bluuebunny/crossref_metadata_2025 huggingface dataset:
LEADERS AND CONSULTANTS FROM AN AGING CENTER IN MICHIGAN: PRODUCTIVE AND TAILORED ENGAGEMENT WITH AFRICAN AMERICANS
Authors: Perry Tam , Stringer Wilma , Howell Cynthia , Rorai Vanessa , Horn Amanda , Mitchell Jamie , Key Kent
Published: January 2025

The Healthier Black Elders Center (HBEC) is the community outreach core for the Michigan Center for Urban African American Aging Research. Established in 1997, this center offers health education to older adults in Detroit and expanded to Flint, Michigan in 2021 and maintains a research registry of over 1100 older Detroiters and over 200 older Flint residents. HBEC Detroit launched a consulting program in 2020 with the Community Advisory Board (CAB) members to offer personal and professional perspectives regarding research. Through this program, CAB members have 1) disseminated knowledge about community engaged research approaches 2) offered feedback on comprehensibility and ease of use to individual researchers on instrument content and research design as well as 3) offered insights beyond the academy (technology and philanthropic sectors). This program has created opportunities for older Black adults to provide direct feedback on product, funding initiatives and research design. This presentation will provide an overview of the initiatives, recruitment, and retention strategies of a long-established center. This presentation will showcase the Consulting program as a way to engage leaders in its center’s work as well as provide learning and growth for its Detroit members. This presentation will also highlight the process of tailoring, adapting, and launching the HBEC program for the Flint community.
QUALITATIVE STUDY IDENTIFIES DEMENTIA TRAINING NEEDS OF CARE WORKERS IN ASSISTED LIVING AND PERSONAL CARE AGENCIES
Authors: Andersen Troy , Kaplan Daniel , Foster Norman , Stefanucci Jeanine , Moffitt Chad , Dremann Andrea , Bechek Bonnie
Published: January 2025

Caring for individuals with dementia can be overwhelming, especially when direct care workers lack knowledge and skills to respond to changing needs of those with dementia. Burnout and turnover are common problems. To better understand wishes for dementia training, we interviewed direct care workers, supervisors and administrators in 4 assisted living facilities (ALFs) and personal care agencies (PCAs). Funded by the NIA, we collected data from 23 direct care workers, 7 supervisors, 8 administrators. Questions focused on needs for dementia training topics and solutions for delivering content. Interviews were recorded, transcribed, and evaluated by two independent raters to identify all topics discussed. These topics were then further analyzed by a second group of raters who specialize in training of direct care providers. Commonalities and thematic differences across direct care workers, supervisors, and administrators were reviewed qualitatively to identify highest priorities. For both ALFs and PCAs, priority topics for training overlapped between administrators, supervisors, and direct care workers and included skill development (e.g., de-escalation strategies), knowledge areas (e.g., bathing, distress), and workforce goals (e.g., training certifications). Direct care workers further mentioned that training should be interactive, fit into their work schedules, and give solutions in real time. PCAs added that greater effort is needed to assure that training is relevant (e.g., current topics often are too pedantic and not practical to daily activities). Real-time, flexible, content meeting identified needs, and individualized to caregiving settings, learner knowledge and experience should be the focus of future improvements in dementia training.
STRUCTURAL STRESSORS, PERCEIVED NEIGHBORHOOD CONTEXT, AND COGNITIVE FUNCTION IN BLACK MIDLIFE AND OLDER ADULTS
Authors: Thierry Amy , Tsuchiya Kazumi , Taylor Harry
Published: January 2025

Racial disparities in Alzheimer’s disease and related dementias have been established in the US, with higher rates in Black compared to White older adults. Because Black populations are disproportionately exposed to greater neighborhood disadvantage, chronic stress via the neighborhood context may contribute to worse cognitive health among Black older adults. However, the role of neighborhood-based stressors on cognitive function within the Black population is less understood. This study aims to examine how lifetime exposure to structural stressors (e.g., discrimination in housing, unemployment, and policing) and current perceived neighborhood stressors (e.g., high disorder and social discohesion) independently and interactively are associated with cognitive function in Black adults >50 years of age (n=1,663) using 2010-2016 Health and Retirement Study data. Linear regression models tested associations between structural stressors, perceived neighborhood stressors, and interaction terms of total number of structural stressors, neighborhood disorder (including safety and cleanliness), and social discohesion with cognitive function measured using the Langa-Weir 27-point scale. Black adults reported exposure to structural stressors as 15.69% in policing, 14.25% in hiring, and 7.88% in housing. In unadjusted models, greater total structural stressors were associated with greater cognitive function, while worse ratings of social cohesion, safety and cleanliness were associated with lower cognitive function. A statistically significant interaction term (b= -.221, SE=0.10, p<0.05) indicated that high social discohesion and greater total structural stressors was associated with lower cognitive function. Thus, life course exposure to multiple domains of neighborhood-based stressors may be important for Black adults’ cognitive function in later life.
SELF-REPORTED EVERYDAY DISCRIMINATION AND CARDIOMETABOLIC RISK IN OLDER BLACK AND WHITE ADULTS
Authors: Cobb Ryon
Published: January 2025

