bluuebunny/crossref_metadata_2025 huggingface dataset:
PRIOR TECHNOLOGY USE AND INTERVENTION OUTCOMES: INSIGHTS FROM A HEARING CARE TRIAL WITH AMPLIFICATION DEVICES
Authors: Suen Jonathan , Wang Ethan , Betz Joshua , Morales Emmanuel Garcia , Trumbo Jami , Marrone Nicole , Han Hae-Ra , Nieman Carrie
Published: January 2025

The total number of older adults in the U.S. with clinically significant hearing loss is projected to grow by an estimated 70% by the year 2060. Nevertheless, the adoption of hearing care strategies such as amplification technologies remains low nationally. Evidence of population disparities in accessing respective care along with adverse health outcomes linked to untreated hearing loss are also increasing, warranting a public health response. The Hearing health Equity through Accessible Research and Solutions (HEARS) intervention offers a novel care model leveraging OTC technologies for community-dwelling older adults with hearing loss and low income. A secondary analysis of data from a community-based RCT investigated the effect modification of self-reported prior use of technologies such as smartphones and computers on intervention outcomes across 151 participants. Participants classified as “tech-connected” showed a -14.1 point decrease (95% CI: -17.6, -9.9) on a standardized measure of hearing-related communication impairments when compared to a control group while “not tech-connected” participants demonstrated a -12.5 point decrease (95% CI: -16.2, -5.2), with a greater decrease indicating more favorable outcomes. The estimated difference in treatment effects of -1.55 points (95% CI: -7.8, 4.1) however was not statistically significant, revealing that prior technology use did not modify intervention outcomes among the RCT’s cohort. Nonetheless, technology literacy remains an important factor for hearing care intervention research to consider when designing outreach to underserved older populations. Key considerations related to prior technology use will be outlined and described for programs reliant upon OTC amplification technologies in addressing age-related hearing loss.
K-HEARS SCREEN: ETHNIC CHURCH-BASED HEARING SCREENING FOR KOREAN IMMIGRANT OLDER ADULTS IN THE UNITED STATES
Authors: Han Hae-Ra , Betz Joshua , Kwak Jacqueline , Park Joanne , Trumbo Jami , Nieman Carrie
Published: January 2025

Age-related hearing loss is highly prevalent in the United States (US), yet there is limited information on the magnitude of hearing loss in certain racial/ethnic minority groups, particularly those with limited English proficiency, due, in large part, to limited accessibility to hearing screening programs and national cohorts of older adults primarily focused on English-proficient communities. Older Korean Americans (KAs)—one of the fastest-growing aging populations in the US—are predominantly monolingual first-generation immigrants. We investigated the prevalence of hearing loss in community-dwelling KA older adults (60+ years) residing in the Baltimore-Washington metropolitan area. Faith-based organizations, such as ethnic churches, serve as epicenters for health promotion activities across diverse immigrant communities. To this end, we mobilized 18 Korean ethnic churches in the target area and screened 514 older KAs (mean=72.6 years, 61.5% women, 54.1% <$50K annual household income, and 97.8% limited English). We found that more than half (55.4% or n=285) had a clinically significant hearing loss and 56% of individuals reported never having their hearing screened. Of those with hearing loss, 61% had a mild degree of hearing loss and 39% with moderate or greater degree of hearing loss. Despite the high rates of hearing loss, prevalence of current hearing aid use was low (12%), similar to findings in other under-resourced communities. To the authors’ knowledge, these findings represent the first estimates regarding hearing health among older KAs. Our findings suggest the urgent need for addressing hearing care disparities in this linguistically and socially disadvantaged group of immigrant older adults.
COMMUNITY-ENGAGED RECRUITMENT IN PARTNERSHIP WITH FAITH-BASED ORGANIZATIONS: FINDINGS FROM K-HEARS SCREEN
Authors: Trumbo Jami , Betz Joshua , Kwak Jacqueline , Park Joanne , Nieman Carrie , Han Hae-Ra
Published: January 2025

Hearing loss is highly prevalent, yet few older adults use hearing aids and disparities based on race, ethnicity, and socioeconomic position exist. With limitations in nationally representative data, little is known regarding the hearing health of older Asian Americans, much less among specific ethnic communities. Older Korean Americans (KAs) are predominantly monolingual first-generation immigrants and have some of the highest rates of poverty among Asian Americans as well as high rates of limited English proficiency and poor health literacy, which may contribute to hearing care disparities. The prevalence of hearing loss and hearing aid use among older KAs is not well understood. An observational study was conducted to recruit participants aged 60 and older from KA churches in a metropolitan area to examine the prevalence of hearing loss and hearing care behaviors. A total of 34 recruitment events occurred over 7 months in 16 Korean churches in the Maryland, DC, and Virginia metropolitan area. Screenings occurred in churches of varying congregation size. At least 2 staff members were present at every event (2-4 hour duration). The recruitment efforts resulted in screening 514 KA participants. 13 staff members contributed 414 hours, equating to 0.8 hours of staff effort per individual screened. The KHEARS Screening study represents one of the largest cohorts of KA older adults with hearing loss. Community-engaged research, partnered with faith-based organizations, may offer critical approaches to increasing representation within hearing-related trials and, ultimately, the development of interventions responsive to the needs of a wider population of older adults.
CAN ARTIFICIAL INTELLIGENCE HELP ADDRESS THE 5MS OF GERIATRICS?
Authors: Kaufmann Christopher
Published: January 2025

