bluuebunny/crossref_metadata_2025 huggingface dataset:
INTEGRATED FAITH BASED CURRICULUM FOR COMMUNITY-BASED OUTREACH WORKERS: ADDRESSING INEQUITIES AMONG OLDER ADULTS
Authors: Bullock Karen , Stansbury Kim , Ruth Terrance
Published: December 2022

Older Latino and Black Americans experience health inequities and a lack of culturally competent clinician may influence this outcome. Community-Based Outreach (CBO) has proven to be effective in addressing such challenges. CBO is an effective approach to engaging communities that have been historically marginalized and are less likely to utilize hospice and palliative than other racial/ethnic groups. Yet, few models and modules for training are available in the literature to prepare CBO workers. This presentation describes the development, coordination, content and implementation of an Interprofessional Educational (IPE) training and curricular innovation to meet needs of diverse older adults diagnosed with a serious illness.

Methods: A community-based outreach approach that integrated faith-based/spiritual care curriculum to train African American and Latino outreach workers to support older adults with serious illnesses, with a focus on advanced care planning (ACP) that explored potential barriers to equitable care. A collaboration with faith-based community representatives to design the intervention research protocol was essential.

Results: The curriculum consisted of three parts: (1) a 36-hour classroom component delivered in three modules organized around eight themes: what is hospice and palliative care, spirituality and the meaning of death, understanding the dying process and decision making, goals of care, culturally responsive care; (2) weekly visits; and (3) field education/workforce development. At the end of the training, learners were able to: (a) express knowledge about culture differences; (b) demonstrate skills – listening, identifying meaning in the decision making, convey health information using patient-centered language; (c) understand cultural influencing decision making.
WHAT DO FAMILY CAREGIVERS WANT? PAYMENT FOR PROVIDING CARE
Authors: Nadash Pamela
Published: December 2022

Although the primary goal of self-directed programs providing long term services and supports (LTSS) is to maximize choice and control for service recipients, such programs may also benefit family caregivers by compensating them for providing supportive services. This study draws on qualitative data from research supporting the RAISE Family Caregiver Advisory Council, finding that family caregivers themselves see the expansion of self-directed programs as a policy priority due to their need for financial security. The request for compensation was the strongest finding, with respondents highlighting the incompatibility of work with caregiving and their inability to rely on the existing paid workforce due to supply and quality issues; the consequences of this loss of earned income were reported as severe. Ultimately, respondents saw payment for providing care as an issue of fairness. This evidence supports the policy case for expanding access to self-directed programs that permit the employment of family caregivers.
IMPACT OF GENDER ON ASSOCIATION BETWEEN RACE AND DISABILITY: THE CALIFORNIA HEALTH INTERVIEW SURVEY (CHIS)
Authors: Quach Lien , Vu Christine , Tran Isabelle , Peeri Noah , Nguyen Uyen-Sa
Published: December 2022

Women generally have higher prevalence of disability than men in later life. Moreover, Blacks and Hispanics usually have higher prevalence of disability than Whites. Little is known about the impact of gender on the association between race and disability. We used 2015-2016 CHIS data, restricted to adults ≥ 65 years old (n=15,044). Disability was classified as present or absent based on responses on questions related to “to physical, mental, and emotional conditions.” Race was classified as: White, Black, Hispanic, Asian, and Other. We estimated sex- and race-specific proportions and 95% confidence intervals (CI) and used sex-specific multivariable logistic regression to examine the associations between race and disability adjusting for age, education, marital status, cigarette smoking, arthritis, hypertension, and diabetes, mental distress, and walking for work or pleasure. All analyses accounted for complex sampling weights. Approximately 52% of women and 47% of men had disability, while 48% of White, 48% of Black, 60% of Hispanic, 43% of Asian, and 50% of Other race responded as having disability. Adjusting for covariates, Hispanic women had 67% higher odds of having disability compared with White women (OR= 1.67, 95% CI= 1.07–2.60), but there were no differences in male counterparts (OR=1.03, 95% CI=0.68-1.56). Compared with White men, men of Asian or Other race had lower odds for disability, while associations were in the opposite direction in female counterparts; however, associations were not statistically significant. Further research is needed to understand higher prevalence of disability among older minority women compared with White women.
BIOLOGICAL RISK FACTORS FOR DEMENTIA AND COGNITIVE FUNCTION AMONG OLDER INDIANS: FINDINGS FROM LASIDAD
Authors: Wu Qiao , Crimmins Eileen , Farina Mateo , Kim Jung Ki , Zhang Xinyao
Published: December 2022

