bluuebunny/crossref_metadata_2025 huggingface dataset:
FUNCTIONAL LIMITATION: DIFFERENCES BY EPIGENETIC AGING, ETHNICITY, AND EXPERIENCES OF DISCRIMINATION
Authors: Brown Maria , Mutambudzi Miriam
Published: December 2023

Epigenetic aging provides an opportunity to rethink processes of aging and policy and health interventions to address health disparities across the life course. Previous research has shown that social factors can result in accelerated epigenetic aging, with subsequent unfavorable health outcomes. This cross-sectional study aimed to evaluate the relationship between epigenetic aging and functional and instrumental limitations in White and Hispanic older adults and to explore how recent experiences of perceived discrimination may differentially impact this association. We used 2014 and 2016 Health and Retirement Study (HRS) data for White (n=1072) and Hispanic (n=139) adults aged 50 and older and epigenetic clock data from the 2016 HRS Venous Blood Study. We hypothesized that accelerated epigenetic aging (PhenoAge epigenetic clock regressed on chronological age) would be associated with greater limitations in activities of daily living (ADLs) and instrumental activities of daily living (iADLs), and this impact would differ by ethnicity and perceived discrimination. On average, Hispanics reported significantly more limitations in ADLs (1.10 vs .47, p<.0001) and iADLs (1.22 vs .72, p<.0001), and more experiences of being treated differently in service situations (44.6% vs 33.3%, p=.0084) and of people acting as if they were afraid of them (28.78% vs 22.01%, p=.0738). Epigenetic age was associated with discrimination (b=-1.98, p=.0078), with ADLs in Hispanics (b=-0.04, p=.0812), and with iADLs in Whites (b=.0069, p=.0443). Further studies of the impact of epigenetic aging on functional and instrumental limitations should be longitudinal, utilize larger samples of older adults, and oversample racial and ethnic minorities.
ROLE OF PLACE AS A DETERMINANT OF PARENT–ADULT CHILD GEOGRAPHIC PROXIMITY AND CAREGIVING
Authors: Mudrazija Stipica , Peters Elizabeth , Lepe Fernando Hernandez
Published: December 2023

While research has shown that the need for care impacts how close parents and adult children live, the relative importance of various factors shaping parent-child geographic proximity remains unclear, especially as it relates to characteristics of their geographic locations and communities. We explore variation in and determinants of the geographic proximity of older parents and adult children, conditional on parents needing care. Using pooled 2004-2014 data from the Health and Retirement Study on respondents age 65 years or older and their children, alongside detailed county-level contextual information from various sources, we analyze the importance of various determinants of parent-child geographic proximity, including parental health, age, and other personal characteristics, children’s personal characteristics, parent-child dyad characteristics, and place-specific characteristics that relate with availability of different health and aging services, housing affordability, and labor market opportunities. Preliminary regression results show that coresidence is substantially less likely in areas with higher availability of nursing care and continuing care options. Among non-coresidents, living in close proximity (distances under 10 miles) is less likely if parent’s area has more nursing care options, but more likely if health services that support living in place are available. Additionally, local economic and housing conditions play a role, with higher median household income associated with children living closer to parents and higher cost of rent with living further. Place-specific characteristics are important determinants of parent-child coresidence and proximity, and policymakers and care providers should consider them when determining the most effective ways to support older adults who need care.
PRECARIOUS HOUSING BEFORE, DURING, AND AFTER AN EPISODE OF LATE-LIFE HOMELESSNESS
Authors: Traver Anthony , Dabelko-Schoeny Holly
Published: December 2023

This qualitative study aims to understand how the living environments occupied by older adults before, during, and after an episode of homelessness inform their access to a healthy, stable, and dignified life. Indicators of accommodation, quality, and service integration are explored using the Aging in the Right Place conceptual framework. Through partnerships with a homeless shelter, a meal site, and a mental health outreach team in Columbus, OH, demographic questionnaires and semi-structured interviews were completed with 22 older adults with an episode of late-life homelessness. Nine direct service providers were also interviewed. Interviews were analyzed using the team-based flexible coding method in Nvivo 1.6.1. Results indicated that low or no income in late life forced older adults to occupy a continuum of precarious and low-quality living environments that include shared housing, doubling up, emergency shelters, institutional settings, and living on the land. AIRP indicators are discussed for each. Conflict, death of a support person, mental and behavioral challenges, unit deterioration, rental price increases, and social isolation forced OA down the housing continuum and into homelessness. Sub-optimal conditions interacted with age to exacerbate health conditions, create social isolation, and expose OA to harm. Informal and formal relationships, emergency shelter services, vouchers, and specific behaviors and attitudes were identified as critical for securing affordable and accommodating housing in which to age. Understanding the experiences of OPEH who are striving to occupy their subjective right place to age can help service providers and policymakers meet the unique needs of precariously housed OA.
VARIATION IN ASSISTED LIVING REGULATION: IMPLICATIONS FOR STATE AGENCY OVERSIGHT, PROVIDER KNOWLEDGE, AND PRACTICE
Authors: Smith Lindsey , Manis Derek
Published: December 2023

