bluuebunny/crossref_metadata_2025 huggingface dataset:
GENDER AND RACE AS MODERATORS BETWEEN ACTIGRAPHY SLEEP AND INFLAMMATORY MARKERS
Authors: Shen Yuqi , Ji Linying , Kessler Claudette , Engeland Christopher , Buxton Orfeu , Zonderman Alan , Evans Michele , Gamaldo Alyssa
Published: January 2025

This cross-sectional study investigated gender and race differences in the association between actigraphic sleep (mean levels and variability) and inflammatory markers (circulating interleukin [IL]-6, IL-10, tumor necrosis factor [TNF]-𝛼 and C-reactive protein [CRP]). The study included participants from the HANDLSleep study (n=99; 74% female, 54% Black adults; age range: 46-82). Within-person mean and standard deviation (iSD) of sleep were estimated using one week of wrist actigraphy (mean ± SD = 6.8 ± 0.5 day), including nighttime sleep time, 24-hr sleep time, wake after sleep onset, nighttime sleep midpoint (Timing), and sleep maintenance efficiency. Linear regression models were conducted including interaction terms (race*sleep; or sex*sleep) and covariates (age, WRAT3 literacy scores, poverty status). Results indicated that race significantly moderated the association between variability in sleep maintenance efficiency and circulating IL-6 (interaction term p =.002). Race-stratified analyses revealed that among White adults, greater variability in sleep maintenance efficiency was significantly associated with higher circulating IL-6 (b = 0.10, p =.003). No significant association was found among Black adults. Results also indicated that gender significantly moderated the relationship between mean level 24-hr total sleep time and circulating IL-6 (interaction term p =.001). Stratification analyses revealed that longer mean 24-hr total sleep time was associated with higher levels of IL-6 among men (b = 0.003, p =.008). No significant association was found among women. Consistent with prior studies, the current study observed associations between actigraphic sleep and inflammation primarily among White adults and among men.
POORER SLEEP HEALTH MAY INCREASE THE RISK OF DEVELOPING PHYSICAL FRAILTY, PARTICULARLY AMONG WOMEN
Authors: Thalil Muhammad , Lee Soomi , Almeida David
Published: January 2025

Longitudinal evidence on the association between sleep and physical frailty is limited, especially using a multidimensional measure of sleep health. In this study, we examined the prospective association between sleep health and physical frailty among U.S. older adults. We also examined how this association differs by age, sex and race. We used data from the National Health and Aging Trends Study (NHATS), with a sample of 929 older adults (65+) who completed a sleep module during 2013 and 2014. Self-reported items on the SATED model (i.e., satisfaction, daytime alertness, timing, efficiency, and duration) were used to create a sleep health composite and Fried’s frailty phenotype was used to assess frailty. Multiple multinomial logistic regression models adjusted for baseline frailty status, socio-demographics, and health correlates revealed that having poorer sleep health increased the risk of onset of frailty at follow-up (RR = 1.30, 95% CI: 1.02–1.64). Among specific sleep health dimensions, lack of daytime alertness and short (< 6 hours) or long (≥ 9 hours) sleep duration were significantly associated with frailty, however, poor sleep satisfaction, timing and efficiency were not significantly associated with frailty. Stratified analyses revealed that the association between sleep health and frailty was significant among women, those aged <80 years, and non-Hispanic Whites after adjusting for socio-demographics, but only significant among women (RR = 1.44, 95% CI: 1.04–1.98) after adding health correlates. Findings suggest that having poorer sleep health across multiple dimensions is associated with increased risk of frailty among older adults, especially among women.
EFFECTS AND DIRECTIONALITY OF A HANDICRAFT INTERVENTION ON HAND FUNCTION AND HIGH-LEVEL COGNITION IN OLDER ADULTS
Authors: Kobayashi-Cuya Kimi , Ogawa Susumu , Iizuka Ai , Takahashi Tomoya , Suzuki Hiroyuki
Published: January 2025

A longitudinal bidirectional association of hand dexterity with executive function and processing speed in high-functioning older adults has been reported, suggesting that community-level intervention programs using activities that demand dexterous abilities may help prevent the decline in these cognitive functions. Therefore, the present single-blind crossover randomized controlled trial examined the intervention effects of a 12-week manual dexterity program in community-dwelling older adults on hand sensorimotor and high-level cognitive functions, and assessed the direction of their associations. Fifty-three participants (mean age±SD, 75.2±5.6, 83% female) were randomly assigned to the intervention (handicrafts and creative cooking) or active control period (lectures on health maintenance). The primary outcome was hand dexterity, and the secondary outcomes were handgrip strength and hand sensation for hand function, and for high-level cognition, executive function, which was assessed with the trail making test (TMT)B, ∆TMT (TMTA-B) and the letter and category fluency tests (LFT and CFT, respectively), and processing speed, evaluated with TMTA and digit symbol. Linear mixed-effects models, testing for carry-over effects, showed intervention effects in hand dexterity (p< 0.05) and executive function (TMTB, ∆TMT and LFT, p< 0.05), whereas no effects were found for handgrip, hand sensation, nor processing speed. Also, cross-lagged panel models, adjusting for potential confounders, further revealed moderate and significant associations between baseline hand dexterity and subsequent increase in TMTB, LFT (p< 0.001) and ∆TMT (p< 0.05). Our results indicate that the implementation of a short-term manual dexterity program may contribute to the prevention of decline in executive function in community-dwelling older adults.
GUARDING AGAINST HARM: UNDERSTANDING AND ADDRESSING ELDER MISTREATMENT RISKS IN THE PARKINSON’S POPULATION
Authors: Smiley Adrianne
Published: January 2025

