bluuebunny/crossref_metadata_2025 huggingface dataset:
VISION LOSS AND PSYCHOSOCIAL FUNCTIONING: WHAT’S THE CONNECTION?
Authors: Almidani Louay , Miller Rhonda , Varadaraj Varshini , Mihailovic Aleksandra , Ramulu Pradeep
Published: December 2023

This study assessed the associations between vision impairment (VI) and psychological and social function in older adults. We conducted a cross-sectional analysis of the National Health and Aging Trends Study, a nationally representative sample of Medicare beneficiaries aged 65 years and older. VI was measured using categorical and continuous scales. Depression and anxiety symptoms were assessed via the Patient Health Questionnaire for Depression and Anxiety (PHQ-4) questionnaire. Social isolation and severe social isolation were defined based on responses to questions on living arrangement, frequency of communication with others, and participation in activities. Results showed that depressive symptoms, social isolation, and severe social isolation were more prevalent in adults with any objective VI measure compared to those without impairment. In adjusted models, objective vision measures were not associated with higher odds of depression or anxiety symptoms, though both outcomes were strongly associated with self-reported VI (OR: 1.82 [95% CI: 1.27 – 2.60], OR: 1.81 [95% CI: 1.30 – 2.53], respectively). In contrast, worse distance and near acuity (per 0.1 logMAR), and worse contrast sensitivity (per 0.1 logCS units) were associated with higher risk of being severely socially isolated (RRR: 3.79 [95% CI: 1.13 – 12.78], 3.26 [95% CI: 1.16 - 9.17], 2.82 [95% CI: 1.11 – 7.18], respectively), however, no associations were found with self-reported VI. This study demonstrates that worse vision is associated with symptoms of depression, anxiety, and social isolation among older US adults. Approaches are needed to enhance the psychological and social well-being of individuals with VI.
GAIT AUTOMATICITY AND COMMUNITY MOBILITY OF OLDER ADULTS
Authors: Rosso Andrea , Baillargeon Emma , Moored Kyle , Crane Breanna , Carlson Michelle , Huppert Theodore , Brach Jennifer , Rosano Caterina
Published: December 2023

Gait automaticity may decline with age-related impairments in the brain. As subcortical structures supporting gait automaticity decline, the prefrontal cortex (PFC) may provide compensatory function, allowing for maintenance of mobility but with loss of efficiency. Loss of efficiency may reduce ability to navigate complex community environments and restrict community mobility. We assessed the relation between PFC activation during walking in the laboratory with self-reported and objectively measured community mobility in participants aged 65+ (n=42, mean age=76, 60% female) from a randomized trial of a physical activity intervention to improve walking speed. PFC activation was measured by functional near-infrared spectroscopy as change from quiet standing to usual pace walking. Community mobility was measured objectively by 7-day global positioning system recordings of spatial (standard deviation ellipse area (SDEa), maximum distance from home) and temporal (percent time out of home (pTOH)) characteristics. Additionally, step count was recorded from 7-day actigraphy and the Life-Space Assessment (LSA) assessed self-reported mobility. Among participants with complete data at baseline (n=27), higher PFC activation during walking was associated with smaller SDEa (beta=-0.93 (-1.72, -0.15)), less pTOH (beta=-0.45 (-0.78, -0.12)), and lower step count (beta=-346 (-575, -118)) which persisted after adjusting for age, gender, education, or gait speed. PFC activation was not associated with maximum distance or LSA. There were no significant associations at the post-intervention visits (n=39). Greater PFC activation, likely indicating reduced gait automaticity, is related to lower spatial extent, duration, and intensity of community mobility. This association may be mitigated by participation in physical activity interventions.
REDESIGNING HOSPITAL WORKFLOW TO INCLUDE FAMILY CAREGIVERS OF PEOPLE LIVING WITH DEMENTIA
Authors: Still Catherine , Yahr Andrea , Istvanek Kathryn , Strayer Andrea , Werner Nicole , Fields Beth
Published: December 2023

Family caregivers of hospitalized people living with dementia (PLWD) report feeling unprepared to fulfill caregiving tasks post hospitalization. Currently, clinicians lack guidance on how to include caregivers in hospital care. This descriptive study used a systems-engineering approach to identify optimal hospital workflows for caregiver inclusion. We conducted 28 hours of direct observations in a large academic hospital with field notes and audio-recorded three hours of interdisciplinary team debriefing meetings. Data analysis was guided by a work system model to map caregiver inclusion workflows using Lucidchart software and identify system barriers and facilitators to caregiver inclusion within each workflow. Results produced workflows of optimal practices for caregiver inclusion during admission, stay, and discharge. Workflow facilitators included healthcare clinicians’ willingness/ability to answer questions, caregiver advocacy skills, and presence of medical record fields focused on patient/family education. Barriers included inconsistent documentation, under-utilization of hospital common spaces, and using a passive approach to caregiver inclusion. Comparison of current practices to desired workflows for caregiver hospital inclusion can provide clinicians guidance on how to identify, assess, and educate caregivers. Future research should determine workflow acceptability and effectiveness for improving caregiver preparedness.
PATIENT PORTAL MESSAGING IN THE CONTEXT OF DEMENTIA: A FIRST LOOK
Authors: Wec Aleksandra , Nothelle Stephanie , Gleason Kelly , Wolff Jennifer , Amjad Halima
Published: December 2023