Researchers spend significant time and effort documenting policy, particularly in assisted living, where there are no national regulatory standards, and state governments develop and enforce regulations, leading to significant variation between and within states. Our panel explores the question we often get—do these regulations matter? Do they really impact the structures, processes, and outcomes of care provision?
ASSESSING REGULATORY STRINGENCY FOR LICENSED ASSISTED LIVING: A MULTIFACETED APPROACH
Authors: Smith Lindsey , Weems Jacy , Hua Cassandra , Dys Sarah , Carder Paula , Thomas Kali
Published: December 2023

Regulations in long-term care settings aim to ensure quality and accessibility for residents. However, inadequate enforcement can limit their impact on the community. Simply increasing regulations does not always lead to improved care, as it may incentivize facilities to limit admissions. Regulatory stringency encompasses the scope, specificity, and enforcement of regulations. This study examines 10 dimensions of specificity related to medical care regulations in assisted living, focusing on scope and enforcement. We found that regulations related to staffing levels and resident assessments governed almost all assisted living communities, while medication review and administrator certification were the least commonly addressed. The “Residential Care Facilities” license with an “Alzheimer’s Dementia Care Unit” certification in Maine had the highest stringency score, though the “Assisted Living Program” license in the same state had one of the lowest. High regulatory specificity and scope scores were not always associated with high enforcement. For example, the “Assisted Living Center” license in South Dakota covered 100% of the scope’s dimensions and 75% of the provisions contributing to the specificity score, but had no regulatory enforcement for these rules. Findings suggest that a multifaceted approach to assessing regulatory stringency is crucial for policymakers and researchers to understand regulatory approaches across license types and states. Accounting for differences in licensure is also important for a broad view of regulatory stringency.
INEQUALITIES IN OLD AGE WELL-BEING: THE ROLE OF REGIONAL DEPOPULATION AND SOCIAL AND MATERIAL CONDITIONS
Authors: Brandt Martina , Schmitz Alina
Published: December 2023

Material conditions and social integration are important predictors of wellbeing in old age. It can be expected that older individuals who reside in depopulating areas experience declines in well-being, as their property loses value, their social networks are shrinking, and public infrastructure is lacking. We conduct comparative analyses of Germany and Poland, two countries that show significant differences with regard to the economic and social situation of the older population. We expect that regional depopulation is more detrimental to well-being in Poland, as older individuals rely more strongly on informal support and individual resources in old age. We apply multilevel regression models to investigate the interrelations between overall life satisfaction, social integration, material conditions and regional factors. We combine micro-data from the Survey of Health, Ageing and Retirement in Europe (SHARE) with macro-data on regional characteristics (depopulation, public infrastructure and economic development). Our preliminary analyses suggest that a substantial part of inequalities in old age well-being can be traced back to regional differences in the level of depopulation. Social integration and material conditions are important mediators of this association. Additionally, regional differences in care and health infrastructure are important predictors of well-being – especially for older adults in need of financial and social support. Regional depopulation can be detrimental to well-being in later life due to material hardship, low social integration and lacking public infrastructure. In the next steps, we will investigate whether there are differences at the country level by comparing Germany and Poland.
COGNITIVE IMPAIRMENT AND SOCIAL CONNECTEDNESS: A DYADIC ANALYSIS OF OLDER COUPLES
Authors: Li Meiyi , Li Yiang
Published: December 2023

Sociological research extensively identifies social connectedness as an important predictor of cognitive health. However, few examine how social connectedness will in turn be affected by cognitive health, especially in the dyadic context. Using couple data from Waves 2 and 3 of the National Social Life, Health, and Aging Project (NSHAP), this study investigates the gendered dyadic link between cognitive impairment and social connectedness. Results from the actor–partner interdependence models show that women’s cognitive impairments negatively affect their socialization. In terms of partner effects, women’s cognitive impairments make negative impacts on men’s number of friends and neighborhood participation. However, women’s social connectedness will not be affected by men’s cognitive impairment. Given the interdependence of older couples, this study points to the importance of understanding cognitive impairment in dyadic contexts. Results also call for dyadic interventions to prevent the negative effects caused by cognitive decline in late life.
PATTERNS AND THEMES OF OLDER ADULTS’ COPING ACROSS TWO YEARS OF THE COVID-19 PANDEMIC
Authors: Fuller Heather , Huseth-Zosel Andrea , Kinkade Emily , Van Vleet Bryce , Hajdar Melisa
Published: December 2023

