bluuebunny/crossref_metadata_2025 huggingface dataset:
ENGAGEMENT OR ENJOYMENT? ATTITUDES OF OLDER ADULTS IN GROUP LUNCH VERSUS. LIFELONG LEARNING PROGRAMS
Authors: Hou Su-I
Published: December 2023

Purpose

This study examines aging attitudes among older adults who participated in the neighborhood lunch (NLP) and lifelong learning (LLP) programs.

Methods

Older adults from an NLP and an LLP in the same county in Florida participated. An aging attitudes measurement originally developed by German researchers was used.

Results

A total of 193 older adults participated, 43% from NLP. The mean age was 73.2 (SD=7.78) years. Data showed that LLP older adults endorsed higher on “would like to have responsibilities,” “have a task,” “do unpaid volunteer work,” and “help others” (p<.001). NLP participants, on the other hand, endorsed higher on “no longer have to contribute to society,” “want to enjoy life,” and “finally want to rest and relax” (all p<.001). Exploratory factor analyses (EFAs) using principal component extraction methods and varimax rotation with Kaiser normalization showed a clear balanced 2-factor pattern, with total variance explained 60% (30% each). These two factors were consistent with the theory representing engagement versus enjoyment aging attitudes. Reliabilities of the two-factor scales were satisfactory, with Cronbach’s alpha of .764 (CITC ranged: .457 ~ .660) for the engagement scale (4-item) and.634 (CITC ranged: .379~.499) for the enjoyment scale (3-item).

Discussion

Current findings showed that LLP participants endorsed higher engagement, while NLP participants endorsed higher enjoyment towards aging. This tested aging attitudes scale consists of 7 items with two clear theory-consistent factors among community-dwelling older adults. Results can help researchers quickly assess aging attitudes of diverse groups of older adults for tailored program and service development.
A SYSTEMATIC REVIEW ON AGING IN THE COMMUNITY AND CULTURE AMONG CHINESE OLDER ADULTS
Authors: Chen Hao-Min , Hou Su-I
Published: December 2023

Chinese older adults face many barriers to healthy aging in community, such as increased financial burden, threatened place security, limited accessibility to medical services, language and transportation difficulties, daily housework and repairs challenges, etc. This systematic review aimed to examine and report the results current scholars have published in journal articles in the last decade (2010-present) on the influence of culture on Chinese older adults aging in community. Combination terms of “aging in community or aging in place,” “Chinese,” and “culture or cultural or ethnicity or identity or values” were used when searching in the four databases: CINAHL Complete; ERIC; MEDLINE; and PsycInfo. Researcher examined abstracts of all journal articles retrieved using the above criteria and further determined their relevance for inclusion. A total of 38 journal articles were included. Findings suggest that aging in community reflects a changing policy tendency from institution-based to community-centered care which better responds to the needs of the growing Chinese senior population. Family care remains older adults’ preferences. However, individual, community, and larger contextual factors can be influenced, such as the number of adult children in the household, education level, residential area, accessibility to healthcare facilities, perceived cultural values of filial piety, state-owned enterprise reformation, and the one-child policy in China. Policymakers are encouraged to promote older adults’ personalized care plans; comprehensive health insurance coverage; constructive social/community environments (e.g. community parks or community open spaces for age-friendly activities); home care support, or smart home technologies for regular health monitoring.
COGNITIVE BEHAVIORAL AND VIRTUAL REALITY TREATMENTS FOR INSOMNIA (CBTI AND IVR): OFF-LABEL IMPACT ON COGNITION
Authors: McCrae Christina , Stearns Melanie , Curtis Ashley
Published: December 2023

Chronic insomnia (CI) is common in mid-to-late life and associated with hyperarousal and impaired cognition and mood. CBTi improves sleep and may also improve cognition, arousal and mood but evidence for these latter outcomes is limited. We examined these outcomes across 3 studies with different delivery platforms (telehealth, digital, VR), dosages (2 sessions, 4 sessions), and (primarily) mid-to-older CI populations (fibromyalgia, dementia caregivers). Study 1 compared 8-week CBTi vs sleep hygiene in women with fibromyalgia (n=43, Mage=44.45). Study 2 piloted 4-session web-based CBTi in caregivers (n=5, Mage=62.40). Study 3 piloted 4-session iVR (n=18, Mage=36.45). Participants completed 2-week daily diaries pre/post treatment (sleep onset latency-SOL; wake after sleep onset-WASO; total sleep time-TST) and Insomnia Severity Index-ISI. Other measures included: study 1(arousal/heart rate variability-RMSDNN), studies 1 and 3(Wisconsin Card Sort Test-WCST, Stroop), study 2(Cognitive Failures Questionnaire-CFQ, Beck Depression Inventory-BDI-II, Perceived Stress Scale). Group x time interactions (study 1) and within-group pre/post differences were examined. CBTi improved sleep across studies (ps<.05). Study 1 found and study 3 trended toward improved cognitive flexibility (WCST %perseverative errors-t(14)=2.65, p=.019 and t(10)=1.76, p=.055, respectively). Study 1 found improved attention and processing speed [Stroop reaction time(RT)-congruent trials-t(14)=2.59, p=.023], inhibition (Stroop RT-incongruent trials-t(14)=2.43, p=.031), and arousal [increased RMSDNN; F(1,41)=4.87, p=.03]. Study 2 found improved subjective cognition-CFQ (t(4)=2.44, p=.04), arousal-RMSDNN (t(4)=2.09, p=.05), and depression-BDI-II (t(4)=2.89, p=.02). CBTi improved sleep, cognition, arousal and mood in mid-to-older CI populations. Research using randomization, active controls, and follow-ups is needed to delineate temporality and explore sleep’s mechanistic contribution to cognition and other “off-label” outcomes.
AGEISM IS NOT A CATCH-ALL: THE INTERRELATEDNESS OF AGEISM AND ABLEISM
Authors: Gendron Tracey , Alyssa Camp , Gigi Amateau , Mia Mullen , Kristen Jacobs , Inker Jenny , Marrs Sarah
Published: December 2023