Primary care providers (PCPs) play an integral role in diagnosis and early management of dementia. Secure messaging through the patient portal is increasingly being used by patients to communicate with PCPs. Little is known about the nature of concerns raised by patients with dementia and their care partners when messaging PCPs following dementia diagnosis. We conducted a content analysis of 100 message threads initiated by patients and care partners with PCPs at an academic integrated health system during the twelve months following diagnosis of dementia. Message threads ranged in length from two to eleven messages and included 337 unique messages from 79 distinct accounts, sent between 01/03/2020 and 01/20/2022. Of 100 message threads, 89 were sent by care partners and 11 were sent by patients. Threads often focused on medications. Of 36 threads mentioning medications, 12 discussed dementia-specific medications. Other common dementia-specific topics included behavioral and/or cognitive symptoms of dementia (22/100) and sleep disturbance (8/100). Safety concerns related to falls, wandering, or driving were also common (15/100). Care partners raised issues related to their own needs or wellbeing (e.g., caregiving stress, need for caregiver education) (15/100 threads) and messaged to coordinate care between the PCP and other providers (26/100). Findings demonstrate care partners commonly message on behalf of persons with dementia and use the portal to address dementia-related care needs. Identifying issues raised via messaging offers insight into resources and strategies for PCPs to effectively and efficiently address common concerns after dementia diagnosis, including strategies that leverage the patient portal.
EPIGENETIC AGE AND MUSCLE CHARACTERISTICS IN BALTIMORE LONGITUDINAL STUDY OF AGING PARTICIPANTS
Authors: Moore Ann Zenobia , Kuo Pei-Lun , Yang Qi , Landman Bennett , Simonsick Eleanor , Ferrucci Luigi
Published: December 2023

Changes in muscle, including loss of muscle mass and fat infiltration, contribute to loss of muscle strength and subsequent declines in physical function in later life. Measures of body composition are consistently associated with DNA methylation (DNAm) in cross sectional studies. Whether differences in DNAm are informative with respect to longitudinal muscle characteristics has not been fully explored. Here we evaluate the relationship between epigenetic age metrics and computed tomography (CT) derived measures, including areas of muscle, subcutaneous fat, and intermuscular fat, as well as the mean and standard deviation of muscle intensity at mid-femur, in the Baltimore Longitudinal Study of Aging. Participants were at least 50 years old at the evaluation of DNAm (n = 471, 51% female), 61.8% of participants had three or more CT scans and mean follow up time was 6.0 years. Relationships between epigenetic age metrics including Horvath and Hannum DNAm age, PhenoAge, GrimAge and DunedinPACE at the index visit, and the trajectory of muscle composition were evaluated using multivariable mixed effects models adjusted for key demographic characteristics, health behaviors and body size. Epigenetic age metrics at the index visit were negatively correlated with the trajectory of muscle area over follow-up. Higher GrimAge at the index visit was associated with faster loss in muscle area and faster increase in fat areas (p < .05). Our analyses suggest that further exploration of DNAm with trajectories of muscle parameters may elucidate novel pathways of muscle dysfunction.
ANNUAL WELLNESS VISITS (AWV) FOR RESIDENTS IN LOW-INCOME SENIOR HOUSING
Authors: Resnick Barbara , Klinedinst Jennifer , Brandt Nicole , Holmes Sarah
Published: December 2023

Despite the known benefits, less than one-fifth of all eligible Medicare patients receive an Annual Wellness Visit (AWV). Consequently, we brought the AWV to the older residents in low-income senior housing. Across all four communities the residents are invited to receive an AWV during their birthday month via an individual invitation. Invitations are sent to the facility manager who places them in the residents’ mailboxes. As per Medicare requirements, the Annual Wellness Visit includes such things as medical and family history, review of providers and/or suppliers, height, weight, blood pressure monitoring, medication review, evaluations of health behaviors, cognition, immunizations, mood, safety, and health screenings. At the end of the review the resident is provided with a set of health goals for the year and a small token birthday gift from the team. Approximately half of those who were invited each month came to the clinic for their Annual Wellness Visit. None of the residents to date who have had a Welcome to Medicare Visit were aware of the opportunity. Goals have focused on better adherence to health behaviors, particularly medication adherence, diet and physical activity, and updating immunizations. Most reported adherence to appropriate age-related screenings, and monitoring of cardiovascular disease and screening for and assessment of diabetes and hypercholesteremia. Lastly, we have been able to encourage the completion of the Maryland Orders for Life Sustaining Treatment among many of the participants who were previously unaware of this form and/or not willing to address it.
GSA STUDENT CHAPTERS: NEW OPPORTUNITIES FOR US AND INTERNATIONAL HIGHER EDUCATION INSTITUTIONS
Authors: Bouchard Lauren , Gugliucci Marilyn , Harvath Terri
Published: December 2023