Throughout the COVID-19 pandemic, older adults developed coping strategies to adapt to the necessary social distancing precautions intended to protect from severe illness. However, over time, especially as vaccines became available, their need and ability to adapt and cope shifted. This longitudinal, mixed-methods study investigates whether older adults’ perceptions of coping changed across the first two years of the pandemic and how older adults described their experiences with coping at different points during this time. Between April 2020 and June 2022, five waves of interviews were conducted with 76 Midwestern older adults between the ages of 70 and 97. At each timepoint, participants rated their level of perceived coping, quality of life, and stress. They also answered several open-ended questions about their current daily life and experiences during the pandemic. Repeated-measures ANOVAs indicated participants’ perceived coping and quality of life significantly increased between the first and final interview. Thematic coding of interview transcripts identified four themes of coping across two years of the pandemic: 1) staying occupied, 2) seeking social support, 3) cultivating an adaptive mindset, and 4) future planning. Theme meaning shifted once vaccines were available, as participants adapted to ‘a new normal’ lifestyle, gained realistic perspectives, and appreciated their own resilience. Findings suggest older adults had nuanced and shifting coping experiences throughout the initial two years of the pandemic, but overall coped by drawing on life experiences. Our discussion will highlight variability in older adults’ coping over time and directions for future study and practice.
HEALTH PROFESSIONALS’ ATTITUDES TOWARD TECHNOLOGY AND ARTIFICIAL INTELLIGENCE: AN EXPLORATORY STUDY
Authors: Choi Moon
Published: December 2023

The growing number of older adults, particularly those living alone, demands innovative health and social care solutions for the aging population. Mobile apps and other technologies are emerging every year to enhance the efficiency and effectiveness of geriatric health professionals’ work management. However, limited knowledge exists regarding geriatric health professionals’ perceptions of technology. The acceptance of technology is critical because emerging technologies cannot be fully utilized in the field without a positive attitude towards accepting them. The current study aims to investigate geriatric health professionals’ perceptions and attitudes towards technology and artificial intelligence (AI). The data were collected from a national survey of health professionals specialized in home visits conducted by community health centers in South Korea (N=1,026). Technology acceptance was evaluated using the Technology Acceptance Model Questionnaire, and study participants were asked about their self-reported knowledge of AI. A series of regression models showed that younger age, higher education level, and male gender were positively associated with higher technology acceptance levels. Regarding AI knowledge, only younger age was positively associated with better AI knowledge. The findings suggest the existence of a cohort difference in perceptions and attitudes towards technology among geriatric health professionals, which warrants further investigation into the underlying mechanism.
IMPROVING HOSPITAL AND POST-ACUTE OUTCOMES AND EXPERIENCES OF DYADS LIVING WITH DEMENTIA: RESULTS OF THE FAM-FFC TRIAL
Authors: Boltz Marie , Kuzmik Ashley , Rose Karen
Published: December 2023

Hospitalizations of persons living with dementia are associated with protracted functional decline, delirium, and behavioral symptoms of distress as well as increased care partner stress. This symposium presents findings from the Family-centered Function -focused Care (Fam-FFC) trial. In Fam-FFC, nurses purposefully empower family care partners in the assessment, decision-making, care delivery, and evaluation of function-focused care during hospitalization and the 60-day post-acute period. The goal is to improve the functional recovery of the patient while increasing family preparedness for caregiving, bridging hospital to post-acute setting. This cluster randomized controlled trial tested the impact of Fam-FFC in 455 dyads of diverse persons living with dementia and their care partners. The first presentation will compare Fam-FFC outcomes for patients and care partners to the attention control group outcomes at discharge, two and six months. The second presentation will report the impact of Fam-FFC upon adverse patient events (falls, emergency department transfers, hospital admissions) in the two arms. Next, the presenter will utilize Fam-FFC data to describe the patient and care partner characteristics that contribute to care partner distress at the time of hospital discharge. The fourth presentation will focus on staff-patient interactions in the Fam-FFC trial, including the influence of clinical factors upon the quality of the interaction. The final paper will report on the trajectory of behavioral symptoms of distress, and associated outcomes, from hospital admission to six-month follow-up. Our discussant, Karen Rose will lead a discussion of unanswered questions, next steps, and implications of this work for policy and practice.
THE IMPACT OF FAM-FFC UPON ADVERSE OUTCOMES IN HOSPITALIZED PERSONS WITH DEMENTIA
Authors: Resnick Barbara
Published: December 2023

The Fam-FCC education and coaching of care partners emphasizes optimizing physical and cognitive function and detection of changes in condition to prevent falls, avoidable transfers to the emergency department and hospital readmissions. Thus, the aim of this study was to examine the impact of Fam-FFC upon the desired outcomes of less transfers to the emergency department, hospital readmissions, and falls. The majority of patients identified as female, with an average age of 81.5 (± 8.4); approximately 64% were White patients and 36% were Black or African American patients. The sample indicated, on average, moderate impairment in cognition (MMoCA=11.7±7.0) and baseline (pre-admission) some impairment in physical function (MBI=78.1±22.6), mild pain (MPAINAD=0.79±1.5) and depression (MCESD=9.1±6.2). There were no group differences in transfers to the emergency department; however intervention participants were approximately 10% less likely to be hospitalized (p<.04) over the study intervention. The total number of falls or transfers to the emergency department did not differ between groups. The findings of this study suggest that Fam-FFC may be implemented without increasing the risk of falls, while possibly decreasing hospitalizations.
RELATIONSHIP DISSOLUTION AND BIOLOGICAL AGING IN MID LIFE
Authors: Bourassa Kyle , Brennan Grace , Caspi Avshalom , Moffitt Terrie
Published: December 2023