Ageism represents discrimination based on age, while ableism represents discrimination toward people with disabilities. Given the natural occurrence of physical decline accompanying aging, it is essential to explore how prejudice toward disability intersects with fear about aging. 913 individuals responded to a survey on ageism and ableism. Multiple regression with internalized ageism as the criterion variable was significant F(7, 705) = 81.71, p <.001. Overall, the regression model explained 44.8% of the variance in internalized ageism with significance for age (t(705) = -5.45, p < .001), relational ageism (t(705) = 11.72, p < .001), affinity for older people (t(705) = -2.77, p = .006), ableism for physical disability (t(705) = 6.88, p < .001), and ableism for cognitive disability (t(705) = -2.86, p = .004), Multiple regression with relational ageism as the criterion variable was significant F(7, 705) = 88.12, p <.001. Overall, the regression model explained 46.7% of the variance in relational ageism with a significant for affinity for older people (t(705) = -3.80, p < .001), internalized ageism (t(705) = 11.72, p < .001), relational ableism (t(705) = 6.73, p < .001), ableism for cognitive disability (t(705) = 2.15, p = .007), and ableism for sensory disability (t(705) = -2.78, p = .006). Examining the intersection between ageism and ableism represents the next critical juncture to increasing our understanding of developing effective anti-ageism interventions that address the root anxieties influencing attitudes about aging.
PATTERNS OF FAMILY CAREGIVING FOR OLDER ADULTS: THE ROLES OF PRIMARY AND SECONDARY CAREGIVERS
Authors: Malhotra Rahul , Lim-Soh Jeremy , Sung Pildoo , Quach Ha-Linh
Published: December 2023

Family members are often front-line carers for older adults. With research studies focusing largely on the primary family caregiver, less is known about how caregiving responsibilities are shared between family members. Using latent class regression, we described the prevalence of distinct patterns of family caregiving for older adults, in terms of who (division of assistance between the primary caregiver and secondary caregivers) provides what assistance (three types: with (a) activities of daily living; (b) health and social services; and (c) other socio-emotional needs), and their correlates. Primary family caregivers of 277 older adults (75 years and older) with functional limitations in Singapore, were interviewed in 2019-2020. Three patterns of family caregiving were identified. The ‘Shared-Diverse’ (43%) pattern typically involved multiple family caregivers providing all three types of assistance. The ‘Shared-Informal’ (27%) pattern also typically involved multiple family caregivers but no provision of assistance with health and social services; such care-recipients were more likely to be female (versus the Shared-Diverse pattern). The ‘Solo-Diverse’ (30%) pattern typically involved the primary family caregiver solely providing all three types of assistance; such caregivers were less likely to be working. Primary family caregivers in the Solo-Diverse pattern, versus the Shared-Diverse pattern, had higher depressive symptoms. The predominance of caregiving patterns involving multiple family members highlights the need for expanding family caregiving research, policies, and programs beyond primary family caregivers. The findings also underscore the importance of solo family caregivers, whose employment ability and mental health may be affected by their caregiving duties.
A CONVERGENT PARALLEL MIXED METHODS ANALYSIS OF SUCCESSFUL AGING IN CHINESE AMERICANS: DOES ACCULTURATION MATTER?
Authors: Khan Mushira , Kang Ezer , Li Chien-Ching
Published: December 2023

Chinese Americans comprise the largest Asian origin group aged 65 years and older (26%), yet little is known about how aging, particularly in the context of acculturation, is experienced within this group. Further, although immigration scholarship underscores a robust, positive relationship between successful aging and acculturation, how major lifecourse events shape perceptions of aging well in Chinese Americans is not well-understood. Using an intersectional lifecourse perspective, this convergent parallel mixed methods study presents integrated findings from a cross-sectional survey (N=98; 58.2% female; mean age=64.4 years) and qualitative interviews (N=32; 53% female; mean age=59.4 years) with community-dwelling Chinese Americans 50+, about 80% of whom were foreign-born. Survey measures included the Short Acculturation Scale, the Successful Aging Scale, self-reported health, and demographic variables. Quantitative data were analyzed using multiple regression analysis. No significant association was found between acculturation and successful aging, even after controlling for length of stay and sociodemographic variables. Thematic analysis of qualitative data revealed feelings of ambivalence and alienation. Several participants shared that despite having lived in the US for decades, they felt like they “no longer belonged”, feared for their safety, and felt a “sense of betrayal” after the recent increase in Anti-Asian hate crimes. Many were planning to return to their home country, where they believed it would be easier to age successfully. These findings suggest that important turning points in the lifecourse trajectory, such as experiences of racism, can negatively influence perceptions of aging in Chinese Americans, regardless of degree of acculturation and length of stay.
ALZHEIMER’S DISEASE AND RELATED DEMENTIAS DIAGNOSES IN THE US BY RACE, ETHNICITY, AND NATIVITY
Authors: Kindratt Tiffany , Zahodne Laura , Ajrouch Kristine , Dallo Florence
Published: December 2023