A number of clinical and exam-generated biomarkers have been associated with dementia. We assess the relative importance of 41 biomarkers using a novel dataset from an understudied population – a national sample of older Indians. The value of our data includes the biomarker extensiveness, the validated classification of dementia, and the relatively lower average education of the population. We use both traditional social science methods based on biological theories and agnostic machine learning algorithms to examine how biomarkers explain variance in dementia diagnosis and cognitive functioning. Comparing different approaches shows how to best characterize the influence of biology and how to trim and combine biomarkers. The six approaches used in our study include: (1) 41 individual biomarkers; (2) identification of subsets of biomarkers with elastic net; (3) support vector machine learning; (4) factor analysis; (5) principal component analysis; and (6) factor classification based on a theoretical approach. Preliminary results show that all the biomarkers or a reduced set of biomarkers identified by elastic net do the best job at explaining variability in dementia outcome, but the biomarkers chosen as most important by elastic net do not match well our understanding of biological mechanisms. Traditional social science approaches (e.g. factor analysis and principal components approach) provide better understanding and interpretation of the relative importance of biological systems as well as the association between biomarkers and cognition. These results are informative for others collecting and analyzing biomarker data in population samples.
STRATEGIES AND TECHNOLOGIES TO SUSTAIN NATIONWIDE IMPLEMENTATION OF ALIVIADO DEMENTIA CARE
Authors: Brody Abraham , Durga Aditi , Ford Ariel , Lassell Rebecca , Lin Shih-Yin
Published: December 2022

It is well documented that knowledge improvement alone is not sufficient to sustain systems level changes. Through supporting dementia care workforce training and the embedding of Aliviado program tools (treatment algorithms, assessments, care plans, and caregiver education materials) into hospices’ clinical workflow across the U.S., we learned that both technologies and human support strategies are essential for lasting changes. In this presentation, we first discuss our experience leveraging a powerful customer relationship management software (Salesforce) to assign, manage, and encourage completion of the interprofessional Aliviado Dementia Care training for thousands of active users across the nation. We then share how we provide additional human support and implementation tools in the face of COVID-19, which can inform implementation of similar trials, including office hours, training reports, Plan-Do-Study-Act worksheets, symptom management cheat sheets, champion calls, and electronic health records integration meetings with each agency to locally tailor and embed Aliviado tools.
CHANGE IN EPISODIC MEMORY AND EXECUTIVE FUNCTIONING PREDICTS MORTALITY RISK
Authors: Odd Kaleena , Boron Julie , Alderson Jacob , Lachman Margie , Turiano Nicholas
Published: December 2022

The current study explored whether the Brief Test of Adult Cognition via Telephone (BTACT) assessment could be used to predict longevity in a national sample of adults from the Midlife Development in the United States (MIDUS) study. Specifically, we examined whether 9-year changes in episodic memory (EM) and executive functioning (EF) predicted all-cause mortality risk (2004-2018). The sample included 2,643 participants (MAge=45.87; 92.23% white; 107 deceased) who completed the BTACT twice: between 2004-06 and between 2013-2017. Using change scores, decreases in EM (HR= 1.45 [1.09-1.93], p=.01) and EF (HR=1.585 [1.17-2.14], p<.001) increased the hazard of dying (controlling for age, gender, race, education, and self-rated health). Results suggest the BTACT is sensitive enough to detect health-consequential decreases in EM/EF. Future research should consider the BTACT as a viable assessment tool for older adults who may not have easy access to cognitive screenings.
WITHIN-PERSON RELATIONSHIP BETWEEN MINDFULNESS AND COGNITION IS MEDIATED BY SUBJECTIVE AGE
Authors: Graham Lyndsey , Neupert Shevaun
Published: December 2022

Cognitive functioning fluctuates daily throughout adulthood. Lapses in mindfulness can have cognitive consequences, which may be impacted by how old a person feels each day. Subjective age was examined as a mediator in the within-person relationship between mindfulness and cognition. 107 younger adults (aged 18-36, M = 19.96) and 116 older adults (aged 60-90, M = 64.71) completed reports of mindfulness and subjective age and tests of inductive reasoning and episodic memory for 8 consecutive days. Within-person multilevel mediation models indicated that daily subjective age mediated the relationship between daily mindfulness lapses and both indicators of daily cognition across ages. However, the mediation effect was stronger for younger adults on inductive reasoning but was stronger for older adults on episodic memory. These results show that daily changes in subjective aging are an important mechanism for daily cognition, with differential impact based on age and cognitive component.
USE OF DIGITAL TECHNOLOGY SOLUTIONS TO SUPPORT CAREGIVING BY FAMILY CAREGIVERS OF OLDER ADULTS
Authors: Malhotra Rahul , Azman Nur Diyana , Goh Veronica Shimin , Visaria Abhijit
Published: December 2022

Caregiving-relevant information and services are increasingly available online. Greater understanding of the extent and purpose of their use by family caregivers of older adults and specific caregiver sub-groups that are more or less likely to use them can inform both policies related to and the content of such solutions. We investigated the extent to which family caregivers of older persons in Singapore use digital technology solutions such as the internet and apps, and the purposes for which they use them. Information on digital device use was collected from 278 caregivers. Of them, 139 caregivers gave detailed information on how they had used the internet or apps to support caregiving in the last six months. Most (89%) caregivers used digital devices regularly (mostly smartphones (87%)). Digital device use was associated with caregiver age, ethnicity and education. Common generic online activities included sending instant messages (77%) and surfing websites (64%). While 54% had used the internet to support caregiving (most common purpose: search for information on care-recipient’s health conditions), 43% had used apps to do so (most common purpose: coordinate care with family members or other caregivers). Such use was associated with caregiver age, education and care-recipient health. While use of digital devices and generic online activities are common among caregivers, their use of the internet or apps to support caregiving is less common. Information-seeking and coordination are indicative of avenues in which digital technology solutions can complement ‘physical’ channels of communication and support with and for caregivers, and be further expanded.
LUCIDITY IN DEMENTIA: EMERGING CONCEPTS AND DATA
Authors: Gilmore-Bykovskyi Andrea , Eldadah Basil
Published: December 2022

