bluuebunny/crossref_metadata_2025 huggingface dataset:
ALL IN THE FAMILY: DIFFERENTIAL IMPACT OF COVID-19 BY TYPE OF CAREGIVER FOR PERSONS LIVING WITH DEMENTIA
Authors: Leggett Amanda , Tsuker Sophia
Published: December 2023

Existing research points toward higher burden for spousal, and particularly wife, caregivers for persons living with dementia (PLwD). Yet how relationship roles and stressors shifted during the COVID-19 pandemic, where some care dyads were isolated together, or physically distancing, is unknown. The current study explores how the variability in reports of COVID-specific care-related stress (e.g., worry about the PLwD getting COVID-19) and general strain (e.g., caregiver burden) differed among husband, wife, adult child, and other family and non-family, unpaid caregivers. Participants include 100 primary family caregivers for PLwDs (mean age=63.3 years, 75% female) from the COVID STYLE study of which 22 were husbands, 39 were wives, 24 were adult children, and 15 were another relation (e.g., daughter-in-law, friend). ANOVAs and linear regressions (adjusting for cohabitation with the PLwD, dementia severity, and race) were run with each relation as a predictor of COVID-19-specific stress (e.g., sleep quality, isolation) and non-COVID-19-specific well-being (e.g., depressive symptoms, positive affect). The “other” caregiver group showed significantly greater COVID-related financial difficulty of care, worse sleep quality, and isolation, whereas adult children were most worried about the PLwD getting COVID-19 and had greater difficulty in their ability to provide care. Associations largely held in adjusted regressions showing particular contrast between other caregivers and husbands, who fared best. On the other hand, relationships groups did not differ on non-COVID-specific measures of well-being. Non-spousal caregivers reported greater pandemic stress related to caregiving, suggesting an overlooked group who may have provided significant COVID-19 care despite a more distant relationship.
RACIAL DIFFERENCES IN THE ASSOCIATIONS BETWEEN SENSORY FUNCTIONS AND PHYSICAL ACTIVITY INTENSITY
Authors: Le Qun , Churchill Linda , Procter-Gray Elizabeth , Clarke Anthony , Cheng Jie , LoPilato Danielle , Chen Lingming , Li Wenjun
Published: December 2023

Sensory functions decline in older age. Multisensory training has been shown to improve balance. We analyzed the race differences in the associations of sensory functions with physical activity (PA) intensity. The Healthy Aging and Neighborhood Study enrolled 379 community-dwelling persons aged 65 and over in Central Massachusetts (2018-2019). Data on sensory functions were assessed using self-report questionnaires, range from 0 (very poor) to 4 (very good). PA intensities were measured using waist-worn Actigraphy accelerometers for at least 8 hours per day and at least 5 days including 1 weekend day. PA intensity was categorized using Copeland cutoff points as sedentary (SB), light (LPA), moderate-to-vigorous-intensity PA (MVPA). Generalized linear models were used to assess the racial differences in the associations of sensory functions with PA intensity, adjusting for age, gender, education, income, general health, comorbidities, activities of daily living (ADL), and instrumental ADL. Average sensory functions of the participants were good to very good (mean±SD: hearing:2.9±1.1, vision:3.4±0.8, touch:3.7±0.6, smell:3.5±0.9, taste:3.6±0.7, balance:3.0±1.0). Two-thirds (66.7%) of participants met the PA guidelines of MVPA (mins/day) SB:465±114, LPA:248±66, MVPA:53±70). Compared to other races, Whites with better touch (b=52.1, SE=23.8) had significantly more SB. Better hearing (b=16.7, SE=7.2), vision (b=32.1, SE=10.5), smell (b=19.3, SE=7.8), taste (b=25.3, SE=9.9) were significantly associated with more LPA. Better vision (RR=1.6, 95%CI:1.1-2.4) and worse touch (RR=0.6, 95%CI:0.4-0.9) were significantly associated with more MVPA. Racial differences are significant in the associations between sensory functions and PA intensity among older adults. The underlying mechanisms should be further investigated to inform future interventions.
THE IMPACT OF A SERVICE-LEARNING COURSE ON UNDERGRADUATE STUDENT ATTITUDES TOWARD OLDER ADULTS
Authors: Howell Britteny
Published: December 2023

Undergraduate students often have little contact with older adults, which may result in a lack of interest regarding career options in gerontology or geriatric practice. To combat this problem, the University of Alaska Anchorage’s 300-level Public Health for an Aging Society course introduces students enrolled in the Health Sciences Bachelor’s program to a variety of gerontological concepts. This service-learning course engages public health and pre-clinical students in the community, providing valuable experience working with local senior agencies to provide a product or service. Students work in interdisciplinary teams and have a variety of community-based projects to select from as part of their coursework. Using the Geriatric Attitudes Scale at the start and end of the semester, this presentation reports on improved student perceptions of older adults as a result of this course. With a sample of 22 undergraduates at the beginning of the semester, scores were relatively high in agreement with positive statements about aging (i.e., “it is society’s responsibility to provide care for the elderly”). However, they also report agreement with less positive statements about aging, such as “taking a medical history from elder patients is frequently an ordeal” and “as people grow older, they become less organized and more confused.” At the conclusion of the 15-week course, students report lower agreement with these negative statements about aging as a result of their learning and hands-on experience.
INTEGRATING HEALTH POLICY EDUCATION INTO AN UNDERGRADUATE PSYCHOLOGY COURSE
Authors: O’Malley Kelly , Graham Kirsten
Published: December 2023