Timely clinical diagnosis of ADRD is important for intervention, resource allocation, and mitigating safety concerns. While studies have examined ADRD diagnoses disparities by race/ethnicity, few include its intersection with nativity. Our aims were to: 1) estimate the odds of diagnosed ADRD among US- and foreign-born racial/ethnic groups compared to US-born White older adults and 2) compare US- and foreign-born older adults within each racial/ethnic group. We linked 2000-2017 National Health Interview Survey (NHIS) and 2001-2018 Medical Expenditure Panel Survey (MEPS) data (65+ years; n=38,033). Race/ethnicity and nativity were measured using NHIS data. Diagnosed ADRD was determined using ICD-9 (290/294/331/797) or ICD-10 (F01/F03/G30/G31) billing codes created from self-reported ADRD diagnoses during MEPS household interviews. Covariates were measured using MEPS data. US-born Black (OR=1.74; 95%CI=1.48-2.05), Hispanic (OR=1.62; 95%CI=1.14-2.29) and foreign-born Hispanic (OR=1.63; 95%CI=1.24-2.15) older adults had higher odds of diagnosed ADRD compared to US-born White older adults after adjusting for age and sex. Results were no longer significant among either Hispanic group after adjusting for education, health insurance, and access to care. However, after adjusting for education, health insurance, access to care, and chronic conditions, US-born Black older adults, but not foreign-born Black older adults, had 1.54 times greater odds (95%CI=1.27-1.87) of diagnosed ADRD compared to US-born White older adults. There were no statistically significant differences in ADRD diagnosis by nativity within each racial/ethnic minoritized group. Findings highlight the need for including nativity in studies comparing racial/ethnic groups to Whites to fully capture the burden of ADRD among US-born Black older adults.
ALZHEIMER’S DISEASE AND OPPORTUNITY FOR POLICY CHANGE
Authors: Brekke Bailee , Mu Christina , Thompson Alisha , D’Antonio Patricia
Published: December 2023

Amidst the introduction of breakthroughs to slow the progression of Alzheimer’s Disease, hesitation remains among people living with dementia and their care partners. Currently, over 7 million Americans are impacted by Alzheimer’s Disease and another 11 million Americans provide unpaid care for someone living with the disease. Despite the immense efforts made to develop treatments for those diagnosed, barriers in accessibility remain. As a GSA policy intern, I attended multiple coalition meetings centered around advocating for equitable access to new treatment options. I also analyzed legislation aimed at improving early detection, delaying disease progression, and improving access to treatments for people with Alzheimer’s disease and related dementias (ADRD). While following the work of agencies including, the Centers for Medicare and Medicaid Services (CMS), I found that noteworthy progress has been made in terms of coverage expansion, but GSA and other organizations will need to continue to advocate for those older adults who have been left out of the equation. It is important to recognize the considerable progress that has been made and the immense efforts in support of people affected by this disease and their care partners; however, it is evident that Alzheimer’s Disease must remain at the forefront of bipartisan policy initiatives to ensure that legislation is passed, and these barriers are alleviated.
ETHNIC DIFFERENCES IN HEALTHY LIFE EXPECTANCY IN CHILE
Authors: Sandoval Moises , Portaccio Marcela Alvear , Albala Cecilia
Published: December 2023

Socioeconomic and sex differences in life expectancy (total and healthy) in Chile have been well established. However, the existence of ethnic differences in population longevity is unknown. Thus, we estimate total, healthy, and unhealthy life expectancy among Mapuche (largest indigenous group) and non-Mapuche older adults (≥60 years) in Chile. We estimated abbreviated mortality tables (using indirect demographic methods) and with the EDES health prevalence we applied Sullivan’s method. Disability was defined as the unhealthy state, evaluated through the methodology suggested by Albala et al. (2004). Results show that at age 60 the Mapuche have a life expectancy 7 years lower (26.4 vs. 18.9 years respectively). Although differences diminish with age, Mapuches always have lower total life expectancy. In addition, we detected that the proportion of disability-free life years is higher for non-Mapuche (1.5, 2.0 and 3.7 times higher at 60, 75 and 90 years respectively). In contrast, Mapuches expect to live a higher fraction of their life with disability compared to non-Mapuche (e.g., 84.1% vs. 62.9% at age 80). This is the first study addressing inequities in healthy life expectancy between the Mapuche ethnic group and non Mapuche population, reflected in lower life expectancy, lower healthy life expectancy and higher disabled life expectancy in Mapuche when compared with no Mapuche population.
THE RELATIONSHIP BETWEEN CHRONO-NUTRITION BEHAVIORS AND MUSCLE HEALTH IN OLDER ADULTS
Authors: Farsijani Samaneh , Mao Ziling , Cawthon Peggy , Kritchevsky Stephen , Glynn Nancy , Toledo Frederico , Newman Anne
Published: December 2023