Episodes of lucidity among people with advanced Alzheimer’s disease and Alzheimer’s disease related dementias (AD/ADRD), reportedly evidenced by an unexpected return of meaningful communication or connection, are an area of growing interest. Event transient recovery of abilities in the setting of advanced AD/ADRD are potentially significant for caregivers and the person living with dementia; as well as for shaping our understanding of AD/ADRD more broadly. Despite the potential significance of these events, existing evidence is largely comprised of anecdotal reports and retrospective/case reports. Recently, the National Institute on Aging funded six studies to advance empiric studies on episodes of lucidity in advanced AD/ADRD. This symposium will provide an update on progress and findings across these funded studies. The first presentation focuses on acceptability and feasibility of a prospective observation study focused on characterizing potential observable indicators of episodes of lucidity in individuals with advanced AD/ADRD near end of life encompassing audiovisual observation, informant field interviews and case reviews. The second presentation will provide an overview of a 3-phase mixed methods study focused on development of preliminary types of lucid episodes. Collectively, presentations demonstrate a variety of approaches to investigating episodes of lucidity and shed light on emergent methods for operationalizing these events. Implications of various conceptualizations for EL and conceptual decisions across studies will be reviewed.
IS THERE A DIFFERENCE BETWEEN TERMINAL LUCIDITY AND PARADOXICAL LUCIDITY?
Authors: Peterson Andrew , Clapp Justin , Harkins Kristin , Kleid Melanie , Largent Emily , Stites Shana , Karlawish Jason
Published: December 2022

Recent arguments in aging and dementia research suggest that “terminal lucidity”—defined as unexpected communication or connectedness occurring shortly before death—is distinct from “paradoxical lucidity”—defined as an episode of communication or connectedness in a person who is assumed to have lost these capacities due to progressive neurodegeneration. We disagree with this distinction and argue that terminal lucidity is a special subtype of paradoxical lucidity. We suggest that specifying the relationship between terminal and paradoxical lucidity is important for investigating the underlying mechanism of lucidity in dementia.
APPROACHES TO INVESTIGATING LUCIDITY IN ADRD: A PRELIMINARY RESEARCH FRAMEWORK TO GUIDE OPERATIONAL HARMONIZATION
Authors: Gilmore-Bykovskyi Andrea , Griffin Joan , Mueller Kimberly , Parnia Sam , Kolanowski Ann
Published: December 2022

Episodes of lucidity (EL) in Alzheimer’s disease and Alzheimer’s disease related dementias (AD/ADRD), also termed “paradoxical lucidity,” have garnered increasing attention as an important area of research. Efforts to study lucidity suffer from a lack of clear definitional criteria, inconsistent conceptualization and diverse approaches to operationalizing features of these events. To advance systematic investigation of EL in AD/ADRD, there is a need for clarity and precision in labeling event attributes, markers, and specific measurement strategies that enable operational harmonization across distinct approaches to investigating the relatively broad and nascent phenomenon. To that end, we propose a preliminary research framework to guide harmonization of approaches to investigating EL in AD/ADRD. Our goal is to provide a systematized approach to characterizing operational decisions that facilitates comparability across different methodological approaches and measurement strategies while allowing for exploration of multiple definitional criteria, measurement standards, and interpretive approaches.
GROUP-BASED TRAJECTORY MODELING OF NURSING HOME RESIDENT PAIN SCORES
Authors: Cole Connie , Hickman Susan , Blackburn Justin , Carpenter Janet , Chen Chen
Published: December 2022

Up to 80% of older adults living in a nursing home (NH) experience pain and up to 32% have substantial pain. Pain in NH residents is associated with poor quality of life, higher likelihood of depression, and decreased life satisfaction. Pain in NH residents has often been studied using a cross-sectional approach, which fails to consider the temporal nature of pain. Therefore, the purpose of this analysis was to identify and characterize clinically meaningful, dynamic pain trajectories in NH residents using data from the Minimum Data Set. A retrospective longitudinal analysis was conducted using group-based trajectory modeling with pain scores from admission to discharge or a maximum of 28 assessments. We identified four distinct trajectories: 1) consistent pain absence (48.9%), 2) decreasing-increasing pain presence (21.8%), 3) increasing-decreasing pain presence (15.3%), and 4) persistent pain presence (14.0%). Relative to residents’ in the consistent pain absence trajectory, the likelihood of being in the persistent pain presence trajectory was more than twice as high for those living in a rural versus (AOR 2.7, CI 2.2-3.4, p<.001), over 4 times higher for those with hip fracture (AOR 4.3 CI 2.6-7.0, p<.001), nearly 3 times higher for those with a fracture other than hip (AOR 2.9, CI 2.0-4.1, p<.001), and almost twice as high for those with contracture (AOR 1.7, CI 1.4-2.1, p<.001). Using residents’ characteristics associated with persistent pain such as hip fracture or contracture may improve care planning based on early identification or risk stratification and can improve mitigation of persistent pain.
TESTING THE MODERATING EFFECTS OF DEPRESSIVE SYMPTOMS ON A PHYSICAL ACTIVITY INTERVENTION
Authors: Smail Emily , Kaufmann Christopher , Manini Todd
Published: December 2022

