bluuebunny/crossref_metadata_2025 huggingface dataset:
UNDERSTANDING CAREGIVER PERSPECTIVES ON LIVE DISCHARGE AND RE-ENROLLMENT ONTO HOSPICE CARE
Authors: Wladkowski Stephanie P
Published: December 2022

Hospice care improves end-of-life outcomes for adults with Alzheimer’s Disease and related dementias (ADRD), yet with eligibility limited to a six-month prognosis, the patient-caregiver dyad can experience a live discharge from hospice. In 2019, nearly 350,000 patients with an ADRD diagnosis received hospice services in the US, and 6.5% of hospice patients were discharged due to being ‘no longer terminally ill.’ Caregivers of adults with ADRD who experienced a live discharge (n=24) were interviewed and thematic analysis was conducted. More than half (58%) noted specific support in their caregiving roles while 46% cited feeling relief. Eleven participants were enrolled for one hospice episode, and six re-enrolled at least one time. While participants would consider re-enrolling, they are waiting for a health crisis (n=7) for eligibility, while others question the meaning of hospice for ADRD patients (n=10). Implications for policy, practice, and research to support the patient-caregiver dyad are discussed.
THE RAISE FAMILY CAREGIVER ADVISORY COUNCIL: STRATEGIES TO BOLSTER CAREGIVERS’ FINANCIAL SECURITY
Authors: Nadash Pamela
Published: December 2022

The RAISE Family Caregiving Advisory Council, created under the Recognize, Assist, Include, Support, and Engage (RAISE) Family Caregivers Act (2018) has been tasked to support the Secretary of Health and Human Services in developing a national family caregiving strategy. The Council began by (in 2021) identifying five key Goals critical to supporting family caregivers, which were reported to Congress in the Council’s Initial Report; the next step (in 2022) was to identify how these Goals are to be operationalized via specific actions, as well as the stakeholders that needed to be involved. This symposium discusses Goal 4, which states that “Family caregivers’ lifetime financial and employment security is protected and enhanced,” a goal incorporating diverse components, including federal legislation (expanding FMLA, for example), enhancing workplace security for working caregivers, and ways to pay family caregivers for providing supportive services. The first paper, by Salom Teshale, PhD, will provide an overview of the Council’s work and the strategies that have been chosen to support the overall national strategy. The second paper, by Eileen J. Tell, MPH, will describe strategies to improve the ability of caregivers to remain and thrive in the workplace. Pamela Nadash, PhD, will report on the research that identified the expansion of self-directed programs to incorporate payment for family caregivers as key, and the fourth paper by Rani Snyder will conclude by identifying the research needed to move these efforts forward. Greg Link of the Administration for Community Living will act as discussant.
A RESEARCH AGENDA TO ADVANCE FAMILY CAREGIVERS' FINANCIAL SECURITY
Authors: Snyder Rani , Tell Eileen
Published: December 2022

The research supporting the RAISE Family Caregiver Advisory Council engaged a broad range of stakeholders who were committed to supporting actions that make a difference to family caregivers’ financial security, with many focusing on actions that sustain continued employment; 103 different organizations participated, including employer representatives. Participants strongly agreed on the need for more data. On a broad level, there was agreement on federal-level coordination regarding data collection on elements specific to family caregivers across federal agencies. In addition, they called for better information on the return on investment of varying strategies for workplace supports for employers, the added value of caregiver employees, and evidence regarding best practices in supporting family caregivers, with a goal of making a business case for family caregiver workplace supports.
THE RAISE COUNCIL'S WORK IN DEVELOPING A NATIONAL FAMILY CAREGIVING STRATEGY
Authors: Teshale Salom
Published: December 2022

Since 2019, the RAISE Family Caregiver Advisory Council (FCAC) has met regularly to carry out its work of developing a national family caregiving strategy. This strategy incorporates five goals to support family caregivers, and key actions that a range of stakeholders can carry out centered around these goals. This overview will describe the RAISE FCAC’s work in developing the national family caregiving strategy, and highlight the development of recommendations and key actions to support the fourth goal, “Family caregivers’ lifetime financial and employment security is protected and enhanced.” This goal’s recommendations include supporting caregivers through flexible workplace policies; supporting affordable long-term services and supports; supporting financial education and planning; and reducing overall negative financial impacts of caregiving short and long-term.
DIRECTORS OF SOCIAL SERVICES: OVERLOOKED LEADERSHIP NEEDS AT SKILLED NURSING FACILITIES (SNFS)
Authors: Abenojar John Paul
Published: December 2022

Skilled Nursing Facilities (SNFs) provide ongoing care to the elderly and chronically ill. To maximize the quality of this care, SNF staff must be trained to respond to patient care crises and communicate across departments. Although researchers have studied the leadership styles, strategies, and interactions of facility administrators and nursing directors, little was known about the leadership styles and strategies employed by the directors of social services (DSSs). The aim of this phenomenological study was to explore how DSSs influenced leadership policies, prepared subordinates for crisis intervention and management, perceived that social workers influenced patient care decisions, and believed that communication amongst SNF staff about patient care could be improved. The conceptual framework was based on the multilevel leadership model construct, the situational leadership model construct, and the complex adaptive leadership model construct. Participants included a purposive sample of 10 DSSs working in a large, corporate SNFs in Virginia. Data were collected via in-person, semi structured interviews consisting of open-ended questions. Data were analyzed via Hycner's phenomenological approach. Findings from this investigation helped clarify roles and responsibilities of DSSs, thereby improving the leadership they provide to subordinate social workers. Findings may be used to improve communication across professionals within SNFs and their roles in patient care decisions.
MITOCHONDRIAL COMMUNICATION AND AGING
Authors: Lee Changhan
Published: December 2022