Over the past year, the world has witnessed an explosion in the availability of tools employing artificial intelligence (AI) to do things never imagined possible. In parallel to its worldwide growth, applications of AI have also entered the healthcare sector. Specifically, AI tools have the potential to assist healthcare professionals in making judicial clinical decisions and to empower patients to monitor their health and make informed healthcare choices. Still, the application of AI to the geriatrics and gerontology field is limitless and represents a major opportunity to promote successful aging and independence of older persons. The 5Ms of Geriatrics is a framework used in clinical practice for assessing an older adult patient’s cognitive and physical functioning. The key Ms include Mind, Mobility, Medications, Multicomplexity, and what Matters Most, and addressing these five domains is essential clinical practice for improving health outcomes, particularly for older patients. In this presentation, we will explore the current applications and approaches of using AI to specifically address each of the 5Ms. The discussion will focus on the applicability of AI to address each domain and provide key examples of how AI, to date, has addressed each domain. The presentation will also propose key opportunities for future applications of AI in the geriatrics and gerontology field, with the ultimate goal of better providing for the healthcare of older people and promoting aging in place and successful aging.
MACHINE LEARNING–ENHANCED FRAILTY ASSESSMENT FOR HIGH-RISK OLDER PATIENTS UNDERGOING TAVR
Authors: Mardini Mamoun , Bai Chen , Price Catherine , Manini Todd , Al-Ani Mohammad
Published: January 2025

Frailty assessment in hospital settings is growing as a method for patient selection, estimating adverse outcomes, and care planning. However, due to time and resource constraints, current frailty assessments are unstandardized and challenging to apply in clinical settings. This study aims to test frailty assessments by combining real-world structured and unstructured data using machine learning (ML) in older patients undergoing Transcatheter Aortic Valve Replacement (TAVR). We extracted data from 131 TAVR patients collected between January 2018 to December 2019, employing the Fried criterion (weight loss, exhaustion, walking speed, grip strength, and physical activity). We used Latent Dirichlet Allocation (LDA) to analyze clinical notes collected 60 days before the TAVR procedure, generating 150 distinct topics. Additionally, we extracted preoperative data from structured EHRs, including patient details up to six months prior to their frailty evaluation. This includes sociodemographic data, medical history, condition severity, and the latest biochemical markers. We merged LDA-generated topics with EHR features, applied LASSO regression to select the most relevant features, and used XGBoost for predicting frailty levels in patients. We validated our models using nested cross-validation. Integrating clinical notes and structured EHR significantly enhanced model performance, with an area under the curve (AUC) of 0.82, surpassing the EHR-only model’s AUC of 0.64. SHAP analysis, a method to explain the output of ML, identified key frailty predictors such as congestive heart failure management, back problems, and Atrial Fibrillation. This approach demonstrates significant potential in standardizing frailty assessments using real-world data and optimizing TAVR patient selection
THE ROLE OF TEMPORAL CONTEXT IN SHAPING LIFE COURSE TRAJECTORIES: INSIGHTS FROM OLDER CHINESE INDIVIDUALS IN THE UK
Authors: Tenquist Miriam
Published: January 2025

International gerontological research has increasingly recognised the importance of larger sociohistorical contexts for understanding the growing needs of an increasingly diverse ageing population. The paper contributes to existing literature by examining how temporal context, including historical time, age cohort, and migration age, influences the life trajectories of older migrant communities, specifically older Chinese migrant communities in the UK. Central to this investigation is an examination of their lived experiences against the backdrop of migration policies and concurrent sociohistorical developments in both the host and home country, both before and during migration. This paper draws on semi-structured interviews with 57 Chinese people over the age of 50 living in the UK more than 5 years. The study identifies two distinct groups within this demographic based on migration waves: the second wave (1945-1980) and the third wave (1980s-2000). The paper highlights disparities in educational opportunities, dispersion patterns, occupation, and socio-linguistic capital between the two waves. Grounded in a life course perspective, this paper emphasises the significance of sociohistorical temporality and spatiality in turning points. We argue that the enduring legacies of Chinese reforms and societal changes are distinctly evident in the life trajectories of the diaspora in the UK, becoming more pronounced in later life stages. Ultimately, the study advocates for a more nuanced understanding of migrant communities that recognise the impacts of distinct migration waves on their unique ageing trajectories. This interdisciplinary, internationally minded perspective allows us to better serve global ageing populations that are increasingly influenced by globalisation.
HISTORICAL CHANGE IN THE HEALTH AND WELL-BEING OF GHANIAN MIDDLE-AGED AND OLDER ADULTS
Authors: Dey Nutifafa , Infurna Frank
Published: January 2025