Chrono-nutrition affects body composition via circadian clock entrainment, yet its impact on muscle health is overlooked. Here, we determined cross-sectional associations between chrono-nutrition behaviors, muscle mass (in kilogram by D3-creatine), and leg power (in Watts by Keiser) in 828 older adults (76 ± 5 years) in SOMMA. We extracted first and last intake time from 24-hr food recalls, and defined eating window as the time between first and last food/beverage intake. Chrono-nutrition’s relationships with muscle mass and power were assessed by linear regression models, adjusting for age, sex, race, energy intake, weight, height, physical activity, education, health status, study site, and marital status. Average eating window was 11 ± 2 h/d; first and last intake time were at 8:00 ± 1:00 and 19:00 ± 1:00, respectively. Eating window and last intake time were associated with muscle mass (b ± SE: 0.20 ± 0.09; 0.30 ± 0.11, respectively, P < 0.05). Longer eating window was associated with higher leg power (4.23 ± 2.14; P = 0.049). Our study found that longer eating duration is associated with higher muscle mass and power in older adults. This finding contradicts the reported benefits of intermittent fasting in promoting muscle health which has been mostly supported by non-human studies. Our findings highlight the importance of meal timing and circadian rhythms in promoting health in older adults. The impact of chrono-nutrition on health requires further investigation in different age groups and clinical settings.
FEASIBILITY OF A DIGITAL FALL PREVENTION EXERCISE PROGRAM FOR AT-RISK OLDER ADULTS
Authors: Bajdek Nicole , Latham Nancy , Dishaw Mary , Farrell Shannon , Williams Alisha , Hachen Naomi , Reid Kieran
Published: December 2023

Falls have serious consequences and are a leading cause of disability, institutionalization, and mortality for older adults. While exercise programs with in-person supervision reduce the occurrence and risk of falls, there are accessibility and adherence barriers associated with older adults’ participation in such programs. Digitally delivered home-based exercise interventions utilizing wearable technology and mobile applications may be an alternative fall prevention strategy for many vulnerable older adults. We evaluated the feasibility of a progressive 12-week, digitally delivered fall prevention exercise program in 23 at-risk older adults who reported ≥ 2 falls or ≥ 1 injurious fall in the past year, or a fear of falling (mean age: 76.6±6 yrs; BMI: 28.9±9 kg/m2; baseline short physical performance battery (SPPB) score: 8.9±3; 73.9% females). The structured exercise program was delivered via a tablet device and consisted of moderate-intensity strength and balance training with an embedded educational component (3x/wk) and walking exercise. A study interventionist provided participants with regular motivational coaching telephone calls throughout the program. Overall program adherence rates were high (≥ 80%) with minimal safety concerns. Preliminary efficacy findings revealed trends for improvements in fear of falling, cognitive performance, gait speed and overall SPPB score. The present study shows that a digitally delivered, home-based exercise program is feasible for older adults with elevated fall risk. Additional studies are warranted to confirm the efficacy of this highly scalable fall prevention strategy which could have important benefits for large populations of at-risk older adults.
QUANTITATIVE RELAXOMETRY APPROACHES TO CHARACTERIZING BRAIN AGING: APPLICATIONS ACROSS THE LIFESPAN
Authors: Dean Doug
Published: December 2023

Quantitative magnetic resonance imaging (qMRI) aims to measure meaningful physical or chemical parameters that are sensitive to and that can be used to characterize the underlying tissue microstructure. The quantitative nature of these data suggest that derived measures are ideally reproducible within and across different sites, allowing qMRI data to be more readily compared across different anatomical regions, among different subjects, and across time. The longitudinal (T1) and transverse (T2) relaxation times are fundamental to the measured MRI signal and, in the brain, highly sensitive to several anatomical changes, including changes of free water, iron content, and brain myelination. Thus, measurement of these relaxation times can be used to characterize the underlying tissue microstructure and can provide insight into the underlying processes of brain development and aging. As such, there is growing interest in using relaxometry-based techniques for a broad range of clinical and research applications. In this presentation, I will discuss recent advancements in quantitative relaxometry approaches and describe how these techniques are being used to gain a better understanding of the highly dynamic and nonlinear mechanisms that support brain development and aging.
SLEEP AND DEPRESSIVE SYMPTOMS IN COMMUNITY-DWELLING OLDER ADULTS: FINDINGS FROM AMBULATORY SLEEP EEG
Authors: Huang Jing , Spira Adam , McPhillips Miranda , Calderon Russell , Li Mengchi , Tufa Yeabsira , LI Junxin
Published: December 2023