Parkinson’s disease (PD), particularly in moderate-to-advanced stages, poses significant challenges, including cognitive and physiological decline, leading to reduced independence in daily activities. Functional dependence—to any degree—is a primary predictor of mistreatment. Despite the recognized predictors of elder mistreatment risks associated with functional impairment, the understanding of its impact within the PD community remains limited. PD research often focuses on physiological changes and pharmacological and rehabilitative interventions; however, the risks for mistreatment are often unaddressed. As such, this project centers on advancing and disseminating knowledge about abuse and mistreatment within the PD population. An evidence-based, community-engaged, participatory action research approach with collaborative analysis methodology was employed with a primary focus on PD-specific organizational partnership, intra-organizational structural and procedural analysis, interdisciplinary collaboration, and relationship-building for reflection on themes, patterns, gaps, and needs for improving patient safety resources as a primary prevention method for reducing risks for mistreatment in the PD community. Outcomes: This action-based approach resulted in 1) the development of a survey instrument to gauge knowledge gaps about mistreatment in the PD community and inform the development of educational offerings for healthcare recipients, caregivers, and licensed medical providers, 2) the development of a patient safety research staffer responsible for analyzing reports submitted to the organization’s helpline to assess the prevalence of mistreatment risks according to self or caregiver reported data, and 3) establishment of a research agenda and population-centered plan for advancing knowledge about PD and elder mistreatment risks for harm prevention.
THE STEP-HI STUDY: IMPACT OF TESTOSTERONE AND RESISTANCE EXERCISE ON SPPB, LEG STRENGTH, AND APPENDICULAR LEAN MASS
Authors: Volpi Elena , Kiel Douglas , Paluch Rocco , Dore Peter , Fortinsky Richard , Kuchel George , Orwig Denise , Binder Ellen
Published: January 2025

The STEP-HI Study tested if testosterone replacement therapy in combination with resistance exercise training for 6 months could improve functional recovery from hip fracture in older women more than resistance exercise alone or standard of care. Here we present the results of the intention to treat analyses (N=122) of the effect of testosterone replacement plus exercise (EX+T, n=53) vs. exercise plus placebo (EX+P, n=51) vs. enhanced usual care (EUC, n=18) on the Short Physical Performance Battery (SPPB) scores, maximal leg press strength, and appendicular lean mass. Group differences were analyzed with contrasts using a mixed model repeated analysis of variance that included the following covariates for each outcome: clinical site, age, days since hip surgery, BMI, hip fracture type, general depression score, lung disease, comorbidity index and baseline level. EX+T had a greater improvement in SPPB score than EX+P (p<0.009). Maximal leg press strength increased in all groups by the end of the intervention period with no differences between groups (p>0.05). Appendicular lean mass increased to the same extent in the EX+T and EX+P groups, but slightly decreased in the EUC group as compared to EX+T (p=0.020) and EX+P (p=0.029). These findings suggest that testosterone may independently impact a composite measure of physical performance, while exercise significantly improves appendicular lean mass independent of testosterone replacement. The implications of these findings will be discussed.
DELIVERING HIGH-INTENSITY STRENGTH TRAINING AND MAINTAINING INTERVENTION FIDELITY: THE STEP-HI STUDY
Authors: Rauzi Michelle , Tran Melissa , Monroe Kelly , Stevens-Lapsley Jennifer
Published: January 2025

Hip fractures in women can result in significant functional decline. The STEP-HI study evaluated the effect of testosterone therapy versus placebo combined with supervised exercise training on functional recovery following hip fracture. Maximizing internal validity was essential to maintain rigor of this study. Further, knowledge of both the intervention protocol and the fidelity process are essential to understand threats to internal validity, identify barriers to the protocol, and implement appropriate solutions. Our purpose is to provide an overview of the supervised exercise training intervention and discuss the advantages of and barriers to a remote intervention fidelity monitoring process. Twenty-eight exercise interventionists (EI) across 8 sites delivered the supervised exercise training protocol. EI training was included during the initial step of a 3-step fidelity process: Step 1 Training Certification, Step 2 Initial Fidelity, and Step 3 Ongoing Fidelity. The fidelity process was managed from one site that assessed intervention fidelity through videos submitted approximately every 6 months by each site. Supervising physical therapists oversaw fidelity at their respective site and completed in-person fidelity assessments once per month. The primary advantage of this process was cost savings that occurred because there were no site visits with associated travel costs. A significant barrier was technological challenges related to recording and uploading videos to a secure file-sharing website. Across all sites, 140 fidelity assessments were completed; the mean (SD) score was 96.3% (3.4%) indicating excellent intervention fidelity. Our procedures and lessons learned will guide planning for future clinical trials of complex interventions.
HIGH SCHOOL CURRICULUM AND COGNITIVE FUNCTION IN THE EIGHTH DECADE OF LIFE
Authors: Moorman Sara , Khani Saber
Published: January 2025