Education on health policy processes are lacking in psychology training programs. Psychologists can be helpful to policy making and evaluation processes; however, few have the training, experience, or exposure to health policy necessary to feel comfortable entering into this area. Health policy education was integrated into an existing undergraduate psychology adult development and aging curriculum. Students completed weekly knowledge quizzes, two health policy specific assignments, and a class lecture on the intersection of health policy, aging, and psychology. N = 97 students (Mage = 21.54, SD = 4.94) over six semesters completed pre-post knowledge, skill, and ability assessments. Paired samples t-tests indicated increased knowledge t(96)= -5.89, p < .001, Cohen’s d = .60, and understanding of health policy making t(94)= -5.69, p < .001, Cohen’s d = .58; and ability to critically evaluate health policies t(96)= -3.03, p = .003, Cohen’s d = .31. Students identified psychology t(95)= -5.20, p < .01, Cohen’s d = .53 and psychological research t(95)= -3.71, p < .001, Cohen’s d = .38 as having a greater role in health policy following the course. Students felt they would use the health policy skills and knowledge learned in this course and agreed the policy related topics and assignments were valuable. Integrating health policy education into an undergraduate psychology course was feasible and had a positive impact on student’s knowledge, skills, and abilities in this domain. This format may be appropriate for graduate psychology training and may help build psychologists confidence to participate in health policy activities.
BOUNCING BACK AFTER SURGERY: QUANTIFYING AND PREDICTING RESILIENCE IN OLDER SURGICAL PATIENTS
Authors: Peeters Geeske , Whitson Heather
Published: December 2023

During this symposium we will discuss the impact of surgery on older adults physical functioning through a resilience lens. Physical resilience is defined as bouncing back in terms of physical functioning in response to a stressor, i.e. surgery. The first speaker will present data of long term trajectories of physical functioning in older women pre and post hip and knee surgery, and compare these with the trajectories in the general population. Profiles of women with higher or lower resilience to surgery will be discussed. The second speaker will talk about which functional measures, such as grip strength and walk speed, predict recovery in physical daily activities after knee replacement surgery, and the implications of these findings for the development of provocative resilience tests. The third presentation explores the role of biological ageing in fitness for surgery. The final presentation unravels the role of the stressor by exploring variations in types and severity of stressors in patients undergoing knee replacement surgery, and tests the hypothesis that severer stressors are associated with worse outcomes. Together, these presentations give a broad overview of determinants of physical resilience in the context of preparedness for, and recovery from, surgery. We will discuss methods to define stressors, and measure and quantify resilience. Moreover, we will illustrate how this information can inform personalization of care.
COMPARISON OF CLINICAL BIOMARKER AND DNAM-DERIVED BIOLOGICAL AGE MEASURES IN AN ELECTIVE SURGERY COHORT
Authors: Parker Daniel , McDonald Shelley , Starr Kathryn Porter , Blazer, III Dan , Hwang E Shelley , Kirk Allan , Lagoo-Deenadayalan Sandhya
Published: December 2023

Older adults face greater post-operative morbidity due to decreasing biological aging (BA)-associated physical resilience. BA measures may quantify these vulnerabilities. Common BA quantification approaches include measures derived from clinical biomarkers and whole blood DNA methylation. The Duke Surgery One Thousand Patient Cohort is a prospective biospecimen and data repository of patients undergoing elective surgery. Using a subset of this cohort (n=119; 61±13 years of age; 50% female; 21% African American), we sought to determine: 1) the inter-relationship of BA measures; 2) associations of race, sex, BMI, and surgery type with BA; and 3) associations of BA with American Society of Anesthesia (ASA) Classification Score . Clinical biomarker BA measures included Klemera-Doubal method (KDM), homeostatic dysregulation (HD), and PhenoAge. DNAm measures included the DNAm PhenoAge, Hannum Age, and GrimAge. We calculated BA advancement (BAA) as BA minus Chronological Age (CA). We calculated Pearson correlation coefficients and fitted regression models, adjusting for CA, sex, race, and BMI. Overall, participants were biologically older than their CA. Male sex and African American race were associated with greater BAA by most measures . Associations of surgery type with BAA were consistent across measures . Greater BAA by most measures was associated with a higher ASA Score, reflecting higher baseline surgical risk. In conclusion, BA measures using different quantitative approaches showed anticipated associations with demographic factors, surgery type, and surgical risk. Ongoing work will identify BA measures that predict adverse surgical outcomes, and that could be used to identify patients for perioperative prehabilitation.
EXPLORING MODELS OF CARE INTEGRATION TO ADDRESS THE NEEDS OF PERSONS AGING WITH HIV
Authors: Baim-Lance Abigail , Fix Gemmae , Laskow Thomas
Published: December 2023