The Gerontological Society of America (GSA) Board of Directors approved the formation of a committee to explore the creation of GSA Student Chapters in their December 2020 board meeting. After 13 meetings, a committee wrote a GSA Student Chapter guide outlining policies and procedures for implementation and operation. Next, a GSA Student Chapter pilot project was implemented during the 2022-23 academic year at nine higher education institutions (HEIs) -- eight in the US and one in Portugal. This session will provide the background of (1) how the GSA Student Chapter project began including its design and implementation process, (2) how a pilot GSA Chapter maneuvered bringing together their Sigma Phi Omega Chapter, DreamCatchers, and GSA Student Chapter under a “Gerontology Club” umbrella, (3) how another chapter developed the chapter across multiple campuses, (4) the implementation of a GSA Student Chapter that is housed in a medical school, (5) how a GSA Student Chapter formed in a non-U.S. country, (6) how to connect a student chapter in the U.S. with a chapter that is in another country. A discussant will conclude this session, and there will be time for a question and answer session.
GSA STUDENT CHAPTERS: THE BEGINNING AND HOW TO START A CHAPTER AT YOUR INSTITUTION
Authors: Gugliucci Marilyn
Published: December 2023

The Gerontological Society of America (GSA) Student Chapter pilot project was approved by the GSA Board of Directors in December 2020. A GSA representative committee was identified where all GSA member groups were represented, including the selection of three ESPO members who applied to participate. Within a year, a GSA Student Chapter Handbook was written by the committee and reviewed by a GSA Student Advisory Panel (ESPO members who applied and agreed to serve). With the support of the GSA leadership and staff, nine higher education institutions (HEIs) volunteered to pilot a GSA Student Chapter (eight in the U.S. and one in Portugal) during the 2022-23 academic year. The first part of this session will provide information on how to create, implement, and operate a GSA Student Chapter at your HEI. The second part of this session will focus on health professions programs and integrating GSA Student Chapters with other national chapters. With a strong support system and mentoring system within ESPO, health professions programs may benefit from having student chapters integrate from various national organizations. These may provide advancement in learning skills, attitudes and knowledge, along with an extensive network of fellow students and practitioners to support their pre-clinical and clinical health professions education. This enhancement for Student Chapters, GSA with other organization chapters provides national and possibly international organizational connections/networking that will serve students throughout their careers.
FACTORS ASSOCIATED WITH ELDER MISTREATMENT AMONG PERSONS LIVING WITH DEMENTIA
Authors: Gassoumis Zach , Yonashiro-Cho Jeanine , Avent Elizabeth , Mosqueda Laura
Published: December 2023

Persons living with dementia (PLWD) are at increased risk of experiencing elder mistreatment (EM), including emotional, physical, or sexual abuse, neglect, or financial exploitation. Because PLWD rely on Care Partners (CP) for varying degrees of support with ADLs/IADLs, factors contributing to EM occurrence may be present in the characteristics of the PLWD, CP, and the environment in which they interact. The present study sought to identify associated risk and protective factors of EM in PLWD-CP care groups. As part of a longitudinal study, survey administration interviews were conducted with 163 care groups consisting of a PLWD and their CP(s) (n=184) to gather data on participant characteristics, current and past relationship quality, current caregiving interactions, and EM occurrence. This analysis used baseline data with responses weighted to control for participation of multiple CPs. Bivariate logistic regression was used to model the likelihood of the PLWD experiencing EM. Nearly a quarter of PLWDs (23.9%; n=39) experienced EM, with emotional abuse (19.0%), neglect (7.4%), and financial exploitation (4.3%) occurring most frequently. Preliminary analyses reveal significant bivariate associations between EM and PLWD alcohol/substance abuse (OR=3.244;CI=1.020-10.320) and educational attainment (OR=1.495;CI=1.077-2.075), and CP symptoms of depression (OR=1.170;CI=1.046-1.308) or anxiety (OR=1.194;CI=1.085-1.315), high caregiving burden (OR=1.099;CI=1.042-1.159), expectations of themselves (OR=1.747;CI=1.064-2.867) and the PLWD (OR=1.730;CI=1.113-2.688), and alcohol/substance abuse (OR=2.163;CI=1.080-4.333). These associations provide a foundation for further evaluation of these characteristics as potential longitudinal risk factors for EM, and provide potential targets for the development of prevention and intervention strategies that are tailored to care groups’ characteristics and needs.
PREDICTORS OF WHETHER SELF-NEGLECT IS VALIDATED BY ADULT PROTECTIVE SERVICES CASE MANAGERS
Authors: Tuft Samantha , Ejaz Farida , Reynolds Courtney
Published: December 2023

The most reported allegation of abuse to Adult Protective Service (APS) agencies nationwide is self-neglect (SN). Researchers collaborated with Oklahoma APS to understand characteristics of community-dwelling clients reported to APS for alleged SN, and examine predictors associated with whether cases were validated by APS case managers. Baseline phone interviews were conducted with 188 clients reported to APS for self-neglect during the COVID-19 pandemic. A logistic regression was run to examine the effects of age, gender, income, race, education, cognitive status, ADL impairment, depression, recent nursing home placements, hospitalizations and falls on the likelihood that participants’ allegation of SN was validated. The model was statistically significant, χ2(12) = 26.67, p = .009. It explained 24.1% of the variance in case validation and correctly classified 81.8% of cases. Having a history of being in a short-term nursing home and having a history of falls was significantly associated with the increased likelihood of having a validated SN allegation. However, a history of hospitalization was significantly associated with a reduction in the likelihood of having a validated SN allegation. These preliminary findings suggest that perhaps hospital discharge planners may be assisting SN patients to access home-and-community based services (HCBS) early on to address their SN so it is not validated by APS compared to nursing home discharge planners. Implications for practice include educating APS staff on predictors of SN and collaborating with community-based partners like short-term rehabilitation facilities to address SN issues to reduce the likelihood of having a case validated by APS.
INTERGENERATIONAL RELATIONSHIPS AND HAPPINESS: MEDIATING ROLES OF PSYCHOLOGICAL RESILIENCE AND COVID-19 ANXIETY
Authors: Bai Xue , Zhou Shuai , Lee Chi-Ko
Published: December 2023