Depressive symptoms affect the physical and cognitive health of approximately 20% of older adults. These symptoms have strong, bidirectional ties with physical activity levels and mobility disability. Physical activity has a positive impact on mood and depression and is highly recommended for symptom management across all ages. However, it’s unclear whether elevated depressive symptoms interfere with potential benefits that physical activity has on other health outcomes like mobility loss. The Lifestyle Interventions and Independence for Elders (LIFE) Study randomized over 1,500 older adults (aged 70+) to either a physical activity (intervention) or successful aging (control) program with an average of 2.2 years of follow-up. Our analysis used Cox proportional hazards models to evaluate whether elevated depressive symptoms (measured using the Center for Epidemiological Studies-Depression (CESD)-11 scale with a cutoff score of 16/22 points) moderated the relationship between intervention status and the primary outcome (incident major mobility disability, objectively measured as the ability to walk 400 meters). In a secondary analysis of 1,534 older adults (Mage = 78.8, 66.7% female), we confirmed significant main effects of both the physical activity intervention and elevated depressive symptoms on incident major mobility disability but found no evidence of moderation (interaction p-value=0.989). Results indicate that the benefits of the intervention were comparable between those with and without significant depressive symptoms at baseline, supporting the inclusion of individuals with depression in clinical trials. In addition to potential symptom relief, promoting physical activity in older adults with depression is important for protecting against mobility loss.
SOMATOTROPIC SIGNALING IN HEALTH AND LONGEVITY
Authors: Brown-Borg Holly
Published: December 2022

The endocrine system is highly integrated and regulates growth, reproduction, metabolism, and stress responses that influence aging. Reduced growth hormone (GH) signaling extends health and lifespan in part, by altering metabolism maintaining enhanced insulin sensitivity and defense mechanisms. Diet composition affects metabolism and GH status integrates these nutrient signals, modulating metabolic responses that result in age-related disease susceptibility. Two pathways affected by somatotropic signaling include methionine and lipid metabolism. GH appears to regulate oxidative defense and the methionine pathway via enzymes that affect S-adenosyl-methionine, glutathione, DNA methylation, and detoxification activities. We also have evidence that GH deficient mice escape fatty liver disease when fed high-fat diets. Together our work and others indicate that GH plays a significant role in an organism’s ability to respond to nutrients and cellular stressors by regulating factors that counter stress, modulating metabolic responsiveness to nutrients, and detoxification of endogenous and exogenous compounds.
PANDEMIC-INSPIRED COLLABORATIVE ROADMAP TO PROMOTE RURAL FOOD EQUITY ACROSS THE LIFESPAN
Authors: Ilardo Joan , Zell Angela
Published: December 2022

Early during the pandemic, access to food by residents across the lifespan was problematic in many communities. We observed well-intentioned responses by community organizations but a lack of centralized coordination across sectors. Most organizations were not aware of the efforts and capabilities of others causing duplication or gaps in services. Our team created a user-friendly, evidence-based roadmap to guide communities through developing and sustaining effective collaborative partnerships for food and nutrition-related problems to address together. We will describe elements of an effective, efficient roadmap development process using currently available evidence-based resources and creating evidence-informed resources when we identify gaps. Expected outcomes are: 1) format of the final roadmap; 2) types of groups willing to use it; 3) how well the roadmap was implemented; 4) feasibility of continued use of the roadmap by groups over the long term; and 5) potential to expand roadmap use to other communities.
POSSIBLE SELVES THROUGH CAREGIVING: CAREGIVING HISTORY'S EFFECTS ON SELF-PERCEPTIONS OF AGING
Authors: Hu Rita , Larkina Marina
Published: December 2022

Most studies examine the consequences of self-perceptions of aging (SPA). Little is known about the antecedents. The possible selves framework suggests that earlier life experiences can shape people’s scenarios about their own aging. We examine the association between early-life informal caregiving experiences and SPA later in life using data from the HRS Retrospective Life History Mail Survey and the Psychosocial and Lifestyle Questionnaire ( N = 2,556, Mage = 72.9). Participants reported up to five periods of unpaid caregiving (≥ 6 months) with family members. SPA was measured by the HRS 8-item scale. Step-wise linear regression revealed that compared with people who had not been caregivers, early-life caregivers reported more negative SPA later in life (β = 0.20, 95%CI[0.12, 0.29]). The association holds after controlling for health-related and demographic covariates. Future research and interventions should focus on the consequences of early-life caregiving on the caregiver’s scenarios about their own aging.
SUBJECTIVE EXPERIENCES OF AGING AND PHYSICAL ACTIVITY IN THE YEARS THAT PRECEDE AND FOLLOW A FALL
Authors: Mejía Shannon , Su Tai-Te , Washington Faith-Christina
Published: December 2022