There is limited and inconsistent evidence on the association between electroencephalography (EEG) measured sleep and depressive symptoms among community-dwelling older adults. This study investigated the cross-sectional association between EEG-measured sleep and depressive symptoms in 72 community-dwelling older adults without dementia [Age> 65 years; Montreal Cognitive Assessment (MoCA)>17], using baseline data from a randomized clinical trial (NCT03959202). Sleep and depressive symptoms were measured using two-night in-home sleep EEG (Sleep Profiler™) and the Geriatric Depression Scale (GDS-15). Multiple linear regression analyses were conducted with each sleep parameter as the primary predictor and GDS score as the outcome; models were adjusted for age, sex, race, education, marital status, chronic conditions, and MoCA score. Several sleep variables were associated with depressive symptoms (GDS score), including a higher percentage of sleep stage N1 (b = 0.11, 95% confidence interval [CI]: 0.02 – 0.20) and N2 (b = 0.04, 95% CI: 0.00 – 0.08), a lower percentage of N3 sleep (b = -0.04, 95%CI: -0.08 – -0.01), greater wake after sleep onset [b = 0.01, 95%CI: 0.00 – 0.02], and more awakenings ≥ 90s/hour (b = 0.87, 95%CI: 0.21–1.53). Neither total sleep time nor sleep efficiency were associated with GDS score. In conclusion, we found that more lighter (stage N1, N2) sleep, less deep (N3) sleep, and more fragmented sleep, measured by EEG, were associated with more depressive symptoms among community-dwelling older adults without dementia. Sleep architecture and fragmentation may play more important roles than sleep duration in relation to depression.
GENDER DIFFERENCES IN ASSOCIATIONS OF SLEEP INTRAINDIVIDUAL VARIABILITY AND MILD COGNITIVE IMPAIRMENT
Authors: Shen Yuqi , Ji Linying , Graham-Engeland Jennifer , Derby Carol , Buxton Orfeu
Published: December 2023

Previous studies suggest that cognitive function in older adults is related to sleep, with females more vulnerable to poor sleep. Little is known about the relationship between cognition and intraindividual variability of sleep (IIV). We examined the cross-sectional relationship between sleep IIV and mild cognitive impairment (MCI) by gender using data from the Einstein Aging Study. We hypothesize that individuals with MCI have a greater IIV in daily sleep characteristics, and these associations will be stronger for females. Eighty-nine men (age = 76.81±4.73, 61% White, 28% Black, 27% MCI) and 197 women (age = 76.60 ± 4.93, 40% White, 46% Black, 29% MCI) were included in the analysis. Individuals completed 2 weeks of actigraphy (mean ± SD = 15.7 ± 1.1 days), and the Montreal Cognitive Assessment, and MCI was based on the Jack/Bondi criteria. Sleep IIV was estimated as within person standard deviation of nighttime sleep duration, 24-hour sleep duration, wake after sleep onset, and nighttime sleep midpoint. Linear regression models evaluated associations between sleep IIV and MCI status separately by gender, controlling for BMI, age, ethnicity/race, nocturnal hypoxemia, Oxygen Desaturation Index ≥15. Among women, having MCI was associated with greater IIV in nighttime sleep midpoint (b=0.19, p=.002), and in 24-hour total sleep duration (b=13.10, p = .047) with a similar trend in nighttime sleep duration (p = .050). No significant associations were found among men. Findings suggest the importance to keep considering gender in work to understand how sleep variability relates to MCI status in older adults.
PREDICTING DEMENTIA DIAGNOSIS FROM COGNITIVE FOOTPRINTS IN ELECTRONIC MEDICAL RECORDS USING MACHINE LEARNING
Authors: Zhou Jiayi , Luo Hao , Liu Wenlong , Zhou Huiquan
Published: December 2023

The cognitive footprint theory suggests that a person’s risk of dementia is affected by activities and events (footprints) across the lifespan. This study aimed to develop a clinical algorithm for predicting dementia diagnosis from cognitive footprints in electronic medical records (EMRs) using machine learning. Population-based EMRs from the Clinical Data Analysis and Reporting System in Hong Kong were employed. We included all patients with dementia diagnosed at 65+ between 2000 and 2018. Controls without dementia were matched (1:1) by age, sex, and index date. The prediction accuracy of a standard logistic regression model was compared with five machine learning models (LASSO, Random Forest, Multilayer perceptron, XGBoost, and LightGBM), using a wide range of established and exploratory risk factors identified at mid- ( < 65 years) and late-life (65+ years). A total of 261,116 individuals (59.3% female; mean age at index date [SD]: 82.70 [8.54]) with and without dementia were included. Compared with the logistic model (area under the curve [AUC]: 0.60), the predictive and diagnostic accuracy of dementia improved substantially in machine learning models. The Multilayer perceptron and LightGBM models showed comparable performance with the same test AUC of 0.720. LASSO (AUC: 0.765) and Random Forest (AUC: 0.768) showed a slightly worse performance. Antipsychotic drugs, education, antidepressants and head injury in late life were the top 4 important predictors in all models. The machine learning-based algorithm for predicting dementia can be used to identify patients with an increased likelihood of dementia to allow precise and timely primary interventions.
THE ASSOCIATION OF A NOVEL PHYSICAL ACTIVITY METRIC WITH COGNITION AND RISK OF DEMENTIA
Authors: Cai Yurun , Zhou Junhong , Tian Qu , Wanigatunga Amal , Simonsick Eleanor , Resnick Susan , Ferrucci Luigi , Schrack Jennifer
Published: December 2023

