. This association is highly nuanced, across groups and measures. For instance, religiosity plays a different role across racial/ethnic groups in the United States, which may influence its association with sense of purpose. To examine whether the relationship between religiosity and sense of purpose differs across White and Black Americans, we used the St. Louis Personality and Aging Network data (N = 732), collected from older adults (M age = 67.96; SD age = 4.31; 76.37% White, 23.63% Black American). We used data from multiple waves to examine religiosity, sense of purpose, and social engagement. To disentangle different aspects of religiosity, we included three items focusing on the meaning of religion to one’s life, participation in religious activities, and how much religion influences one’s daily life. Black participants scored higher on all religiosity items compared to White participants. Nevertheless, the relationship between religiosity and sense of purpose did not differ based on one’s racial/ethnic identity or the aspect of religiosity. Additionally, social support did not moderate relationships between religiosity and sense of purpose, suggesting that these relationships are similar regardless of whether one perceives more or less social support from others. These findings add to our understanding of when and for whom religiosity correlates with purpose among older adults, and future directions include examining the influence of religiosity on changes in purpose over time.
ASSOCIATION BETWEEN LONG-TERM EXPOSURE TO AIR POLLUTION AND LOWER URINARY TRACT SYMPTOMS IN KOREAN OLDER MEN
Authors: Jee Youngmin
Published: December 2023

Low Urinary Tract Symptoms(LUTS) is one of the common symptoms in older men and is important factor in terms of quality of life. The purpose of this research was to investigate the association between long-term exposure to air pollution and LUTS in korean older men. The study participants were recruited from a health checkup center of Seoul National University Hospital from January 1st, 2015 to December 31st, 2019. A total of 7,979 participants were aged over 65 years and underwent screening health checkup including International prostate symptom score (IPSS) for LUTS. To evaluate the exposure to air pollution, hourly measurements of air pollutants from nationwide air quality monitoring sites were utilized. The associations between exposure to air pollutants and LUTS were analyzed using logistic analysis in a crude model and an adjusted model, the latter of which included covariates. Most air pollutants including PM10, NO2, SO2, and CO were all significantly associated with LUTS in crude models, but the correlations were no longer significant in the adjusted models. PM2.5 exposures showed significantly positive association with voiding symptoms in adjusted model (OR, 1.07; 95% CI, 1.02~1.13; p=0.012). The associations of other air pollutants with voiding and storage symptoms showed negative tendency in unadjusted model, and some of them were significant. However, the associations were no longer significant in adjusted model. This study demonstrated that air pollutants including PM10, NO2, SO2, and CO are associated with LUTS, particularly PM2.5 showed a positive correlation with voiding symptoms of LUTS in the adjusted model.
GLYCATION-LOWERING COMBO EXTENDS LIFESPAN, IMPROVES INSULIN, REDUCES CALORIC INTAKE
Authors: Kapahi Pankaj
Published: December 2023

Non-enzymatic reactions in glycolysis lead to the accumulation of methylglyoxal (MGO), a reactive precursor to advanced glycation end-products (AGEs), which has been suggested to drive obesity- and aging-associated pathologies. We observe that a combination of nicotinamide, lipoic acid, thiamine, pyridoxamine and piperine, which were selected to lower glycation (Gly-Low), reduce toxic glycolytic byproducts, MGO and MGO-derived AGE, MG-H1. Administration of Gly-Low reduced food consumption and body weight, improving insulin sensitivity and survival in both leptin receptor deficient (Lepr db) and wildtype C57 control mouse models. Unlike calorie restriction, Gly-Low inhibited ghrelin-mediated hunger responses and upregulated Tor pathway signaling in the hypothalamus. Gly-Low also extended lifespan when administered as a late life intervention, suggesting its potential benefits in ameliorating age-associated decline by inducing voluntary calorie restriction and reducing glycation.
REPRODUCIBILITY OF BRAIN AGE SALIENCIES ACROSS DEEP NEURAL NETWORK ARCHITECTURES
Authors: Kim Nicholas , Imms Phoebe , Chaudhari Nikhil , Chowdhury Nahian , Amgalan Anar , Bogdan Paul , Irimia Andrei
Published: December 2023