The COVID-19 pandemic has largely worsened the well-being of older adults worldwide. Despite recent literature highlighting either social connectedness or psychological responses, whether and how intergenerational relationships influence the emotional well-being of older adults during the pandemic remains unclear. This study aimed to examine the association between intergenerational relationships and happiness among ageing Chinese adults during the pandemic and the mediating roles of psychological resilience and COVID-19 anxiety. A representative survey was conducted from November 2020-January 2021 to collect data from 819 Chinese adults aged 55 or above (52.4% females) in Hong Kong. Path models were used to examine the associations between intergenerational relationships, resilience, COVID-19 anxiety, and happiness. Regression results showed that intergenerational relationship quality was associated with more psychological resilience (b = 0.21, p < 0.001), lower COVID-19 anxiety (b = -0.14, p < 0.001), and a high level of happiness (b = 0.15, p < 0.001). COVID-19 anxiety partially mediated the effects of intergenerational relationship quality on happiness. Moreover, psychological resilience was associated with a higher level of happiness through ameliorated COVID-19 anxiety. This study elucidates that intergenerational relationship quality was positively associated with happiness during the pandemic and the association could be partly explained by enhanced psychological resilience and alleviated COVID-19 anxiety. The findings provide implications that targeted policies and services that strengthen intergenerational solidarity and psychological resilience may be effective in improving emotional well-being in older populations.
THE EFFECT OF INTERVENTIONS TO REDUCE SOCIAL ISOLATION AND LONELINESS AMONG FAMILY CAREGIVERS: A SYSTEMATIC REVIEW
Authors: Kim Boah , Li Lun , Wister Andrew
Published: December 2023

Social isolation and loneliness are among the key risk factors for deleterious health and well-being among family caregivers. Interventions to reduce caregiver isolation and loneliness are of great interest as family caregivers are essential in community care, particularly senior care. The current study aims to review the literature on interventions regarding social isolation and loneliness among family caregivers and summarize successful strategies for reducing isolation and loneliness among family caregivers. A systematic literature review was conducted. Electronic databases were searched, and 1130 peer-reviewed journal articles published in English since 2000 were identified. A total of 34 eligible studies (16 quantitative studies, 8 qualitative studies, and 10 mixed methods studies) were included in this review. Findings from qualitative studies (including qualitative components from mixed methods studies) consistently reveal the positive experience of family caregivers in reducing isolation and loneliness. However, findings from quantitative studies add more layers of complexity with considerable evidence of failing to identify the change of isolation or loneliness after attending interventions. The studied caregiver groups, length of intervention, and scales used to measure isolation and loneliness are closely relevant to the effect of the intervention. Besides peer support, mentoring and skill training, technology (Internet-based programs) plays a significant role in facilitating family caregivers to maintain social interaction and connectedness. This review confirms the pleasant impacts of different interventions in reducing caregiver isolation and loneliness, but also calls for more research in identifying changes of isolation and loneliness both short- and long-term among family caregivers.
“BUILDING A PLANE WHILE IT’S TAKING OFF”: PERSPECTIVES OF HOSPICE PROVIDERS FROM GROUND ZERO OF THE COVID-19 CRISIS IN NYC
Authors: David Daniel , Boafo Jonelle , Kim Patricia , Moreines Laura , Franzosa Emily , Schulman-Green Dena , Brody Abraham , Aldridge Melissa
Published: December 2023

The provision of care to older adults with serious illness through home hospice visits was extremely challenging for interdisciplinary teams during the COVID-19 pandemic in NYC. We interviewed 20 interdisciplinary providers (nurses, managers, administrators, physicians, medical directors, social workers, and clergy) from three organizations that provided end-of-life care in-person and through telehealth to older adults and their caregivers in NYC. Qualitative content analysis was used to identify themes, categorize findings, and identify important adaptations that were required to provide hospice care during the pandemic. Findings reveal how organizations, providers, patients, and families contended with fear, communicated challenges, and adapted to an ever-changing regulatory landscape. The experience of providing care was markedly different for those who were required to deliver care in person vs. by telehealth. Difficult care choices were made impacting access and the services offered by hospice organizations. Salient themes included: organizational challenges – “building a plane while it’s taking off” (e.g., implementing institutional safety protocols with imperfect COVID-19 information to a wary staff), patient/family challenges – “you aren’t coming in my home” (e.g., inability to enroll patients into hospice without a face-to-face visit), and provider challenges – “some things you can’t do through telehealth.” (e.g., telehealth is a vastly inferior medium to teach isolated family caregivers how to provide end-of-life support to dying family members). These findings provide an opportunity to consider the unique qualities of hospice care, what care can and cannot be effectively delivered through virtual modalities, and what effective adaptations may be sustained long-term.
TRANSITIONING TO HOSPICE DURING THE COVID-19 CRISIS: LESSONS FOR CARE COORDINATION AT THE END OF LIFE
Authors: Franzosa Emily , Kim Patricia , Moreines Laura , Boafo Jonelle , David Daniel , Brody Abraham , McDonald Margaret , Aldridge Melissa
Published: December 2023