Several decades of empirical research has shown that people who experience relationship dissolution—such as romantic breakups, divorce, and bereavement—have increased risk for poor health across a range of disease outcomes. However, it remains less clear which physiological pathways might best explain links between relationship dissolution and later health. One candidate mechanism that might help explain this wide range of observed health outcomes is accelerated biological aging, which is theorized to represent a common cause of age-related chronic diseases, disability, and early mortality. The current study examined whether relationship dissolution, measured across a 20-year period of adulthood, was associated with biological age in midlife using participants (n = 910) from the Dunedin Study, a birth cohort assessed over four decades of life. Relationship dissolution was assessed using a count of romantic breakups from age 26 until age 44 from life history calendars. Biological aging was assessed using a midlife aging factor derived from four validated measures of aging—the Pace of Aging, gait speed, BrainAGE, and facial age—assessed at age 45. We found that people with more breakups in adulthood had more advanced biological age in midlife, β = 0.10, 95% CI [0.04, 0.16], p = .003. This association remained when controlling for adversity and poor health in childhood, as well as disadvantaged socioeconomic origins and time spent in romantic relationships, β = 0.09, 95% CI [0.03, 0.15], p = .007. The results suggest accelerated aging may be one physiological mechanism linking relationship dissolution to poor health.
PRAGMATIC, SUSTAINABLE, AND COST-FEASIBLE TECHNOLOGIES TO ENABLE REMOTE CARE COORDINATION SERVICES
Authors: Lee Knoo , Bacon Suzette , Conrow Elizabeth , Curtis Elizabeth , Roberts Ashley , Reeder Blaine
Published: December 2023

The aim of this presentation is to communicate the approach and lessons learned in successfully deploying open source smart home and consumer-grade technologies to enable novel remote care coordination services for older adults as part of the CMS-funded ASSETs for Aging in Place demonstration project. Major barriers to use of technologies that enable service reach to rural or home-bound at-risk populations are technology availability, internet connectivity, cost, configuration, installation, ease of management, and usability and usefulness of clinically relevant data displays for decision-making to support personalized care coordination, coaching, and self-management goals. We have pioneered a reusable, innovative approach and infrastructure through partnership with the State of Missouri Department of Social Services and a non-profit hosting partner that facilitates testing and deployment of such remote services with broad goals of scalability and translation as starting principles. The specific focus of this presentation will describe technology selection, configuration, proof-of-concept testing, use of mobile hot spots to overcome broadband availability in rural areas, team composition and skills, introduction and training of the OT/Nurse/Social Worker teams to technology, resources required to stand up the team and transition to independent technology expertise in the field with mobile, video, and remote messaging tools, and user-centered design engagement of the care coordination and informatics teams to drive dashboard features and visual display developments for new work flows. An overview of the approach, technologies, and practical considerations to support research and development of new technology-enabled services for older adults will be presented.
CIRCULATING SASP FACTORS ARE ELEVATED IN PATIENTS WITH POSTOPERATIVE DELIRIUM
Authors: Palmer Allyson K , White Thomas , Atkinson Elizabeth , LeBrasseur Nathan
Published: December 2023

Aging, a major risk factor for delirium, is associated with accumulation of senescent cells in many tissues of the body. Senescent cells produce a host of proinflammatory and tissue remodeling factors collectively termed the senescence-associated secretory phenotype (SASP), which are secreted into circulation. The relationship between increased senescent cell burden and risk of delirium is not known. This study aimed to determine whether changes in circulating SASP proteins are associated with increased risk of postoperative delirium in cognitively intact older adults. Participants were recruited among patients scheduled for surgical or transcatheter aortic valve replacement, and blood was obtained at the presurgical visit. SASP factors were measured using commercially available multiplex magnetic bead immunoassays based on Luminex xMAP multianalyte profiling platform and analyzed on a MAGPIX system. Activin A concentration was determined by a Quantikine ELISA kit. Delirium cases were identified by manual chart abstraction, utilizing the problem list, ICD-10 codes, clinical notes, and nursing flowsheets. Eight of 62 (12.9%) of patients within the cohort developed postoperative delirium. Length of stay was significantly longer for patients who developed delirium (10.6 days) versus patients without delirium (6 days). Concentrations of SASP factors Activin A and PAPP-A were significantly higher in plasma of patients with delirium vs. those who did not develop delirium. IL-1 alpha concentration was significantly lower in patients with delirium vs without delirium. Other SASP factors measured were not statistically different between groups. More study is needed to determine whether these changes are directly related to increased senescent cell burden.
MAXIMIZING COLLECTIVE IMPACT ACROSS THE AGE-FRIENDLY ECOSYSTEM
Authors: Dabelko-Schoeny Holly , Kennedy Teri
Published: December 2023