By 2035, the majority of persons living with HIV will be 50 and older. The clinical and social needs of this population have been well documented, including the negative impacts of persistent stigma on quality of life and health outcomes. Responding to such needs requires integrated, patient-centered approaches to care and supportive services. Care integration is defined as the bringing together of two or more previously unlinked services. Care integration is used within and outside of the HIV care settings, but how such models should be designed or adapted for older persons with HIV (OPWH) is less certain given their unique needs. This symposium will explore case studies representing different models of care integration developed within and outside of HIV care settings, their relevance to OPWH, evidence of implementation including known barriers and facilitators, and opportunities to advance such models. Our first presentation describes an embedded geriatrics outpatient consultation service within an HIV care setting in New York City (Condo). Our second presentation focuses on the barriers and facilitators to the integration of substance use treatment into HIV care in Georgia (Bender). Our third and fourth presentations will describe service models developed outside of HIV care, which are now being applied to support OPWH including the Veterans Affairs patient-centered Whole Health approach (Fix) and the CAPABLE program to support aging in place (Smith). With our discussant, we will reflect on these models of integration to enhance care and support systems for this population.
BRINGING GERIATRIC CARE INTO THE HIV PRIMARY CARE CLINIC: A COMBINED HIV/GERIATRIC MULTIDISCIPLINARY CLINIC MODEL
Authors: Condo Angela , Baim-Lance Abigail , Golstein Nathan
Published: December 2023

Persons living with HIV (PLWH) experience accelerated and accentuated aging, developing co-morbidities at earlier ages and with higher frequencies than those without HIV. Older persons with HIV (OPWH) also experience geriatric syndromes. In 2020 we developed a combined HIV/geriatrics multidisciplinary clinic at Mount Sinai Hospital in New York where a geriatrician and multidisciplinary team including a nurse, pharmacist, and social worker are embedded in an HIV primary care clinic. Patients are referred for comprehensive geriatric assessments. We conducted a retrospective chart review after the first 15 months of the program to describe this population of OPWH living in NYC who are referred to a geriatrician. From 9/2020-11/2021, there were 183 appointments scheduled of which 112 (61%) were new patient visits. Sixty-two percent of patients came to their appointment. The average age of patients was 67 years. Fifty-seven percent identified as male. The majority of referrals (50%) were for cognitive assessment followed by mobility assessment (25%), polypharmacy (14%), multimorbidity (8%), advance care planning (1%), and other (2%). Based on this data, we identified a need to improve the show rate to our clinic and implement cognitive screening in OPWH. We have incorporated a community health worker into our interdisciplinary team to assist in this goal and continue to educate patients and providers on geriatric syndromes. A geriatric approach to care is crucial to incorporate into existing HIV clinical practices and we hope to optimize this integration based on the needs of patients and providers.
HOW CAN DYING, DEATH, LOSS AND BEREAVEMENT BE INCORPORATED IN THE POLICY AND PRACTICE OF AGING IN PLACE?
Authors: Dury Sarah , Smetcoren An-Sofie
Published: December 2023

‘Aging in place’ has been one of the key goals for policymakers in the last 20 years, often translated into policies of deinstitutionalization. Due to the high costs of residential care, the home has re-emerged as a key site for the provision and consumption of care and support. Several critiques of this evolution have been formulated, including the challenges ageing in place might represent for older people, leading to reduced quality of life, and the need to consider low quality of older people’s houses, meaning that older people’s homes might not be the “best” places to age. However, what has received too little attention in the whole “aging in place” discourse is the end-of-life. This symposium addresses this by illustrating that we cannot talk about ageing in place without talking about dying in place. The authors present research on how dying, death, loss and bereavement might be included in the ageing-in-place policy and practice: Doran sets the stage with a critical reflection of ageing in place and the need to reflect on joining up ageing in place and end-of-life theory and practice. Smetcoren reports on the development of a ‘maison de mourance’ in a ‘co-housing and co-caring’ project in Brussels. Dury discusses consolation spaces in Flanders and how they decrease the taboo on death, grief and loss in the neighborhood. And Stegen reports on the caring neighbourhood-movement in Belgium and how some orient themselves to becoming part of a worldwide network of ‘compassionate communities’.
EXPLORING THE ROLE OF THE COMMUNITY AT THE END OF LIFE: EXPERIENCES FROM A SMALL COMMUNITY-LED END-OF-LIFE PROJECT
Authors: Smetcoren An-Sofie
Published: December 2023