Falls are the leading preventable cause of death and disability in older adulthood. Subjective experiences of aging could facilitate fall prevention and adaptation to post-falls life. We use data from the 2008-2018 waves of the Health and Retirement Study to follow self-perceptions of aging (SPA), health-domain control (HDC), and physical activity (PA) in 12,000+ adults (Mage=69.09; 59% women; 83% white) to examine trajectories of subjective experiences and health behaviors preceding and following a fall. In total, 57% experienced falling. Both SPA and HDC were lower among fallers. Spline growth models showed that HDC, SPA, and PA significantly decreased over time. Additionally, the rate of decline in HDC and PA increased following the fall. After falling, the protective effect of HDC amplified, while positive SPA dampened change in PA. Our study illustrates the importance of subjective experiences of aging on adaptation and recovery in the context of falling.
INTERVENTION FIDELITY IN THE FAMILY-CENTERED FUNCTION-FOCUSED CARE INTERVENTION
Authors: Resnick Barbara
Published: December 2022

This session will provide a description of the treatment fidelity (TF) plan from the Family-centered Function-focused Care (Fam-FFC) trial. Components of the TF plan, measures, procedures for implementation, and findings will be presented, and discussed within the context of the COVID-19 pandemic. The components of the Fam-FFC TF plan and results include: 1) Delivery based on completion of the steps in Fam-FFC ; 2) Receipt based on evidence of Staff knowledge of Fam-FFC (percentage of nursing staff that demonstrated test scores above 80%); 3) Enactment based on achievement of goals using the Goal Attainment Scale ; completion of the Fam-Path Audit of bedside goals and treatment plans, post-acute follow-up and plan update ; and evidence of Fam-FFC based on the Fam-FFC Behavior Checklist (80% staff performance of Fam-FFC). The TF plan demonstrated evidence of delivery, receipt and enactment of study activities. Findings will be used to develop an implementation trial.
DOES CALORIC RESTRICTION SLOW THE PROCESS OF BIOLOGICAL AGING? EVIDENCE FROM THE CALERIE TRIAL
Authors: Waziry Reem
Published: December 2022

Calorie restriction (CR) slows aging and increases healthy lifespan in model organisms. We tested if CR slowed biological aging in humans using DNA methylation analysis of blood samples from N=197 participants in the Comprehensive Assessment of Long-term Effects ofReducing Intake of Energy (CALERIE™) randomized controlled trial. We quantified CR effects on biological aging by comparing change scores for six epigenetic-clock and Pace-of-Aging measures between n=128 CR-group and n=69 ad-libitum-control-group participants at 12- and24-month follow-ups. CR effects were strongest for DunedinPACE Pace of Aging (12-month Cohen’s d=0.3; 24-month Cohen’s d=0.2, p<0.01 for both), followed by DunedinPoAm and the GrimAge epigenetic clock, although effects for these measures were not statistically differentfrom zero (p>0.08). CR effects for other epigenetic clocks were in the opposite direction (all p>0.15). CALERIE intervention slowed Pace of Aging but showed minimal effect on epigenetic clocks hypothesized to reflect longer term accumulation of aging burden.
THE JOY AND CHALLENGES OF STORY CREATION WITH TIMESLIPS: STUDENT FACILITATOR PERCEPTIONS
Authors: Ihara Emily , Perez Emily , Barrett Kendall , Inoue Megumi , Tompkins Catherine
Published: December 2022

Creative arts interventions for people living with dementia have been shown to improve mood, emotions, communication, and relationships for older people living with dementia and their care partners. Previous research demonstrates that TimeSlips, a creative storytelling intervention, provides a “failure-free” environment and an opportunity for individuals to use their imagination. Because it does not involve memory, people living with dementia are encouraged to contribute and interact, thus creating an environment that focuses on dignity and strengths rather than deficits. This case study explores the student facilitators’ experiences of running TimeSlips sessions in different levels of care. The two facilitators ran continuous sessions over six months – with an individual at home, group sessions in memory care, and group sessions in assisted living. The facilitators journaled about their experiences after each session and the same picture prompts were used across the different types of sessions. Each journal entry was coded by two independent researchers using grounded theory principles. Through the coding, it was clear that the facilitators needed to use different skills to engage participants in storytelling based on their level of care. Themes that emerged include joy of connection, playfulness, and engagement. In addition, specific skills are needed to accommodate some behaviors of people living with dementia (such as aggressive behavior toward others in the group) and how to distract from those behaviors to continue with the storytelling. The benefits and challenges of each modality and gaps that may need to be addressed for student facilitators will be discussed.
DIFFERENCES IN THE MEASUREMENT OF COGNITION FOR THE ASSESSMENT OF DEMENTIA ACROSS GEOGRAPHIC CONTEXTS
Authors: Nichols Emma , Ng Derek , Hayat Shabina , Langa Kenneth , Lee Jinkook , Steptoe Andrew , Deal Jennifer , Gross Alden
Published: December 2022

Most cognitive assessments have been developed in high-income countries but are subsequently used in diverse contexts. Differences in culture and context may affect performance of cognitive items. We used the Harmonized Cognitive Assessment Protocol surveys in the US, Mexico, India, England, and South Africa (combined N=11,364) to quantify associations across countries between cognitive items and cognitive impairment status using age- and gender-adjusted logistic regression. Associations were stronger in the US (Median Odds Ratio [OR] across items=0.17) and England (Median OR=0.19), compared to South Africa (Median OR=0.23), India (Median OR=0.29), and Mexico (Median OR=0.28). Items assessing memory (e.g. delayed recall tasks) had the most consistent associations of the largest magnitudes across contexts. Transporting cognitive items among countries and cultures warrants caution. We identified items that performed well either in individual contexts or across the range of contexts considered; this information can be used to guide the design of future instruments.
DYADIC AND LONGITUDINAL STUDIES OF CLOSE RELATIONSHIPS: NEW INSIGHTS INTO HEALTH AND WELL-BEING ACROSS ADULTHOOD
Authors: Luong Gloria , Fruhauf Christine
Published: December 2022