This study investigates the relationship between self-reported instances of everyday discrimination and cardiometabolic risk among older, focusing on potential variations by racial classification. This analysis draws on a subsample of older Black and White respondents from the 2010/2012 Health and Retirement Study (N=8,924), a biennial nationally representative survey of older adults across the United States. Cardiometabolic risk is assessed using a count of high-risk cardiometabolic biomarkers while we self-reported everyday discrimination and racial identification. We included an interaction term (self-reported everyday discrimination x race) to test whether the relationship between everyday discrimination and cardiometabolic risk varied by racial classification. We used negative binomial regression to estimate incidence rate ratios (IRRs) and corresponding 95% confidence intervals (CI) of self-reported everyday discrimination, racial classification, and cardiometabolic risk, controlling for potential confounders. Respondents with higher levels of self-reported everyday discrimination scores had higher levels of cardiometabolic risk after adjusting for demographic characteristics (IRR: 1.08, 95% C.I. 1.05-1.11), and while attenuated, remained significant (IRR: 1.08, 95% C.I. 1.01-1.07) after further adjustments for smoking status, physical activity, alcohol consumption, educational attainment, and household wealth. The relationship between self-reported instances of everyday discrimination and cardiometabolic risk was significantly weaker for older Black adults than their White counterparts. The present study confirms that self-reported instances of everyday discrimination are a psychosocial factor associated with higher levels of cardiometabolic risk among older adults; this association is especially pronounced among older White adults. Future studies among this population must examine whether the relationship changes over time.
MIDLIFE CHRONIC STRESS, PHYSIOLOGICAL DYSREGULATION, AND COGNITION: A LONGITUDINAL MEDIATION ANALYSIS
Authors: Mitchell Uchechi
Published: January 2025

The current study investigates how exposure to chronic stressors during mid-life indirectly affects cognitive function through changes in physiological dysregulation. Data come from 4,684 adults ages 51-64 at baseline who participated in the Health and Retirement Study between 2006 and 2018. Mid-life stressors include experiences of everyday discrimination and financial strain, both of which were assessed at baseline only. Physiological dysregulation was assessed as a count of high-risk inflammatory, cardiovascular, and metabolic biomarkers and was assessed every four years. Cognitive function assessed every two years using a modified version of the TICS. A longitudinal mediation analysis was conducted using R and MPLUS. Unadjusted analyses showed that cognitive function decreased over time, while physiological dysregulation significantly increased. The indirect effects of financial strain on cognitive decline were mediated by baseline dysregulation levels and increases in physiological dysregulation over time. On the other hand, the effect of everyday discrimination on cognitive decline was only mediated by its effect on baseline physiological dysregulation. These findings suggest that 1) physiologic vulnerability to financial strain and everyday discrimination may be more salient earlier in the life course setting the stage for changes in cognition later in life, and 2) financial strain in mid-life continues to adversely affect physiological functioning and cognition over time. That said, adjusting for age, gender, race/ethnicity and education fully accounted for the significant direct and indirect effects of financial strain and discrimination on changes in cognition, suggesting a more complex and nuanced relationship between chronic stress, physiological function and cognition.
FAMILY STRUCTURE AND DEMENTIA CAREGIVER NETWORK COMPOSITION
Authors: McConnell William , Haggar Katherine , Hinson Justin , Linares Jackeline , Bamdas Jo Ann , Hernández María Ortega
Published: January 2025

Ongoing shifts in family structure, including a growing number of adults aging without spouses or children, raise questions about who will step into a caregiving role for persons living with dementia (PLWD). Furthermore, research and interventions targeting caregivers typically limit their focus to one primary caregiver, but PLWD often rely on many interconnected informal and professional supporters. Social Network Analysis (SNA) is a valuable tool for identifying potential and actual caregivers for PLWD, including nontraditional and secondary caregivers who are often overlooked. In this presentation, we report results from an ongoing quantitative study of 250 dementia caregiver networks in the southeastern United States. Detailed SNA data were obtained from survey-based interviews with self-identified caregivers for PLWD utilizing outpatient services at a Memory Disorder Clinic or living in the community. Results indicate that PLWD in this sample are supported by 7.7 caregivers, on average. While traditional caregivers such as spouses and adult children remain common, other relatives including siblings, nieces/nephews, and grandchildren comprise nearly 20% of all informal caregivers. Non-kin friends comprise an additional 20% of informal caregivers on their own. We describe how family, extended family, and non-kin caregivers in the networks differ in terms of their participation rates and task-specific roles. We also present multivariate analyses examining how caregiver network composition changes based on disease severity and the availability of potential caregivers within families/households. We conclude by discussing implications of SNA for understanding caregiving in the context of shifting family norms.
NIECE AND NEPHEW DEMENTIA CAREGIVERS: FAMILY RELATIONSHIPS AND CARE DYNAMICS
Authors: Roberto Karen , Savla Jyoti
Published: January 2025