The last 70 years in Ghana has seen political and socioeconomic transformations that have impacted adult life through the types of policies implemented and social programs made accessible. It has not yet been studied whether these transformations have led to better health and well-being for middle-aged and older adults in Ghana. Up to this point, studies examining historical change or cohort differences are largely from high-income nations and report trends of historical improvements in health and well-being for middle-aged and older adults in European nations, compared to middle-aged and older adults in the U.S. where historical declines are largely observed. Our goal is to use data from Ghana’s WHO Study on Global Ageing and Adult Health (SAGE) to fill this gap. Multilevel models were applied to three waves of data collected between 2002-2015 and the outcomes were self-rated health and depressive symptoms. Results revealed that later-born cohorts are reporting poorer self-rated health, which is indicative of historical declines. This trend did not differ across women and educational attainment. No significant cohort effects or modifying effects of gender and education were found for depressive symptoms. These findings shed light on the unique historical trajectory of self-rated health and depressive symptoms in middle-aged and older adults in Ghana. Our findings show similarities and differences to previous findings from the U.S. and Europe. Future research is required that tests potential mechanisms, such as changing dynamics in employment, financial demands, and disruptions in traditional family and social life due to modernization and urbanization.
SEQUENTIAL ANALYSIS OF DEMENTIA FAMILY DYADIC COMMUNICATION: CARE RECIPIENT ENGAGING COMMUNICATION
Authors: Kim Sohyun , Chen Will , Sun-Mitchell Shan
Published: January 2025

Persons living with dementia (care-recipient) engaging communication is responsive and collaborative communication. Examining dementia family dyadic communication is useful for prioritizing caregiver response to care-recipient communication. This study examined temporal relationships between antecedent care-recipient engaging communication and subsequent family caregiver communication (facilitative, disabling, and neutral) during 75 in-home care video observations. A secondary analysis of 5- to 60-second timed-window analysis with 5-second intervals was conducted. 95% confidence intervals, p-values, and Yule’s Q statistics were used. The results showed all types of caregiver communication were less likely to occur within all time widows after care-recipient engaging verbal communication (OR = 0.19– 0.43, p < 0.001, Yule’s Q = -0.398 – -0.685). Caregiver facilitative verbal, disabling verbal and nonverbal, and neutral verbal communication were less likely to occur within all time widows after care-recipient engaging nonverbal communication (OR = 0.37 – 0.83, p < 0.001 – p = 0.017, Yule’s Q = -0.093 – -0.459). Caregiver facilitative nonverbal communication was less likely to occur until 35-second after care-recipient engaging nonverbal communication (OR = 0.67 – 0.81, p < 0.001 – p = 0.001 – 0.020, Yule’s Q = -0.099 – -0.198). Care-recipient engaging communication was significantly associated with a decreased likelihood of subsequent caregiver communication, with a small to large probability of non-occurrence. Caregivers failed to respond to care-recipient communication, regardless of its nature. This emphasizes the urgent need for healthcare providers and researchers to prioritize caregiver education to promote a more supportive and engaging environment for persons living with dementia.
PERCEPTIONS OF COMMUNICATION: INCLUSION OF DEMENTIA CARE PARTNERS IN HOSPITALIZED PATIENT CARE
Authors: Medlin Austin , Still Catherine , Strayer Andrea , Fields Beth , Werner Nicole
Published: January 2025

Care partners provide the majority of care to people living with dementia (PLWD) during and after hospitalizations. Yet, they often report dissatisfaction with their inclusion in the hospitalization and feel unprepared to provide care after hospital discharge. Effective communication between clinicians and care partners of PLWD during a hospitalization is foundational to care partner inclusion and preparation. However, our current understanding of care partner communication with hospital-based clinicians is lacking. The present study aims to explore care partners’ experiences with clinician communication during hospitalizations of PLWD. A qualitative descriptive study was conducted using semi-structured interviews with 15 care partners of PLWD who had experienced a hospitalization within the last year. Our interdisciplinary team completed an inductive content analysis of the interview transcripts focused on identifying factors influencing care partner and clinician communication. Excerpts were first structurally coded related to hospital communication and then overarching categories were generated through consensus-based discussion over multiple team meetings. We identified five distinct categories related to care partner communication with clinicians: amount of communication, care transition communication, communication style, care partner communication expectations, and inclusion of PLWD in communication. Negative perceptions arose surrounding physical presence of the care partner dictating amount of communication, while lack of communication between hospitals and home health led to decreased care transition communication. Those with positive experiences, however, described a “family-like” communication style. These findings point to areas of communication that could be targets for future intervention to improve care partner inclusion and preparation during hospitalizations of PLWD.
REPURPOSED FOR AGING
Authors: Aleksic Sandra
Published: January 2025

Chronic diseases represent the leading driver of health care cost, with detrimental impact on function, independence, and quality of life in the aging society. Geroscience-guided approaches seek to target aging biology to extend healthspan, defined as the period of life spent without major disease and disability. Repurposing Food and Drug Administration (FDA) - approved drugs as gerotherapeutics (geroscience-guided pharmacologic interventions) offers the advantage of known pharmacologic profile and existing clinical experience and can represent a cost-effective strategy to test interventions for extension of healthspan. Among FDA-approved drugs, candidates with geroscience potential can be identified based on the evidence of extension of healthspan and lifespan in model organisms coupled with clinical evidence of benefits extending beyond the diseases targeted by the drug, through mechanisms that involve modulation of hallmarks of aging. Given the inseparable connections between metabolism and aging, it is not surprising that several FDA-approved drugs developed for treatment of metabolic dysfunction are emerging as potential gerotherapeutics. Metformin (discussed by Dr. Sara Espinoza), a widely used oral antidiabetic drug, extends lifespan in preclinical models, while observational clinical evidence supports its role in prevention of several chronic diseases. Two newer antidiabetic drug classes, glucagon-like peptide 1 (GLP1) receptor agonists (discussed by Dr. John Newman) and sodium- glucose cotransporter 2 (SGLT2) inhibitors (discussed by Dr. Carolina Solis-Herrera), have demonstrated healthspan and lifespan benefits above and beyond treatment of diabetes. Emerging evidence for modulation of multiple hallmarks of aging supports gerotherapeutic properties of these drugs. Clinical trials targeting several aging-relevant outcomes are underway.
ASSESSING GEROTHERAPEUTIC POTENTIAL OF GLP-1 RECEPTOR AGONISTS
Authors: Newman John
Published: January 2025