The COVID-19 pandemic caused widespread delays and disruption in end-of-life services. We examined the impact of these disruptions among patients in a large, NYC health system who were referred to hospice and died between March 1, 2020 and March 1, 2021. We linked the electronic health records (EHR) of 124 patients cared for by a geriatric outpatient practice to the hospice EHRs to create longitudinal trajectories of patients’ care. We conducted an in-depth qualitative thematic analysis of linked medical and hospice records to examine provider and patient experiences as reflected in the EHR. Our sample (mean age of 91 years) were enrolled in hospice for an average of 173 days, and 81% died at home. We found challenges transitioning from medical to hospice care, including referral and enrollment delays due to infection prevention protocols, communication issues, staffing and equipment shortages (e.g., oxygen, morphine). These disruptions impacted quality of care as patients experienced shortages in personal care services, medical equipment and supplies, and missed home visits due to fear or isolation protocols. Virtual visits helped maintain access to hospice, particularly social work and spiritual care, as did ongoing communication with both the primary care and hospice teams. Our findings demonstrate that while COVID-19 added care transition challenges, new flexibilities and adaptations helped manage disruptions. Retaining these practices, such as reimbursing telehealth social work and spiritual care visits and maintaining ongoing patient contact with trusted primary care providers may help extend emotional support to patients and families during the end of life.
MODIFICATION OF THE ASSOCIATION BETWEEN HEARING LOSS AND DEMENTIA PREVALENCE BY SELF-REPORTED SLEEP DISTURBANCES
Authors: Jiang Kening , Spira Adam , Reed Nicholas , Huang Alison , Lin Frank , Deal Jennifer
Published: December 2023

Hearing loss and sleep disturbances are both known risk factors for dementia. High prevalence and modifiability in late life make them potential targets for dementia prevention. However, their combined contribution to dementia is unknown. The National Health and Aging Trends Study (NHATS) is a longitudinal panel survey of a nationally representative sample of Medicare beneficiaries. A validated algorithm based on self- or proxy-reported diagnosis, AD8 dementia screening, and cognitive tests was used to classify participants as having probable/possible vs. no dementia. Pure-tone audiometry was added to the 2021 round of NHATS; participants with better-ear 4-frequency (0.5, 1, 2, 4 kilohertz) pure-tone average above 25 decibels were categorized as having hearing loss. Participants reported their frequencies of taking >30 minutes to fall asleep and having trouble falling back asleep and were defined as having each symptom if it was experienced ≥2 nights/week. We used Poisson regression with robust standard errors and included an interaction term between sleep disturbances and hearing loss, adjusting for demographics, smoking, body mass index and comorbidities. Among 2,383 participants aged 71+ years (46% male, 7% Black), hearing loss was cross-sectionally associated with higher dementia prevalence only among participants with sleep disturbances (>30 minutes to fall asleep: prevalence ratio [PR]=1.81, 95% CI:0.99, 3.31; difficulties falling back asleep: PR=1.82, 95% CI:1.02, 3.26). Older adults with both hearing loss and sleep disturbances might represent a high-risk subgroup that needs to be prioritized. With the complex etiology of dementia, a better understanding of the co-occurrence of multiple risk factors is needed.
ASSOCIATIONS OF OBJECTIVE MULTISENSORY IMPAIRMENT WITH COGNITIVE IMPAIRMENT: THE ARIC-NCS STUDY
Authors: Smith Jason , Kamath Vidyulata , Chen Honglei , Shrestha Srishti , Abraham Alison , Gross Alden , Reed Nicholas , Deal Jennifer
Published: December 2023

Sensory impairments frequently co-occur among older adults. Characterizing the combined impact of a multisensory phenotype on cognitive impairment could help elucidate a potential mode of pathogenesis. We investigated associations between multisensory impairment (co-occurring, objectively-measured hearing loss [pure-tone average ≥25 dB], vision loss [presenting near or distance acuity >0.3 logMAR], anosmia [Sniffin’ Sticks test score ≤6], and peripheral nerve damage [≥1 insensate site on left or right foot]) and cognitive impairment (mild cognitive impairment [MCI] or dementia). Our study sample consisted of Black and White adults aged 70+ years in the Atherosclerosis Risk in Communities (ARIC) study; a longitudinal, community-based cohort. We estimated prevalence ratios (PRs) of baseline (ARIC visit 6, 2016-2017) expert-adjudicated MCI/dementia and odds ratios (ORs) of progression to MCI/dementia through ARIC visit 7 (2019) by number of impairments (0 [reference], 1, 2, 3 or more) using Poisson and logistic regression models, respectively. Overall, among 814 participants (age range: 71-93 years, 62% female, 41% Black race), an increasing number of impairments was associated with increased prevalence of baseline MCI/dementia (1 impairment, PR=1.14 [95% CI: 0.67-2.01]; 2 impairments, PR=1.53 [95% CI: 0.87-2.79]; ≥3 impairments, PR=2.26 [95% CI: 1.18-4.38]; p-trend: .007) and increased progression to MCI/dementia (1 impairment, OR=1.47 [95% CI: 0.67-3.49]; 2 impairments, OR=1.64 [95% CI: 0.69-4.12]; ≥3 impairments, OR=5.68 [95% CI: 2.18-15.52]; p-trend: .001). These findings suggest multiple concurrent sensory impairments contribute additively to greater MCI/dementia prevalence, signaling the importance of considering multiple impairments together in studies of the contribution of sensory losses to cognitive impairment.
SENSORY AND MOTOR FUNCTIONS IMPROVE LONG-TERM PREDICTIONS OF NEURODEGENERATION AND COGNITIVE DECLINE
Authors: Merten Natascha , Paulsen Adam , Chappell Richard , Chen Yanjun , Ferrucci Luigi , Hancock Laura , Johnson Sterling , Schubert Carla
Published: December 2023