Changing demographics and a host of social trends have created variations in dementia family care, including older adults’ reliance on extended kin. To advance understanding of the heterogeneity of dementia family care structures, we focused on nieces and nephews who serve as primary caregivers for their aunts and uncles living with dementia. Guided by a life course perspective and grounded in a stress-coping framework, we used a mixed-method study design to explore how past and present family relationships and dynamics shape caregiving responsibilities, practices, and outcomes. Mixed-method interviews with 20 niece and 5 nephew dementia caregivers (Mage = 55 yrs; R = 38-67) revealed diverse pathways to care provision. Close relationships were established in childhood for 21 respondents, even among those who lived at a distance from their aunt/uncle. Two-thirds of the nieces/nephews never expected to be their relative’s caregiver, but rather either gradually “fell into it” or abruptly assumed the role because of “family circumstances.” Rarely were nieces/nephews the sole caregiver; some coordinated care with their aunts’/uncles’ family members, their own family members, and formal service providers whereas others looked to another family member only for occasional assistance. Nieces/nephews who relied on family support to care for their relative living with dementia experienced more caregiver burden (rs = 0.49, p<0.03) and faced greater family strain (rs = 0.61, p<0.01). Notably, niece caregivers reported more difficulties with other family members than nephews (rpb =0.50, p<0.02). Discussion elaborates on the complexity of extended family relationships and realities of dementia care today.
DO STEPCHILDREN PROVIDE DEMENTIA CARE TO AGING BIOLOGICAL PARENTS COMMENSURATE WITH THEIR LEVEL OF NEED?
Authors: Silverstein Merril , Lee Seonhwa , Lakomy Martin
Published: January 2025

The research in this presentation addresses the critical issue of whether divorce, remarriage/repartnering, and stepfamily formation have weakened adult intergenerational bonds due to stepchildren’s weaker commitment to the care of their vulnerable stepparents. A life-course approach is taken to link early relationship characteristics to later care trajectories. We use data from the Longitudinal Study of Generations to examine whether earlier kinship strength with stepmothers and stepfathers increases the amount of care stepchildren provide to meet the needs of their aging stepparents between1997-2022. We use latent growth curve analysis to examine whether the rate of increase in care to stepparents with advancing dementia and functional impairment is stronger when stepchildren in earlier adulthood evaluated their relationship with stepparents as more “kin-like” and “family-like.” In comparison, we also examine rate of change in care for biological mothers and fathers by their levels of functional impairment. We also consider structural characteristics of step-relationships, including the child’s age when the relationship was formed and the number of years the child lived with the stepparent. We expect that earlier reported kinship strength with stepparents will moderate the care response to stepparents’ impairment such that it will approach the care response to biological parents. We expect the severely impaired stepmothers to elicit more care from stepchildren when compared to severely impaired stepfathers. Analyses reveal the conditions under which stepchildren serve as a vital resource to their vulnerable older stepmothers and stepfathers with dementia in complex aging families, which have become increasingly prevalent but remain under-investigated.
STARTING A GSA STUDENT CHAPTER WITH POSTGRADUATE STUDENTS IN THE UK: OPPORTUNITIES AND CHALLENGES
Authors: Tsimpida Dialechti
Published: January 2025

As the global aging population continues to expand, there is a growing demand for professionals skilled in gerontology. To meet this need, the creation of Gerontological Society of America (GSA) Student Chapters within Higher Education Institutions (HEIs) has emerged as a pioneering initiative to support and cultivate emerging gerontology professionals. The University of Southampton, home to the UK’s sole Department of Gerontology, was invited to establish a GSA Student Chapter in the 2023-24 academic year. While enthusiastic about the opportunity to deepen student engagement with the GSA, initiating a GSA Student Chapter within a postgraduate-focused program posed challenges. This endeavor involved strategic engagement efforts to recruit postgraduate students specializing in aging studies, and to organize activities to establish and formally affiliate the new Student Chapter with the University of Southampton. The initiative aimed to foster professional development in education, research, advocacy, policy, and sciences related to aging. Affiliation with GSA undoubtedly enriches the careers of postgraduate students by providing access to a global network of experts, mentorship opportunities, international connections, and a comprehensive toolkit for aging studies. In this session, Dr Dalia Tsimpida, Faculty Advisor of the newly established GSA Student Chapter at the University of Southampton, will discuss the rewarding experiences and challenges encountered in launching and establishing the Student Chapter. Attendees will be prompted to consider why and how a GSA Student Chapter can effectively engage postgraduate students specializing in aging studies, and how such chapters can be integrated into their respective Institutions.
INCLUSIVE NEIGHBORHOODS TO SUPPORT OUTDOOR MOBILITY AND PARTICIPATION OF PEOPLE LIVING WITH DEMENTIA
Authors: Chaudhury Habib , Charness Neil
Published: January 2025