Gerotherapeutics are drugs that target biological mechanisms of aging to achieve broad impacts on multiple chronic diseases of aging as well as geriatric syndromes. No drugs have yet been shown in clinical trials to act as gerotherapeutics. However, several potential candidates have been identified from existing drugs based on proposed interactions with biological mechanisms of aging and supportive data from clinical trials affecting multiple age-related diseases. Metabolism and aging have been mechanistically intertwined since the first rodent studies of caloric restriction a century ago and the identification of the insulin/IGF receptor as the first aging-regulating gene thirty years ago, so it is unsurprising that several candidate gerotherapeutics were first developed for type 2 diabetes (T2DM). Here we will focus on the class of GLP-1 receptor agonists (GLP-1RA), describing preclinical data on interactions with hallmarks of aging that could support a gerotherapeutic role. We will summarize current clinical trial data that includes reduced cardiovascular disease, kidney disease, and mortality in patients with T2DM as well as early or ongoing studies in Alzheimer’s and Parkinson’s disease. We will discuss the limits of current data, priorities for further research, and the known risks of GLP-1RA in considering their development as potential gerotherapeutics.
CARING FOR HEALTH AND CULTURE: INSIGHTS INTO DISEASE MANAGEMENT, CAREGIVING, AND WELL-BEING IN BLACK COMMUNITIES
Authors: Esiaka Darlingtina , Nkimbeng Manka
Published: January 2025

There has been growing advocacy for a nuanced understanding of health practices and challenges in diverse Black contexts in recent years. This symposium aims to show the multifaceted intersection of health, culture, and well-being within Black communities, offering a comprehensive exploration of chronic disease management, family caregiving, and mental well-being. Ado-Mensah scrutinizes the nuanced roles and characteristics of family caregivers in African American and Black immigrant communities, shedding light on the unique challenges they face in the context of diabetes management. Groves introduces a novel approach to hypertension management by combining the DASH diet with culturally tailored recipes, recognizing the importance of culturally sensitive interventions for improving health outcomes among Black women. Kum explores the cultural aspects influencing family caregiving practices among African and Afro-Caribbean immigrants, contributing valuable insights into the broader context of eldercare within these communities. Lastly, Hutton sheds light on mental health challenges, emphasizing the need for a nuanced understanding of depression and loneliness symptoms within the diverse diasporic experiences of African Americans and Black communities. Together, these contributions weave a rich tapestry of knowledge, providing valuable insights into disease management, caregiving dynamics, and mental well-being in the intricate intersection of health and culture within Black communities.
ECONOMIC VALUE OF UNPAID FAMILY CAREGIVER TIME FOLLOWING HOSPITAL DISCHARGE AND AT END-OF-LIFE
Authors: Kaufman Brystana , Wenhan Zhang , Shibeika Sahar , Huang Ro , Vanderboom Catherine , Holland Diane , Van Houtven Courtney , Griffin Joan
Published: January 2025

Estimates of patient care costs often overlook the economic value of unpaid caregiving. This study aims to quantify the economic value of unpaid caregiving by rural FCGs. Using data from a multi-site randomized controlled trial evaluating Transitional Palliative Care (TPC) intervention for FCGs, this study quantifies the economic value of family caregiving in the six months following seriously ill care recipients’ hospital discharge using three valuation methods. Caregiving hours were self-reported by FCGs. The proxy cost approach assigned value to FCG hours using the national median home health aide wage. The unadjusted opportunity cost approach assigned value using the national median wage, by sex and education level. The adjusted opportunity cost approach assigned value by work force participation, using opportunity cost if employed and proxy cost otherwise. Of 282 FCGs, 94% were non-Hispanic White, 71% had a college degree, 56% were spouses, and 51% were in the workforce. FCG cost did not differ by treatment arm. FCGs of decedents compared to survivors reported significantly more hours per person-month (392 vs. 272, p< 0.001), resulting in higher median opportunity cost ($12,653 vs. $8,843, p< 0.001), proxy cost ($5,689 vs. $3,955, p< 0.001), and adjusted opportunity cost ($9,490 vs. $6,443, p< 0.001) per person-month. Proxy cost may undervalue FCG time, while opportunity cost may perpetuate labor market inequities. Policymakers must weigh trade-offs of different valuation methods. The high intensity of unpaid post-acute care, especially end-of-life, should be considered when designing policies and interventions to support unpaid FCG due to the economic impact on FCGs and employers.
EVALUATION OF AN ALZHEIMER’S DISEASE TRAINING FOR LATINX COMMUNITY HEALTH WORKERS
Authors: Bishop Sonia , Pascoe Kelley , Rojina Janet , Lopez Katherine , Kehne Theresa , Torres Karen , Domoto-Reilly Kimiko , Ko Linda
Published: January 2025