‘Care and living in community’ (CALICO) is an intergenerational co-housing and co-caring project in Brussels. Within this larger project, a small community-based initiative for palliative and end-of-life care was founded, called Maison Mourance. This initiative aims to mobilize capacity in the broader community to make ‘dying-in-place’ possible. Given the innovative and grassroots nature of Maison Mourance, the present study wants to understand its vision, functioning, roles of stakeholders involved and the challenges it faces. Therefore a qualitative study was conducted consisting of 10 in-depth interview with several stakeholders and 1 focus group with the steering committee. Their vision centers on creating a homelike environment where people at the end of their lives still feel part of the community. As organisation they want to be nonhierarchical in which each member, formal and informal, is valued and assigned a certain role. Attention is given to the central role of the patient and breaking taboos about dying and death by making it part of the (broader) community. Creating a supportive network of informal and formal actors in palliative care, and thus embedding care in the neighbourhood, is seen as a great added value. Future challenges are financing the project, expanding and keeping the network of volunteers motivated, designing an evaluation plan and selecting evaluation tools. Although this is a promising initiative in terms of community-led palliative care and for making ‘dying-in-place’ possible, the initiative faces several challenges and threats and thus it will be important to monitor future developments.
EXAMINING RELATIONS BETWEEN OLDER ADULTS’ HEALTH, WISDOM, AND WELL-BEING DURING TIMES OF HARDSHIP
Authors: Ardelt Monika , Aldwin Carolyn
Published: December 2023

This symposium investigates the roles of health and wisdom characteristics as older adults’ resources during difficult times and whether ill health might explain lower wisdom during the later years of life. The first two presentations explored COVID-related changes in mental health. Utilizing a national sample of 1258 adults, Park found that acceptance of negative emotions, emotion regulation, and perceived social support at the beginning of the COVID pandemic (mid-April of 2020) predicted middle-aged (36-60 years, Mage=52) and older adults’ (61-88 years, Mage=70) lower distress five weeks later. Feng and colleagues analyzed well-being changes in 69 older adults (50-77 years, Mage=59) from before COVID (Time1) to the summer of 2020 (Time2) and 18 months later (Time3). Multiple logistic regressions revealed that greater wisdom and better health at Time2 and higher self-transcendence and better health at Time3 increased the likelihood of being well-adapted across time. Cogdill-Richardson and Bluck examined grief adaptation among 54 older widowed adults (Mage=81). Regression analyses showed that greater wisdom and better physical functioning predicted better grief-related mental health. Whereas good health and wisdom are consistent predictors of well-being in old age, ill health itself is a stressor. Analyzing data of 976 older adults (51-99 years, Mage = 77), Ardelt and Jeste found that the negative association between age and wisdom might be due to ill health that reduces older adults’ sense of mastery, which might lessen their motivation for wisdom development. Overall, this symposium demonstrates how health, wisdom, and well-being are interrelated, particularly during times of hardship.
HIV KNOWLEDGE AND INFORMATION ACCESS AMONG FEMALE CANCER SURVIVORS IN NIGERIA
Authors: Nwakasi Candidus , Esiaka Darlingtina , Nweke Chizobam
Published: December 2023

While Nigeria remains heavily burdened by HIV, especially among Nigerian women, there is also a rapidly increasing incidence and prevalence of cancer among aging women in Nigeria. growing. A body of research posits that HIV can be detrimental to cancer survivorship experiences including a worsened health outcome for cancer survivors. Further, HIV-relevant healthy behaviors such as sexual and reproductive health may be limited by a knowledge gap in the relationship between HIV and cancer, thus, increasing the risk of negative health outcomes among cancer survivors. This stresses the importance of HIV prevention and health promotion among cancer survivors in Nigeria, and one of such prevention strategy is the use of HIV health information. This study employed a qualitative descriptive method to assess HIV knowledge and information access among female cancer survivors in Nigeria. Thirty female cancer survivors in Nigeria were recruited and interviewed using a semi-structured interviewing format. Findings based on their responses indicated their knowledge about the connection between HIV and cancer. The themes are comparing HIV and cancer, views on the effect of HIV on cancer, and seeking HIV health information. Our findings highlight the need to utilize tailored public health education interventions for the growing number of cancer survivors in Nigeria to reduce the risk of poor health outcomes in this population.
PSYCHOMETRIC EVALUATION OF A SWAHILI-TRANSLATED KESSLER 6 AMONG OLDER KENYANS
Authors: Muruthi James , Maina Lucy , Mwega Elijah , Kagai Violet , Muruthi Ndungu , Nwakasi Candidus
Published: December 2023

The six-item Kessler Psychological Distress Scale (K6) has successfully been used to screen psychological distress, albeit among primarily Western dwelling adults. A major advantage of the K6 scale is the capacity to measure a variety of mental health disorders, such as depression and anxiety. However, limited studies have investigated the applicability of the K6 scale to assess psychological distress among aging individuals in Africa. The purpose of the present study is to evaluate the psychometric properties of a culturally adapted (Swahili version) of the K6 in a sample of aging Kenyans. A sample of 376 participants (N = 376; mean age =69.56 years; 73.7% women) was obtained from three regions in Kenya. Factor analyses were used to examine the properties of the translated K6 in aging Kenyans. The correlation between the scale and other health measures were also estimated using structural equation modeling. Factor analyses revealed a single factor model. CFA demonstrated excellent fit (CFI = 0.950; RMSEA = 0.109). Internal consistency was good (alpha =.83) and the scale had acceptable correlations with chronic (r = .15) and physical health (r = .16). Results underlined that the K6 is a one-factor scale that can be used to measure psychological distress in aging Kenyans. These are promising results for health professionals who seek to conduct population studies on psychological health using a brief scale. Future studies should refine these results to maximize the utility of the K6 scale among aging Kenyans.
FACTORS CONTRIBUTING TO GROWING DEPRESSION AMONG ELDERS IN SUB-SAHARAN AFRICA
Authors: Adamek Margaret , Kotecho Messay
Published: December 2023