The creation of a supportive and inclusive neighborhood is instrumental to maintaining mobility and social participation of people living with dementia in the community. Achieving this objective requires a clear understanding of how the condition of dementia shapes people’s use of streets and outdoor spaces, and how neighborhood built environmental features influence movement and activity of people living with dementia. This understanding is fairly limited in current research and practice, owing to the paucity of empirical evidence, as well as evidence-based resources that can guide decision-making and planning. These research gaps are addressed in a multi-site, mixed-methods study in British Columbia, Canada, titled “Dementia-inclusive Spaces for Community Access, Participation, and Engagement (DemSCAPE)”. The aims of this study are to 1) explore the outdoor mobility patterns and experiences of people living with dementia in the community, and the role of the neighborhood built environment in shaping their mobility and participation In outdoor activities, and 2) develop evidence-based resources that can guide dementia-friendly and inclusive planning and design. This symposium will also present findings from the knowledge generation and knowledge mobilization phases of the DemSCAPE study. Knowledge generated in the study is based on qualitative and quantitative analyses of data collected with participants living with dementia and care partners in British Columbia. Knowledge mobilization activities involve three key resources developed in our project: documentary video, photo exhibit, and dementia-inclusive planning and design guide. Together, these five presentations offer insights that can guide stakeholders in creating dementia-friendly and inclusive outdoor spaces.
AN INTRODUCTION TO THE MAXIMIZING INDEPENDENCE AT HOME (MIND AT HOME) PROGRAM
Authors: Samus Quincy
Published: January 2025

People living with dementia (PLWD) represent some of the highest-need and highest-cost individuals living in the community. The complexity and range of needs (including medical, behavioral, and social needs) make dementia one of the most expensive chronic conditions in the U.S., and a strong candidate for improving care and reducing costs through care management support. The Maximizing Independence at Home (MIND at Home) dementia care program, developed and implemented in a variety of settings and contexts over the last 15 years, is a care coordination program for community-living persons with dementia and cognitive impairment and their informal caregiver. The MIND program consists of a comprehensive set of assessments, tools and staff trainings designed to increase the ability to stay at home in the community; reduce unmet care needs and improve quality of care; reduce caregiver burden and avoid high health care costs. The MIND at Home program model builds on three prior trials (two RCTs, one quasi-experimental design) of the MIND at Home dementia care coordination model and five practice-based implementations in real world practice settings to date. This session will review key components of the MIND at Home dementia care model, the characteristics of the care team, core training elements, and summarize research findings to date across the developmental pipeline.
EXPERIENCES EMBEDDING MIND AT HOME DEMENTIA CARE COORDINATION PROGRAM IN PRIMARY CARE
Authors: Ciemins Elizabeth , Samus Quincy , Shields Stephen , Yang Mia , Herrig Shelby , Breyfogle Rachel , Rooney Alicia , McKinnon Monette
Published: January 2025

The prevalence of people living with dementia (PLWD) is growing and dementia is one of the highest burden, and highest cost chronic conditions in the US. Care management support within primary care practices is one solution to provide patient- and care partner (CP)-centered care, improve patient care outcomes, e.g., hospitalizations, ED visits, polypharmacy, high care partner strain, and reduce healthcare costs. This session describes a collaborative adaptation and implementation of the MIND at Home Dementia Care Coordination Program into two large primary care clinics in two states (e.g., Iowa and North Carolina). The program pilot expanded the skills of existing primary care staff members to the level of Memory Care Coordinators (MCCs), who worked with larger primary care teams on combining the benefits of clinic-based with home-based services that support PLWD, their families, and CPs. 106 primary care patients and their CPs were recruited for a 3-month intervention period and process measures, including identified and addressed needs of the PLWD and CP, were ascertained. This session will discuss the feasibility of program implementation in a racially, economically, and geographically diverse population of PLWD and provide qualitative and quantitative outcomes on patient, provider and MCC program acceptability, program impact, and barriers and facilitators to implementation from the primary care practice perspective. The presentation will reflect on specific issues important to consider in primary care including underdiagnosis of dementia, patient recruitment and outreach, incorporation of home visits, interdisciplinary collaboration and consultation, and outcomes ascertainment.
RESILIENCY AMONG WHI’S WOMEN AGED 80 AND OLDER BY RACE, ETHNICITY, AND NEIGHBORHOOD SOCIOECONOMIC STATUS
Authors: Krok-Schoen Jessica
Published: January 2025

A comprehensive examination of resilience by race, ethnicity, and neighborhood socioeconomic status (NSES) among women aged ≥80 is needed, given the aging U.S. population, increasing longevity, and growing racial and ethnic diversity. Participants (n=29,367, median age=84.3) were women aged ≥80 enrolled in the Women’s Health Initiative. There were no significant differences by race and ethnicity in resiliency. Mean resiliency scores differed between those with low NSES (3.94±0.83) and high NSES (4.00±0.81). Older age, higher education, higher self-rated health, lower stress, and living alone were correlates of resilience. Social support correlated with resilience among White, Black, and Asian women, but not for Hispanic women. Living alone, smoking, and spirituality were significantly associated with higher resilience among women with moderate NSES. Despite some differing correlates of resilience by race, ethnicity, and NSES, there were many similarities. These results may aid in designing resilience interventions for the increasingly diverse population of older women.
DIFFERENT INTERPRETATIONS OF “HONOR YOUR PARENTS”: IMPLICATIONS FOR OBLIGATION OF PARENTAL CAREGIVING
Authors: Esiaka Darlingtina , Luth Elizabeth
Published: January 2025