Pathological changes in dementia often start decades before clinical symptoms making early detection important for interventions. We assessed if midlife sensory and motor functions improve prediction of long-term neurodegeneration as indicated by blood-based biomarker positivity and of cognitive decline and impairment when included in models with the CAIDE or Framingham Risk Score (FRS). This longitudinal study included 1529 (mean age 49yrs) Beaver Dam Offspring Study participants with measured serum neurofilament light chain (NfL) from baseline, 5-, and 10-yr follow-up. We assessed hearing,vision,olfaction, motor, and health history data, and calculated CAIDE and FRS at baseline. Outcomes were neurodegeneration (NfL+; value≥age-specific 97.5%ile), 10-yr cognitive decline (trail-making test B time;10% most decline), and cognitive impairment (neurocognitive case review). Logistic regressions were used to test whether adding baseline sensory and motor functions improves models of 10-yr incidence of NfL+, cognitive decline or impairment compared to models based on CAIDE or FRS alone. There were 115 incident NfL+, 139 cognitive decline, and 240 cognitive impairment cases. The area under the receiver operating characteristics curve (AUROC) for NfL+ prediction improved from 0.68[0.62,0.73] to 0.72[0.66,0.77](p<0.01) after adding sensory and motor functions to CAIDE-only models. AUROCs also improved for cognitive decline from 0.72[0.68,0.76] to 0.77[0.73,0.81](p<0.001) and impairment from 0.59[0.55,0.63] to 0.65[0.61,0.68](p<0.001) in CAIDE-only versus CAIDE-sensory-motor models. Improvements were similar in FRS-models. Including midlife sensory and motor functions improved long-term predictions of neurodegeneration, cognitive decline and impairment. Sensory and motor assessments might become relevant for cost-effective and non-invasive screenings to identify high-risk individuals early for future prevention and interventions.
CO-MORBID DEMENTIA AND CANCER THERAPY DECISION-MAKING: A SCOPING REVIEW
Authors: Halpin Sean , Alain Gabriel , Zhao Hui , Fowler Mackenzie , Zhang Qiuyang , Cadet Tamara , Ye Minzhi , Krok-Schoen Jessica
Published: December 2023

Co-morbid dementia complicates cancer therapy decision-making in older adults. Our scoping review examined cancer therapy decision-making among older persons with co-morbid cancer and dementia and their caregivers. Pubmed, Embase, CINAHL, PsycINFO, Cochrane Library, Scopus, and Web of Science were searched from 2018-2022, resulting in 8,654 articles screened, with eight meeting the inclusion criteria. Most studies were conducted in the UK (89%) and reported homogeneity in race and geography. Breast (56%) and prostate (45%, with one reported stage) were the most frequent cancers reported. Five studies (56%) reported multiple types of dementia, with two (22%) indicating stages. The studies indicated that communication between patients, caregivers, and clinical teams might alleviate stress caused by worsening health prospects. Future research should consider diverse racial, geographic, cancer types, dementia types, and healthcare stages to improve understanding of these decision-making processes.
PHENOTYPES OF COGNITIVE FUNCTION IN THE CONTEXT OF COMORBIDITIES
Authors: Zheng Yaguang , Mao Weiyu , Wang Jing
Published: December 2023

While a growing body of evidence has shown that the prevalence of cognitive impairment varies depending on the population, limited research has explored the complex relationships among different cognitive function domains or changes in cognitive functions in the context of comorbidities (e.g., diabetes and stroke). The objective of this symposium is to address knowledge gaps by demonstrating these complex relationships in the context of comorbidities. Zheng and colleagues discuss the prevalence of mild cognitive impairment and dementia in adults with diabetes using nationally representative data from a large-scale dataset. Zhu et al. explore the inference of changes in cognitive function and relationships among cognitive function domains using a novel phenotypic network approach. Further, Li et al. use a similar phenotypic network approach to identify the dynamic associations across cognitive, physical, psychological function, and quality of life among Chinese patients with acute ischemic stroke. Nan Wang & colleagues discuss factors associated with the perceived risk of Alzheimer’s disease and related dementias (ADRD) and how the perceived risk of ADRD is related to cognitive function. Following the paper presentations, Dr. Jing Wang will lead a discussion. The novel finding from this symposium will provide a more comprehensive understanding of how cognition changes over time and how interventions could target multiple domains or be tailored to the varied medical comorbid conditions to improve overall cognitive functions.
MECHANISMS OF CHANGE IN COGNITIVE FUNCTION DOMAINS IN OLDER ADULTS
Authors: Zhu Zheng , Zwerling Jessica , Qi Xiang , Pei Yaolin , Zheng Yaguang , Wu Bei
Published: December 2023