Mitochondria evidently originate from endosymbiotic bacteria that presumably provided several advantages for eukaryotic life. For the past 1–2 billion years, mitochondria co-evolved with the ancestral cell to coordinate various cellular functions. Coordination requires communication and mitochondrial signaling has been shown to be vital to cellular fitness and aging. In this symposium, the speakers will discuss the role of mitochondria as a signaling organelle and their impact on key cellular functions in the context of aging. Consistent with emerging evidence of the complexity and sophistication of mitochondrial communication mechanisms, some of the mitochondrial-to-nuclear communication modes, including nuclear transcriptional programs and cellular signaling networks, that regulate molecular and cellular processes to promote fitness will be discussed. Dr. Chen will discuss how a mitochondrial metabolic checkpoint can regulate stem cell quiescence and maintenance that is important to stem cell aging. Dr. Picard will discuss the impact of mitochondrial stress on increased energetic cost of living (i.e. hypermetabolism) and cellular lifespan. Finally, Dr. Lee will discuss how signaling peptides that are encoded withing the mitochondrial genome regulate cellular homeostasis, increase physiological resilience, and promote healthy aging.
MITOCHONDRIA: POWERHOUSE, SLAUGHTERHOUSE, AND SPEAKER OF THE HOUSE
Authors: Lee Changhan
Published: December 2022

The nuclear and mitochondrial genomes have co-evolved since the union forged 1-2 billion years ago between our ancestral cell and free-living bacteria. The bi-genomic system is coordinated by close communication between the two genome-possessing organelles. More recently, peptides that are encoded in the mitochondrial genome have been identified and shown to communicate mitochondrial messages. In this symposium, I will discuss MOTS-c as a mitochondrial-encoded communication factor in the context of aging. MOTS-c can translocate to the nucleus under metabolic stress to directly regulate adaptive nuclear gene expression. In humans, MOTS-c levels increase in skeletal muscle and in circulation upon exercise. In mice, MOTS-c treatment significantly reversed physical decline in aged mice (22 mo.), including doubling in treadmill running time. Studies from our lab and others point to a novel class of mitochondrial-encoded longevity genes that coordinate cellular homeostasis.
MITOCHONDRIAL METABOLIC CHECKPOINT, STEM CELL AGING AND REJUVENATION
Authors: Chen Danica
Published: December 2022

Cell cycle checkpoints are surveillance mechanisms in eukaryotic cells that monitor the condition of the cell, repair cellular damages, and allow the cell to progress through the various phases of the cell cycle when conditions become favorable. Recent advances in stem cell biology highlight a mitochondrial metabolic checkpoint that is essential for stem cells to return to the quiescent state. As quiescent stem cells enter the cell cycle, mitochondrial biogenesis is induced and mitochondrial stress is increased. Mitochondrial unfolded protein response and mitochondrial oxidative stress response are activated to alleviate stresses and allow stem cells to exit the cell cycle and return to quiescence. These processes are critically regulated by several sirtuin family members, which are NAD+-dependent deacetylases. Because loss of stem cell quiescence results in the depletion of the stem cell pool and compromised tissue regeneration, deciphering the molecular mechanisms that regulate the mitochondrial metabolic checkpoint in stem cells will increase our understanding of tissue homeostasis and how it becomes dysregulated under pathological conditions and during aging. More broadly, this knowledge is instrumental for understanding the maintenance of cells that convert between quiescence and proliferation to support their physiological functions.
IT WAS TERRIBLE, I DIDN'T SLEEP FOR TWO YEARS: A MIXED-METHODS EXPLORATION OF SLEEP AMONG HOSPICE FAMILY CAREGIVERS
Authors: Starr Lauren , Washington Karla , McPhillips Miranda , Demiris George , Oliver Debra Parker
Published: December 2022

Due to overnight caregiving demands and inadequate social support, over 1.2 million hospice family caregivers in the U.S. and millions more worldwide are at risk of poor sleep and resulting negative effects on health. Sleep problems are a modifiable source of global health inequities. The purpose of this study was to describe hospice family caregiver sleep experiences, efforts to improve sleep, and effects of sleep. Developed using the Symptom Management Model, this mixed methods study featured a concurrent nested design prioritizing qualitative reflexive thematic analysis. In 2021, 47 family caregivers of hospice care-recipients from two randomized clinical trials in the United States (NCT03712410, NCT02929108) were interviewed. Sleep-related questions from PHQ-9 and GAD-7, and self-rated health and energy were administered at baseline. Three themes emerged: quality of sleep, factors influencing sleep, and effects of sleep. Hospice family caregivers commonly experienced “interrupted” sleep with frequent night-waking due to “on-call” “vigilance” and anxiety overnight and, sometimes, in bereavement. Negative effects included exhaustion, mental and physical health decline, and reduced performance. 72.5% described sleep quality as “fair” or “poor.” At baseline, 35.5% of caregivers were bothered by trouble falling asleep, staying asleep, or sleeping too much at least “more than half the days” in a week. Caregivers were reluctant to take sleep medications. Over half quit jobs or reduced work hours to provide care; few reported adequate support. Hospice family caregivers commonly experience disordered sleep with negative effects. Clinicians must assess sleep, offer tailored sleep interventions, and provide more supports to hospice family caregivers.
HEARING LOSS AND SUBJECTIVE COGNITIVE DECLINE IN THE ARIC-NEUROCOGNITIVE STUDY
Authors: Deal Jennifer , Lenzen Natalie , Majid Marjan , Jiang Kening , Reed Nicholas
Published: December 2022