Although the concept of “honor your parents” is [universally] important, its understanding and manifestation vary by cultural context and community. This variation potentially has important implications for how parental caregiving obligations are perceived and performed. The current study explored the diverse conceptualizations of “honoring your parents” in the United States, Ghana, and Nigeria. It also assessed how the interpretations influence individuals’ perceptions of caregiving obligations to older parents. Through semi-structured interviews with 153 participants, we found that in the United States, “honoring your parents” is predominantly viewed through the lens of emotional care rather than material care and instrumental support. In contrast, individuals in Nigeria and Ghana strongly associate the concept with providing tangible assistance and hands-on care to parents. Our findings shed light on cultural nuances and expectations regarding parental caregiving, offering insights into potential strategies to address the diverse caregiving needs of aging populations.
ASSOCIATIONS BETWEEN LONGITUDINAL LONELINESS, DNA METHYLATION AGE ACCELERATION, AND COGNITIVE FUNCTIONING
Authors: Lynch Morgan , Beam Christopher , Arpawong Thalida Em
Published: January 2025

Loneliness may influence aging biomarkers related to cognitive functioning, for example, through accelerated DNA methylation (DNAm) aging. In a study involving 1,814 participants from the Health and Retirement Study, we investigated the role of six DNAm age acceleration measures (DNAmAA) in mediating the effects of baseline loneliness and latent longitudinal loneliness trajectories on cognitive abilities. Higher baseline loneliness and a moderate-intercept loneliness trajectory predicted poorer general cognitive ability and memory scores. Second-generation DNAmAA measures (specifically, PhenoAge, GrimAge, and DunedinPoAm38) mediated the effect of loneliness on overall cognitive ability and memory. Additionally, immediate and delayed memory scores were mediated by GrimAge Accel in the lowest and two highest latent loneliness trajectories. Notably, self-rated health, depressive symptoms, social isolation, and body mass index contributed significantly to total and mediated effects. The study suggests that DNAmAA, especially GrimAge, have promise for explaining the prospective association between loneliness and poorer cognitive functioning.
IMPACT OF HIGH SCHOOL BACKGROUND ON OLD AGE COGNITION: EVIDENCE FROM A WISCONSIN COHORT
Authors: Topping Michael , Engelman Michal
Published: January 2025

Individuals with higher academic performance in high school, those who participated in enriching activities, and those with higher socioeconomic status are known to have cognitive advantages in later life. Yet, less is known about whether and how these factors constitute unique social typologies of students in high school. Such background typologies may confer differing cognitive benefits and may have different consequences for later life cognition. Using unique longitudinal survey and cognitive assessment data from the Wisconsin Longitudinal Study and latent class analysis, we identify five different typologies of high school students in 1957: high disadvantage, moderate disadvantage, low advantage, moderate advantage and high advantage. We then estimated regression models examining differences in immediate recall, delayed recall, and letter fluency across different timepoints (2004, 2011, and 2020). We find that compared to the most disadvantaged, those from other class backgrounds see higher average scores for immediate recall and letter fluency as they enter old age in 2004, and maintain these advantages through to 2011. This effect dissipates for some classes in 2020 when WLS participants were nearing the oldest-old ages (80+). Class differences in delayed recall were more clearly apparent in 2011 than either before or after. In addition to socioeconomic mobility and changes in cognition over the life course, these results also reflect health and mortality-related changes to the composition of the cohort at successively older ages.
MID-LIFE AND LATE-LIFE ENVIRONMENTAL EXPOSURES ON DEMENTIA RISK: THE MODIFYING EFFECTS OF APOE
Authors: Williams Victoria , Trane Ralph , Sicinski Kamil , Herd Pamela , Engleman Michal , Asthana Sanjay
Published: January 2025

Increasing evidence supports a deleterious effect of late-life air pollution exposure on dementia risk that is exacerbated among older ApolipoproteinE-4 (ApoE-4) carriers. However, the protracted effects of mid-life occupational exposures on dementia outcomes, and potential interactions with ApoE, are unknown. Using prospective life course data from 3,814 participants in the Wisconsin Longitudinal Study (WLS), we evaluated the effects of mid-life occupational exposure to respiratory hazards and late-life air pollution exposures on dementia risk, and whether these associations varied by ApoE-4 status. Mid-life occupational exposure was associated with 1.64 times greater odds of all-cause dementia, but only among ApoE-4 noncarriers. Conversely, late-life air pollution exposure (higher levels of particulate matter (PM2.5) and lower levels of ozone) associated with increased dementia risk only within ApoE-4 carriers. Findings suggest that ApoE-4 differentially impacts the association between environmental exposures and dementia risk based on timing of exposure across the life course – supporting ApoE as a pleiotropic modifying gene. While ApoE-4 appears protective against the adverse effects of hazardous respiratory exposures in mid-life, it increases risk for dementia associated with environmental exposures in late-life.
SIBLING RELATIONSHIPS AND COGNITIVE TRAJECTORIES IN THE WISCONSIN LONGITUDINAL STUDY
Authors: Lee Gina , Engelman Michal , Kong Jooyoung
Published: January 2025