It is crucial to gain a better understanding of these relationships in order to have a more comprehensive understanding of cognitive abilities over time and how interventions can target multiple domains to improve overall cognitive function. This study aimed to investigate the mechanism of changes in cognitive function domains in phenotypic networks. This study used data from the Aging, Demographics, and Memory Study (ADAMS) in Wave A and Wave B. We assessed 12 cognitive function domains. Latent profile transition analysis (LPTA) and cross-lagged panel network model were employed to the dynamic interactions of the 12 cognitive function domains over time in both the deterioration and improvement groups. A total of 252 participants were included in the final analysis. LPTA identified five subgroups and categorized all samples into three main categories: improvement group (n=61), deterioration group (n=54), and no change group (n=137). “D9: psychomotor processing” showed the largest value of out-strength in the deterioration group (r=0.941) and improvement group (r=0.969). The strongest direct positive effect in the deterioration group was “C9: psychomotor processing” -> “C8: attention” (β=0.39). In the improvement group, the strongest direct positive effect was “C9=psychomotor processing” -> “C7=visual memory” (β=0.69). Psychomotor processing can affect other cognitive domains, and it plays a crucial role in changes of cognitive function. The paths of psychomotor processing to attention and visual memory were found to be major factors in cognitive deterioration and improvement. Targeting psychomotor processing may lead to the development of more effective and precise interventions.
PERCEIVED RISK OF ALZHEIMER’S DISEASE/DEMENTIAS AND COGNITIVE FUNCTION AMONG US OLDER ADULTS
Authors: Wang Nan , Xu Hanzhang , West Jessica , Østbye Truls , Wu Bei , Xian Ying , Dupre Matthew
Published: December 2023

To assess factors associated with the perceived risk of Alzheimer’s disease and related dementias (ADRD) and how the perceived risk of ADRD was related to cognitive function. We conducted a retrospective cohort study using 5 waves of data from the Health and Retirement Study (2012-2022) that included adults aged 65 years or older with no previous diagnosis of ADRD at baseline. Cognitive function was measured at baseline and over time using a summary score that included immediate/delayed word recall, serial 7’s test, objective naming test, backwards counting, recall of the current date, and naming the president/vice-president (range=0-35). Perceived risk of developing ADRD was categorized at baseline as “definitely not” (0% probability), “unlikely” (1-49%), “uncertain” (50%), and “more than likely” (>50-100%). Additional baseline measures included participants’ sociodemographic background, psychosocial resources, health behaviors, physiological status, and healthcare utilization. Of 1,457 participants (median age 74 [IQR=63-85] and 59.8% women), individuals who perceived that they would “definitely not” develop ADRD were more likely to be non-Hispanic Black, less educated, and have lower household income than individuals who indicated it was “unlikely” they would develop ADRD. Participants who reported their risks of developing ADRD as “definitely not,” “uncertain,” and “more than likely” had lower cognitive function than participants who perceived their risk of developing ADRD as “unlikely.” Perceived risk of developing ADRD is associated with cognitive function. The (dis)concordance between individuals’ perceived risk of ADRD and their cognitive function has implications for increasing public awareness and developing interventions to prevent ADRD.
SOCIAL DISPARITIES IN SLEEP PATTERNS AMONG US ADULTS IN MID AND OLDER ADULTHOOD
Authors: Sheehan Connor
Published: December 2023

As the U.S. population ages, understanding social disparities in sleep among older adults is paramount. Even as humans physiologically require sleep, sleep duration decreases, and insomnia increases throughout older adulthood. Further, the implications of sleep related conditions (e.g., heart disease) are elevated in older adulthood. Importantly, these changes in sleep patterns throughout older adulthood are distributed in a manner that reflects broader social inequities, as quality sleep is contingent upon resources that are distributed unequally across society (e.g., time, stress, quiet, comfort, access to quality medical care). The inequities in sleep have profound implications for intergenerational social inequality, well-being, and longevity. Novel results regarding social based sleep disparities by gender, race/ethnicity, and educational attainment among older adults from the Health and Retirement Study and the National Health Interview Survey will be presented. The profound implications of sleep disparities and potential interventions will also be discussed.
SLEEP DISPARITIES AMONG ASIAN AMERICANS: IMPACTS OF DISCRIMINATION AND ACCULTURATIVE STRESS
Authors: Sunmin Lee
Published: December 2023