Subjective cognitive decline (SCD) impacts quality-of-life, healthcare utilization and predicts dementia. If hearing loss is associated with SCD is unknown. We estimated the cross-sectional association between hearing loss and SCD in 2,536 participants (79.3±4.4 years, 60% female, 20% Black) in the Atherosclerosis Risk in Communities Neurocognitive Study. SCD was defined as self-reported persistent decline in memory (yes/no) among adults with normal cognition. Hearing was measured using pure tone better-ear thresholds (0.5-4 kHz), speech-in-noise, and self-report. Using Poisson models with robust standard errors, after adjustment for demographic and clinical covariates, self-reported moderate or greater trouble hearing (vs. excellent/good) was associated with a 30% increase in the prevalence of SCD (95%CI:1.12,1.51). Audiometric hearing and speech-in-noise performance were not associated. Use of self-report to approximate audiometric hearing warrants caution, particularly when the outcome is also self-reported; our findings suggest the association between self-reported hearing and SCD may be due to correlated measurement error.
THE ECONOMIC CONSEQUENCES OF GRAY DIVORCE FOR WOMEN AND MEN
Authors: Lin I-Fen , Brown Susan
Published: December 2022

Surprisingly little is known about the consequences of gray divorce (after age 50) and how women and men fare economically during the aftermath. Using longitudinal data from the 2004-2014 Health and Retirement Study, we estimated hybrid fixed/random effects models comparing women’s and men’s economic well-being prior to, during, and following gray divorce and subsequent repartnering. Women experienced a 45% decline in their standard of living, whereas men’s dropped by just 21%. These declines persisted over time for men, and only reversed for women following repartnering, which essentially offset women’s losses associated with gray divorce. Both men and women experienced roughly a 50% drop in wealth. Although repartnering seems to reverse most of the economic costs of gray divorce for women, few form new co-residential unions after divorce. This study offers insight about the financial aftermath of gray divorce, which is likely to contribute to growing economic disadvantage among older adults.
CON/DISCORDANCE BETWEEN SUBJECTIVE AND OBJECTIVE SLEEP PARAMETERS AND THEIR ASSOCIATION WITH COGNITIVE FUNCTION
Authors: Calfee Kristin , Lee Soomi
Published: December 2022

Studies report that subjective and objective sleep parameters often do not agree with each other. This study examined if discordance between subjective and objective sleep measures are associated with cognition. Participants from the Midlife in the United States study (n=627) provided subjective (self-report) and objective (actigraphy) sleep duration and sleep quality. Discordance was assessed by absolute difference between subjective and objective z-scores in each sleep variable. Cognitive function was measured by the Brief Test of Adult Cognition by Telephone (BTACT). The correlations between subjective and objective sleep measures were weak-to-moderate (r=.43, .18 for duration and quality, respectively). Discordance scores in sleep duration and quality were each significantly associated with BTACT, such that greater discrepancy was associated with poorer cognitive function. These associations remained persistent after adjusting for sociodemographic differences. Results suggest that discordance between subjective and objective sleep parameters may relate to cognitive abilities needed to accurately monitor sleep characteristics.
ACUTE RELATIONSHIPS BETWEEN MENTAL HEALTH AND COGNITIVE FUNCTION AMONG AGING ADULTS DURING THE COVID-19 PANDEMIC
Authors: Kobayashi Lindsay , O'Shea Brendan , Joseph Carly , Finlay Jessica
Published: December 2022

The acute impacts of COVID-19-related mental health concerns on cognitive function among aging adults are unknown. We investigated whether between-person (BP) differences and within-person (WP) changes in loneliness, anxiety, and COVID-19 worry were related to cognitive function and abilities in the COVID-19 Coping Study over nine months from August/September 2020 through April/May 2021 (n=2,262). Marginal structural models accounting for depression as a time-varying confounder and incorporating attrition and sampling weights estimated the BP and WP relationships of loneliness, anxiety, and COVID-19 worry with PROMIS cognitive function and abilities scores over time. In any given month, experiencing a loneliness or anxiety score higher than the sample mean (BP difference) as well higher than one’s personal mean across the nine-month period (WP change) were negatively associated with cognitive function and abilities in that month. Future research should explore long-term impacts of loneliness and anxiety experienced during the pandemic for population cognitive aging.
DIVERSE CONTEXTS, UNIQUE EXPERIENCES: IMPACT OF SOCIAL ISOLATION ON PSYCHOSOCIAL FACTORS AND COGNITION
Authors: Francis Jess
Published: December 2022