Sibling relationships are positively associated with psychological well-being over time. However, no prior studies have examined the impact of sibling relationships in middle and older adulthood on longitudinal patterns in cognitive functioning. Using four waves (spanning 27 years) of sibling data from the Wisconsin Longitudinal Study (N = 19,046), our study explores the relationship between sibling closeness, emotional support, and contact frequency in 1993, 2004, and 2011 (when participants were roughly 54, 65, and 72) and trajectories in cognitive measures including immediate and delayed recall, digit ordering, and letter fluency in later life (2004, 2011, and 2020). In growth curve models, sibling closeness (measured in 2004) and emotional support received from siblings (measured in 1993, 2004, 2011) were positively associated with baseline levels of letter fluency but not change over time. Next, we employed the sibling dyad data with at least one letter fluency data available from each source (n = 3,243 pairs of siblings) to fit a parallel process model to examine whether siblings’ letter fluency scores moved together over time. We found that both the intercepts and slopes of letter fluency trajectories were positively associated for siblings, implying that participants who experienced a steep decline in letter fluency were likely to have siblings who experienced similarly steep declines. Future studies can further explore what aspects of siblings relationship or shared exposures (e.g. shared family characteristics or environments, spending time together, having similar health behaviors, or providing care for each other) influence the shared cognitive patterns.
PREPAREDNESS NEEDS OF THE FAMILY CARE PARTNER OF THE PERSON WITH DEMENTIA DURING TRANSITION FROM THE HOSPITAL
Authors: Boltz Marie
Published: January 2025

In the Fam-FFC approach, nurses purposefully engage family care partners in the assessment, decision-making, care delivery and evaluation of function-focused care during hospitalization and the 60-day post-acute period. The goal is to promote functional recovery and well-being in the patient, and prevent unnecessary long-term care admissions, while improving care partners’ preparation for caregiving and well-being. At hospital discharge, on the Preparation for Caregiving Scale, care partners (N=229, 60% female, 59% White, 39% African American) described the least preparation to care for emotional (M= 2.8, SD=1.2) and physical needs (M= 2.9, SD=1.1), deal with the stress of caregiving (M= 2.7, SD=1.2), provide positive activities (M= 2.9, SD=1.1), followed by get the help they need from the health care system (M= 3.11, SD=1.0). Content analysis of nurses’ transitional care notes during the 60 day post-acute period identified five themes that describe care partner needs to support preparedness; they converge with and help explain the quantitative findings. The themes included: psychosocial support for the patient, managing symptoms, physical and cognitive activity, advocacy, and care partner self-care. Findings suggest the need to attend to the psychological and informational needs of care partners, while considering patient well-being and comfort.
RACIAL RESIDENTIAL SEGREGATION AND SUICIDAL BEHAVIOR ACROSS THE LIFECOURSE AMONG BLACK AMERICANS
Authors: Kahsay Eskira , Mezuk Briana
Published: January 2025

Residential segregation is a well-studied contextual factor with adverse impacts on physical health. However, the neighborhood is both a material and social space. Given hypothesized mechanisms of increased social support and reduced discrimination, racial/ethnic homogeneity may not be necessarily harmful to mental health. Still, little is known about its implications for suicidality among Black Americans, particularly older adults. This study investigated the associations between residential segregation and suicidal behavior using the National Survey of American Life (N = 5,191; mean age: 42.5). Lifetime suicidal behavior (ideation [10.4%] and attempt [3.6%]) were self-reported. The Getis-Ord Gi* statistic was used to measure the spatial segregation of Black residents at the census-tract level (low, medium, high). Weighted mixed-effects models were fit, adjusting for demographics and tract-level poverty and stratified by age group (early [18-29], middle [30-49], older adulthood [50+]). The prevalence of ideation and attempt did not significantly differ across segregation levels. Odds of ideation were not significantly different in high vs low segregation areas though were significantly lower in medium vs low segregation areas (OR = 0.70, 95% CI: 0.49, 0.99). Findings for suicide attempt were non-significant. Among older adults, the odds of attempt were significantly lower for high vs low segregation areas (0.98, 95% CI: 0.97, 0.99) only. No significant findings were found for other age groups, except ideation in medium vs low segregation in early adults (OR = 0.33, 95% CI: 0.15, 0.74). Despite economic disadvantage in racially segregated areas, findings suggest higher segregation is not associated with increased suicidality.
RACIAL DIFFERENCES IN PREDICTORS OF CARDIOMETABOLIC RISK FOR OLDER US WOMEN
Authors: Erving Christy , Davidson-Turner K J , Frazier Cleothia , Coats Jacquelyn
Published: January 2025