Physical activity (PA) is associated with cognitive function and Alzheimer’s disease and related dementias (ADRD). Although associations between continuously measured PA and ADRD have been assessed, multiscale entropy (MSE), which quantifies dynamics of physiological systems over multiple time scales, has not been used to quantify daily activity rhythms in older adults by cognitive status. We examined the association of this novel metric of PA complexity with cognitive function, mild cognitive impairment (MCI), and dementia in participants of the Baltimore Longitudinal Study of Aging. A total of 615 older adults (mean age=73.9±11.3 years, 54.5% women) completed a 7-day wrist-worn accelerometer assessment between 2015-2019. Global cognitive function was measured using the Mini-Mental State Examination (MMSE). Mild cognitive impairment (MCI) or dementia was diagnosed based on Petersen criteria and Diagnostic and Statistical Manual of Mental Disorders, respectively. Unadjusted logistic regression models showed that participants in the lowest tertile of complexity had 2.31 times the odds of low MMSE score (≤26) compared to those in the highest tertile (odds ratio [OR]=2.31, 95% confidence interval [CI]=1.09-4.89). This association lost significance after adjusting for age, sex, race, and education years. The lowest tertile of complexity was also associated with 2.58 times the odds of MCI/dementia diagnosis, adjusting for demographics (OR=2.58, 95% CI=1.06-6.31). These results suggest that lower complexity of accelerometry-detected movement is associated with poorer cognitive function and greater risk of MCI/dementia. Future longitudinal studies are warranted to examine whether altered complexity of daily activity rhythms may act as a preclinical indicator of ADRD.
BUILDING RESILIENCE IN SKILLED NURSING (BRISK): A CASE OF COMMUNITY-ENGAGED RESEARCH IN SKILLED NURSING FACILITIES
Authors: Plys Evan , Lyons Christopher , Vranceanu Ana-Maria
Published: December 2023

Older adults receiving post-acute rehabilitation care in a skilled nursing facility (SNF) commonly present with high physical, psychological, and social needs. Psychosocial stressors and associated consequences (e.g., poor transitions, re-hospitalizations) may be magnified among families with limited financial resources. The current study aimed to co-develop a dyadic psychological intervention tailored to meet the unique psychosocial needs of socioeconomically disadvantaged patients and their care-partners during the transition from SNF to home. In this presentation, we describe the process of partnering with SNFs and forming a community advisory board (CAB) to meet the objectives of the current study. First, we discuss practical and regulatory considerations related to identifying facility partners (e.g., facility chains, physician groups) and recruiting patient-care-partner dyads in partner facilities. Second, we highlight strategies to incentivize potential SNF partners as well as historically and systematically under-represented patient participants, including budgetary considerations, recruitment strategies, sustained contact after discharge, and clinical service provision. Third, we discuss the recruitment, formation, and role of a CAB with diverse perspectives, including patients, family care-partners, SNF staff, policy makers and advocates. Overall, this presentation will generate discussion on practical strategies for building and maintaining mutually beneficial research partnerships with SNFs and similar hard-to-reach healthcare settings (e.g., long-term care facilities, home health agencies).
BEST PRACTICES FOR STUDYING OLDER MIGRANTS IN CONTEXT
Authors: Ritter Ashley , Glicksman Allen , Schrauf Robert
Published: December 2023

Understanding health outcomes of the older migrant (ages 60+) requires insight into the perceptions of the older person and considering the impact of the environment in which the older person lives. The four papers on this panel address these issues, each using a different methodology. Bilecen’s study, using qualitative methods, examines the impact of the wording of questions on the ways in which older Turkish migrants in the Netherlands discuss loneliness. The paper helps us understand both perceptions of older migrants and the influence of methodology used on the types of responses collected. Diederich’s paper on Cuban migrants to the United States uses census data to investigate the impact of changes in the environment of arrival at different points in time on care arrangements later in life. She demonstrates the value and limitations of using this type of data. Torres uses a survey of the scientific literature to ask questions about the impact of bigotry on the well-being of older immigrants and whether lack of attention to this topic means there is an important missing piece in our understanding of the experience of the older migrant. Glicksman et. al. use clinical data to describe interactions with the formal health and social service systems by persons of limited English proficiency, an opportunity to understand both actual service use and the benefits and limitations of using clinical data for this purpose. Schrauf’s response will discuss both the findings and the relation of methods to goals in the study of older migrants. This is an International Aging and Migration Interest Group Sponsored Symposium.
ORAL HEALTH INTERVENTIONS AND TREATMENTS FOR OLDER ADULTS WITH COGNITIVE IMPAIRMENT AND DIABETES
Authors: Shuman Stephen , Wu Bei , Saunders Michele
Published: December 2023

Older adults with cognitive impairment or diabetes have a higher risk of poor oral health. It is therefore critically important to develop effective intervention strategies to improve oral health for these vulnerable populations. In this session, we have included three studies that aim to achieve this goal using different strategies. The first study used stakeholder engaged processes to develop an app that provides information and guidance to caregivers (i.e., paid and family caregivers) to support their oral care provision for older adults with dementia. Findings from this study show that the app was well-accepted and provided an easily accessible tool for caregivers during care provision. The second study aimed to improve oral hygiene outcomes (plaque index and gingival index) for individuals with mild cognitive impairment (MCI) or mild dementia (MD). In this study, the authors identified and compared active behavior change techniques (BCT) used in a care partner-assisted oral health intervention for individuals with MCI and MD using a qualitative, secondary analysis of coaching sessions with care partners. Findings from this study provide insight into the mechanisms of change in individuals’ behaviors using these interventions. The third study was a systematic review aiming to explore the age differences in the effect of multi-component periodontal treatments on oral and metabolic indicators among individuals with periodontitis and diabetes. This study identified 115 eligible trials. This study found that the effect of multi-component periodontal treatments on periodontal outcomes and HbA1c may be more effective among younger populations. This is an Oral Health Interest Group Sponsored Symposium.
DAILY FACTORS ASSOCIATED WITH EMOTIONAL DYSREGULATION AMONG DEMENTIA CAREGIVERS
Authors: Puga Frank , Wang Danny , Bibriescas Natashia , Poe Abigail , Alvarez Loreli , Jablonski Rita , Vance David
Published: December 2023