Age-friendly initiatives have the potential to transform communities through inclusive policies and practices that meet the needs of people, families, and communities across ages and abilities. The ecosystem of age-friendly initiatives (communities, universities, public health systems, and health systems) has grown exponentially over the last decade. Despite shared values and principles, each age-friendly initiative largely operates independently with limited opportunities to share knowledge to maximize collective impact and social change. This theoretically-driven symposium provides an overview of each age-friendly initiative, challenges faced, and ideas for innovation within and across each initiative. Dabelko-Schoeny and Sheldon will utilize a macro application of the KAP (knowledge, attitude, practice) theory of behavior change to identify the vast opportunity for synergies and grand challenges across the age-friendly ecosystem. Greenfield will provide an overview of the development of the Age-Friendly Cities and Community Movement, and present ideas regarding challenges and opportunities for the future based on insights from an ongoing, community-engaged study in New Jersey. Montepare will describe the Age-Friendly University initiative and how age-inclusive practices in higher education can extend and enhance ecosystem efforts. Phillips and Wolfe will provide examples of Age-Friendly Public Health Systems including a description of a collective impact approach for state-wide age-friendly policy and practice adoption. Finally, Kennedy will offer approaches and models to advance the adoption and sustainability of age-friendly principles, programs, and policies by leveraging synergies and implementation science. This is an Age-Inclusivity in Higher Education Interest Group Sponsored Symposium.
AGE-FRIENDLY PUBLIC HEALTH SYSTEMS IN ACTION
Authors: Phillips Karon , Wolfe Megan
Published: December 2023

Trust for America’s Health (TFAH) leads the national Age-Friendly Public Health Systems movement, the goal of which is to elevate healthy aging as a core function of state and local departments of health. The nation’s public health system has contributed to the increased longevity of the population and there are numerous opportunities for public health to advance healthy aging in collaboration with the health care system, the aging services sector and others. TFAH has worked directly with state and local health departments to test the Age-Friendly Public Health Systems framework and seen first-hand the policy and systems changes that are possible through collective impact. During this symposium, participants will learn about the changes that are occurring in Mississippi and Washington state, where Age-Friendly Public Health practices are being adopted and implemented in collaboration with key partners, including expanding data collection on older adult health, ensuring older adults and caregivers are considered in emergency planning, and working directly with older adults in Tribal communities.
FAMILY CAREGIVING DURING THE COVID-19 PANDEMIC FOR OLDER ADULTS WITH DEMENTIA
Authors: Wiemers Emily , Lin I-Fen
Published: December 2023

Family caregiving plays a crucial role in meeting the care needs of older adults, especially those living with Alzheimer’s disease and related dementias (ADRD). The COVID-19 disrupted an already fragile care landscape by reducing the desirability of nursing home care and the availability of paid caregivers in the home and by destabilizing family caregiving arrangements. Older adult living with ADRD may be at higher risk for destabilized care and more vulnerable to adverse effects from the COVID-19 pandemic’s disruption to the long-term care landscape. This symposium draws on five papers providing qualitative and quantitative evidence of how care arrangements shifted during the COVID-19 pandemic among older adults with ADRD. Patterson and colleagues set the stage for understanding the impacts of the pandemic on family caregiving for older adults with dementia by providing estimates of how many families and households include someone with dementia. Choi and colleagues use a mixed-methods approach to show that family members provided more care during than before the pandemic, especially coresident family members. Lin and colleagues use quantitative evidence to examine how pandemic-specific needs and help from nonresident adult children varied by older adults’ cognitive functioning. Leggett and Tsuker examine the consequences of the pandemic for caregiver stress across different ADRD caregiver relationship types. Finally, Wiemers and colleagues extend the focus on unpaid family caregivers to include paid care and show how tradeoffs between paid and unpaid care for older adults with ADRD were affected by pandemic severity.
FAMILIES AND DEMENTIA: ESTIMATES AND EXPOSURES
Authors: Friedman Esther , Freedman Vicki , Patterson Sarah
Published: December 2023

Roughly 10 to 20% of older adults in the U.S. have dementia, which could have implications for their families and household members, who are likely to be called upon to provide care. Yet, it is not clear how many families and households include someone with dementia. This study provides national level estimates of families and households with an older adult with possible dementia using the 2017 Panel Study of Income Dynamics (PSID). Consistent with prior work, we find that 21.5% of older adults 65+ have possible dementia. Moreover, more than a quarter (26.3%) of households with an adult aged 65+ include an older adult with dementia, and 37.0% of extended family networks (with at least one adult aged 65+) have at least one older adult with dementia. Individual-level stratification of dementia by racial-ethnic group and socioeconomic status translates directly to household- and family-level patterns. For instance, households and families with an older adult who is either Black or Hispanic or does not hold a college degree are more likely to include at least one person with possible dementia. These findings have implications for the extent to which American families and households include someone with dementia, which comes with a risk of serving as a caregiver as well as possible implications for health and well-being. Our findings also establish important baseline estimates that can be measured against future estimates, for instance those post COVID-19.
A COMPARISON OF THE IMPACT OF ADVERSE CHILDHOOD EXPERIENCES ON BRAIN HEALTH IN LATINA AND NON-LATINA WOMEN
Authors: Tsotsoros Cindy
Published: December 2023