Despite an anticipated 800% increase in Alzheimer’s disease (AD) prevalence among U.S. Hispanic/Latinx by 2060, Hispanic/Latinx are persistently underrepresented in AD research, which is partly due to low participation in Alzheimer’s Disease Research Centers (ADRC). Community Health Workers (CHWs) are trusted community members and can serve as educators of AD and ADRC. This study evaluated changes in pre and post knowledge about AD and ADRC among CHWs serving Hispanic/Latinx after delivery of a culturally and linguistically appropriate AD training. The training covered AD prevalence and risk factors, AD preventive behaviors, knowledge about ADRC, and the importance of AD research. Pre/post assessment was conducted using non-matched, anonymous surveys; differences in pre/post measures (mean+SD) were estimated and analyzed using Wilcoxon-Mann-Whitney U tests. Participants (N=68) had a mean (SD) age of 40 (10.7) years, were majority female (87%), identified as Latinx (91%), born outside the U.S. (55%) and represented 21 Washington counties. There was a significant increase in knowledge of AD (pre: 2.16 + 1.25; post: 3.51 + 1.09; p< 0.001), AD signs and symptoms (pre: 2.04 + 1.25, post: 3.38 + 1.13; p< 0.001), and AD prevention (pre: 1.84 + 1.16, post: 3.46 + 1.19; p< 0.001) pre/post training. Similarly, there was significant increase in knowledge of the local ADRC (pre: 1.38 + 0.92, post: 3.27 + 1.48; p< 0.001), ADRC studies (pre: 1.63 + 1.11, post: 3.31 + 1.22; p< 0.001) and what ADRC participation entails (pre: 2.59 + 1.74, post: 4 + 1.17; p< 0.001) pre/post training. Culturally and linguistically concordant training for CHWs showed promise for increasing knowledge about AD and ADRC. Future research should explore how CHWs use training information to educate Hispanic/Latinx individuals about AD and ADRC.
EXPERIENCES OF SENIOR SCHOLARS AND PROFESSORS EMERITI: FOCUS GROUP RESULTS
Authors: Porter Michelle , Kops William , Kauenhowen Cornelia
Published: January 2025

In this study we were interested in learning about the experiences of Senior Scholars and Professors Emeriti at the University of Manitoba (UM), as part of a larger age-friendly university project on these term and lifetime positions for retired academics. Focus groups were held online with 11 women and men. The interview guide, developed based on earlier findings from a survey of a larger group of individuals in these same positions, included questions on their reasons for attaining the positions, benefits, challenges, and processes. Six themes were identified from the data collected: 1) commitment, 2) connection/access, 3) variability, 4) overlooked, 5) clarity (lack of) and 6) opportunity. 1) Participants indicated they are committed to their departments and colleagues locally, nationally and internationally. 2) Connections to colleagues and resources are important and appreciated (e.g., email, computer technical support, office and lab space). 3) Despite being at the same university, experiences were not consistent in how they acquired and subsequently renewed positions. 4) While there were many positive experiences shared, some respondents expressed disappointment, concern, anger and even fear, as well as having a sense of not being supported or even ignored. 5) There is an apparent misunderstanding of the designations, access to resources, and resulting expectations and roles. 6) Finally, all were positive about the opportunities to make changes to: nurture a sense of belonging of Senior Scholars and Professors Emeriti; acknowledge their efforts and achievements; create opportunities for increased participation; and ultimately foster a model workplace for retired academics.
COMPUTER-MEDIATED COMMUNICATION (CMC) AND SOCIAL ENGAGEMENT AMONG INDIVIDUALS WITH ALZHEIMER’S
Authors: Wong Yun Leng , Hemmy Laura , Conway Mike , Lozoya Daniel Cabrera , Lim Kelvin , Mikal Jude
Published: January 2025

Normal aging confers a host of risk factors for loneliness and social isolation. Aging accompanied by Alzheimer’s-related changes in cognition and function may result in even higher risk of loneliness and social isolation. Nevertheless, older adults now represent the fastest-growing demographic of both Internet and social media users. Moreover, uptake continues to rise, with younger-older adults - or the Baby Boomer Generation - using social media on average two hours more per week than younger generations. This widespread increase in digital engagement has profound implications on loneliness and social isolation among individuals living with Alzheimer’s. In this study, we examine the lived experiences of individuals living with ADRD using blogs managed by individuals with early-onset AD to assess how the Internet enables them to stay connected and safe. Following a phenomenological approach, we apply rigorous bottom-up, constant-comparison methods to identify the impact of computer-mediated communication (CMC) technologies on social engagement, focusing on mental and physical health outcomes, social support exchange, and health resource sharing. Four key themes emerged from analysis: (1) the Internet as a gateway to formal networks of support and mentorship, (2) the ability to bridge geographical distances in pursuit of fitting and responsive support, (3) feelings of validation contribution coming from sharing experiences, and (4) feelings of embarrassment or forced awareness of functional and cognitive decline. Themes are contextualized, and used to make recommendations for the development of novel support exchange platforms focused on the needs of individuals with ADRD - and those with early-onset ADRD, specifically.
THE ASSOCIATION OF PERCEIVED SOCIAL SUPPORT AND SOCIAL ISOLATION WITH SUBJECTIVE COGNITIVE DECLINE IN OLDER ADULTS
Authors: Amin Iftekhar , Jesmin Syeda
Published: January 2025

Objective

Early detection and diagnosis of subjective cognitive decline (SCD) has been prioritized in the Healthy People 2030 objectives. Two specific objectives are to increase the proportion of adults with SCD who know they have it and who have discussed this with a care provider. Although the literature shows that women may have faster cognitive decline than men, research is lacking on whether differential levels of social support and isolation play any role in the prevention and delay of the onset of cognitive decline in older men and women.