Family dementia caregivers experience increased burden and stress that can negatively impact emotion regulation and overall well-being. Further, a lack of social connection may contribute to emotion dysregulation among dementia caregivers. The purpose of this study was to examine relationships between daily caregiving stress, social isolation, emotion regulation, and depression in a sample of community-dwelling dementia caregivers. Participants (N=30) completed a baseline survey and a series of daily diaries over a 14-day period (n=323 data points) that asked about day-to-day caregiving experiences. Data were analyzed using mixed-level modeling. Higher than average stress related to behavioral symptoms of dementia was associated with an increase in the odds of experiencing feelings of losing control over one’s emotions (OR=1.08, 95% CI [1.01, 1.15], p<0.05). Similarly, higher perceived social isolation on a given day was associated with an increase in the daily odds of feeling a loss of control over one’s emotions (OR=1.28, 95% CI [1.00, 1.27], p<0.05). Further, feeling a loss of control over one’s emotions was associated with an increase in the daily odds of depression-related symptoms (OR=3.39, 95% CI [1.43, 8.08], p<0.01). These findings highlight the importance of addressing the emotional well-being of family dementia caregivers, particularly in the context of stress related to behavioral symptoms of dementia and social isolation. Caregiver support programs and interventions that focus on improving emotion regulation and reducing social isolation may help promote the mental health and well-being of dementia caregivers.
LISTENING TO THE PATIENTS’ VOICE: A CONCEPTUAL FRAMEWORK OF HIP FRACTURE PATIENTS’ WALKING EXPERIENCE
Authors: Delgado-Ortiz Laura , Polhemus Ashley , Keogh Alison , Rochester Lynn , Frei Anja , Puhan Milo , Garcia-Aymerich Judith
Published: December 2023

Walking is crucial for an active and healthy ageing, but it changes with age and in the presence of diverse health conditions, including hip fracture and frailty. So far, conceptual frameworks of walking have not included the impact of these conditions and individuals’ lived experiences on their walking. Thus, we aimed to identify and synthesize evidence describing the walking experience from the perspective of individuals recovering from a hip fracture, as well as from the perspective of individuals living with highly prevalent walking-impairing conditions of diverse etiology. We conducted a systematic review and meta-ethnography, following appropriate guidance. Out of 2,552 unique records, 117 (8.5% hip fracture) were deemed eligible for the meta-ethnography. We identified seven themes that explain the experience of walking: (1) becoming aware of the walking experience, (2) the walking experience as a link between individuals’ activities and sense of self, (3) the physical walking experience, (4) the mental and emotional walking experience, (5) the social walking experience, (6) the context of the walking experience, and (7) behavioral and attitudinal adaptations resulting from the walking experience. We proposed a framework that describes the interplay between these themes, providing a conceptualization of walking that is grounded in the experiences of individuals recovering from a hip fracture or living with other walking-impairing health conditions, and that may be used to set priorities and improve patient centricity in clinical practice, research and public health initiatives.
IMPROVING COGNITIVE FUNCTION IN THE NEW COHORT—BUT ONLY FOR MEN. FINDINGS FROM THE KYOTANGO CENTENARIAN STUDY
Authors: Gondo Yasuyuki , Zhang Xinyu
Published: December 2023

The Kyotango Centenarian Cohort Study was established with the aim of tracing long-term changes in the overall functioning of centenarians. This study started in 2014 in Kyotango City. Since then, new centenarians and those who were expected to be 100 years old the following April were invited to the study every year in September. Eligible centenarians were invited by the city, and centenarians and their families agreed to participate to answer questions either by mail or face-to-face interviews, according to their preference. For the non-participants, anonymized living conditions and care need levels were provided by the city. The number of centenarian candidates varied by year (24-55). However, the number of woman centenarians had increased through the 8-year surveyed period (31 and 42 for women, 10 and 9 for men in 2014 and 2021). On average, every year 40 new centenarians were invited and 80% of them participated in the survey. Among the functional variables, cognitive function was estimated by proxies, which had a high correlation with MMSE. No clear improving trend for nursing care level in Japanese long-term care insurance, as measured by activities of daily living and cognitive function rating, was observed. Meanwhile, an improving trend for cognitive function was observed among men but not among women. This might be caused by the gender difference in the survival ratio that frail women were more likely to survive. Future research should investigate possible reasons for a cohort improvement in Japanese centenarian men, and cognitive intervention programs should particularly target women.
SERIAL TRICHOTOMIZATION TO IDENTIFY UNSAFE DRIVERS: UPDATE FROM A PROSPECTIVE STUDY
Authors: Bedard Michel , Dubois Sacha , Maxwell Hillary , Schurr Stephanie , Weaver Bruce , Stinchcombe Arne
Published: December 2023