Though cardiovascular disease is the leading cause of death among women, significant racial disparities in cardiovascular disease persist. This study investigated psychosocial predictors of cardiometabolic risk (CMR), a count of high-risk cardiovascular and metabolic biomarkers, among older U.S women and whether predictors differed for Black, and Hispanic, and White respondents. Data were from the Health and Retirement Study (HRS; age 50 years+). Predictors including health behaviors, socioeconomic status, psychological factors, and relational demands (with spouse, children, relatives, friends) were drawn from the 2010/2012 waves. CMR, drawn from the 2014/2016 waves, was assessed using six biomarkers: pulse pressure, resting heart rate, C-reactive protein, waist glycosylated hemoglobin A1c, and total and high-density lipoprotein cholesterol. The sample comprised 6707 women (1197 Black, 672 Hispanic, 4838 White). Linear regression analyses were conducted to assess the association between the predictors and CMR in race-stratified models. Preliminary results revealed that predictors of CMR were distinct for different racialized groups. Specifically, for Black women, obesity and former smoking status were associated with increased CMR while working part-time was associated with decreased CMR. Among Hispanic women, having a GED or high school diploma (compared to less than a high school education) was associated with decreased CMR. Among White women, obesity, smoking, depressive symptoms, and having no spouse were associated with increased CMR while higher education, working part-time, and mastery were associated with decreased CMR. Surprisingly, no one factor was a predictor of CMR for all women; moreover, relational demands did not emerge as a significant predictor of CMR.
A LONGITUDINAL ANALYSIS OF EVERYDAY DISCRIMINATION
Authors: Wheaton Felicia
Published: January 2025

Experiences of everyday discrimination are associated with poorer mental and physical health in later life. However, most studies examine discrimination at a single time point. There is a need to better understand how experiences of everyday discrimination change over time, change with age, and differ by cohort. This study examined longitudinal change in everyday discrimination using data from the 2006-2020 waves of the Health and Retirement Study (HRS), a nationally-representative study of Americans 50+ (N=23,523). Frequency of everyday discrimination was summed across 5 items: you are treated with less courtesy or respect than other people, receive poorer service than other people at restaurants or stores, are threatened or harassed, people act as if the think you are not smart, and act as if they are afraid of you (1=never, 6=almost every day). Overall, everyday discrimination discrimination decreased from 2006 until 2016 when it peaked again, then fell through 2020. Average everyday discrimination increased across cohorts, with the oldest cohort (born before 1924) having the lowest average discrimination and the late Baby Boomers (born 1960-1965) experiencing the highest average discrimination. Across waves, as people aged, their discrimination scores decreased. The adjusted linear mixed model confirmed these trends: age was negatively associated with everyday discrimination and younger cohorts reported higher everyday discrimination. These findings indicate that age, period and cohort differences exist in experiences of everyday discrimination, and this has important implications for health across the life course.
NAVIGATING REAL-WORLD BARRIERS IN NURSING HOME PRAGMATIC TRIALS
Authors: Snow A Lynn , Snow A Lynn
Published: January 2025

Nursing homes (NHs) are an important setting for the use of pragmatic clinical trial (PCT) approaches, particularly due to the challenging implementation environments since the COVID-19 pandemic. NHs have well documented, long-standing quality challenges, staffing shortages, and substantial time gaps between the development of new evidence and innovations and their wide-spread industry adoption. Thus, NHs are an opportune setting for the development of pragmatic methods to accelerate the adoption of efficacious interventions into practice. In this symposium we explore successful approaches used in current NH PCTs to address five common challenges: organizational partnerships, intervention adaptation, use of technology in PCTs, pragmatic measurement of outcomes, and evaluating intervention-related staff competencies. We will explore each topic through an example from one or two recent NH PCTs, sharing challenges and successes. The discussant and panel will then examine the topics across all four represented PCTs and consider applications to future PCTs.
PATIENT-CENTERED OUTCOME MEASUREMENT IN NURSING HOME-BASED PRAGMATIC TRIALS: CAPTURING WHAT COUNTS
Authors: McCreedy Ellen , Sisti Anthony , Gutman Roee , Baier Rosa , Reddy Ann , Mor Vincent
Published: January 2025

Embedded pragmatic randomized controlled trials (ePCTs) rely on routinely collected data to evaluate study outcomes. Using data from Music & MEmory: A Pragmatic TRial for Nursing Home Residents With ALzheimer’s Disease (METRIcAL), we highlight the strengths and weaknesses of using routinely collected data to evaluate agitated behaviors in nursing home (NH) residents with dementia. We conducted two National Institute on Aging-funded ePCTs, one enrolled 976 residents (483 treatment, 493 control) from 54 NHs between June, 2019 and March, 2020, and the other enrolled 850 residents (431 Treatment, 419 control) from 54 NHs between May, 2021 and September, 2022. In both trials, there was no effect of the intervention on agitated behaviors, as measured by the Minimum Data Set (MDS), a routinely collected, pragmatic source of data in NHs. The intervention also did not affect behaviors as reported by staff using the Cohen-Mansfield Agitation Inventory (CMAI). However, we found a reduction in the frequency of nonaggressive agitated behaviors in response to the personalized music intervention, using the Agitation Behavior Mapping Instrument to conduct structured observations of residents, at standardized times of day, in treatment and control NHs. A personalized music intervention for NH residents with dementia reduced nonaggressive agitation, but these changes were not captured in the routinely collected administrative data (MDS) or by interviewing staff using the CMAI. Temporary reprieve from agitated behaviors may improve the quality of life for persons living with dementia, but these effects are not captured using pragmatic data or tools that rely on staff recall.
SYSTEMATIC EVALUATION OF ADAPTATIONS AND FIDELITY IN PRAGMATIC NURSING HOME CLINICAL TRIALS
Authors: Hilgeman Michelle , Madrigal Caroline , Curyto Kimberly , Ott Corilyn , Geisser Sophia , Hartmann Christine , Snow A Lynn
Published: January 2025