Methods

We used data from the 2022 Behavioral Risk Factor Surveillance System (BRFSS, N= 4,45,132). Logistic regression models have been used to examine the association between social support, isolation, and SCD in a sample of community-dwelling older adults with SCD aged over 65.

Results

Overall, among 31,625 respondents over age 65, nearly 10.1% reported experience of confusion or memory loss. Lower scores on the composite measure of social support and isolation were associated with greater reports of SCD for both men (OR 2.6, 95% CI = 2.3, 2.9) and women (OR 2.9, 95% CI = 2.6, 3.2). Compared to Hispanic older adults, the effects of isolation and lack of social support on the odds of SCD were higher for Whites (OR 2.0, 95% CI = 1.8, 2.3), and Blacks (OR 1.4, 95% CI = 1.2, 1.7).

Conclusion

Our findings highlight the importance of addressing social support and social connectedness in cognitive decline-related health promotion efforts for older adults, women in particular.
ASSOCIATIONS OF SOCIAL ISOLATION AND LONELINESS WITH MCI AMONG OLDER ADULTS FROM UNDERRESOURCED COMMUNITIES
Authors: Fang Fang , Hughes Tiffany , Wang Yueting , Jacobsen Erin
Published: January 2025

Previous studies have shown social isolation and loneliness are associated with poor cognitive outcomes in later life, yet it is unclear if these findings could be confounded by selective attrition. This study examines longitudinal associations of social isolation and loneliness with incident mild cognitive impairment (MCI) accounting for informative drop-out due to death or disease. Data were from a population-based cohort study of older adults in Southwestern Pennsylvania, whose once-vibrant economy heavily relied on the steel industry until it collapsed in the 1970s and has not fully recovered. Participants (N=1,254) were followed for 12 years for the development of MCI. Composite measures of social isolation and loneliness were created using longitudinal data across the study period. A generalized linear mixed model (GLMM) analyzing incident MCI as a binary outcome with joint modeling to adjust for potential attrition bias, along with adjustment for demographic, health, and lifestyle factors was used to examine the associations of social isolation and loneliness with incident MCI. The analyses revealed that greater social isolation was associated with higher risk of incident MCI (odds ratio=1.33, p=0.014) even when accounting for potential attrition bias, other potentially confounding factors, and loneliness. Loneliness was not significantly associated with incident MCI with or without accounting for social isolation (odds ratio=1.04, p=0.716; odds ratio=1.12, p=0.255). Over time, social isolation, rather than loneliness, may negatively affect cognition and strategies to keep older adults socially connected may reduce the risk for cognitive impairment.
SOCIAL RESOURCES PREDICT EMOTIONAL WELL-BEING IN COGNITIVELY IMPAIRED OLDER ADULTS: RESULTS FROM THE ARMADA STUDY
Authors: Johnson Melanie , Growney Claire , Salmon David
Published: January 2025

As older adults tend to prioritize meaningful relationships, they are likely to have higher quality social relationships, which may contribute to maintained or improved emotional well-being with age. Social resources may be especially important for maintaining well-being among older adults with neurodegenerative diseases. We utilized NIH Toolbox (NIHTB) measures to examine group differences in the associations between social resource quality and emotional well-being among an ethnoracially and cognitively diverse sample of older adults. As part of the Assessing Reliable Measurement in Alzheimer’s Disease and Cognitive Aging (ARMADA) study, older adults who were cognitively normal (CN-Young: aged 65-84; n=161; CN-Old: aged 85+; n=116), with amnestic mild cognitive impairment (MCI; aged 64+; n=109), and with Alzheimer’s disease (AD; aged 62+; n=76) completed NIHTB measures of emotional well-being and social resource quality. Results from linear regression models indicated that social resource quality was associated with better emotional well-being on all thirteen emotional well-being measures (ps <.001). Social Resources X Group interactions showed associations between high quality social resources and emotional well-being to be stronger for participants with AD relative to CN-Young on nine measures including anger (b=–0.51(0.17), p=.002), physical aggression (b=–0.26(0.11, p=.023), life satisfaction (b=0.35(0.16), p=.033), meaning and purpose (b=0.34,SE=.17,p=.043), positive affect (b=0.36(0.15), p=.018), and perceived stress (b=–0.43(0.17), p=.013). Findings underscore the importance of social resources in older age, particularly among adults with AD. Results suggest that individuals with AD draw upon social resources to improve their emotional well-being, perhaps helping alleviate some of the emotional and behavioral disturbances associated with AD.
COGNITIVE IMPAIRMENT IN VIETNAMESE OLDER ADULTS: EFFECTS OF LIVING ARRANGEMENTS AND FAMILIAL SUPPORT
Authors: Bandyopadhyay Attrayee , Korinek Kim , Adkins Daniel
Published: January 2025