Early-life experiences and social determinants of health influence late-life cognitive performance, cognitive aging trajectories, and risk of Alzheimer’s disease and related dementias (ADRD). Research shows adversity during childhood plays a central role in health outcomes later in life, such that more adverse childhood experiences (ACEs) predict higher likelihood of negative physical and mental health outcomes. As ACEs may also predict neurocognitive performance and historically marginalized groups are disproportionately exposed to ACEs, this study aims to enhance diversity in research on ACEs and cognitive aging by clarifying the role of ethnicity. Latinos are 51% more likely to experience ACEs and 1.5x more likely to experience ADRD than their non-Latino counterparts. Data were collected in two studies assessing cognitive functioning in women aged 65-85 who reported no ACEs or 3+ ACEs (54 non-Latinas, Oklahoma; 50 Latinas, Rhode Island). ACEs were measured with the Adverse Childhood Experiences Questionnaire. Cognition was measured using NIH Toolbox Cognition-Battery and Automated Neuropsychological Assessment Metrics. In the non-Latina white sample (Mage=73.2), those with 3+ ACEs exhibited inferior scores on Stroop Interference, p=.050, d=-.44. The ACEs group demonstrated higher scores on List Sorting, p=.003, d=-.78. Small effects were found in Stroop Color, Stroop Color-Word, Cognition Fluid Composite, Flanker, and Cart Sort (d=-.25, -.39, -.29, .24, -.25, respectively). These findings are compared to those within the Latina sample, demonstrating the need to extend research on life course risk factors for ADRD to this underrepresented group, which is at elevated risk of both ACEs and ADRD.
THE USE OF CAREGIVER SUPPORT SERVICES AND CAREGIVING IMPACT AMONG DIVERSE CAREGIVERS OF OLDER ADULTS WITH DEMENTIA
Authors: Bouldin Erin , Eppich Kaleb , Webster Noah , Leggett Amanda , Zahodne Laura
Published: December 2023

Caregiver support services may improve experiences among caregivers of people with dementia, but racial/ethnic disparities exist in service use. Using data from the 2021 National Study of Caregiving, we measured caregiver service use and caregiving impacts among 470 Black (n=187), Hispanic (n=37), and White (n=246) caregivers of older adults with possible/probable dementia from the National Health and Aging Trends Study. We classified caregivers as using at least one or none of the following services in the past year: caregiver support group, training, or respite care. We calculated the weighted proportion of caregivers reporting caregiver burden (at least one: physical, emotional or financial difficulty), exhaustion, and feeling overwhelmed within each racial/ethnic group. Caregiver service use varied by race/ethnicity (47% of Hispanic, 29% of Black, and 32% of White caregivers). Black and White caregiver service-users were significantly more likely to report a burden than their peers using no service (59% versus 36% of Black, p=0.04, and 90% versus 41% of White, p<0.001, caregivers). There was no significant difference in burden among Hispanic caregivers (59% versus 69%, p=0.65). In each racial/ethnic category, caregivers reported similar prevalence of exhaustion and feeling overwhelmed from caregiving whether they used a service or not. Based on these cross-sectional data, we hypothesize that Black and White caregivers who feel burdened use services more often, and that service use mitigates caregivers’ feelings of being exhausted or overwhelmed by caregiving, despite burden. Racial/ethnic differences highlight the need to understand contextual factors that influence caregiver burden and service use.
DOES INCREASING LIGHT PHYSICAL ACTIVITY IN MIDLIFE AND OLD AGE BUFFER AGAINST COGNITIVE DECLINES?
Authors: Hamm Jeremy , Parker Kelly , Lachman Margie , Mogle Jacqueline , Duggan Katherine , McGrath Ryan
Published: December 2023

Although it is well established that moderate-to-vigorous physical activity (MVPA) buffers against cognitive declines, less is known about the benefits of lower intensity physical activities that are more feasible, inclusive, and amenable to change in old age. Our study examined the extent to which increases in light physical activity protected against longitudinal declines in cognitive functioning and whether such a relationship become pronounced in old age when opportunities for MVPA are often reduced. We analyzed 9-year data from the national Midlife in the United States Study (n=2,229; age=56±11.13 years) using regression models that assessed whether change in light physical activity predicted corresponding changes in episodic memory and executive functioning for adults across the lifespan. All models controlled for age, sex, socioeconomic status, functional status, and moderate and vigorous physical activity. Beyond more vigorous forms of physical activity, increasing light physical activity predicted less decline in episodic memory (β=.06, p=.010) and executive functioning (β=.15, p<.001) over the 9-year follow-up period. Effect sizes for moderate and vigorous physical activity on episodic memory (βs=.01-.02) and executive functioning (βs=.03) were less than half that observed for light physical activity. Moderation models showed that, for episodic memory, the benefits of increasing light physical activity were pronounced at older ages. Findings provide initial evidence that increasing light physical activity may help slow age-related declines in episodic memory and executive functioning and that its protective influence may become paramount in later life when individuals commonly encounter constraints that can limit their capacity to engage in MVPA.
PHYSICAL FUNCTIONING 12 YEARS BEFORE AND AFTER KNEE OR HIP SURGERY IN OLDER WOMEN
Authors: Peeters Geeske , de Munck Isabel , Tooth Leigh , Melis Rene
Published: December 2023