While growing research has addressed physical ailments and communicable diseases in the older adult population in Sub-Saharan Africa, little research has investigated mental health conditions such as depression and anxiety among older Africans. In many African nations, mental health diagnoses are not acknowledged let alone well understood by the general public. Little has been documented about the extent of depression among older adults in Sub-Saharan Africa and the factors contributing to depression among older African adults. This study used secondary sources and a synthesis of recent empirical literature to examine and document the extent of depression among older adults in Sub-Saharan Africa and the contributing factors to geriatric depression. Sources indicate that mental health symptoms of Africans are often considered the work of evil spirits or may be overlooked by families. Available studies report rates of geriatric depression ranging from 37.8% in Ghana, 40% in South Africa, 41.2% in Ethiopia, and up to 44% in Tanzania. Older women in Sub-Saharan Africa have higher rates of depression than older men. Contributing factors to depression include lack of formal education, chronic illness, unstable income, and waning social supports. With an estimated 2 out of 5 older adults in Sub-Saharan Africa experiencing depression, interventions are needed to address the factors contributing to depression among older adults as well as culturally relevant interventions to ameliorate current symptoms. Interventions common in Global North nations such as anti-depressant medication or private therapy may not be appropriate for older African adults struggling with depression.
POLICY SERIES: A SECURE RETIREMENT FOR OLDER WOMEN
Authors: Lindberg Brian , Hounsell Cindy
Published: December 2023

This session will address policy development related to women and their financial well-being in later life. Panelists will discuss the recently passed SECURE 2.0, the latest programs providing financial literacy to older adults, healthcare workforce related issues, and the role of the Consumer Financial Protection Bureau is protecting older adults from fraud and elder exploitation.
FEASIBILITY AND EFFICACY OF THE LEAD DEMENTIA ADVANCE CARE PLANNING INTERVENTION
Authors: Dassel Kara , Iacob Eli , Clayton Jordana , Aruscavage Nancy , Supiano Katherine , Utz Rebecca
Published: December 2023

Using our dementia-focused advance care planning tool (ACP), the LEAD Guide (Life-Planning in Early Alzheimer’s and Other Dementias), we implemented a 9-month NIH Stage-1 behavioral intervention to promote ACP concordance in community-based dementia dyads. Baseline concordance was assessed using individual responses on the LEAD Guide (patient for themselves, care partner as if they were the patient). Dyads compared responses, discussed discrepancies, and the patient revised their responses. Concordance for values (quality of life, burden) and preferences (care location and life-sustaining treatments) across the disease trajectory was calculated using cross-tabs. At baseline, dyadic discordance was less than 10% on quality-of-life measures except for whether the patient would prefer a longer but less satisfying life (23.8%); however, post-conversation, 5.9% of patients changed their responses. About a fifth of the dyads showed discordance regarding financial, emotional, and physical burden (19.0%, 19.1%, and 16.7%, respectively); however, post-conversation, a few patients changed their responses (14.6%, 8.8%, and 5.9%). At baseline, discordance on questions for life-sustaining treatments across the disease trajectory varied; ventilator (now 14.3%, future 26.2%), brain dead (16.7% now and future), feeding tube (30.1% now, 28.6% future), and severe pain (23.8% now, 21.4% future). Following conversations, a few patients’ changed their responses on these items (8.8%, 12.1%, 8.8%, and 12.1%). Higher discordance on value questions on burden compared to the quality of life may result from care partners’ bias. Fluctuations in concordance regarding life-sustaining treatments in the present versus future states of advanced dementia demonstrate the need to engage in more in-depth care conversations.
MOVING TOGETHER: IMPACT OF LIVESTREAM GROUP PROGRAM FOR PEOPLE LIVING WITH COGNITIVE IMPAIRMENT AND CARE PARTNERS
Authors: Barnes Deborah , Lee Jennifer , Chesney Margaret , Mehling Wolf , Nicosia Francesca , Sudore Rebecca , Chao Linda , Benjamin Cynthia
Published: December 2023