Living alone has emerged as a prominent modifiable risk factor for cognitive impairment and dementia. How living arrangements influence risk for cognitive disorder is less well understood in low-to-middle income countries (LMICs) where Alzheimer’s disease and related dementias (ADRD) burden is rising and falls heavily upon family members. Vietnam is one such LMIC where ADRD rates are rising as demographic and cultural changes alter the living arrangements pertinent to cognitive aging. In this paper, we analyze data from the Vietnam Health and Aging Study, a longitudinal study of 2,447 older adults aged 60 and above residing in four districts of northern Vietnam, to examine the association between living arrangements and cognitive impairment. In a series of multiple linear and ordered logistic regression analyses, we estimate cognitive function using an abridged version of the Mini-Mental Scale Examination and its association with a categorical measure of living arrangements, and mediated by measures of social support, stress, and socioeconomic status. Findings indicate that females generally have poorer cognitive function than males, particularly those living alone. By comparison, those living with both spouse and children exhibit higher cognitive functioning. Nested model comparisons suggest that the ill effects of living alone on cognitive function are due in part to weaker social support, greater stress, and poorer socioeconomic conditions as compared to those living with spouses and children. These findings suggest research on the etiology of cognitive impairment should address nuanced forms of family support and stress as they occur and diverge across living arrangement configurations.
POLICY SERIES: ENSURING SCALE-UP AND SPREAD OF EVIDENCE-BASED PRACTICE: AGE-FRIENDLY HEALTH SYSTEMS IMPLEMENTATION BOOSTERS
Authors: Schiltz Nicholas , Aldossary Heba
Published: January 2025

This symposium presents a series of studies focused on the implementation of the Age-Friendly Health System (AFHS) 4Ms Framework within the largest convenient care health system in the U.S. These studies highlight the need for innovative “booster” strategies to improve the delivery of the 4Ms—Mobility, Medications, Mentation, and What Matters Most. The first study provides an overview of the implementation and improvement science methods used to facilitate the adoption of the 4Ms. Despite initial efforts, delivery of 4Ms care remained low after one year, highlighting the need for additional booster strategies. The second study introduces the Virtual Clinic, a serious video game designed to improve provider competency and confidence in delivering 4Ms care. The game simulates realistic older adult patient visits, providing valuable practice for providers. The third study presents the Reflection and Action strategy, a frontline feedback-driven approach aimed at enhancing both competency and confidence among providers in delivering the 4Ms. The strategy leverages the well-established “Plan, Do, Study, Act” model for improvement. The fourth study discusses the Age-Friendly Health Systems Questionnaire (AFHS-Q), a novel approach developed by frontline providers that enhances efficiency by having patients complete eight 4Ms-related questions while awaiting their medical visit. The final study introduces the Age-Friendly Health Systems Advocacy Tip Sheet, a tool designed to empower older adults and caregivers to advocate for Age-Friendly care. Collectively, these studies emphasize the importance of innovative booster strategies, frontline feedback, and patient empowerment in enhancing the delivery of age-friendly care.
IMPLEMENTATION BOOSTER: TESTING A VIRTUAL SIMULATION GAME TO ENHANCE CONFIDENCE AND COMPETENCE
Authors: Armstrong Grace , McCormack Mary , Seaman Ilona , Dolansky Mary , Pohnert Anne , Schiltz Nicholas , Ball Sarah
Published: January 2025

The Virtual Clinic, a serious video game, aimed to improve provider competency and confidence in the delivery of AFHS 4Ms care through simulation of realistic older adult patient visits. The Virtual Clinic (VC) was developed in response to focus groups of front-line providers that revealed they valued gaining competency in delivering 4Ms through practice. The first prototype was tested in July 2021. Based on feedback the prototype was iteratively modified, tested and evaluated for effectiveness over three additional pilot waves. Regions of low 4Ms delivery were specifically targeted in an open-enrollment style of recruitment, with various incentives depending on the wave. A total of 262 providers have participated. Providers’ performance were evaluated one week before, one week after, and four weeks after participation in the virtual clinic. Participating providers were matched at a 3:1 ratio to providers in the system that did not participate in the VC and had similar baseline 4Ms delivery and patient volume. Across all waves, participants in the VC were found on average to have a 24% increase in M-score, and a 7% increase in eligible appointments with at least one M delivered four weeks after participation in the virtual clinic. Overall, participation in the virtual clinic shows moderate, but statistically significant increase in the delivery of evidence-based 4Ms care in providers with low baseline performance.
IMPLEMENTATION BOOSTER: A FRONTLINE INNOVATION USING AN AFHS-QUESTIONNAIRE
Authors: Aldossary Heba , Kouts Holly , Dolansky Mary
Published: January 2025