Formal educational attainment, or years of schooling, has a well-established positive effect on cognitive health across the life course. If educators and policymakers could imbue education with even more of the vital ingredients for sustained cognitive health, then rates of cognitive impairment might continue to decline in the population as cohorts age. We hypothesized that the content and difficulty of the curriculum in high school lead to higher levels of socioeconomic attainment in adulthood and, in turn, to better cognitive outcomes in older adulthood. We estimated multilevel structural equation models (MSEMs) in data from 2,405 individuals who attended one of 1,312 U.S. high schools in 1960 and participated in the Project Talent Aging Study in 2018. Curricular difficulty (i.e., college preparatory track) and content (i.e., a greater number of semesters of math and science) in high school were positively related to cognitive function (i.e., word recall and verbal fluency) at average age 75. Effects were robust to controlling for adolescent cognitive ability, academic performance, socioeconomic background, and school characteristics. Overall educational attainment significantly mediated the association: High school curricular content and difficulty were associated with higher degree attainment, which was associated with better cognitive function in later life. We discuss implications of these findings for educational policy, where the results suggest that interventions into the content and difficulty of the high school curriculum could potentially reap cognitive benefits decades later.
UNDERSTANDING THE ROLE OF EDUCATION IN COGNITIVE FUNCTIONING AMONG OLDER BRAZILIANS
Authors: Farina Mateo
Published: January 2025

Education has been linked to cognitive functioning in older adulthood across time and place. However, how education is linked to later life cognitive functioning may differ across country contexts. The role of education has been widely debated with evidence for both direct and indirect pathways (i.e. occupation, health behaviors, etc.). However, much of the research has been limited in low- and middle-income countries that, in general, have lower levels of education and greater levels of social inequity. As one of the fastest-aging countries that has seen substantial improvements in education levels over the last 60 years but with significant social inequality, Brazil provides a prime example to understand how education as an exposure or the sequelae of pathways from education may impact cognitive health in older adulthood. This study uses nationally representative data from the ELSI-Brazil Study (50+) to examine the association of education with older adult cognitive functioning (global and domain-specific). I used a series of linear regression models to assess the sensitivity of the association of education with cognitive functioning after adjustments for health behaviors, health conditions, and wealth. I found that education was positively associated with cognitive functioning; for the total population, it remained relatively unchanged with downstream adulthood factors. Nevertheless, among those with more than 8 years of education, differences were attenuated by downstream factors. This suggests that education as an exposure may drive future trends in cognitive health in countries with low levels of overall education.
TESTING A CONTEXT-ENRICHED MODEL OF SUCCESSFUL AGING IN MULTIPLE REPRESENTATIVE SAMPLES OF VERY OLD ADULTS
Authors: Kaspar Roman , Wahl Hans-Werner
Published: January 2025

Objectively measurable outcomes of successful aging (SA) as used in Rowe and Kahn’s model of SA always operate in multiple contexts that may or may not be perceived as providing opportunity structures for aging well. Context may become most critical in advanced old age. We posit that so far, no empirical test of a contextually enriched model of SA in advanced old age exists. We use multiple representative survey samples of very old individuals, i.e., the D80+ study (study 1; N = 3.233) and the NRW80+ study (study 2; N [baseline] = 1.863; N [wave 2, new independent sample] = 950; N [2-year panel sample] = 912). Study protocols were highly similar across studies and included a multidimensional self-report- based assessment of perceived aging context. Whereas rates of SA according to Rowe and Kahn decreased from 9.1% in those 80-84 years to 0.7% in those 90 years or older, rates for those with many contextually driven opportunity structures at their disposal even if not fulfilling Rowe and Kahn’s criteria were much higher and decreased less steeply from 54.9% (80-84 years) to 44.4% (90 years and older). Also, greater stability of SA across 2 years was observed in supportive contexts. Decontextualizing SA may result in misleadingly low rates of SA in very old adults. Our findings underline the demand to go beyond SA as a process/outcome only at the individual level and aim future policies for aging well much more at strengthening opportunity structures.
SELF-PERCEPTIONS OF AGING MEDIATE THE ASSOCIATIONS OF CHANGE IN DEPRESSION WITH LIFE SATISFACTION AND DISABILITY
Authors: Sabatini Serena
Published: January 2025