Moving Together is an online, mind-body, group movement program for people living with cognitive impairment or mild dementia (PLCI/D) and care partners (CPs). We performed a randomized, controlled trial to test the impact of Moving Together on quality of life (primary) or physical, cognitive, social or emotional (secondary) outcomes in PLCI/D or CPs. Study participants were enrolled as dyads and randomly assigned to intervention or waitlist control groups. Participants joined live-streaming classes for 1 hour, 2 days/week, for 12 weeks. Intention-to-treat analyses compared 12-week change between groups. We assessed 603 dyads for eligibility: 382 (63%) declined to participate, primarily due to lack of interest; 123 (20%) were ineligible, primarily due to lack of CP or moderate/severe dementia; and 98 (16%) were eligible and enrolled. Of these, 77 (79%) completed the 12-week assessment and 21 (21%) withdrew, primarily due to health or scheduling issues. PLCI/D were 77±11 years old, 44% women, 22% non-White/Hispanic, 32% Alzheimer’s disease, 26% unspecified/mixed dementia, 14% mild cognitive impairment, 10% vascular dementia, and 19% other/unknown causes. CPs were 66±12 years old, 78% women, 31% non-White/Hispanic, 71% spouses, 25% adult children, and 3% paid. Baseline characteristics were similar between groups. Participants who completed the program reported high satisfaction (98% good/excellent). There were no serious adverse events related to study participation. We conclude that Moving Together is a safe program with good retention and high satisfaction. Data collection will be completed in May 2023, and we will present efficacy outcomes at the meeting.
PROVIDER PERCEPTIONS OF FACTORS IMPACTING COUPLES’ EMOTIONAL DISTRESS AND ADJUSTMENT TO DEMENTIA DIAGNOSES
Authors: Bannon Sarah , Brewer Julie , Ahmad Nina , Cornelius Talea , Parker Robert , Dickerson Bradford , Ritchie Christine , Vranceanu Ana-Maria
Published: December 2023

Alzheimer’s disease and related dementias (ADRD) are increasingly common conditions that disrupt the lives of persons living with dementia and their spousal care-partners. At the time of ADRD diagnoses, many couples experience challenges that produce emotional distress and relationship strain. At present there are no interventions to address these challenges early after diagnosis to promote positive dyadic adjustment. As the first phase of a larger study, we conducted a qualitative study to elicit and systematically summarize the perspectives of ADRD medical stakeholders (e.g., neurologists, geriatricians, social workers, neuropsychologists, care coordinators) surrounding common factors impacting distress following ADRD diagnoses. Participants (n=15) were recruited from two U.S. academic medical centers and completed a 60-minute focus group or individual interview that was transcribed, deidentified, and analyzed using a rapid data analysis approach to thematic analysis. We identified findings within 3 overarching themes: reactions to diagnosis, changes in relationship roles/dynamics, and insufficient resources. Participants described couples’ distress surrounding one partner’s denial or lack of insight into the diagnosis and symptoms, experiences of loss and hopelessness, and uncertainty surrounding illness trajectory. They noticed changes in couples’ historic roles, social determinants of health, and divergent understandings and reactions to diagnosis as contributors to couples’ distress. Finally, providers observed unmet needs surrounding embedded counseling, care-planning, and financial support for current and future care needs. Most providers felt insufficiently prepared to help couples experiencing distress. Our findings underscore the importance of improving resources to address individual, interpersonal, and system-level factors that contribute to couples’ adjustment to ADRD diagnoses.
CLUTTER AS A BARRIER TO MAINTAINING FUNCTIONAL INDEPENDENCE
Authors: Dozier Mary , Nix Caitlyn
Published: December 2023

Excessive levels of household clutter can increase fall risk and subsequently prevent older adults from living independently. This may be a particular concern for rural-dwelling older adults, who are likely to have a stronger sense of connection with their physical location. This talk will present data from a comprehensive baseline assessment administered to older adults enrolled in treatment studies for hoarding disorder in rural Mississippi (n = 25; mean age: 67). The majority of participants described themselves as “collectors,” (79%) and individuals who considered themselves to be collectors were more likely to have experienced at least one intervention from friends, family, or the community (42% vs. 20%). Thirty-two percent of participants reported they had experienced at least one fall in their home in the previous year and 60% reported they were at least “a little bit” concerned about falling in their home, with 20% indicating that they or someone else had expressed concern specifically about clutter increasing their risk of falling. In addition to fall risk, 28% of participants indicated having at least one health hazard in the home (e.g., mold, insect infestation). Forty-three percent of the sample reported low physical functioning and 50% of the sample indicated a high degree of loneliness. These results highlight the impairment experienced by rural-dwelling older adults with high amounts of clutter. Interventions that target de-cluttering may provide additional utility by also increasing the ability of these older adults to age in place.
PATIENT-FOCUSED TELEHEALTH 101: CONTENT, RESULTS, FEEDBACK, AND PLANS FOR REVISION AND EXPANSION
Authors: Freddolino Paul , Kim Ha Neul , Sun Fei , Bentley Megan , Macomber Catherine
Published: December 2023

A five-part patient-focused Telehealth 101 mini-course was offered one-to-one as part of a technology literacy program for older adults in a rural Midwest community who received home-delivered meals. Participants had already received content on basic digital skills including safety and security, email, internet browsing, videoconferencing, and photo tools. Topics included an overview of material to be covered, types of telehealth (real time encounters, remote patient monitoring, and patient portals), what to expect from providers, how to prepare for telehealth encounters, and a live simulation of a telehealth visit. Subjects rated the sessions positively, and patient engagement in health care (Patient Activation Measure scores) significantly increased after the training. The mini course was also offered virtually on Zoom to groups of older adults at five urban senior centers. Feedback from both settings suggest the need to reduce repetition in the material presented and to include more diversity in the personnel presenting the content, both live and through YouTube videos accessed as part of the content. Revision will also add content on mental health and substance abuse services available through telehealth.
RACIAL/ETHNIC DISPARITIES IN HELP-SEEKING BEHAVIORS IN OLDER AMERICANS WITH SUBJECTIVE COGNITIVE DECLINE
Authors: Qi Xiang , Pei Yaolin , Zhu Zheng , Wu Bei
Published: December 2023