This symposium includes 5 papers using intensive, longitudinal, and/or dyadic data on social relationships, revealing novel insights into health and well-being across adulthood. Fruhauf and colleagues conducted a feasibility and acceptability to test their Merging Yoga and self-management to develop Skills (MY-Skills) intervention, which targets caregiving dyads (caregivers and care receivers) dealing with persistent pain. Participants completed group interventions meeting twice a week for eight weeks, with each two-hour session including self-management education followed by yoga. A priori benchmarks for feasibility were met for the dyads, suggesting that these interventions may lead to improved well-being for caregiving dyads. Turner and Hooker conducted a 30-day microlongitudinal study of middle-aged daughters who are caring for their parents with dementia. On days when caregivers had more positive appraisals of caregiving than their own average, they had greater physical activity goal pursuit, independent of that day’s negative appraisals. Luong and colleagues also leverage an intensive longitudinal study spanning 3.5 month that prospectively tracked older adults and their close partners as they transitioned into senior housing facilities. Well-being varied by marital status, and changes over time varied by age. Weidmann & Chopik examined older romantic couples from 36 nations and found that between-partner correlations between depressive symptoms, self-rated health, and cognitive performance diffed across cultures. Finally, Purol et al. found that among middle-aged and older couples, similarity effects of personality facets on health and well-being were relatively small in magnitude, suggesting personality similarity among couples may be overstated in the literature.
LINKS BETWEEN DEPRESSIVE SYMPTOMS AND SELF-RATED AND COGNITIVE HEALTH IN OLDER COUPLES AROUND THE WORLD
Authors: Weidmann Rebekka , Chopik William
Published: December 2022

Mental and physical health are important concerns in late adulthood. To gain a deeper understanding of the associations between depressive symptoms and self-rated and cognitive health as they occur contextualized within romantic relationships and across different cultures, we examined these links in older romantic couples of 36 nations. To that end, we used data from North and South America, Europe, and Asia with a total sample of 47,396 romantic couples. Between-partner correlations of depressive symptoms, self-rated health, and cognitive health demonstrated substantial variations across cultures. Further, we found that the depressive symptoms in one partner were linked to worse self-rated health and worse cognitive performance in both partners. Age, education, and functional difficulties partly accounted for these associations. These findings were also characterized by cross-cultural variation. Hence, depressive symptoms represent a potential risk factor for health in couples.
EPIDEMIOLOGY OF FALLS: RACIAL/ETHNIC CONSIDERATIONS
Authors: Li Wenjun , Hou Su-I
Published: December 2022

Prevention of falls is important to independent living and good health in older age. This symposium brings together four studies on epidemiology of falls among community-dwelling older adults. The first study examined location and activity-specific fall rates among 388 older adults in Massachusetts. Compared to Asians, annual rates of indoor and outdoor falls and falls while walking were substantially higher among non-Hispanic White and Hispanics. The second study evaluated racial/ethnic differences in fear of falling, depression, lack of physical activity and negative self-perceptions of aging in 121 low-income older adults. The highest levels of fall risk were found in Hispanics and Asian Americans, fear of falling in African Americans, and depression in Hispanics. The third study assessed the relationship between objectively measured sedentary bout frequency with recurrent falls (2+ falls/year) among 2,918 men aged 79.0±5.1 years attending the Osteoporotic Fractures in Men Study (MrOS) Year 7 (2007-2009) visit. The analysis found a likely U-shaped association between sedentary bout frequency and recurrent falls risk, with the least and most active men are at higher risk. The fourth study investigated the association between fear of falling and falls risk among Chinese and non-Chinese older adults in Singapore using data collected via an electronic survey between January and February 2022. The analysis did not find significant ethnic differences in fear of falling. Although limited by sizes, these studies found racial and ethic differences in fall rates, physical activity, fear of falling and other risk factors, which are of great interest for further investigations.
RACIAL DIFFERENCES IN LOCATION AND ACTIVITY-SPECIFIC FALLS IN MASSACHUSETTS, US
Authors: Li Wenjun , Churchill Linda , Aguirre Annabella , Clarke Anthony , Procter-Gray Elizabeth , Kane Kevin , Berry Sarah , Hannan Marian
Published: December 2022