Understanding long-term recovery patterns in the context of ageing-related decline may improve knee or hip surgery outcomes. We examined the impact of hip and knee surgery on long-term trajectories of physical functioning (PF) in older women, and profiled women with higher and lower resilience to surgery. Resilience, defined as bouncing back (PF) after a stressor (hip or knee surgery), was quantified using the expected recovery differential method. Data were from 10,434 women (73-79 yrs) in the Australian Longitudinal Study on Women’s Health who completed surveys 2-6 (1999-2011). Adjusted linear mixed models were run to examine the surgery-by-time (-12 to +12 yrs) interaction in association with PF (SF-36 subscale). The difference between observed and expected PF were calculated, with positive/negative values reflecting higher/lower resilience, respectively. PF trajectories differed between women with (n=982) and without (n=8117) hip surgery (p<0.001). Among hip surgery patients, the decline was more rapid pre-surgery than post-surgery (b=-0.7, p<0.001). Women with knee surgery (n=1144) had lower PF than those without surgery (n=7971), but with a slower rate of decline (p=0.01). Among knee surgery patients, the rate of decline was similar pre- and post-surgery (b=-0.3, p=0.25). Both in hip and knee patients, women with higher resilience had fewer comorbidities and symptoms, and were more often physically active and independent in daily activities than those with lower resilience (p<0.05). In conclusion, women with and without hip or knee surgery have different trajectories of PF. Women who function better than expected after surgery, tend to have fewer health problems.
INTEGRATING A PATIENT-CENTERED, WHOLE-HEALTH APPROACH WHEN CARING FOR PEOPLE AGING WITH HIV
Authors: Fix Gemmae , Clark Janet , Gifford Allen
Published: December 2023

The US Department of Veteran Affairs (VA) is implementing a patient-centered, “Whole Health System of Care” to align care with What Matters Most to patients within their unique circumstances. Implementation is focused on primary care, where most patients receive care. Yet HIV Clinics have historically provided both HIV and primary care because of the complexity of HIV. People living with HIV are now aging and experiencing a constellation of health and life circumstances that would benefit from a Whole Health approach. While there is desire to spread Whole Health beyond primary care, little is known about how to integrate Whole Health into HIV Clinics. We sought to identify Whole Health implementation considerations for HIV Clinics. Our qualitative study design included interviews with vignettes based on our prior work, illustrating themes like aging alone. Findings were mapped to the i-PARIHS implementation framework which includes recipients (HIV providers), context (HIV clinics), and innovation (Whole Health). We interviewed physicians, psychologists, nurses and leadership (N=11) from three HIV Clinics (Northeast, Northwest, South). Participants were largely aware of Whole Health, although few had taken trainings and no clinics currently offered Whole Health services. Many expressed interest incorporating Whole Health into HIV care. They also saw great value, given patients’ complexities. Participants described logistical barriers hindering implementation, like awareness of specific resources or how to refer. Only some providers were able to conceptualize a Whole Health clinical encounter- where patients’ life circumstances are connected to health. HIV Clinics offer an ideal setting to spread Whole Health.
UNRAVELING NONGENOMIC MECHANISMS BY WHICH 17Α-ESTRADIOL EXTENDS HEALTHSPAN AND LONGEVITY
Authors: Zomer Helena , Sirohi Vijay , Medrano Theresa , Cooke Paul
Published: December 2023

Recent work indicates that exogenous 17α-estradiol (17α-E2), a stereoisomer of 17β-E2, produces unprecedented longevity increases (~20%) in male mice, challenging prevailing assumptions that 17α-E2 is a weak estrogen. However, is unclear how 17α-E2 acts. Therefore, this study aimed to obtain mechanistic insights into 17α-E2 actions in the uterus, the most widely used vivo model system for estrogen action. We hypothesized that 17α-E2 signals through membrane (m)ESR1 to affect target tissues and promote longevity. To test this, we treated pre-pubertal (postnatal day 20) female CD-1 mice with 3 daily IP injections of vehicle or 10 mg/kg of 17α-E2 or 17β-E2 (n=4/group). 17α-E2 treatment did not significantly increase uterine weight – a marker of nuclear (n)ESR1 signaling (20.3 ± 2.1 mg vs. vehicle 15.7 ± 2.0 mg, p>0.05), while 17β-E2 strongly increased it to 41.4 ± 1.1 mg (p<0.05). Accordingly, histological analysis revealed reduced cell proliferation in 17α-E2- vs. 17β-E2-treated uteri. Both 17α-E2 and 17β-E2 robustly stimulated epithelial p-ERK and p-AKT expression, the active phosphorylated forms of these protein kinases, and western blotting showed a strong and comparable stimulation of EZH2, a critical mediator of estrogen’s epigenetic effects, which are linked to mESR1 signaling. In conclusion, our results indicate that despite limited actions through nESR1, 17α-E2 robustly signals through mESR1 to activate uterine protein kinase cascades and produce epigenetic effects. These findings may cause a significant reappraisal of 17α-E2 biological effects and role in normal estrogen physiology and provide critical insights into its unique ability to stimulate longevity.
ACCELERATED BIOLOGICAL AGE IS ASSOCIATED WITH DELIRIUM AND PLASMA NEUROFILAMENT LIGHT IN GERIATRIC HIP FRACTURE
Authors: LaHue Sara , Youn Joy , Fuentealba Matias , Douglas Vanja , Furman David , Rojas Julio , VandeVrede Lawren , Newman John
Published: December 2023