Subjective cognitive decline (SCD) refers to individuals’ perceived decline in memory that negatively impacts the daily activities or work. Seeking help for SCD and/or related functional limitations may be beneficial as it can prompts screening and intervention for cognitive impairment. However, racial/ethnic minorities may face disadvantages in help-seeking behaviors due to healthcare access disparities, dementia-related stigma, and cultural differences. To investigate the racial/ethnic differences in help-seeking for cognitive problems among middle-aged and older adults with SCD and/or related functional limitation, we used data from the Behavioral Risk Factor Surveillance System (BRFSS) 2015-2021. The sample included 41,115 adults aged ≥45 with SCD and 20,227 (45.4%) with SCD-related functional limitation. We estimated the prevalence of help-seeking behaviors and conducted a logistic regression analysis accounting for BRFSS survey weights, missing data, state-level clustering, and covariates. Among those with SCD and/or related functional limitation, Asian American and Pacific Islanders (AAPIs) are least likely to initiate communication with their healthcare provider with their cognitive problems. In the multivariate logistic model, AAPIs (OR, 0.45; 95% CI, 0.33-0.61) and non-Hispanic blacks (OR, 0.76; 95% CI, 0.63-0.91) with SCD-related functional limitation were less likely to discuss cognitive problems compared to non-Hispanic whites. Our findings were consistent with studies suggesting that AAPIs with cognitive impairment were less likely to seek for dementia care due to their lower health literacy, limited English proficiency, and dementia-related stigma. Our study emphasizes the need for tailored interventions that promote early patient-provider communication to address racial/ethnic disparities in help-seeking for cognitive problems.
TRANSLATING SCIENCE INTO PRACTICE: APPLYING IMPLEMENTATION SCIENCE TO STREAMLINE FUTURE HIH ROLL-OUT
Authors: Nooraie Reza Yousefi , Sullivan Jennifer , Zimmerman Lindsey , Shin Marlena , Franzosa Emily , Dadgostar Porooshat , Levine Adele , Darcy Derek
Published: December 2023

The delay between establishing evidence-based practice and translating effective practices is well documented. This presentation will focus on the application of implementation science principles to the Department of Veterans Affairs (VA) Hospital-In-Home program using a staged approach. The stages are: 1) assessing current program implementation, 2) measuring organizational readiness with new sites, 3) developing tools and resources to assist new HIH sites, and 4) working with new sites interested in adopting the HIH program using a participatory implementation planning process guided by system dynamics. In this session we will profile our use of theories, models and frameworks including the Consolidated Framework for Implementation Research (CFIR) and Reach Effectiveness Adoption Implementation Maintenance (REAIM) framework. The CFIR Expert Recommendation for Implementing Change (ERIC) Mapping Tool will be introduced as useful to identifying strategies to overcome barriers to implementation. We will apply the participatory approaches for implementation planning, including Implementation Mapping, development of Implementation Logic Models, and Group Model Building to plan for the implementation of HIH in prospective sites. Key implementation science concepts and techniques will be introduced, along with a description of how participatory approaches will facilitate informed planning and stakeholder engagement in future implementation, adaptation, and roll-out of an evidence-based systemic program. Key anticipated outputs include a framework for the core components of HIH intervention, a catalog of important determinants of HIH implementation success, a profile of existing strategies to enhance implementation and sustainability, and a roadmap for the participatory planning of HIH implementation in future contexts.
EXPANDING INSIGHTS INTO LATE-LIFE DISABILITY USING OBJECTIVE ASSESSMENTS IN NHATS
Authors: Schrack Jennifer , Fazio Elena
Published: December 2023

The National Health and Aging Trends Study (NHATS) is a NIA-funded national panel study that conducts annual in-home interviews with a representative sample of US Medicare beneficiaries ages 65 years and older. Designed as a platform for the scientific study of late life disability trends and trajectories, NHATS fosters research to guide efforts to maximize health, promote independent functioning, and enhance quality of life at older ages. NHATS has collected performance-based measures of physical function since its inception (2011). In 2021 NHATS responded to expanded interest in objective measures of sensory loss and physical activity, by adding measures of vision (visual acuity, contrast sensitivity), hearing (pure tone audiometry), and physical activity (accelerometry). This symposium will introduce these measures and demonstrate their scientific application to answer key research questions related to physical and cognitive health. Dr. Schrack will present an overview of the accelerometry data collection procedures, as well as results by key demographic and health-related features. Dr. Twardzik will examine the association between features of participants’ social and physical environments and patterns of accelerometry-based physical activity. Dr. Martinez-Amezcua will examine the association between hearing and phenotypic frailty. Dr. Davoudi will present evidence on the links among sensory and motor function and risk of dementia. Finally, Dr. Wanigatunga will describe the association between measures of hand and leg strength and dementia incidence. Collectively, these presentations will highlight population-level associations of objective measures of health and function with physical and cognitive outcomes to advance the science of disability in older adults.
POLICY SERIES: AGING AND HEALTH POLICY UPDATE: A VIEW FROM WASHINGTON
Authors: Lindberg Brian , D’Antonio Patricia
Published: December 2023