The aging population is not a monolithic group. Older adults’ experiences of and behaviors within their social networks are as varied as their diverse backgrounds and lifestyles. Although the threat of social isolation is particularly salient among older adults, the psychosocial and cognitive impact can differ along demographic and socioeconomic lines. The objective of this symposium is to highlight how different older adults are effected by their social network characteristics and structure, and how they mobilize their psychosocial resources to protect against loneliness, depression, and threats to cognition. First, Hong & Mejia examine how older men and women compare in their use of information and communication technology (ICT) as each influenced the experience of loneliness during the COVID-19 pandemic. Francis & Brauer also look at ICT use as they assess demographic and socioeconomic differences in social isolation, perceived mattering, and Facebook use among single older adults who are childless and live alone. Oh & Chopik explore uncoupled older adults along demographic lines in a 10-year longitudinal study of single people, their perceptions of change, satisfaction with singlehood, and major life events. Further exploring the theme of well-being during the COVID-19 pandemic, Cooper, Ajrouch, & Antonucci assess cognition, depressive symptoms, and their association with race among a sample of Whites, Blacks, and Arab Americans. Finally, Lee & Colleagues round out this symposium by sharing results of their study in which they examine the coping styles of non-Hispanic Whites and non-Hispanic Blacks and the impact on cognition.
FRIENDSHIP IS IN THE DETAILS: CO-CONSTRUCTION OF RELATIONSHIPS AMONG PERSONS WITH DEMENTIA IN LONG-TERM CARE
Authors: Saunders Pamela
Published: December 2022

Friendships have been linked to psychological and emotional wellbeing and better physical functioning in older adults. Conversely, negative consequences (e.g., depression) are associated with losing friendships and shrinking social networks. While cognitive decline might be a limiting factor for persons with dementia (PWD) to establish friendships, this has not been proven in the literature. This paper reports on 20 interactions between PWD collected during the Friendship Study (de Medeiros et al. 2011), an ethnographic study of friendship in long-term care (LTC). Participants are male and female residents in an LTC community. Diagnoses range from mild to severe Alzheimer’s disease. Conversational interactions were transcribed and coded for linguistic and discursive devices signaling friendly interactions. Findings reveal that friendships are co-constructed by PWD using 4 primary linguistic discursive devices, including topic (meals, religion, medication, furniture, directions, baking), co-constructed narrative, repetition, and alignment. Implications for future research on friendship among PWD are discussed.
TECHNOLOGY TO SUPPORT OLDER ADULTS' HEALTH, SAFETY, AND WELLBEING
Authors: Boot Walter
Published: December 2022

Technology has revolutionized the ability to deliver interventions to support older adults’ health, safety, and wellbeing, and technology-based solutions have become increasingly important in the delivery of remote care during the COVID-19 pandemic. However, these interventions and novel approaches require a careful understanding of older adults’ needs, preferences, and abilities, and need to undergo tests of feasibility, acceptability, and efficacy. This session will present a sampling of research examining the development, testing, and implementation of technology-based solutions to support older adults. R. Azevedo will present on the development of a novel digital therapeutic for the self-management of hypertension medication adherence among older adults. S. Kwon will present on the initial efficacy of an app-based mindfulness-meditation intervention to alleviate stress and depressive symptoms among bereaved older adults. Y. Du will discuss the use of a commercial fitness tracker to facilitate activity self-monitoring among overweight diabetic older adults with and without kidney disease. S. Dimmick will discuss the development of a novel augmented reality (AR) safety checklist to reduce fall risk among older adults. Finally, F. Jain will present on the development of a new mobile application platform to meet the needs of family dementia caregivers informed by focus groups and an inductive and deductive mixed method analytic approach. Themes of the necessity of a user-centered design approach in the development of technology-solutions will be emphasized.
SELF-MONITORING OF LIFESTYLES FOR DISEASE MANAGEMENT IN OVERWEIGHT DIABETIC SENIORS WITH/WITHOUT KIDNEY DISEASE
Authors: Du Yan , Kumar Sharma , Ramirez Valerie , Brittany Dennis , Li Shiyu , Li Chengdong , Wang Jing
Published: December 2022

Overweight/obesity, diabetes, and chronic kidney disease (CKD) are common multiple chronic conditions (MCCs) in seniors. Fitbit fitness trackers were used to track physical activity and food intake over 12-week in 15 overweight/obese diabetic seniors (age=70.5±4.8) with/without CKD. The associations of percentage of days with tracked steps (PDWTS), percentage of days with food logs (PDWFL) and 7-day mean step count with body mass index, fasting glucose, HbA1c and renal function were examined using Pearson Correlation analysis. Qualitative data assessing perceived factors related to self-monitoring and lifestyle behaviors was collected and analyzed using content analysis. At week 12, PDWTS and PDWFL was positively and negatively associated with renal function (P<0.05) and HbA1c (P<0.05), respectively. Motivation and perceived benefits of self-monitoring were frequently cited facilitators for self-monitoring. Self-monitoring might help seniors manage MCCs. Motivating self-monitoring and providing health education on the benefits of self-monitoring in lifestyle interventions to manage MCCs are warranted.
NAVIGATING LIFE UNCOUPLED: CHANGES IN SINGLEHOOD SATISFACTION IN RESPONSE TO MAJOR LIFE EVENTS
Authors: Oh Jeewon , Chopik William
Published: December 2022