Booster strategies originating from frontline providers are essential for optimizing 4Ms care delivery. The Age-Friendly Health Systems Questionnaire (AFHS-Q) is a novel approach, developed by frontline providers in the MinuteClinic, that enhances efficiency by having patients complete eight 4Ms-related questions while awaiting their medical visit. This approach fosters patient engagement, allowing individuals to express their concerns and preferences, ensuring personalized care. Providers (nurse practitioners and physician associates) across the ~1,100 MinuteClinic sites nationwide received AFHS-Q kits. Survey sent to 3,300 nurse practitioners completing the 4Ms and documenting findings before implementation. After four weeks, we surveyed 100 providers to provide feedback (scale range 1 to 5). 91 providers completed the survey. In general, feedback on the AFHS-Q was positive relating to the comfort of use (M = 4.18, SD =.99), usefulness (M = 3.97, SD = 1.10), acceptability (M = 4.12, SD =.83), and effort for use (M = 2.75, SD = 1.17). Providers confidence in completing the 4Ms (before AFHS-Q: M = 3.92, SD = 1.90; after AFHS-Q: M = 4.18, M =.97) and documenting the 4Ms before AFHS-Q: M = 3.84, SD =.99; after AFHS-Q: M = 4.17, M =.91) was significantly higher following AFHS-Q use. Providers also reported a significant reduction in time for visits after using the AFHS-Q. In summary, AFHS-Q proves effective, feasible, and well-received. Valuable feedback drives continuous refinement. Our findings emphasize the importance of provider-driven solutions for evidence-based healthcare quality improvement efforts.
ENVIRONMENTAL FORTITUDE: NEIGHBORHOOD CONTEXT AND COGNITIVE HEALTH
Authors: Webster Noah , Markides Kyriakos
Published: January 2025

It is estimated that up to forty percent of Alzheimer’s Disease and Related Dementia (ADRD) cases are preventable. While modifiable risk factors are often linked with neighborhood characteristics, less attention is given to this context in interventions. Further, as prevalence of ADRD rises and racial/ethnic disparities persist, research is needed within groups to guide development of culturally and environmentally specific interventions. This symposium includes four complementary papers focusing on diverse neighborhood factors and their associations with cognitive health among a sample of older Mexican Americans from the Hispanic Established Population for the Epidemiological Study of the Elderly. The papers result from participation in the Michigan Center for Contextual Factors in Alzheimer’s Disease (MCCFAD) 2023 Summer Data Immersion Program at the University of Michigan. MCCFAD is an NIA funded ADRD Resource Center for Minority Aging Research. Milani and colleagues found that limitations in activities of daily living mediate the association between living in a census tract with more highways and worse cognitive health. Clark and colleagues investigate the effect of ethnic enclaves and demonstrate a negative effect on both cognitive and functional decline. Lee and colleagues found that in urban settings, presence of religious organizations is associated with better cognitive health, while more civic organizations is linked to worse. Scambray and colleagues document an adverse effect of living in a disadvantaged neighborhood on cognition among those reporting moderate levels of relationship quality. These papers will be discussed by Kyriakos Markides who will provide an outlook for future research in this area.
MENTAL AND PHYSICAL HEALTH PATHWAYS LINKING EXPOSURE TO HIGHWAYS AND COGNITIVE HEALTH AMONG OLDER MEXICAN AMERICANS
Authors: Milani Sadaf , Meza Erika , Carrion Carmen , Meier Helen , Zahodne Laura
Published: January 2025

Residing in an area with more major roadways is associated with worse cognitive function, yet few studies examine this relationship among older Mexican Americans. Our objective is to explore mental and physical health pathways linking exposure to highways to cognitive performance/function among Mexican Americans aged 75 and older. We used data from the Hispanic Established Population for the Epidemiological Study of the Elderly (2004/2005). Our exposure was the number of primary and secondary roads in a participant’s census tract. Our outcome was the Mini-Mental State Examination (MMSE) score. We examined depressive symptoms (Center for Epidemiologic Studies Depression Scale), neighborhood satisfaction (very satisfied/satisfied vs. neutral/dissatisfied/very dissatisfied), basic activity of daily living (ADL) limitations (7-item modified Katz ADL scale), and physical function (Short Physical Performance Battery) as separate potential mediators, using path analysis. Covariates included age, sex, education, marital status, nativity, language of interview, length of time in residence, and census tract characteristics (urbanicity, affluence, disadvantage, and proportion of Hispanic residents). Our analytic sample (n=1,723) had an average age of 81.5 years (standard deviation: 4.9) and was 61.2% female. Residing in census tracts with more highways was associated with lower MMSE scores. Depressive symptoms, neighborhood satisfaction, and physical function were not mediators while ADL limitations mediated 40% of the relationship between living in census tracts with more highways and MMSE scores. Future work is needed to understand the direct and indirect mechanisms underlying the association between exposure to highways and ADL limitations, as well as between ADL limitations and cognitive health.
ACADEMIC NURSING RESEARCH, INNOVATION, AND ENTREPRENEURSHIP
Authors: Shade Marcia
Published: January 2025

Marcia Shade PhD, BS, RN is the Founder and CEO of Voice-It Inc. The start-up company focuses on creating digital health solutions that engage, inform, and empower older adults. Voice-It Inc. is harnessing, AI, the power of machine learning and natural language processing to help improve the health and quality of life of older adults. Dr. Shade will share: 1) Her perceptions on the importance of understanding entrepreneurship as an academic nurse researcher and innovator, and 2) Reflections on her experience as a finalist in the 2023 NIA Start-Up Challenge. “I received invaluable guidance from the NIA Team, experts, mentors, advisors, and fellow cohort finalists to help me grow as an entrepreneur and lay a foundation for my start-up company.”