Self-perceptions of ageing (SPAs) significantly influence individuals’ health trajectories and satisfaction with life. This study explores (1) the associations between 14-year change in depressive symptoms as predictor of follow-up scores on SPAs, satisfaction with life, and informant-rated disability and (2) whether SPAs mediate the associations of 14-year change in depressive symptoms with follow-up scores on satisfaction with life and informant-rated disability. Participants were 174 older adults (Mean age= 87.41; SD= 3.67; 60% women) from the Sydney Memory and Ageing Study (MAS) with complete wave 7 (14-year follow-up) data. Measures used were the Geriatric Depression Scale (GDS); the informant-rated World Health Organisation Disability Assessment Schedule (WHODAS); the Diener Satisfaction with Life Sclae (SwL); and the Laidlaw’ Attitudes to Aging Questionnaire (AAQ) as indicator of SPAs. We calculated a change score for depressive symptoms. Linear regression models and structural equation models were used. After controlling for covariates of age, sex, marital status, occupation, and number of chronic health conditions, greater 14-year increase in depressive symptoms predicted more negative scores on SPAs (Standardised beta, β = 0.41; p<.001), lower SwL (β = 0.30; p<.001), and greater informant-rated disability (β = 0.26; p=.001). Participants’ scores on SPAs partially mediated the association of 14-year change in depressive symptoms as predictors of follow-up scores on satisfaction with life and informant-rated disability. Negative SPAs may be one of the reasons why increased depressive symptoms in old and very old age can be related to lower satisfaction with life and informant-rated disability.
TRAJECTORIES OF LONELINESS IN LATER LIFE: EVIDENCE FROM A 10-YEAR ENGLISH PANEL STUDY
Authors: Gessa Giorgio Di
Published: January 2025

Loneliness is generally defined as the discrepancy between individuals’ desired and actual social interactions and emotional support. Although the prevalence of loneliness is high among older people and is projected to rise, few studies have examined longitudinal patterns of loneliness. Moreover, most studies have focused on more “objective” risk factors for loneliness such as partnership status and frequency of contact, overlooking the quality of the relationship with and support from family and friends. Using data from six waves of the English Longitudinal Study of Ageing (2008/09 to 2018/19, N=4740), we used group-based trajectory modelling to identify distinctive trajectories of loneliness. Multinomial regression models were then used to examine characteristics associated with these trajectories, with a particular focus on size, support, closeness, and frequency of contact with social network members. We identified 5 groups of loneliness trajectories in later life, representing “stable low” (40% of the sample), “medium/low” (26%), “stable high” (11%), and “increasing” (14%) or “decreasing” (9%) levels of loneliness over time. Although there are socioeconomic and demographic differences across these trajectories of loneliness, health and relationship quality are their main drivers. Respondents with poor and deteriorating health were more likely to be classified as having “stable high” or “increasing” loneliness. Even if not having social networks is undoubtedly associated with higher risks of persistent loneliness, having friends and family is not enough: Respondents with low-quality relationships with both friends and family were also significantly more likely to be classified as having “stable high” or “increasing” levels of loneliness.
A HOUSING COALITION IN DETROIT MICHIGAN PLANS AHEAD FOR INDIVIDUAL AND COMMUNITY-LEVEL EMERGENCIES
Authors: Perry Tam , Kilgore Zach , Watkins Michele , Sanford Claudia , Price Brenda , Archambault Dennis
Published: January 2025

Since its founding in 2013, Senior Housing Preservation-Detroit has worked tirelessly to address the displacement of older adults, the loss of senior housing as the city gentrifies; and ways to improve quality of life to those living in senior housing. As we turn the corner on the acute phase of the COVID-19 pandemic, the members of Senior Housing Preservation-Detroit are compelled to take stock of the lessons learned from the urgent, emergency context of serving older adults in the city of Detroit, and particularly those living in senior buildings. Whether the next emergency is isolated to a single building (in case of power outages or flooding) or affects many buildings (due to another infectious disease, our changing climate, etc.), we know that preparation must continue to happen on an individual and building level. Building staff and residents alike must be ready to respond to multi-faceted problems, and there must be better plans for serving a diverse senior population. SHP-D has explored ways to reduce risks to seniors in the next emergency, including improving communication, implementing preparedness plans, and enhancing the physical resiliency of buildings. This presentation will focus on the coalition’s work on emergency planning to share knowledge which may benefit other communities planning for older adults in emergencies.
RUNNING PAST 50: THE FORTITUDE OF THE OLDER RUNNER
Authors: Dowd James
Published: January 2025

Considering the low numbers of physically active older Americans (Elgaddal, Kramarow, Reuben, 2022), those over the age of 50 who belie this generalization are of interest for their commitment to fitness. Despite their regret over their loss of running speed, any comparison with their more sedentary age peers would favor the older runner: they are healthier, fitter, and stronger. The question I address in this paper is why the older runner continues to run. Based on a sample of over 60 interviews conducted from July to December of 2023, I found that it is not simply a matter of striving to be healthy, although that is part of their motivation. As important as health are (1) running has been a habit and consequently a foundational part of their identity; and (2) running brings joy and a sense of profound well-being that older runners experience following a race, almost regardless of their performance. When asked about their motivation, runners acknowledge the positive effects of exercise on their health. But as one 72-year-old runner explained “Well, physical health and conditioning is important. But I wouldn’t say. I mean, that’s a benefit. I wouldn’t say that’s why I run.” The remainder of this paper probes more deeply into what might best be described as the fortitude of the older runner. The data confirm that older runners persist both because their running has become a habitual part of their everyday lives and also because their habit is a source of considerable joy for them.
HEARING LOSS AND COGNITIVE DECLINE: EVIDENCE FROM THE LONGITUDINAL STUDY OF ADULT HEALTH (ELSA-BRASIL)
Authors: Goncalves Natalia Gomes , Samelli Alessandra , Lotufo Paulo , Bensenor Isabela , Suemoto Claudia
Published: January 2025