Experiencing challenging events without a partner who can be supportive can be hard and change perceptions of the singlehood experience. We conducted growth curve analyses predicting intercepts and slopes of singlehood satisfaction from ten major life events (MLEs). Single people (N = 5,191; Mage= 46.98, 60.1% women) were followed longitudinally over 10 years (2008-2017) and provided information on MLEs and singlehood satisfaction. People were fairly satisfied with singlehood (Mintercept=6.52/10), and satisfaction increased over time (Mquadratic slope=.01). Some difficult events (e.g., becoming ill and losing parents) were associated with declines in singlehood satisfaction. However, responses to MLEs were overall complex—unemployment was related to lower levels of satisfaction but unrelated to changes in satisfaction. Seemingly positive events (e.g., buying a house, getting a job) were also related to lower levels of satisfaction. Results for each MLE will be discussed in line with additional qualitative data on single people’s perceptions of change.
CORRELATES OF PHYSICAL ACTIVITY HISTORY IN PARTICIPANTS OF THE BALTIMORE LONGITUDINAL STUDY OF AGING
Authors: Moore Ann , Simonsick Eleanor , Landman Bennett , Ferrucci Luigi
Published: December 2022

Physical activity across the life course contributes to physical function and health in later life. Here we characterize a measure of physical activity history, newly implemented in participants of the Baltimore Longitudinal Study of Aging (n = 690). Participants selected one of four levels to describe activity during each decade of life from age ten to the present. Recalled levels of physical activity are positively associated with activity assessed in current and prior decade study visits, suggesting that the recalled estimates are consistent with historic activity. A summary measure based on ranking activity patterns was associated with measures of physical performance, muscle and fat areas quantified from computed tomography images as well as some indicators of homeostatic dysregulation (p <.05). The observed associations suggest that an estimate of physical activity across decades provides complementary information to estimates of current activity and reemphasizes the importance of consistently engaging in physical activity.
FIT2DRIVE: DEVELOPMENT AND TESTING OF A PREDICTOR OF DRIVING CAPACITY OF OLDER ADULTS WITH COGNITIVE CONCERNS
Authors: Tappen Ruth , Newman David , Rosselli Monica , Coniff Joshua
Published: December 2022

The decision to stop driving has been reported by caregivers of persons with dementia as one of the most difficult ones they confront. Additionally, primary care providers to whom they often turn for guidance report being unprepared to provide them with evidence-based information. Our aim was to develop and test a predictive model employing 2 or 3 brief, easily administered cognitive tests to predict the individual’s likelihood of passing an on road driving test. Participants were licensed drivers recruited from our Memory Center’s driver evaluation program and the community to obtain a broadly representative sample of older drivers. A total of 357 drivers age 60 to 97 (mean 81) completed an established on-road driving test and battery of short cognitive tests. Two-thirds of the sample were white, non-Hispanic, one third were Black, African American, 59% male and 41% female, mean MMSE score of 24. Employing Receiver Operating curve analysis, the best set of predictors included participant age, MMSE utilizing world spelled backwards (a better predictor than serial 7’s), Trails B time in seconds and participant age yielding 95% AUC (area under the curve). The model was invariant across gender, education and ethnic group. A website with an interactive calculator in which this data is entered and likelihood of passing an on-road driving test prediction is presently under construction and will be available first to providers and later to individuals with a concern about continuing capacity to drive. Funded by Florida Department of Health Ed and Ethel Moore Alzheimer’s Disease Initiative.
IMPACT OF COVID-19 MOVEMENT CONTROL ON OLDER ADULTS’ HEALTHCARE UTILIZATION
Authors: Tan Vanessa , Ang Gregory , Goh Kim Huat , Yeow Adrian , Tan Gamaliel , Chen Cynthia
Published: December 2022

Singapore was one of the first countries affected by COVID-19. Measures to contain the spread of COVID-19 include raising the Disease Outbreak Response System Condition (DORSCON) risk assessment to Orange and instituting a movement control order, termed as the Circuit Breaker. These measures have caused significant disruption in primary care and chronic disease management. As the first point of contact in testing suspected cases, primary care providers shifted their focus from non-COVID-19 services. Using an interrupted time series analysis, we examine the associations of DORSON Orange and Circuit Breaker on acute and chronic primary care visits among older adults aged above 50. We found significant reductions in both acute and chronic primary care visits immediately following DORSCON Orange and Circuit Breaker. DORSCON Orange was associated with a drop of 231 mean acute and chronic daily visits (95% CI -356 to -106). Circuit Breaker was associated with a further drop of 268 mean daily visits (95% CI -426 to -111). These reductions were also observed for acute and chronic visits separately. Routine chronic care appointments were deferred or cancelled to reduce the risk of transmission as patients with underlying medical conditions were at higher risk of developing severe complications. Delayed access to primary care can have profound health implications, especially for older adults. Ensuring accessibility to primary care is a key priority in maintaining population health. Understanding the impact of COVID-19 tightening measures on older adults’ primary care utilisation will be useful for future public health planning.
DUAL FUNCTIONALITY IN LATER LIFE
Authors: Ferraro Kenneth
Published: December 2022