Prevention of falls is important to independent living and good health in older age. Circumstances of falls may vary by older person’s sociodemographic attributes, health conditions and living environment. Health Aging and Neighborhood Study (HANS) examined rates of location and activity-specific falls among 388 community-living older adults living in Central Massachusetts between 2018 and 2020. Data on falls were collected using monthly calendar, and information on falls was collected by trained staff via telephone interviews with the participants. The follow-up time ranging from 11.9 to 24.4 months. In total, 431 falls were reported, of which 97% had information on location of fall, and 95% had information on activity at time of fall. Annualized rate of any fall differed significantly by race/ethnicity. Asians had the lowest rate (0.26/year). Rate of Hispanics was approximately twice higher (0.55, p=0.04) and non-Hispanic Whites three times higher (0.84, p<0.001). For indoor falls, Asians reported significantly lower rates than Hispanics (0.10 vs. 0.44, p=0.005) or non-Hispanic Whites (0.10 vs. 0.36, p=0.009). Greater outdoor fall rate was associated with male gender (p=0.04); younger age (p=0.03); Asian (p=0.02) and, especially, non-Hispanic White race (p<0.001, with Hispanics as referent); higher income (p<0.001); and more years of education (p=0.001). Falls while walking were significantly associated with non-Hispanic White race (p<0.001) and Hispanic ethnicity (p=0.001). In summary, rates of any, indoor or outdoor falls vary significantly by race. The underlying mechanisms should be further investigated.
THE ASSOCIATION BETWEEN OBJECTIVE MEASURES OF INTERMITTENT SEDENTARY BREAKS WITH RECURRENT FALL RISK IN OLDER MEN
Authors: Roe Lauren , Harrison Stephanie , Cawthon Peggy , Ensrud Kristine , Gabriel Kelley , Kado Deborah , Cauley Jane
Published: December 2022

BACKGROUND

We assessed the relationship between objectively measured sedentary bout frequency with recurrent falls (2+ falls/year).

METHODS

The sample included 2,918 men aged 79.0±5.1 years attending the Osteoporotic Fractures in Men Study (MrOS) Year 7 (2007-2009) visit. Sedentary bout frequencies were defined as the average daily number of transitions out of 5+ minutes sedentary (<1.5 METS). Falls were self-reported from mailed questionnaires. Generalized Estimating Equations estimated the odds of recurrent falls.

RESULTS

Over four follow-up years, 1,025 (35.1%) men had recurrent falls. Compared to men with <13.6 transitions from sedentary (Quartile (Q)1), the odds of recurrent falls among men with 13.6-<17.0 transitions (Q2), 17.0-<20.4 transitions (Q3), and 20.4-<34.6 transitions (Q4) were 0.82 (95%CI: 0.66-1.01), 0.79 (95%CI: 0.64, 0.99), and 1.01 (95%CI: 0.81, 1.27), respectively, after adjustment.

CONCLUSIONS

A U-shaped association may exist between sedentary bout frequency and recurrent falls risk. The least and most active men are at higher risk.
ENHANCING RESILIENCE IN OLDER ADULTS WITH ADVANCED LUNG CANCER
Authors: Ramos Katherine
Published: December 2022

For older adults with advanced cancer, the negative impacts on their emotional and physical health are prevalent, often jeopardizing their capacity to effectively cope and exhibit resilience. Research on multidisciplinary interventions that promote resilience in older adults facing advanced lung cancer has received limited attention. To enhance how healthcare systems/teams may improve oncogeriatric care, we present study findings from a theory-driven behavioral intervention pilot (Self-System Therapy; SST) designed to target patient self-regulation (e.g., behavioral activation, promotion-focused goal setting) to enhance psychological and physical resilience. A total of 15 older adults with late-stage lung cancer completed 6–8-weeks of SST all delivered via videoconference. Self-report, accelerometry, and exit interview data will be presented along with prior pilot data of 30 older adults (total N = 45). Preliminary findings suggest that participants found the use of videoconference feasible and acceptable; with a 95% adherence rate, 7% attrition rate, and 95% satisfaction with SST.
PROTECTIVE RESILIENCE INDEX FOR SUCCESSFUL AGING IN MUSCULOSKELETAL PAIN (PRISM): PRELIMINARY FINDINGS
Authors: Brooks Amber , Sibille Kimberly , Bartley Emily , Garvan Cynthia , Mickle Angela
Published: December 2022

Chronic musculoskeletal pain is a highly prevalent condition in older adults and is associated with a decrease in function, biological dysregulation and cellular aging, and increased risk of morbidity and mortality. Our previous work shows that a resilience index comprised of measures of recognized biobehavioral and psychosocial protective factors based on clinically validated norms (waist hip ratio, tobacco use, social support, perceived stress, optimism, positive affect, negative affect-low, active coping) was positively associated with telomere length, lower levels of clinical pain and pain-related functional decline which, also correlated with pain-related brain structure. We will report the initial findings from our multi-centered, NIA RCCN funded study, Protective Resilience Index for Successful Aging in Musculoskeletal Pain (PRISM), which seeks to refine and validate a resilience index that is predictive of biological and pain-related outcomes. This work will lay the foundation for a resilience index that can be used in everyday clinical practice.
EXAMINING THE PROCESS OF COMMUNITY-DWELLING OLDER ADULTS CREATING A LEGACY OF VALUES
Authors: Neller Sarah , Cloyes Kristin , Edelman Linda , Wong Bob , Towsley Gail
Published: December 2022