Hearing loss is common in older adults and its prevalence increases with age, being present in 40% of adults aged 50 years or older and increasing to 70% in adults aged 70 years or older. Hearing loss in middle age is one of the main risk factors for dementia, and it is estimated that 7% of dementia cases in Brazil are due to hearing loss. Therefore, this study aimed to study the association between hearing loss and cognitive decline during 8 years of follow-up. Data included participants from the São Paulo center of the Longitudinal Study of Adult Health (ELSA-Brasil), who were evaluated in three study waves (2008-10, 2012-14, and 2017-19). Hearing loss was defined as pure-tone audiometry above 25 dB in either ear. Six tests evaluated cognitive performance in the memory, verbal fluency, and executive function domains. A global cognitive z-score was derived from these tests. The association between hearing loss and cognitive decline was evaluated with linear mixed-effects models adjusted for sociodemographic, lifestyle, and clinical variables. Of 805 participants (mean age 50.6±9.4 years, 52% women, 60% White), 62 had hearing loss. During follow-up, hearing loss was associated with faster global cognitive decline (β=-0.012, 95% CI=-0.023; 0.000, p=0.039). These results suggest that prevention of hearing loss in middle age could contribute to slowing cognitive decline in this population.
OSTEOSARCOPENIA: A GEROSCIENCE APPROACH
Authors: Duque Gustavo
Published: January 2025

In older persons, the combination of osteopenia/osteoporosis and sarcopenia - known as osteosarcopenia - has been proposed as a subset of individuals at higher risk of adverse outcomes. The pathophysiology of osteosarcopenia results from a complex set of interactions between bone, muscle, and fat influenced by genetic, mechanical, and biochemical factors. There is a complex crosstalk system between muscle and bone, in which fat has become a new player. This communication system comprises osteokines, myokines, adipokines and other secreted factors (i.e., extracellular vesicles, exosomes and microRNAs), some of which have positive or negative effects on muscle and/or bone metabolism and function. These effects include alterations in most of the hallmarks of aging, triggered by conditions such as sedentarism, obesity, malnutrition, inflammation, and menopause, which induce tissue loss and dysfunction. In contrast, anabolic factors could be stimulated to prevent muscle and bone loss of mass and function. Therefore, osteosarcopenia is an optimal condition in which geroscience-based approaches could target several hallmarks of aging to have a beneficial dual effect on bone and muscle. This session will discuss the biological characteristics of osteosarcopenia shared by muscle and bone, their relevance in the pathogenesis of the condition, and their potential use as therapeutic targets in osteosarcopenia.
OBESITY AND ACCELERATED AGING
Authors: Villareal Dennis
Published: January 2025

Obesity in the older population has increased in prevalence and incidence over the last several decades and has been associated with a decline in physical function, quality of life, and increased risk of complications from cardiometabolic diseases. Several interrelated hallmarks of aging have been proposed. The pathophysiologic changes that occur with obesity are similar or contribute to those that occur with aging. In fact, the positive energy balance typical of obesity worsens the excess deposition of ectopic fat with aging. Obesity and aging are characterized by chronic low-grade inflammation, which contributes to reduced muscle quality and protein control mechanisms. Obesity causes oxidative stress and inflammation, which can increase telomere shortening. Obesity induces epigenetic alteration, which can accelerate age-related dysfunction. Calorie excess increases formation of reactive oxygen species (ROS), which damages nucleus, endoplasmic reticulum, and mitochondria. DNA damage from ROS upregulates p16 and p21, resulting in chromatic reorganization, cellular senescence, and production of proinflammatory factors (senescence-associated secretory phenotypes [SASP]). Persistent DNA damage associated with inefficient DNA repair with both obesity and aging may be the principal molecular event that underlies accelerated aging. Both obesity and aging deregulate cellular mechanisms related to nutrient signaling. Caloric restriction in combination with exercise slows biologic aging by protecting against the molecular and cellular damages that occur in obesity and aging.
UNDERSTANDING SOCIAL ISOLATION AMONG MEXICAN AMERICAN ALZHEIMER’S CAREGIVERS: ROLE OF TECHNOLOGY
Authors: Jiang Lin
Published: January 2025

The projected increase in Latinos affected by Alzheimer’s disease and related dementia (ADRD) to 1.3 million by 2050 underscores the importance of understanding the experiences of Mexican American family caregivers. Despite recognized benefits of information communication technology (ICT) for caregivers, current research predominantly focuses on White American caregivers, leaving a gap in understanding the unique challenges faced by Mexican American caregivers. This study addresses this gap by conducting semi-structured, in-depth interviews with 24 Mexican American family caregivers of ADRD patients along the South Texas and Mexico Border. Participants were recruited through various channels, and Zoom interviews were conducted from January to Fall 2023, followed by thematic analysis. Participants ranged in age from 24 to 73, with an average of a college degree. Fourteen identified as Catholic, while seven identified as Christian. The average caregiving duration ranges from 1 to 13 years. Key findings reveal distinct experiences of social isolation and loneliness, aggravated by a lack of understanding from family members, with ICT playing a significant role in reducing social isolation, particularly during the COVID-19 pandemic. Additionally, religion emerged as a vital coping mechanism, alleviating social isolation and loneliness through online activities. The study highlights disparities in social isolation and emphasizes the potential of technology in addressing these challenges among Mexican American family caregivers of ADRD patients. Recognizing their unique obstacles and leveraging technology can inform interventions to enhance well-being and support. Future research should prioritize culturally sensitive ICT interventions to improve the quality of life for both caregivers and patients.
NIA DIVISION OF GERIATRICS AND CLINICAL GERONTOLOGY
Authors: Eldadah Basil
Published: January 2025