Background

Biological age may be distinct from chronological age. Epigenetic clocks (e.g., PhenoAge) estimate biological age by quantifying changes in DNA methylation (DNAm). Biological age is “accelerated” (AgeAccel) when epigenetic>chronological age. AgeAccel predicts age-related diseases but its association with delirium or neuronal injury markers (e.g., neurofilament light “NfL”) is unknown.

Methods

Adults age 65+ hospitalized for acute hip fracture underwent daily delirium screening with the Confusion Assessment Method Long Form. DNAm status of 850,000 CpG sites was measured in triplicate from pre-op peripheral blood mononuclear cells using Illumina MethylationEPIC arrays. AgeAccel represented the residual of the linear regression model of PhenoAge regressed on chronological age. Plasma NfL was measured in duplicate using Simoa immunoassays. Group differences calculated by T-test.

Results

Of 12 subjects (enrollment ongoing): mean age 79±8, 75% women, 42% with dementia, 33% were delirious on pre-op blood collection day. Mean AgeAccel was 4.4 years (p=0.02) in delirious vs non-delirious subjects (Fig1A). Those with positive (vs negative) AgeAccel had higher mean NfL (Fig1B, p=0.002). Delirious (vs non-delirious) subjects had higher mean NfL (p=0.004). We found no difference in either AgeAccel or NfL by dementia status.

Conclusions

In this geriatric hip fracture pilot, accelerated biological age was associated with higher delirium prevalence and NfL. Delirium was also associated with higher NfL. This pilot demonstrates feasibility and utility of measuring biological aging in delirium that warrants study in a larger cohort.
HEALTH SYSTEM PARTNERSHIPS IN INTERVENTION AND OBSERVATIONAL STUDIES: REFLECTIONS FROM AN EARLY-CAREER SCHOLAR
Authors: Gassoumis Zach
Published: December 2023

The early knowledge base and interventions in the field of elder mistreatment were built by clinician researchers, leading to a natural research-to-practice pipeline. But with more non-clinical researchers steadily entering the field, care must be taken to forge strong research-practitioner partnerships, to three ends: 1) developing clinically informed research and intervention approaches, 2) recruiting clinically relevant samples, and 3) implementing findings into clinical practice. This process can be particularly challenging for early-career non-clinical researchers, who may lack strong partnerships on which to build their research. This presentation extracts lessons for early career scholars by providing overviews of the development of and findings from two studies. The Comprehensive Older Adult Caregiving Supports (COACH) EM prevention program was delivered in partnership with a managed care health system, with referrals received from health system providers. The Better Together study of dementia care groups (i.e., persons living with dementia and their care partners) received referrals from clinicians in mixed managed care/fee-for-service settings, county health facilities, and community partners. Drawing from the principles of community-engaged research, the presentation highlights the relevance of various engagement approaches to elder mistreatment research, including: 1) partnering with senior researchers with existing networks; 2) taking the time to learn the health system’s and clinicians’ operational systems, pressures, and constraints; 3) honoring practitioner expertise in building research projects and developing research questions; 4) prioritizing meaningful reciprocal engagement, through offering topical or research presentations, funding, co-authorship, etc.; and 5) educating health system administrators about the nuances of conducting elder mistreatment research.
RISKY WORK ENVIRONMENTS AND METABOLIC DISEASE: CUMULATIVE CONSEQUENCES OF BAD JOBS IN EARLY AND MID LIFE
Authors: Carpenter Rebekah
Published: December 2023

Approximately one in three adults in the United States have a metabolic disease or illness. Metabolic diseases and illnesses are particularly costly for older adults, often resulting from decreased human capital and increased health care-based costs in later life. Social contexts have been hypothesized to be a key contributor to later-life health; however, work environments are often understudied as a critical social factor shaping health over the life course. Utilizing new data from the Health and Retirement Study’s Life History Mail Survey linked to occupational work context data from the Occupational Information Network (O*NET), we examine how exposure to dangerous work environments over one’s working career relates to the likelihood of developing a metabolic disease or illness between the ages of 50 and 62. Results from logistic regressions suggest that dangerous work environment exposures, such as exposures to contaminants or hazardous conditions, are associated with increased risk of developing metabolic disease and illnesses between ages 50 and 62; however, these associations are dependent upon when in the life course people are exposed to dangerous work contexts and for how long people are exposed to dangerous work contexts. This study speaks to the growing need for understanding the role of occupations as an important social and contextual factor shaping population health. Specifically, findings from this study may better inform the development of social and organizational policies targeted at improving work environments in the US, thereby helping to reduce the risk of developing health-related challenges, including metabolic diseases and illnesses.