Leading aging and health policy advocates will present their findings and viewpoints regarding aging and health care policy during a divided Congress. Issues will include behavioral health, social isolation, health care workforce, telehealth, hospice policy, elder justice and nursing home care, home and community-based services, and Medicare and Medicaid. The group will discuss what progress has been made during the 118th Congress and what is still possible in the election year ahead.
THERAPEUTIC CANNABIS USE: UNIQUE CONTEXTS FOR OLDER ADULTS
Authors: Cohen Pinchas
Published: December 2023

Nationwide cannabis use prompts new questions about its therapeutic use. Self-administered cannabis among older adults demands careful study on their treatment outcomes and consumption patterns, in light of a more accessible, legalized cannabis market. Changing sentiments toward the illicit drug urges new research into its viability as a treatment for conditions in older adults. Ailshire uses the 2018-2021 Behavioral Risk Factor Surveillance System (BRFSS) surveys to compare cannabis use by age group. The data, which is representative of 39 U.S. states, indicate that medical marijuana use increases with age. Furthermore, Kaskie’s Cannabis and Older Persons Study (COPS) uncovers the influence of age on cannabis use and motives for consumption. The study is grounded in three core objectives: distinguishing senior consumers from other age groups, distinguishing therapeutic and recreational use, and distinguishing life-time and naive cannabis consumers. With the support of the National Cancer Institute, Fahey conducts a cross-sectional study on consumption patterns of cancer patients over the age of 65, analyzing patient reported outcomes of symptom management through cannabis. Finally, Bluthenthal and Cohen perform quantitative, health surveys among 429 community-recruited people who inject drugs (PWID) to understand the potential benefit of a legal cannabis as a substitution for criminalized substances and alcohol. The papers in this symposium provide updated insights into widespread cannabis use among older adults. These findings may help forward conversations about the political and clinical changes that must be made in order to protect the therapeutic needs of older adults amidst a rapidly expanding cannabis industry.
THE LTSS STATE SCORECARD AND MULTISECTOR PLANS FOR AGING
Authors: Ipakchi Narda
Published: December 2023

Strong, comprehensive plans are crucial to secure lasting success in state LTSS systems. State Multisector Plans for Aging meet this need and are present and/or under development in more than a dozen states and DC. A Multisector Plan for Aging, a concept led by The SCAN Foundation, is a blueprint that: a) includes planning for 10 or more years; b) is often led by a governor with other executive and legislative leaders; and c) is developed to guide the restructuring of state and local policy, programs, and funding toward aging well in the community. For the first time, the LTSS State Scorecard credits states for having these plans. This portion of the symposium will describe Scorecard findings on Multisector Plans for Aging and address more broadly the important role of these plans to state leadership.
METABOLISM AND AGING
Authors: Baur Joseph
Published: December 2023

Reducing energy intake in the absence of malnutrition (caloric restriction) has long been known as the most robust and reproducible way to experimentally increase lifespan in laboratory models. However, our understanding of which metabolites and nutrient-sensing pathways interact with longevity and where they act remains rudimentary, and in many cases, controversial. This session will explore recent findings linking changes in metabolites to the aging process and to organismal health.
TRACING THE COORDINATED CONTROL OF NAD+ HOMEOSTASIS USING C. ELEGANS
Authors: McReynolds Melanie
Published: December 2023

Nicotinamide adenine dinucleotide (NAD+) is a vital coenzyme involved in redox reactions and cellular signaling. Its levels decline with age in humans, mice, and worms, leading to metabolic disturbances associated with age-related diseases. Interestingly, our studies in aged mice indicate that the rate of NAD+ synthesis remains unchanged, ruling out a lack of precursors as the cause of NAD+ decline. Instead, we found that tissues with lower NAD+ concentrations in aged mice exhibit higher fractional turnover, suggesting increased consumption as the primary driver of NAD+ decline during aging. This led us to hypothesize that the loss of NAD+ metabolic robustness and resiliency with age is linked to the hyper-activation and competition of NAD+-consuming enzymes. To investigate the physiological impact of NAD+ consuming enzymes on metabolic robustness, we used genetic tools and mass spectrometry in C. elegans. Surprisingly, we identified novel reproductive and aging phenotypes in mutant animals lacking specific NAD+ consuming enzymes, including Poly ADP-Ribose Polymerase (parp-1 and parp-2), TANKyrase (tank-1), and Toll and Interleukin 1 Receptor (tir-1). These mutants displayed significant reductions in fecundity and extensions in longevity. Additionally, employing High-Performance Liquid Chromatography coupled with Mass Spectrometry (HP-LC-MS), we examined the NAD+ metabolome across different developmental stages in our mutant strains, revealing notable metabolic disruptions associated with the loss of NAD+ consumers. In summary, our findings establish a novel connection between the hyper-activation of NAD+ degradation and the onset of reproductive aging. This research provides valuable insights into the role of NAD+ metabolism and its impact on aging-related processes.