Dr. Eldadah will discuss research priorities of the NIA Division of Geriatrics and Clinical Gerontology. Dr. Eldadah will also be available for small group discussion.
DEVELOPMENT AND OPTIMIZATION OF MECHANISTICALLY SOUND DEMENTIA CARE INTERVENTIONS
Authors: Vranceanu Ana-Maria , Cornelius Talea , Rice Elise
Published: January 2025

Optimizing care for persons living with dementia (PLWD) and their caregivers (CGs) is an urgent priority. A recent AHRQ report highlights the poor quality of existent dementia interventions emphasizing the need to develop methodologically sound interventions that test theory-based mechanisms hypothesized to underlie intervention effects. This symposium will describe methodology and applications of the NIH Stage Model and the Science Of Behavior Change (SOBC) experimental medicine approach and how they inform interventions for PLWD and their CGs. Dr. Cornelius will introduce SOBC and discuss complexities of specifying conceptual models, measuring mechanisms, and study methodology in a dyadic context. Dr. Vranceanu will introduce the NIH stage model and discuss the development and refinement of the Mindfulness and Self-Compassionate Care Program for stressed CGs of PLWD who endorse behavioral symptoms (NIH Stage 1A), showcasing mechanism and measure selection, feasibility testing, and first test of mechanistic target engagement. Dr. Mroz will describe a Stage 0 Appreciative Inquiry approach, in partnership with PLWD (mild-moderate), to define promising pathways for measuring and intervening to bolster purpose in the wake of a dementia diagnosis. Dr. Plys will present feasibility, mechanism engagement, and clinical outcome results of an NIH Stage 1B trial comparing a mindfulness mobile app to a podcast control for stressed CGs of PLWD. Dr. Berridge will describe an intervention’s non-linear pathway to Stage 1B mechanistic research to support empowered shared decision making about technology use for dementia care. The discussant, Dr. Rice will contextualize these findings within the larger literature and NIA funding opportunities.
BOLSTERING SENSE OF PURPOSE FOR INDIVIDUALS LIVING WITH EARLY DEMENTIA: AN APPRECIATIVE INQUIRY APPROACH
Authors: Mroz Emily , Monin Joan , Keefe Kate , DeFrancesco Erica , Gil Heidi
Published: January 2025

Maintenance of a sense of purpose is a hallmark of wellbeing. Individuals consistently report a diminished sense of purpose in the wake of a diagnosis of Alzheimer’s disease or related dementias (ADRD). One recently-proposed hypothesis (Sutin et al., 2023) is that this trend is a consequence of early, ADRD-related neurodegeneration, implying that adults living with early ADRD may be less cognitively able to pursue purpose. In contrast, our team hypothesizes that these declines are the result of a lack of evidence-based practices in clinical and community settings focused on bolstering purpose following this life-changing diagnosis. Our team pursued Stage 0 research given the lack of existing interventions. In partnership with people (N = 17) living with mild-moderate ADRD recruited from the Empowering Partnership Network, we completed a Design Thinking workshop using an Appreciative Inquiry method (Stowell, 2013). Workshop insights were recorded, and the first author completed qualitative thick descriptions to synthesize insights. Findings establish that, with the availability of support, adults with mild-moderate ADRD can generate meaningful purposes. Findings also described how the ADRD diagnosis journey can undermine purpose and suggest opportunities for multicomponent, community-based interventions to bolster purpose following diagnosis. This presentation will end with recommendations for partnering with people living with ADRD and applying the Appreciative Inquiry method at Stage 0. We will also discuss how our findings help to re-define living well with purpose and ADRD, and to refine the Healthy Lifestyle Course, a novel community-based resource that shows promise for bolstering purpose in this population.
LET’S TALK TECH: NAVIGATING TECHNOLOGY USE DECISIONS AND AN INDIRECT ROUTE TO MECHANISTIC RESEARCH
Authors: Berridge Clara
Published: January 2025

Grounded in the Theory of Dyadic Illness Management, Let’s Talk Tech is the first tool to support informed, shared decision making about a range of technologies commonly used in dementia care. This presentation will describe the non-linear pathway taken to incorporate SOBC to examine the mechanisms and outcomes of Let’s Talk Tech. In a Stage 1A pilot with people living with mild Alzheimer’s disease (AD) and care partners, 88% of recruited dyads (n=29 dyads) completed 100% of the self-administered intervention delivered as a web-application. This pilot established promising preliminary feasibility and efficacy on post-test outcomes, with statistically significant improvements in care partner preparedness to make decisions about technology use, knowledge of the person living with AD’s preferences, alignment, mutual understanding, and understanding of each featured technology category, as well as improvements for two categories for people living with AD. Strong interview themes clarified person-centered outcomes and surfaced additional potential mechanisms of change. By completing the intervention, all dyads developed a documented summary of the person living with AD’s choices, available for future reference and updating. Participants wanted to share these choices beyond the dyads to prevent familial conflict and obtain technology use support from their broader care networks. A Stage 1A study through the Penn AITC enabled enhancements responsive to this feedback, including electronic person-directed sharing of the documented choices using FHIR and the SMART Health Links protocol. A current Stage1B study is powered to evaluate the impact of LTT on an expanded set of hypothesized mechanisms and outcomes.
ACTIVITY DIVERSITY ASSOCIATED WITH INCOME LEVEL AMONG US ADULTS BUT LESS SO FOR RACIAL/ETHNIC MINORITIES
Authors: Santos-Lozada Alexis , Lee Soomi
Published: January 2025