Although Asian Americans have shorter sleep duration and more sleep difficulty compared to Whites or Hispanics, research on Asians remains scarce. 60% of Asians are foreign-born and have high levels of limited English proficiency, which is positively associated with a range of immigrant stressors, such as discrimination and acculturative stress. Importantly, COVID-19 has exacerbated discrimination towards Asian Americans giving rise to ‘Asian hate’. In a study using data from the National Epidemiology Study of Alcohol and Related Conditions III (n=1,765), we found that individuals with high discrimination were sleeping 14.4 minutes less (SE: 6.0, p < .05) and had a higher prevalence of sleep difficulty (prevalence ratio (PR): 1.73, 95% Confidence Interval (CI): 1.33-2.24) compared to those with low discrimination. An interaction effect was observed in sleep difficulty by nativity. The association between discrimination and sleep difficulty was stronger among the U.S.-born than the foreign-born. In another study of Chinese and Korean Americans (n=400), Poisson models revealed that greater acculturative stress was associated with a higher prevalence of sleep disturbance (PR: 1.18, 95% CI: 1.06% to 1.31%). Interaction tests indicated that only women had a significant association between acculturative stress and sleep disturbance (PR: 1.30; 95% CI: 1.13 to 1.49), while the association was significant for individuals identifying as “very Asian” (PR: 1.21; 95% CI: 1.08 to 1.35), but not for those identifying as “mostly Asian” or “bicultural/western”. Future sleep health research in Asian Americans should consider the critical role of discrimination and acculturative stress.
OPTIMISM MITIGATED THE DETRIMENTAL ROLE OF DEPRESSION AND ANXIETY IN SUBJECTIVE WELL-BEING AFTER CARDIAC SURGERY
Authors: Ai Amy , Nash Veronika
Published: December 2023

Cardiac diseases, the primary cause of death among older adults of any races, is comorbid with mental health problems such as depression and anxeity. A recent review article found that cardiovascular health was more consistently associated with optimism and hedonic/subjective well-being than with meaning-laden eudaimonic/psychological well-being. Extensive research has shown the health benefit of dispositional optimism, a personality trait. Few studies, however, have explored the protective effect of optimism the on subjective wellbeing (SWB) one months after cardiac surgery, a life altering procedure in late life. This study estimated the mediating effect of dispositional optimism between preoperative mental health and postoperative SWB. Using a prospective design, we followed 300 patients undergoing cardiac surgery. Mental health was indicated by anxiety and depression, while SWB was indicated by low symptom levels of general distress, based on its definition, one month postoperavely. A confirmatory factor analyses were performed to validate SWB with three subscales. The final solution of a structural equation model (SEM) indicated good fit (Chi-square = 47.55, df = 18, p = 0.000; CFI = 0.95; TLI = 0.92, RMSEA = 0.07, with 90 percent CI from 0.05 to 0.10). Both the CFI (0.96) and TLI (0.93) exceeded the benchmark criterion of .90. The lower CI of RMSEA is under 0.05. Optimism, indicted by two subscales, mediated preoperative mental health and postoperative symptom levels. The finding supports its mitigating role against the damage of depression and anxiety in the SWB of cardiac patients during the critical recovery time – postoperative month.
GENDER DIFFERENCES IN SLEEP QUALITY, FATIGUE, AND DEPRESSIVE SYMPTOMS AMONG ADULTS OVER 50 WITH TOTAL BLINDNESS
Authors: Choi Soyoung , Harrison Tracie
Published: December 2023

Visual limitations and blindness have been associated with poor sleep quality, increased fatigue, and a higher risk of depressive symptoms in the aging population. In this study, we aimed to investigate sleep quality, fatigue, and depressive symptoms in US adults over the age of 50 with total blindness, and to examine potential gender differences. The study included 88 participants (59 females, mean age 61.34±8.04; 19 males, mean age 62.32±8.17) who completed an online survey providing data on socioeconomic status, comorbidities, sleep quality, fatigue, and depressive symptoms. Descriptive and bivariate analyses were performed using R software and its required packages. While females slept less than males (t = -2.98, p <.05), there was no significant difference in sleep quality (t = 1.82, p = .08) or depressive symptoms (t = 0.51, p = 0.62). Fatigue levels were significantly higher in females than males (t = 2.53, p <.05). Poorer sleep quality was associated with increased fatigue and severe depressive symptoms in both subgroups. The findings indicate potential gender effects, however, given the small sample size and limitations of the cross-sectional design, further longitudinal research is needed to fully understand gender differences in sleep quality, fatigue, and depressive symptoms among adults over 50 with visual limitations.
PARTICIPANT ACCEPTABILITY OF THE DEPRESSION AND PAIN PERSEVERANCE THROUGH EMPOWERED RECOVERY PROGRAM
Authors: Clair Catherine , Taylor Janiece , Bhansali Rebekah , Harrison Tracie , Beeber Anna , Szanton Sarah L
Published: December 2023

Between 2019-2023, the Depression and Pain Perseverance through Empowered Recovery (DAPPER) program was implemented with older African American women living with pain and low mood (N=34) in Baltimore, MD. Of the 21 who completed the intervention, we interviewed 9 women to understand their experiences in the program, their successes, challenges, and areas to improve the program. The average age of the participants was 64.8 (SD: 10.5). Using a qualitative descriptive design, we analyzed the interviews using content analysis. Overall, the main themes related to 1) Changes in Pain Experiences; 2) Influence of Research Study Team; and 3) Value in Resources and Being Listened To. The women described their experience in the DAPPER program positively and the impact that it had on their pain experience. Additionally, participants mentioned how the qualities, knowledge, and perspectives of the study team impacted them: “Respectful,” “A good listener,” and “Caring.” Finally, several of the women mentioned the value of strategies learned, resources provided, and the impact that communicating with the nurses had on them. These findings demonstrate the acceptability of the DAPPER program and highlight the importance of innovative components of intervention and study development (e.g., qualities of team members, budget for purchasing items) that are often not intentionally considered during the research process. Suggestions include adding a group component to the intervention to increase social interactions.