Longevity and quality of life are core interests in gerontology, but debate has ensued as scholars have sought to integrate the two. I propose the concept of dual functionality to examine how humans reach advanced ages while maintaining both physical and cognitive function. Using a large national sample, my colleagues and I operationalize dual functionality and identify life course factors that predict it. Analyses of 33,310 respondents 50 years or older from the Health and Retirement Study show an estimated median age of 74 for loss of dual functionality. Lifetime stress exposure leads to earlier loss of dual functionality, even after adjustment for socioeconomic status and lifestyle factors. Estimates of dual-function life expectancy, moreover, reveal greater racial-ethnic disparities than those for life expectancy per se. Dual functionality may be useful for assessing the quality of longevity across societies and social categories and for identifying exceptional longevity.
SEQUENCING OF PLANNED AND UNPLANNED BIRTHS AND IMPLICATIONS FOR MID- AND LATER-LIFE HEALTH AMONG NLSY79 WOMEN
Authors: Thomeer Mieke , Ross Clifford , Reczek Rin , Bijou Christina
Published: December 2022

Existing studies demonstrate that unplanned births (e.g., unwanted, mistimed) are associated with worse health for mothers in the short-term and—according to some preliminary evidence—in mid- and later-life. Yet as life course and reproductive career frameworks highlight, childbearing experiences often unfold over a number of years, with a considerable amount of diversity in pregnancy and birth experiences even for the same individual. For example, a person may have an unplanned birth in late adolescence followed by only planned births in early adulthood. In order to provide a more holistic understanding of how birthing experiences births are associated with midlife health, we use Sequence Analysis (SA) on the 1979 National Longitudinal Survey of Youth (NLSY79; N=3,992) to examine how patterning of planned and unplanned births is associated with physical and mental health at ages 50 and 60 (SF-12). Preliminary analysis indicates that compared to respondents with only planned births, respondents with unplanned birth(s) followed by planned birth(s) have worse physical and mental health at midlife, but there is no difference in health for respondents with only planned births, only unplanned births, and planned birth(s) followed by unplanned birth(s). Future analysis with SA will consider how more detailed sequences (e.g., timing, number and type, ordering, spacing) are associated with these mid- and later-life health outcomes, taking into account selection factors such as childhood SES and educational attainment. This project demonstrates the need for life course perspectives on the long-term health implications of unplanned births, recognizing diversity within and between individuals.
AGING-DEPENDENT CHANGES IN ADIPOSE PRECURSORS
Authors: Sul Hei Sook , Lin Frances
Published: December 2022

Adipose tissue mass and adiposity change throughout the lifespan. During aging, while visceral adipose tissue (VAT) tends to increase, peripheral subcutaneous adipose tissue (SAT) decreases significantly. Unlike VAT, which is linked to metabolic diseases, including type 2 diabetes, SAT has beneficial effects. However, the molecular details behind the aging-associated loss of SAT remain unclear. Here, by comparing scRNA-seq of total stromal vascular cells of SAT from young and aging mice, we identify an aging-dependent regulatory cell (ARC) population that emerges only in SAT of aged mice and humans. ARCs express adipose progenitor markers but lack adipogenic capacity; they secrete high levels of pro-inflammatory chemokines, including Ccl6, to inhibit proliferation and differentiation of neighboring adipose precursors. We also found Pu.1 to be a driving factor for ARC development. We identify an ARC population and its capacity to inhibit differentiation of neighboring adipose precursors, correlating with aging-associated loss of SAT.
”HOW OLD IS OLD?” ADDRESSING AGEISM AND UNCONSCIOUS BIAS AMONG MEDICAL STUDENTS DURING GERIATRICS CLERKSHIP
Authors: Ramaswamy Ravishankar , Chow Stephanie , Javier Noelle Marie , Leipzig Rosanne , Hinrichsen Gregory , Kelley Amy
Published: December 2022

Ageism (stereotyping, prejudice and discrimination based on age) has deleterious consequences on older adults’ health. Medical students have variable attitudes and biases toward older people. We hypothesized that an embedded ageism curriculum within the Ambulatory Care-Geriatrics clerkship would increase ageism awareness and commitment to reduce ageism in the clinical environment for third year medical students. The 2021 curriculum included assigned pre-reading, videos, short didactics, expert-facilitated small group discussion of clinical vignettes, reflective journaling, and posting of personal commitments on a virtual messaging board. We surveyed students at the start and end of the clerkship to evaluate baseline awareness, change in UCLA Geriatrics Attitudes Scale, and satisfaction with curricular components. Of the 95 students who thusfar participated in the curriculum, we received 92 pre- and 48 post-curriculum survey responses. Pre-curriculum students reported the median age for “old” was 65 years (range 35-90) and 42% of students expressed preference for younger patients (33% neutral). Proportion of students with self-assessed ability to identify ageist remarks/actions increased from 52%(pre) to 92%(post), and ability to minimize own ageist biases increased from 23%(pre) to 83%(post). 86% of students found the curriculum useful; discussion with experts and viewing an ageism TED Talk were the most favorably scored components. Integrating an ageism curriculum with pre-work, didactic, guided discussion and reflection components in the Geriatrics clerkship increased medical student awareness and confidence in addressing ageism-related behaviors. This curriculum complements students’ clinical interactions with older adults and has the potential to reduce the future impact of ageism in medicine.
GEROFIT TO HOME: REDUCING BARRIERS TO GROUP EXERCISE TO RURAL AND NONRURAL OLDER ADULTS IN A SUCCESSFUL FASHION
Authors: Gregor Neil , Christman Eva-Marie , Crivello David , Schukle Jamie
Published: December 2022