Active lifestyle is a key to healthy aging. Emerging research has shown that individuals with greater activity diversity are happier and healthier. Activity diversity, defined as the breadth and evenness of activity engagement across different types, may also allow opportunities to build human capital. This study examined whether activity diversity is associated with family income and its interaction with race/ethnicity. Data come from adults (n=115,771; Mage=45.62; 51% female; 37% racial/ethnic minorities) who participated in the American Time Use Survey between 2011 and 2022, excluding for 2020 due to the COVID-19 pandemic. An activity diversity index was calculated as conceptualized by Blau, using responses to a time-use questionnaire that covered all activities in which the respondent participated during the previous day. Generalized linear models revealed higher income to be associated with higher activity diversity. Further, there were differences in family income and activity diversity by race/ethnicity. Compared to non-Hispanic whites, racial/ethnic minorities reported earning less and engaging in less diverse activities. Moreover, the association between activity diversity and family income was moderated by race/ethnicity, such that higher family income was not as predictive of activity diversity among racial/ethnic minorities as it was among non-Hispanic Whites. Findings suggest that activity diversity may not only indicate one’s lifestyle, but also relate to one’s resources and capacity to explore new things in their life. Less resources available for racial/ethnic minorities may limit their opportunity to engage in diverse activities thought to improve human capital.
FINANCIAL HARDSHIP IS ASSOCIATED WITH REPEATED STRESSORS AS MEASURED BY STRESSOR DIVERSITY
Authors: Surachman Agus
Published: January 2025

Financial hardship supplements traditional measures of socioeconomic status (i.e., education, income) to elucidate how the insufficiency of socioeconomic resources is experienced. Financial hardship may impact health by differentiating exposure to stressors in daily life. This study examined how three domains of financial hardship (i.e., material, behavioral, and psychological) relate to daily stressor concentration (e.g., experiencing many stressors that are all arguments versus fewer stressors spread across arguments, work stress, home overloads). Higher stressor concentration has been associated with poorer health and well-being across adulthood. The present analyses used data from the Midlife in the United States study wave 3 (2016-2020), in which 1,024 participants (ages = 43-90, 57% female) completed 8-day daily diary interviews. Measures of financial hardship include material indicators of poverty, healthcare, and financial aid; psychological perceptions of financial situation; and behaviors including payments, earnings, and spending. Daily stressor concentration was calculated using 1- the Gini diversity index. In a regression model accounting for age, sex, daily stressor exposure, and education, a higher total score of financial hardship was associated with higher stressor concentration (b = 0.07, SE = 0.03, p <.01). This result replicated across material (b = 0.26, SE = 0.09, p <.01) and psychological domains (b = 0.11, SE = 0.04, p <.01) of financial hardship, and the findings were exacerbated with older age (ps <.05). Experiencing repeated stressors in specific domains may be a mechanism by which insufficient economic resources can worsen health outcomes for adults as they age.
EAST MEETS WEST : APPLICATION OF AI TO SUPPORT HEALTHY AGING AND EFFECTIVE CARE IN DIVERSE CULTURES
Authors: Sun Fei , Guo Guifang , Ding Yong
Published: January 2025

This East Meets West symposium showcases five studies focused on the utilization of Artificial Intelligence (AI) in fostering healthy aging and effective care for older adults in the U.S.A. and mainland China. The first study delves into older Chinese adults’ preferences for assistive robots, highlighting their need for safety, physical functioning, and emotional support, alongside concerns regarding cost and user-friendliness. The second study introduces an innovative approach by integrating assistive robots with reminiscence music therapy to aid stroke recovery, showing promising outcomes in enhancing self-efficacy, daily living activities, positive emotions, and upper limb functionality. The subsequent three studies explore the feasibility, usefulness, and efficacy of AI-based technologies in interpreting medical records, monitoring disease progression, and providing customized health information to family caregivers. The study from the U.S. reveals that lab results interpretation generated by ChatGPT-4 demonstrated higher accuracy, relevance, and helpfulness. Similarly, the research from China is pioneering modules for early detection and comprehensive monitoring of neurodegenerative disease progression. Despite encouraging evidence, the final study points out the limitations in using GPT-3.5 Turbo for health information classification (with a focus on daily care category) into three levels with the accuracy rate falling short of expectations. In summary, these studies offer promising evidence of the benefits of AI-based innovations in promoting healthy aging and supporting caregivers in the U.S.A and mainland China. They also underline the existing limitations and adopting a person-centered approach to cater to the specific needs of older adults. After individual presentations, a discussant will provide critical feedback.
USING A LARGE LANGUAGE MODEL TO CLASSIFY DEMENTIA CAREGIVERS’ HEALTH INFORMATION WANTS
Authors: Li Zhuochun , Luo Zhimeng , Zou Ning , He Daqing , Xie Bo , Hilsabeck Robin , Aguirre Alyssa
Published: January 2025