Identifying older adults who may be unsafe to drive remains a difficult task. Gibbons et al. (2017, American Journal of Occupational Therapy) used serial trichotomization based on five cognitive tests to determine if drivers should: 1) continue driving, 2) undergo further evaluation, or 3) stop driving. The tests included the Trail-making-tests A and B (TMT-A/B), the clock-drawing test (CDT), the Motor-Free Visual Perception Test (MVPT), and the Montreal Cognitive Assessment (MoCA). Gibbons et al. relied on dual cut-off values to achieve 100% sensitivity and specificity (within their sample) to reduce false positives and false negatives that arise from using these tests in stand-alone fashion. We used the Gibbons et al. cut-off values prospectively on a cohort of 293 drivers (mean age = 66, SD = 14) referred for driving evaluations at a chronic care and rehabilitation hospital. Each driver completed the five tests. Trained occupational therapists (OTs) provided a recommendation to continue driving, undergo further evaluation, or stop driving. We examined congruence between the tests and the OTs recommendations. Weighted Kappas ranged from a low of .03 (95% CI = -.01 to .08) for the CDT, to a high of .53 (95% CI = .45 to .61) for the TMT-B. Using the same cut-offs, and serial trichotomization, the congruence with the final recommendations was moderate (k = .57, 95% CI = .49 to .66). These results remind us of the variability inherent in stand-alone cognitive tests and even within a serial trichotomization framework.
RECEIPT OF GENDER-AFFIRMING SURGERY AMONG MEDICARE BENEFICIARIES
Authors: Balkan Em , Babbs Gray , Shireman Theresa , Hughto Jaclyn , Meyers David
Published: December 2023

While transgender and gender diverse (TGD) people may never seek treatment related to their gender identity, many require access to gender-affirming treatments, including surgery. Starting in 2014, Medicare began covering gender-affirming surgery (GAS) on a case-by-case basis. In this study, we use national Medicare data to compare receipt of GAS by beneficiary characteristics. We classified TGD beneficiaries using an algorithm that combines diagnosis and procedure codes. Our study compared characteristics for all TGD identified beneficiaries and those who received GAS using a population-averaged logistic model using a generalized estimating equation (GEE) adjusting for dual status, age group, race/ethnicity, original reason for entitlement, and CMS region. Our sample accounted for 49,945 observations for 11,162 individuals, with a total of 290 identified records of GAS. In our adjusted analysis, we found that TGD beneficiaries in certain parts of the country had lower odds of GAS compared to their counterparts. Compared to CMS Region 1 (which includes Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont), those living in Region 3 (Delaware, District of Columbia, Maryland, Pennsylvania, Virginia, and West Virginia), Region 4 (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee), and Region 6 (Arkansas, Louisiana, New Mexico, Oklahoma, and Texas) had a significantly lower odds of receiving GAS. Access to gender-affirming care may be influenced by CMS regional contractors, as well as state-by-state variation in Medicaid coverage for gender-affirming care. Further research is needed to explain why beneficiaries may have lower access to GAS to inform policy recommendations.
LGBTQ AGING PARADOX: NEEDING WHILE AVOIDING LONG-TERM SERVICES AND SUPPORTS
Authors: Moone Rajean
Published: December 2023

A growing body of literature recognizes the significant health disparities experienced by sexual and gender minority (SGM) older adults including higher rates of chronic conditions, mental illness, and disabilities in comparison to their peers. Simultaneously SGM older adults are more likely to age alone and not have a friend or family caregiver to provide support. At the same time SGM older adults express hesitation and fear in accessing formal long term services and supports (LTSS). One study of trans older adults noted that suicide was a preferred option to a nursing home. This paper will outline a complex paradox: Many SGM older adults (1) experience significant health disparities which may require additional support; (2) lack informal support thus needing to rely on formal LTSS; and (3) avoid formal services due in large part to fear of discrimination and poor treatment. Opportunities to mitigate the paradox through education and awareness as well as implications for policy and research will be discussed.
POLYPHARMACY AND THE SYMPTOM EXPERIENCE OF OLDER ADULTS WITH AND WITHOUT ALZHEIMER’S DISEASE AND RELATED DEMENTIAS
Authors: Coates Martha , McClure Leslie , Finley Margaret , Sefcik Justine , Gitlin Laura , DiMaria-Ghalili Rose Ann
Published: December 2023

Older adults, including those living with Alzheimer’s disease and related dementias (ADRD), experience polypharmacy (PPY) (>5 medications daily) due to multiple chronic conditions. High symptom burden in older adults with ADRD and multimorbidity is well known. However, there is a gap in knowledge regarding symptoms experienced by older adults with and without ADRD who experience PPY. To address this gap, we conducted a longitudinal case-control observational study utilizing Rounds 6 to 9 (2016 to 2019) of the National Health and Aging Trends Study (NHATS) datasets. PPY was categorized by the number of medications from Round 6. We categorized individuals into four groups based on presence of ADRD and/or PPY (PPY and ADRD, PPY only, ADRD only, no PPY/ADRD) (N=2052). We identified symptoms associated with PPY (hopelessness, anxiety, general pain, stomach pain, breathing problems, weight loss, balance problems, fatigue, insomnia) in each group over each time point. Among those with ADRD (11.8%), over half experienced PPY (52.3%). Older adults with PPY and ADRD experienced a mean of 4.85 symptoms over all time points compared to 3.52 (ADRD only), 2.79 (no PPY/ADRD) and 3.93 (PPY only) (p=<0.001). Symptom frequencies in the PPY and ADRD group remained higher than all other groups across all four time points. Understanding the impact of medications on older adult’s quality life is a goal of the 4Ms framework. Future research will examine the symptoms associated with PPY and ADRD, physical function and health outcomes to inform medication management for older adults with dementia.