Transportation, scheduling and travel distance can present as barriers to participation in facility based exercise programs. Gerofit to Home(GTH) eliminates aforementioned burdens commonly associated with in-person programs. Understanding participant satisfaction and retention in rural(R) and non-rural(NR) groups assists in planning to better serve these populations with group exercise. This study aims to explore GTH participant satisfaction and retention in over 100 participants, through 3 months, for veterans over 65yo in rural and non-rural areas. Current results illustrate “Highly Satisfied” in majority of both R and NR groups. Retention at 3 months, in both groups, and factors associated with 3-month retention will be discussed in this presentation. Further research into the reasoning for participant stoppage prior to 3 months will aide in understanding how to better cater group exercise to these groups. Satisfaction scores in this study endorse further efforts for virtual group exercise in older adults.
ENRICHING OUR DISCOVERY BY TRAINING FOR ENGAGEMENT: METHODS FOR PATIENT/PERSON ENGAGEMENT IN RESEARCH
Authors: Lessem Rachel , Roes Martina , Abbott Katherine
Published: December 2022

There has been a recent movement towards greater involvement of the patient/person voice in aging research. However, many researchers embark on engaged research without adequate training or knowledge and without the skills or experience to train those they hope to engage. We define engaged research as research topics, designs, methods, analyses and/or dissemination strategies that have been informed through collaboration with or input from those who have a direct stake in research. This symposium explores education as a method of engaged research and is premised on the notion that engaged research enriches our discovery and ultimately leads to better outcomes in interventions as well as policy. There is an identified need for training of researchers as well as stakeholders in order to do successful engaged research. This symposium details educational methods for training those who utilize engaged research: student, researcher, and patient/person stakeholder, culminating in an examination of supporting patients in being trainers themselves. The first presentation investigates an overarching educational strategy to change the research paradigm. The second presentation explores a unique method for training researchers to engage older adults as advisory board members. The third presentation details a strategy for training a specific group of older adults to be active in engaged research. The symposium concludes by highlighting a method by which older adults engage in a research intervention as trainers. Attendees will be able to identify and evaluate the outcomes of the different educational methods and translate these methods to new settings.
TRAINING LONG-TERM SURVIVORS OF HIV TO ENGAGE IN RESEARCH TO IDENTIFY PRIORITIES FOR AGING WITH HIV
Authors: Rapoport Andy , Lessem Rachel , Danilovich Margaret
Published: December 2022

With effective antiretroviral therapies, HIV has become a chronic disease. Currently, >50% of people living with HIV are 50+ years old, and they face dual challenges of aging and HIV management. Overall, <15% of published studies in HIV engage stakeholders in research. These rates are even lower for older adults with HIV. Thus, there is a critical need to engage long-term survivors in developing meaningful research questions for aging with HIV. To address this gap, we created the SHARE (Survivors of HIV Advocating for Research Engagement) board. Presenters will discuss the process for building the board’s research capacity and results of a community needs assessment that board members designed and conducted to ascertain priorities for HIV-aging research. Presenters will discuss evidence-based educational strategies utilized to build member research knowledge, and pre-post training changes in knowledge, confidence, and understanding. Presenters will focus on novel training approaches implemented in the remote environment.
FLEXIBILITY MEETS COMPLEXITY: LESSONS FROM EMBEDDING A DEMENTIA CARE COORDINATION MODEL IN PRACTICE
Authors: Samus Quincy
Published: December 2022

People living with dementia (PLWD) are among the highest-need and highest-cost individuals because of the complexity, duration, and range of medical, behavioral, environmental, and social needs. There is a growing evidence base showing that family-centered active management approaches that include activation and empowerment of care partners are well suited to improve care quality and health-related outcomes, and have potential to curb high ADRD-related healthcare costs. This presentation will outline key experiences and lessons learned after a decade of work developing, adapting and embedding a comprehensive family-focused care management model called MIND at Home into practice. The work, supported in part by the IMPACT Collaboratory Health Care System Scholars Award to partner with Centene Corporation, a large managed care organization, illustrates two overriding principles: (1) the necessity of “meeting people and health systems where they are” (literally and figuratively), and (2) the importance of effectively matching intervention to outcome and context.
ABNORMALITIES IN THE CITRATE CYCLE METABOLISM ARE ASSOCIATED WITH DECLINED INTRINSIC CAPACITY IN OLDER ADULTS
Authors: Pan Yiming , Liu Pan , Li Yun , Ma Lina
Published: December 2022

Background

Aging is accompanied by a decline in physical and mental functions, manifested as the declines in intrinsic capacity. However, there is still a lack of understanding about the metabolic mechanisms underlying the declining intrinsic capacity. Objective: To explore the metabolic characteristics and pathways of the declines in intrinsic capacity with the assistance of metabolomics methods.

Methods

Our study recruited 38 participants in total. The Short Physical Performance Battery, Mini-Mental State Exam, 30-item Geriatric Depression Scale, self-reported hearing/visual impairment and Mini Nutritional Assessment were used to assess the five domains of intrinsic capacity respectively. The untargeted liquid chromatography-mass spectrometry-based metabolomics was performed on the serum of participants. Multivariate statistical analysis and pathway analysis were then implemented.