The brain’s biological age (BA) reflects structural changes related to neuroanatomic senescence. BA is estimated from magnetic resonance images (MRIs) using convolutional neural networks (CNNs), which provide interpretability through saliency maps. By conveying the importance of brain regions to BA estimation, these maps reveal sex differences in brain-aging. We compared two CNN architectures to assess the reproducibility of such differences. Both regression CNNs had T1-weighted MRIs as inputs; outputs were estimated BAs. One CNN was trained on males and females separately, whereas the other was trained on both sexes. The dataset used consisted of T1-weighted MRIs from 5,851 cognitively normal individuals (3,142 females) aged 22 to 95 years, sampled from the Alzheimer’s Disease Neuroimaging Initiative (N = 510), Human Connectome Project Aging (N = 508) and Young Adult (N = 1,112), and UK Biobank (N = 3,721). For both models, compared to the average saliency for a null distribution, males’ BA estimation relied significantly (p < 0.05) more on the right lateral temporal lobe and superior frontal gyrus. Females’ BA estimation depended significantly (p <; 0.05) more on the right posterior and bilateral occipital regions, and medial parietal lobe. Simulated alterations in brain morphometry indicated saliencies correctly revealed regions with aging-related dynamics, which confirm prior findings on sex differences in brain-aging. Variations in CNN models’ saliencies did not affect overall anatomic patterns, suggesting that CNNs can capture brain-aging patterns robustly despite architecture differences. Novel statistical models for formal comparison of CNN saliencies should be developed to accommodate their nonlinear nature.
SCOPING REVIEW OF CLINICAL STUDIES EXPLORING THE ASSOCIATION BETWEEN EPIGENETIC AGE AND FRAILTY
Authors: Hillstedt Ebba , Wahlin Rebecka Rubsenson , Castegren Markus , Sandblom Gabriel , Kane Alice
Published: December 2023

An overall increase in life expectancy shines light on the complexity of human aging where some individuals seem to age at a faster pace than others, a phenomenon health care systems are already battling to identify. Multiple frailty scoring systems have been proposed as models for biological age estimations but their implementation within health care systems is time consuming and often deprioritized. Epigenetic clocks based on DNA methylation (DNAm) changes have been proposed as newer estimations of biological age, but there is conflicting data on the correlation between these two measures. We conducted a review of the literature to identify studies that have explored the correlation between frailty and epigenetic age. Our search strategy identified 37 articles, and after further screening we found 15 articles that directly compared frailty scores to epigenetic age. Most studies measured DNAm in whole blood (9/15), although there was great variability in the specific epigenetic clocks applied. Almost all studies measured frailty with either Fried’s frailty phenotype (4/15) or a Frailty Index (9/15). The studies were divided in their findings, with 7/15 showing moderate to strong associations and the other 8 studies showing no or weak associations. Interestingly, the associations with frailty were usually seen for epigenetic clocks predicting mortality or other phenotypes (eg GrimAge, PhenoAge), rather than epigenetic clocks predicting chronological age. More work is needed to understand the relationship between these biological age measures and their potential role in clinical risk assessment for older adults.
SECONDARY USE OF NIH AD/ADRD DATA RESOURCES FOR BIOMEDICAL RESEARCH
Authors: Tingle Sharna , Martin Damali , Larkin Jennie
Published: December 2023