Creating a legacy of values (e.g., legacy letter) is a way to promote generativity by communicating emotional and supportive instruction (e.g., values, life lessons) to others. This study aimed to a) understand the process of how older adults create a legacy of values, b) identify contextual factors surrounding creation, and c) describe older adults’ experiences of creation. We recruited community-dwelling older adults who had previously created a legacy of values to participate in semi-structured interviews. Interpretive description guided data collection and analysis. We initially coded the transcripts deductively, based on the literature, and inductively; data were organized into categories (i.e., by contextual factors and process steps) and analyzed using constant comparison to identify patterns. Participants (n=16) had a mean age of 72.3 years (SD=5.8, range=65-83), most were female (n=14), and all had children and identified as non-Hispanic White. Motivations for creation included aging, transitions, or events (e.g., travel). Participants tailored the contents (e.g., life lessons) and format to recipients, revised their legacy of values over time, and recommended the process to others. The creation process was non-linear, iterative, and influenced by participants’ personal and familial contextual factors. Synthesis of these findings resulted in developing the Process Model for Creating a Legacy of Values, which depicts the iterative and interconnected nature of the content, process, and experience of creating a legacy of values. Our findings indicate older adults are seeking resources to create their legacy of values in a self-directed way, and that it is an acceptable, accessible, and relevant process.
PREPARING YOUR MANUSCRIPT: STRONG AND ETHICAL SCHOLARLY WRITING FOR MULTIDISCIPLINARY AUDIENCES
Authors: Meeks Suzanne
Published: December 2022

This presentation will emphasize the importance of plain, good writing. Editors read 10 or more manuscripts per week with pressure to reject 80-90% of them. If the point and contribution are not clear in a quick scan of the paper, it will not be reviewed favorably. I will provide tips for writing that are commonly violated in submissions, provide references for additional writing support, cover expectations for language consistent with GSA’s Reframing Aging initiative, and discuss some common publication ethics issues that arise during the review process, including author contributions and embedding your scholarship in the context of prior work.
IT’S A COOL LITTLE TOOL: PROVIDER PERSPECTIVES ON IMPLEMENTING PAL CARDS DURING COVID-19
Authors: Abbott Katherine , Douglas Natalie
Published: December 2022

This symposium describes the implementation of a person-centered care (PCC) communication tool in nursing homes. PCC is a philosophy that recognizes “knowing the person” and honoring individual preferences. The communication tool is based on an assessment of NH resident likes and dislikes via the Preferences for Everyday Living Inventory (PELI). The PELI is an evidenced-based, validated instrument that can be used to enhance the delivery of PCC. The Preferences for Activity and Leisure (PAL) Card was developed to communicate important resident preferences across care team members. From July 2020 to July 2021 we lead a Quality Improvement Project (QIP) approved by the Ohio Department of Aging providing virtual coaching to providers who created 15-20 PAL Cards for their residents. Our first presentation describes the QIP where n=16 started implementation and n=11 communities completed the project during the height of the pandemic. Providers were non-profit (50%) with an average star rating of 3.29 (SD 1.33). Feedback from n=68 direct care staff on PAL Card usage are reported. The next four presentations describe implementation of PAL Cards from the perspective of the provider champions who contributed to n=66 monthly interviews. Interviews were recorded, transcribed verbatim, and coded in Dedoose using the Consolidated Framework for Implementation Research as an a priori coding scheme. We present barriers and facilitators related to the domains of Inner Setting, Characteristics of the Individual, Characteristics of the Intervention, and Process. The Discussant, Dr. Natalie Douglas will discuss the implications of initiatives to address the quality of resident care.
DIRECT CARE STAFF PERSPECTIVES ON THE IMPACT OF PAL CARDS IN CARE DELIVERY
Authors: Abbott Katherine , Heppner Alexandra , Kelley Megan , Kasler Kamryn , Kunkel Miranda , Van Haitsma Kimberly
Published: December 2022

This was the third time replicating the Preferences for Activity and Leisure (PAL) Card quality improvement project, but the first conducted entirely during the height of the pandemic. Nursing home providers attempted n=174 PAL Cards and completed n=166 (96%). Feedback from surveys with n=68 staff who came in daily contact with residents (e.g., 26% CNAs, 10% housekeepers, 6% maintenance, 9% dining) were collected by project champions. Staff had worked on average 6 years, indicated that they remember being been told about PAL Cards (81%), noticed them (94%), reported that the information on the PAL Card helped them start a conversation with a resident (79%), and helped them provide care (59%). PAL Cards are a feasible method to communicate important resident preferences to staff who come in daily contact with residents and may not have access to electronic health records. Recommendations for practice will be discussed including staff recommendations for improvements.
THAT'S JUST MY SUPERPOWER: THE ROLE OF NURSING HOME PROVIDER CHAMPIONS IN IMPLEMENTING A PERSON-CENTERED PROJECT
Authors: Kunkel Miranda , Kelley Megan , Moore Reese , Kasler Kamryn , Arrasmith Chloe , Heppner Alexandra , Van Haitsma Kimberly , Abbott Katherine
Published: December 2022

Champions are crucial to successful intervention implementation; however, as an area of research champions have only recently begun to gain empirical focus. The purpose of this study was to identify the barriers and facilitators regarding champion qualities using the domain “Characteristics of the Individual” from CFIR. Qualitative interviews were conducted with nursing home provider champions (n=16) who led efforts to create PAL Cards for 15-20 residents and participated in a total of n=50 monthly interviews that were audio-recorded and transcribed verbatim. The following themes regarding characteristics of the individual emerged: champions’ investment in their community, capacity and existing workload, and willingness to ask for help. While some champions saw the value of the PAL Cards, they lacked the bandwidth necessary to widely implement the intervention in their community. Champions who recruited a supportive team and valued person-centered care exhibited success in implementing PAL Cards.