Many caregivers of persons living with dementia use social media to express dementia care-related health information wants (HIWs), i.e., types of information caregivers seek that can help them manage challenges and concerns. Recent developments in large language models (LLMs) hold promise in automatic classification of HIWs expressed in large quantities of social media posts. As a first step, we evaluated GPT-3.5 Turbo’s performance in classifying 60 social media posts based on our previously developed HIW framework, which includes 7 first-level categories, including daily care. Under daily care, there are 7 second-level categories and a total of 32 third-level subcategories. All 60 posts were previously verified by 3 experienced clinicians as being in the daily care category; 40 posts were in the second-level category of mood and behavior management and 20 in the second-level category of safety; and 20 posts in each of the 3 third-level categories: agitation; memory loss and confusion; and driving safety. We asked GPT-3.5 Turbo to classify the posts on the first level; 14 (23%) were accurately classified to daily care. Next, we asked GPT-3.5 Turbo to classify those 14 posts into one of the second-level categories in daily care; 10 (71%) were accurately classified into mood and behavior management or safety. Finally, we asked GPT-3.5 Turbo to classify the 10 remaining posts into the third-level subcategories. Seven (70%) were accurately classified: agitation 5/5 (100%), driving safety 2/2 (100%) and memory loss and confusion 0/3 (0%). Disappointed by GPT-3.5 Turbo’s performance, we discuss plausible reasons and solutions.
GAIT SPEED MODERATES EFFICACY OF HOME-BASED EXERCISE ON FALLS IN OLDER ADULTS WITH PREVIOUS FALL
Authors: Rice Jordyn , Falck Ryan , Davis Jennifer , Dian Larry , Madden Kenneth , Cook Wendy , Miran-Khan Karim , Liu-Ambrose Teresa
Published: January 2025

Exercise is an evidence-based strategy for preventing falls. However, its efficacy may vary based on individual characteristics, like gait speed. We performed a secondary analysis of a randomized controlled trial, to assess if baseline gait speed moderated the effects of an exercise program on subsequent falls among older adults. Community-dwelling adults >70 years who had fallen within the previous 12 months were randomized to either 12 months of home-based exercise (EX; n=172) or standard of care (SC; n=172). For this study, we examined intervention effects on fall rates at 6 and 12 months stratified by baseline gait speed (slow < 0.80m/s or normal >0.80 m/s) using negative binomial regressions. We also investigated whether baseline gait speed moderated the intervention effects on mobility and cognitive function using linear mixed modeling. At baseline, 134 participants had slow (EX=70; SC=64) and 210 had normal (EX=102; SC=108) gait speed. For participants with slow gait speed, EX reduced fall rates by 44% at 6 months (IRR=0.56; 95% CI:[0.33, 0.95]; p= 0.03) compared with SC; for participants with normal gait speed, there was no significant effect of exercise on fall rates at 6 or 12 months. Gait speed moderated intervention effects; EX participants with slow gait improved: 1) Timed Up-and-Go at 6 months (estimated mean difference= -4.05; 95% CI:[-6.82, -1.27]; p= 0.00); and 2) Digit Symbol Substitution Test at 12 months (estimated mean difference= 2.51; 95% CI:[0.81, 4.21]; p=0.00). Our study suggests older adults with slow gait speed may be a target population for exercise-based falls prevention.
END-OF-LIFE PLANNING IN GERMANY AND SOUTH KOREA: PERCEIVED ENGAGEMENT AND ACTUAL BEHAVIOR
Authors: Kim-Knauss Yaeji , Shin Yumi , Ha Jung-Hwa , Lang Frieder
Published: January 2025

End-of-life planning could manifest differently across cultures, shaped by prevailing social norms. This study examines behaviors associated with perceived engagement in end-of-life planning and explores potential cultural variations. We focus on two distinct cultures, Germany and South Korea, drawing on data from the ‘Ageing as Future’ project’s online survey conducted in 2023 for the German sample (aged 60+, n=708) and data collected between 2023 and 2024 for the Korean sample (aged 60+, n=519). We identify two outcome behaviors of interest: advance care planning (ACP) and discussions with relatives about one’s death, commonly known as formal and informal end-of-life planning, respectively. Logistic regression models revealed that perceiving oneself as actively engaged in end-of-life planning increased the likelihood of completing ACP, a finding consistent across cultures. Additionally, being German, older, female, and having higher education levels were associated with higher odds of ACP completion. Concerning discussions with relatives, on the other hand, perceiving engagement in end-of-life planning increased the likelihood of this informal planning, with a significantly stronger effect observed in the Korean sample compared to the German sample. Being German and having at least one child were also positively associated with engaging in these discussions. These findings suggest a greater reliance on informal discussions about death with relatives in the Korean context. Given the cultural differences and the lower prevalence of end-of-life discussions in Korea compared to Germany, the normalization of such discussions in Korea is needed, but with a culturally tailored approach.