People are living longer than ever before, and the world’s population aged 60 and older is expected to increase from 1 billion to 2.1 billion by 2050. As populations get older, they become more susceptible to age-related diseases such as Alzheimer’s Disease and Related Dementias (AD/ADRD), which affects more than 55 million individuals worldwide. The National Institutes of Health (NIH) aims to prevent and treat diseases such as AD/ADRD through generalist and disease-specific data resources that foster findable, interconnected, and interoperable data to accelerate biomedical innovations and medical interventions that improve human health. The goal of this assessment was to understand the value of AD/ADRD secondary data use from NIH genomic and multi-omics data resources: NIA Genetics of Alzheimer’s Disease Data Storage Site (NIAGADS), database of Genotypes and Phenotypes (dbGaP), AD Knowledge Portal (ADKP), and Gene Expression Omnibus (GEO). List of AD/ADRD datasets were retrieved through database searches or directly from repository staff (N=183). Citation frequency of data accessions were used to determine utilization of AD/ADRD genomic and multi-omics datasets in published literature. iSearch tool was used to assess secondary use drivers in resulting publications. Query of data accessions in Pubmed Central returned 284 unique publications. iSearch clustering by term showed that genomic datasets were used to study genetic risk factors of AD/ADRD while multi-omics datasets were used to functionally characterize genetic risk variants, identify gene regulatory networks, and biomarkers associated with neurodegenerative diseases. These findings indicate the usefulness of AD/ADRD secondary data to the scientific literature.
SPATIAL NAVIGATION SKILLS IN MILD COGNITIVE IMPAIRMENT (MCI) – A META-ANALYSIS
Authors: Kossowska-Kuhn Dorota , Charness Neil
Published: December 2023

Background

Dementia has a tremendous impact on societies and individuals world-wide. One of the earliest symptoms of Alzheimer’s Disease (AD) is spatial disorientation (Coughlan et al. 2018). Spatial orientation problems commonly manifest in Mild Cognitive Impairment (MCI), which represents a state between cognitively healthy aging and dementia. It appears that spatial navigation skills might be an early indicator of cognitive decline due to MCI.

Methods

The present meta-analysis examines the difference between the performance of cognitively healthy older adults and older adults with MCI on spatial navigation tests. The standardized mean difference (Hedge’s g) is used as the effect size measure. In addition to simple characteristics (year of publication, country of study, age of participants, gender, education), we examined the form of test administration (i.e., real-world, virtual reality), type of measure (time, accuracy) and the additional spatial tasks connected with the main spatial navigation test in moderator analyses.

Results

Current data consists of 69 effect sizes across 26 studies. These studies represent 1359 participants (682 MCI, 677 healthy older adults). The overall result shows that the navigation skills of healthy cognitively older adults are significantly better (p < 0.05) comparing to people with MCI by the standardized mean difference (SMD) = 0.81.

Conclusion

Given the large effect size, it is worthwhile to examine potential moderators. It would also be useful to assess the effect size for spatial navigation in people with Alzheimer’s Disease.
STATE-LEVEL DESCRIPTION OF MEDICAID POLICY AND ACCESS TO LICENSED ASSISTED LIVING CARE FOR LOW-INCOME ADULTS
Authors: Gunderson Rachel , Smith Lindsey , Cornell Portia , Gadkari Gauri , Thomas Kali
Published: December 2023

A growing proportion of Medicaid funds are allocated to care in assisted living (AL) settings. However, a state must have a state plan amendment or waiver to utilize these funds. States issue levels of licensure for AL communities, which govern the care and oversight that can be provided and may determine whether ALs can accept Medicaid funding. However, until now, Medicaid coverage for AL has been analyzed at the state level and is not well-documented for license types. Using Medicaid state plans and waiver applications, we describe the types of Medicaid funding mechanisms that states use to finance care in AL and identify the demographics and health characteristics of residents in Medicaid-eligible ALs. We find that five states do not utilize Medicaid to finance care in AL. Among the 45 states and DC with Medicaid-financed AL, 12 states limit Medicaid funding to specific licenses, whereas 34 states provide access to Medicaid-funded care for all AL license types. Among identified ALs, 86% are licensed to accept Medicaid funds. Although the modal funding mechanism is through 1915c waivers, the largest percentage (40%) of ALs licensed to accept Medicaid funding are in states that utilize multiple mechanisms. In states that fund AL through state plan amendments, 88% of Medicare beneficiaries reside in covered ALs; conversely, in states that use 1115 demonstration waivers, 99% of Medicare beneficiaries reside in covered ALs. This work will benefit future research and policymaking aiming to use Medicaid funding to increase access to appropriate, high-quality care in licensed ALs.