Results

Among the 38 participants aged 66.50±15.20 years, 22 were with the declines in at least one domain of intrinsic capacity. In the 349 identified metabolites, 35 were candidate biomarkers for declining intrinsic capacity with variable importance in the projection > 1.5 and p < 0.05. Citrate cycle, tryptophan metabolism, phenylalanine and tyrosine metabolism, and Arginine biosynthesis were significant pathways associated with the declines in intrinsic capacity.

Conclusions

Decreased intrinsic capacity is an age-related change with characteristic metabolomics features. Many pathways, especially the dysregulation of the citrate cycle metabolism, may be involved in the pathogenesis of intrinsic capacity decline.
PATTERNS OF AGING CHANGES IN BODY WEIGHT AND BMI MAY PREDICT CHANCES OF ALZHEIMER'S DISEASE AND LONGEVITY
Authors: Ukraintseva Svetlana , Arbeev Konstantin , Duan Hongzhe , Holmes Rachel , Akushevich Igor , Yashkin Arseniy , Whitson Heather , Yashin Anatoliy
Published: December 2022

Background

Lower bodyweight/BMI was previously linked to AD and frailty; however, the role of long-term changes in the bodyweight/BMI in both AD and longevity is not well understood, as is the role of APOE polymorphism in such changes.

Methods

Using longitudinal data from the Framingham Heart Study (FHS) and the Health and Retirement Study (HRS), we estimated trajectories of the weight and BMI at ages 40 to 75, and compared them between individuals who did and who did not develop AD at ages 75+. We also evaluated associations between APOE4 carrier status and key characteristics of the age-trajectories of weight/BMI, including the age at peak value of the bodyweight/BMI (AgeMax), and slope of the decline in bodyweight/BMI after reaching the maximum.

Results

Women with late-onset-AD had lower bodyweight/BMI values up to three decades before AD diagnosis. They reached the peak of bodyweight in their 50s, about 10 years earlier than AD-free women. Younger AgeMax was associated with lower survival chances after age 80 in women. APOE4 carriers showed earlier/faster declines in weight and BMI than non-carriers; however, relevance of this to AD was unclear.

Conclusion

Younger age at peak value of the bodyweight/BMI indicates higher chances of late-onset-AD, while older age can predict better survival later in life and may favor longevity in women. The earlier start of the decline in bodyweight/BMI values could be sign of accelerated aging, which may contribute to AD. Relevance of APOE4 effects on age-trajectories of weight/BMI to AD warrants further investigation.
THE ROLE OF SYSTEMIC INFLAMMATION IN HEALTH NOW, LATER, AND CHANGE OVER TIME: EVIDENCE FROM MIDUS
Authors: Allen Julie Ober
Published: December 2022

Systemic inflammation is theorized to be a biological pathway through which chronic stressors (e.g., discrimination, social marginalization) contribute to adverse health outcomes and disparities among older adults. Cross sectional research documents associations between inflammation and a broad array of health outcomes. Less is known about whether and how inflammation may influence health longitudinally. This study investigated whether a composite measure of inflammatory burden predicted physical health: a) concurrently, b) approximately 7 years later, and c) changes during that time. Data derive the National Survey of Midlife in the United States (MIDUS) participants who provided inflammatory biomarker data (2004-2009 Biomarker study) and health data in MIDUS 2 (2004-2006) and MIDUS 3 (2013-2014) (N=931, Mage 57, 45% male, 91% White). Inflammatory burden reflected the number of inflammatory biomarkers in the highest risk quartile, out of five: C-reactive protein, interleukin-6, fibrinogen, E-selectin, and intracellular adhesion molecule. Three general indicators of physical health were examined: number of commonplace chronic physical health conditions, out of 7; functional limitations; and self-rated physical health. Multivariate regression analyses indicated that inflammatory burden predicted all three concurrent physical health outcomes and the same health outcomes seven years later (p-values <.02). Inflammatory burden was unrelated to changes in these outcomes over time. This study adds to the literature on stress-related biological mechanisms of health and identifies a potential clinical indicator of enduring health problems. It also suggests that while inflammatory burden may demonstrate consistent relationships with physical health over time, other mechanisms may account for health changes and deterioration.
RISK REDUCTION OF HOSPITAL ADMISSIONS FOR PEOPLE WITH DEMENTIA IN SHARED-HOUSING ARRANGEMENTS: THE DEMWG STUDY
Authors: Wolf-Ostermann Karin , Stiefler Susanne , Schmidt Annika , Friedrich Anna-Carina , Gräßel Elmar , Donath Carolin , Scheel Jennifer , Kratzer André
Published: December 2022

People living with dementia (PlwD) have an increased risk of hospital admission which may result in severe consequences. The DemWG-study therefore aims to investigate whether a complex intervention in shared housing arrangements (SHA) for PlwD reduces the number of hospital admissions. Furthermore, quality of life, risk of falls, and stabilization of cognitive abilities are assessed. The intervention includes motor and cognitive training for PlwD and education of caregivers and general practitioners. The study is conducted in 88 SHA in Germany with a total of 330 PlwD and a 6 months intervention. Data are collected up to 18 months after baseline, including quantitative and qualitative data. Results from caregivers’ perspectives on the intervention designate a perceived improved social interaction, which in turn has a positive effect on living together in the SHA. Based also on the results of the ongoing quantitative assessments recommendations for better care and support will be derived.