Adaptation of interventions to local contexts is often required for sustainable implementation. Yet maintaining and measuring fidelity to an intervention’s core components is necessary during pragmatic clinical trials. We systematically addressed this inherent tension across two studies of Montessori approaches for person-centered care in Department of Veterans Affairs (VA) nursing homes. We first conducted a 3-phase pre-implementation study (2018-2021) to adapt Montessori for VA with input from operations partners, frontline clinical teams, long-term care residents, implementation scientists, and intervention developers. We used the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) to track changes in real-time using qualitative and quantitative data at eight VAs. Primary motivators for adaptation were expanding reach of the intervention and engagement with staff training/delivery. Next, the adapted Montessori intervention was tested in a pragmatic, randomized stepped-wedge clinical trial at eight additional VAs (2021-2023). Diverse frontline staff (e.g., nursing assistants, nurses, therapists) delivered the intervention to all residents. Low burden methods were used to gather reach, implementation, and fidelity data over 12-months (i.e., 15-minute weekly neighborhood check-ins, individual staff surveys, organizational-level fidelity tools completed by the clinical team). Adherence to and delivery of the intervention remained high at most sites over time across all measures. Evidence of fidelity and sustained use across sites in the trial may be attributed to the fit of the adapted Montessori intervention with the needs, resources, and clinical priorities of VA long-term care residents and staff.
PILOT FEASIBILITY STUDY OF EMR-BASED IDENTIFICATION OF PSYCHOLOGICAL DISTRESS AROUND RECENT DEMENTIA DIAGNOSES
Authors: Bannon Sarah , Divecha Ayushi , Dams-O’Connor Kristen , Federman Alex
Published: January 2025

ADRDs have a significant impact on individuals, families, and systems. Though technological advances have enabled earlier diagnoses, early psychological distress experienced around the time diagnosis is largely overlooked. Psychological distress is an important early intervention target given its pronounced negative impact on ADRD adjustment. Interventions are limited by our insufficient understanding of psychological distress experienced around the time of ADRD diagnoses. Our primary objective was to investigate the feasibility of identifying EMR-based psychological distress in a diverse sample of individuals with recent ADRD diagnoses. We conducted secondary data analysis of EMR records obtained from the Mount Sinai Data Warehouse (MSDW) and identified N=12249 individuals with recent ADRD diagnoses after age 65. ICD-10 diagnoses of depression and anxiety were identified in (32.73%) and (27.58%) of the sample, respectively. We also examined scores above the standard cut-offs for clinically elevated distress using self-report measures of depression [PHQ-9 (>=10)] and anxiety [GAD-7 (>=10)]. Unfortunately, these measures were assessed in a very small proportion of the sample at the visit of dementia diagnosis. Out of 509 (4.1%) individuals with self-report measures available, 113 (22%) indicated clinically elevated distress.. Structured data elements can be used to identify distress in the context of dementia diagnosis, though they are limited in their administration and may only offer the potential to identify distress in a subset of individuals. Our findings emphasize the importance of further exploration of unstructured data elements to identify distress.
USING SUPERVISED MACHINE LEARNING METHODS TO IDENTIFY INDIVIDUALS AT RISK OF DEMENTIA
Authors: Divecha Ayushi , Bannon Sarah , Dams-O’Connor Kristen
Published: January 2025

There has been an increased interest in AI and machine learning based models in early detection and diagnosis of Alzheimer’s disease (AD) and Alzheimer’s disease related dementia (ADRD). However, there is a need for feasible tools to identify individuals at risk of AD/ADRD using machine learning methods that can be validated. Early identification of risk of AD/ADRD can be valuable for building a monitoring system and planning of care. The aim of the study is to identify individuals at risk of developing dementia at baseline visit using machine learning models. Clinical and cognitive data from 5 of the largest NIH-funded studies of aging across the US (ACT, ROS, MAP, MARS, FHS) will be used to predict all-cause dementia in cognitively normal individuals at baseline using random forest models with competing risk of death. Cognitive elements like executive functioning, language, memory, visuospatial ability will be included. Since cognitive function was assessed using different measures across cohorts (MMSE and CASI), co-calibrated cognitive factor scores will be used in the trained models to allow for direct comparison of cognition across cohorts and joint analyses. We examined 3 out of 5 cohorts. From ROS/MAP/MARS cohorts, 2235 individuals qualified for the study and had a mean follow-up of 8.6 ± 5.3 years. AOC will be used to assess sensitivity and specificity of the trained models (75% training set, 25% testing set) with each of the 5 cohorts. The models will also identify features important in predicting dementia.